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    2006 Year 12 Vol. 4 Issue

      OriginalPaper

    • Zhang Hui-qin,Zhao Hong-xin,Gu Dun-yu,Jia Xiao-feng,Yan Bei,Cao Lin,Wang Lei,Shi Hui-juan
      2006, 12(4): 244-249. DOI: 10.1007/s11655-006-0244-0
      Abstract:To assess embryo implantation rate (IR) and pregnancy rate (PR) in women who received Bushen Wengong Decoction (??, BSWGD), a Chinese herbal formula, combined with low dose of human menopausal gonadotropin (hMG) prior to frozen thawed embryo transfer (FET). A total of 262 subjects (674 transferred embryos) who received FET were analyzed retrospectively. In them, 122 women were under 30 years old, 106 between 30–35 years and 32 over 35 years. The 85 subjects with normal ovulation were assigned to Group A, the natural menstruation cycling group, on whom no pre-transfer treatment was applied. The other 177 subjects with abnormal ovulation were assigned to Group B, and subdivided, according to the pre transfer treatment they received, into three groups, Group B1 (50 cases) received BSWGD, Group B2 (58 cases) received hMG and Group B3 (69 cases) received both BSWGD and low dose hMG. The IR and PR of FET in the four groups were compared, and the effect of the embryo cryo time on PR of FET were compared also. Besides, the influencing factors to FET were analyzed. IR and PR were significantly higher in all age sects of Group B3 than those in Group A, showing significant difference (P < 0.05). IR and PR in subjects in age sects of <30 years and > 35 years in group B3 were significantly higher than those in Group B1 (P < 0.05), but no significant difference was shown in the two parameters between Group B 2 and Group B3 (P >0.05). PR in the subjects who received embryos with cryo-time of > 200 days was significantly lower than that in those with cryo-time of < 100 days (P <0.05). Embryo cryo-time, endometrial thickness, use of BSWGD and use of hMG were of significance in FET (P < 0.05). A programmed cycle of BSWGD combined with low dose of hMG could improve the embryo IR and PR of FET. Embryo cryo-time, endometrial thickness, and the use of BSWGD and hMG are of significance for FET.  
      Keywords:frozen-thawed embryo transfer;Bushen Wengong Decoction;human menopausal gonadotropin;endometrium   
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    • Jiang Hong,Chen Su-hua,Wen Liang-zhen
      2006, 12(4): 250-254. DOI: 10.1007/s11655-006-0250-3
      Abstract:To evaluate the effects of Jinye Baidu Granule (金叶败毒颗粒, JYBDG), a traditional Chinese medicine compound prescription, on fetal growth and development with maternal active human cytomegalovirus infection. A prospective, randomized and controlled trial was adopted during January 1996 to June 2002. From the pregnant women with an abnormal pregnant history, 240 cases were screened to be infected by human cytomegalovirus (HCMV) by enzyme-linked immunoabsorbent assay (ELISA) and reverse transcription polymerase chain reaction (RT-PCR). They were assigned according to the random number table to two groups. The 122 cases in the treatment group were administrated with JYBDG, one package each time, three times a day for two continuous weeks, while the other 118 in the control group did not receive any treatment. The negative conversion rate of both HCMV-IgM and HCMV late mRNA, the positive rate of HCMV-DNA in placenta and the intrauterine transmission rate between the two groups were compared, and fetal growth and development in partial fetuses were also observed. The negative conversion rate of both HCMV-IgM and HCMV late mRNA, the positive rate of HCMV-DNA in placenta and the intrauterine transmission rate in the treatment group were 77.05% (94/122), 48.98% (48/98) and 21.74% (10/46) respectively, while those in the control group were 38.14% (45/118), 67.50% (54/80) and 52.63% (20/38) respectively, all showing significant difference between the two groups (P<0.01). Totally 35 normal infants and 11 abnormal infants were born in the treatment group, and the number in the control group was 20 and 18 respectively, and comparison between the two groups showed significant difference (P<0.01). Six months of child birth, the scores of both mental development index (MDI) and psychomotor development index (PDI) of infants were higher in the treatment group (20 cases) than those in the control group (20 cases), but there was no significant difference between the two groups (P>0.05). JYBDG could decrease the intrauterine transmission of HCMV and is beneficial to fetal growth and development.  
      Keywords:Chinese Herbal Medicine;cytomegalovirus;intrauterine infection;fetal growth and development;Jinye Baidu Granule   
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    • Tong Guang-dong,Zhou Da-qiao,He Jin-song,Li Song-lin,Peng Li-sheng
      2006, 12(4): 255-261. DOI: 10.1007/s11655-006-0255-4
      Abstract:To explore the influence of Shehuang Paste (麝黄膏, SHP) to the hemodynamics, endotoxin, nitric oxide (NO), and endothelin-1 (ET-1) in patients with refractory cirrhotic ascites. Fifty-nine cases of refractory cirrhotic ascites were randomly assigned to two groups, 32 cases in the treatment group and 27 cases in the control group. The basic treatment was the same for both groups, including liver protecting medicines, diuretics and supportive drugs, but SHP navel sticking was applied for the treatment group additionally once a day. A course of one month of treatment was applied and the general efficacy on ascites was observed by the end of the therapeutic course. Before and after the treatment, examinations by limulus lysate chromogenic test was conducted to measure plasma endotoxin content; colorimetry to measure plasma content of NO indirectly, radioimmunoassay to measure plasma ET-1 content; and color Doppler ultrasonography to measure the blood flow of portal vein and splenic vein. The relationship between the blood flow of portal vein and splenic vein and endotoxin, NO and ET-1 in the treatment group was analyzed as well. The total effective rate on ascites was 84.4% in the treatment group, and 48.1% in the control group, with significant difference shown between them (P<0.01). In the treatment group the blood flow of portal vein and splenic vein, contents of endotoxin, NO and ET-1 all got significantly reduced after treatment (P<0.05 or P<0.01); while these indexes in the control group were not significantly changed (P>0.05). Moreover, it was found that in the treatment group, the blood flow of portal vein and splenic vein had a positive correlation to the levels of NO, ET-1, and endotoxin, either before or after treatment. Application of SHP navel sticking could clearly reduce the blood flow of portal vein and splenic vein, and lower the content of endotoxin, NO and ET-1. The blood flow of portal vein and splenic vein in the treatment group showed a positive correlation with the contents of endotoxin, NO and ET-1.  
      Keywords:liver cirrhosis;refractory ascites;vasoactive substance;hemodynamics   
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    • Wang Gang,Liu Chun-tao,Wang Zeng-li,Yan Cun-liang,Luo Feng-ming,Wang Lei,Li Ting-qian
      2006, 12(4): 262-267. DOI: 10.1007/s11655-006-0262-y
      Abstract:To explore the effect of Astragalus membranaceus (AM) on T-helper cell type 1 (Th1) specific transcription factor T-box expressed in T cells (T-bet) expression and Th1/Th2 equilibrium. The levels of T-bet mRNA in peripheral blood mononuclear cells (PBMCs) from 15 patients with asthma and 15 healthy subjects were determined by reverse transcription-polymerase chain reaction (RT-PCR). PBMCs in asthma patients were incubated with AM and then the concentration of interferon γ (IFN-γ) and interleukin-4 (IL-4) in the supernate before and after AM intervention were determined by ELISA. The numbers of CD4+CCR3+ and CD4+CCR5+ cells were counted by flow cytometry. The expression of T-bet mRNA and the level of IFN-γ were lower, but level of serum IL-4 was higher in asthma patients when compared with those in healthy subjects respectively. After AM (60 μ g/ml) intervention, the former two parameters raised and showed a positive correlation between them, while the level of IL-4 was decreased. The mean percentage of CD4+CCR3+ cells in asthma patients was significantly higher but that of CD4+CCR5+ cells was lower when compared with those in healthy subjects respectively. After AM intervention, the abnormal change in the two indexes was improved to certain extent, showing a reversing status of Th2 polarization. AM could increase the expression of T-bet mRNA and Th1 cytokines such as IFN-γ, and might reverse the Th2 predominant status in asthma patients.  
      Keywords:Asthma;Astragalus membranaceus;transcription factor;T-box expressed in T cells;T helper cells;Tinterferon-γ   
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    • Cao Zong-xin,Zhao Zhong-fang,Zhao Xiu-fen
      2006, 12(4): 268-272. DOI: 10.1007/s11655-006-0268-1
      Abstract:To investigate the effects of Compound Glycyrrhizin Injection (CGI) on liver function and cellular immunity of children with infectious mononucleosis complicated liver impairment (IM-LI) and to explore its clinical therapeutic effect. Forty-two patients with IM-LI were randomly assigned, according to the randomizing number table, to two groups, 20 in the control group and 22 in the treated group. All the patients were treated with conventional treatment, but to those in the treated group, CGI was given additionally once a day, at the dosage of 10 ml for children aged below 2 years, 20 ml for 2–4 years old, 30 ml for 5–7 years old and 40 ml for 8–12 years old, in 100–200 ml of 5% glucose solution by intravenous dripping. The treatment lasted for 2 weeks. T lymphocyte subsets and serum levels of alanine transaminase (ALT), aspartate aminotransferase (AST) and total bilirubin (TBil) were detected before and after treatment. Besides, a normal control group consisting of 20 healthy children was also set up. Baseline of the percentage of CD3 +, CD8 + lymphocyte and serum levels of ALT, AST, TBiL in the children with IM-LI were markedly higher, while the percentage of CD4 + lymphocyte and the CD4 +/CD8 + ratio was markedly lower in IM-LI children as compared with the corresponding indices in the healthy children (P<0.01). These indices were improved after treatment in both groups of patients, but the improvement in the treated group was better than that in the control group (P<0.01). Cellular immunity dysfunction often occurs in patients with IM-LI, and CGI treatment can not only obviously promote the recovery of liver function, but also regulate the immune function in organism.  
      Keywords:infectious mononucleosis;liver impairment;T lymphocyte subsets;Compound Glycyrrhizin Injection;treatment   
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    • He Ze-feng,Wang Jian-jun,Wang Wen-dong
      2006, 12(4): 273-276. DOI: 10.1007/s11655-006-0273-x
      Abstract:To observe the effect of Kang’ ai Injection (康艾注射液, KAI) on serum level of soluble interleukin-2 receptor (sIL-2R) and vascular endothelial growth factor (VEGF) in patients with esophageal carcinoma (EC) during radiotherapy (RT), and to investigate its synergistic effect with RT and its influence on immunological function of the body. One hundred and seventy patients with EC, who had missed the chance of surgical operational therapy, were assigned to the treated group (90 cases) and the RT group (80 cases), and at the same time a control group consisting of 80 inpatients without tumors was set up. Patients in the RT group were treated with RT alone but KAI was given additionally to those in the treated group, with 50 ml given once per day via intravenous dripping, 15 days as one course, and 2 courses administered in total. The immediate therapeutic efficacy and changes of serum sIL-2R and VEGF levels were observed, and the effect of KAI on patients’ quality of life (QOF) was evaluated by Karnofsky scoring. In 16 patients of the treated group it was completely remission (CR), in 54 partially remission (PR), in 18 it was stabilized disease (SD) and in 2 progressive disease (PD), with the total effective rate (CR+PR) as 77.8%, while in those of the control group it was 12, 46, 18, 4 and 72.5%, respectively, the immediate therapeutic efficacy in the treated group was somewhat better than that in the RT group, but showed no statistical significance (P>0.05). Serum levels of sIL-2R and VEGF in all the patients before treatment were higher than those in the control group, which were decreased after treatment in both groups (P<0.05), but the improvement in the treated group was better than that in the RT group, showing significant difference (P<0.05), and patients’ QOF improved more significantly in the former as well (62.2% vs 40.0%, P<0.05). KAI in combination with RT in treating patients with EC could enhance the immunological function of patients, improve their QOF and enhance their sensitivity to RT.  
      Keywords:soluble interleukin-2 receptor;vascular endothelial growth factor;esophageal carcinoma;radiotherapy;Kang’ ai Injection;sensitivity enhancing   
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    • Yu Tu-gen,Zheng Yi-zhi,Zhu Jin-tu,Guo Wen
      2006, 12(4): 277-280. DOI: 10.1007/s11655-006-0277-1
      Abstract:To observe the clinical efficacy of Chibixiao Recipe (赤鼻消方, CBX) in combination with minocycline and spironolactone in treating rosacea in females. Sixty-eight women with rosacea were randomly assigned to the treated group (48 cases) and the control group (20 cases), both of which were treated with minocycline and spironolactone taken orally, but to the treated group, the Chinese herbal recipe, CBX was given additionally. Besides, cryotherapy with liquid nitrogen was applied to those with apparent capillary dilatation. The therapeutic course for both groups was 8 weeks. The levels of serum testosterone before and after treatment were determined by radioimmunoassay (RIA), and a 4-month follow-up was conducted. In the treated group the cure-markedly effective rate was 87.5% and the recurrent rate was 6.5%, while in the control group, they were 45.0% and 41.2% respectively. Comparisons in the indexes between the two groups all showed significant difference (both P<0.01), with the cure-markedly effective rate higher, and the recurrent rate lower in the treated group. The serum level of testosterone got lowered in both groups (P<0.05 and P<0.01), but the lowering in the treated group was more significant, showing significance when compared with that in the control group (P<0.01). CBX in combination with Western medicine has effect in treating rosacea superior to that of Western medicine alone, and could effectively reduce recurrent rate and the serum level of testosterone.  
      Keywords:female rosacea;Testosterone;Chibixiao Recipe;Minocycline;spironolactone   
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    • Cui Jian-wei,Hu Yi-yang,Fang Zhi-hong,Wang Xiao-ning,Cheng Yang,Peng Jing-hua,Feng Qin,Zhang Hui
      2006, 12(4): 281-286. DOI: 10.1007/s11655-006-0281-0
      Abstract:To study the intervention effects of Jianpi Liqi Huoxue Decoction (健脾理气活血汤, JLHD) on lipid peroxidative liver injury induced by alcohol. The rat alcoholic model of liver disease (ALD) induced by Lieber DeCarli liquid diet was established. Thirty two male SD rats were randomly divided into 4 groups: the normal group (n=5), the control group (n=9), the model group (n=9) and the JLHD group (n=9). From the 4th week after modeling, the rats were given JLHD or distilled water by gastrogavage respectively, and the samples of blood and liver tissues were taken out from the rats for determination by the end of the 8th week. The hepatic pathological changes were observed with HE staining; the liver injury related indices, including activity of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in serum, γ-glutamyl transpeptidase (γ-GT) activity and triglyceride (TG) content in liver tissues, as well as the lipid peroxidation related indices, including malonaldehyde (MDA) content and nitric oxide synthase (NOS) activity in liver tissue, serum Fe2+ level, and the anti-peroxidation capacity related indices, including superoxide dismutase (SOD) activity, glutathion (GSH) content and reactive oxygen species (anti ROS) activity in liver tissues were determined. (1) There were obvious figures of fatty degeneration and inflammatory infiltration in liver tissues of the model group. As compared with the control group, in the model group, the activity of ALT and AST, and Fe2+ content in serum, γ-GT and NOS activity, TG and MDA content in liver tissues were significantly higher (P<0.01), while the activity of SOD, GSH and anti ROS in liver tissues were significantly lower (P<0.01). (2) The fatty degeneration and inflammatory infiltration of liver tissues in the JLHD group were significantly lessen as compared with those in the model group; and the abnormalities of all the indexes revealed in the model rats were restored to certain extent in the JLHD group, and especially significant were the levels of ALT activity, MDA content and Fe2+, which were nearly normal. JLHD has significant effects against alcoholic liver injury, the acting mechanism of which is likely to be related with its anti lipid peroxidative effect.  
      Keywords:Jianpi Liqi Huoxue Decoction;alcohol;liver injury;lipid peroxidation;Lieber DeCarli model   
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    • Wang Bo,Zhang Ji-dong,Wang Shi-hua
      2006, 12(4): 287-291. DOI: 10.1007/s11655-001-0287-6
      Abstract:To observe the hypotensive effects of Qindan Capsule (芩丹胶囊, QC) on spontaneous hypertensive rats (SHR) and its effect on the contents of endothelin (ET), calcitonin gene-related peptide (CGRP) and angiotensin-II (Ang-II) in plasma and vascular tissues, and to investigate the possible mechanism of QC in lowering blood pressure. Forty SHRs were divided into 5 groups: the high dosage QC group [QCHD, 750 mg/(kg·d)], the low dosage QC group [QCLD, 150 mg/(kg·d)], the Niuhuang Jiangya Pill group [牛黄降压丸, NJP, 200 mg/(kg·d)], the Captopril group [ 15 mg/(kg·d) ] and the model group, 8 in each group. Meanwhile, a normal control group consisting of 8 WistarKyoto (WKY) rats was set up also. All the rats were administered with medicine through gastrogavage. Systolic blood pressure (SBP), level of ET, CGRP and Ang-II in plasma and Ang-II in tissues of mesenteric artery were detected in all the rats after 12 weeks of treatment. The level of SBP after treatment in the QCHD group was lower than that in the model group (P < 0.01), but with no significant difference as compared with that in the Captopril group and the NJP group (P > 0.05). After treatment, the plasma level of ET was lower and CGRP higher than those in the model group (both P < 0.05), and also higher than those in the NJP and Captopril group (both P < 0.05). As for the content of Ang-II, in mesenteric arterial tissues, it was lower in the QCHD group than that in the model group (P < 0.05), but in plasma, it showed no significant difference between the two groups (P > 0.05). QC has a satisfactory hypotensive action on SHR rats, and its mechanism may be associated with the regulation on plasma vasoactive peptide and regional renin-angiotensin system.  
      Keywords:Qindan Capsule;spontaneous hypertensive rat;endothelin;calcitonin generelated peptide;angiotensin II   
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    • Cai Jing,Du Jian,Ge Zhen-hua,Zhou Fan,Zhou Lin-yin,Chen Lian-yun
      2006, 12(4): 292-296. DOI: 10.1007/s11655-001-0292-9
      Abstract:To observe the effect of Kangxin Capsule (康欣胶囊, KXC) on the expression of nerve growth factor (NGF) as well as the morphology and amount of nerve synapse in the cortical parietal lobe and hippocampus CA1 area of vascular dementia (VD) model rats. The model rats of VD made by photochemical reaction technique were randomly divided into five groups: the model group (MG), the high-dose, middle-dose and low-dose KXC groups (HDG, MDG and LDG), and the Western medicine hydergin control group (WMG). They were treated respectively with distilled water, high, middle and low dosage of KXC suspended liquid, and hydergin for a month. Besides, a blank group consisting of normal (non-model) rats was set up for control (CG). The ultrastructure of nerve synapse in the cortical partietal lobe and hippocampus CA1 area of the rats were observed and its density estimated. The condition of NGF positive neurons in the above-mentioned two regions were also observed by immunohistochemical stain. All the KXC or hydergin treated groups demonstrated a normal amount of nerve synapse with integral structure in the cortical parietal lobe and hippocampus CA1 area, which approached that in the CG and was superior to that in the MG. Also, the NGF positive neuron in all the treated groups was much more than that in MG with significant difference (P<0.01), approaching to that in the CG. KXC could elevate the expression of NGF in the cortical parietal lobe and hippocampus CA1 area, preserve the number and morphology of synapse, thus to protect the function of nerve system from ischemic injury.  
      Keywords:Kangxin Capsule;Vascular Dementia;Nerve Growth Factor;nerve synapse;ultrastructure   
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    • Wang De jun,Dai Xiao-jun,Xu Feng,Sun Yun
      2006, 12(4): 297-300. DOI: 10.1007/s11655-001-0297-4
      Abstract:To study the effect of sodium ferulate (SF), an active component of Radix Angelica, on lung damage induced by ozone (O3). Mice model of lung injury was induced by ozone inhalation and treated with SF. The level of lipid peroxide and microviscosity in alveolar epithelial cell membrane of the mice was determined, and the structural change of lung cells was observed by microscopy. Ozone could increase the level of malondialdehyde (MDA) and the microviscosity in alveolar epithelial cell membrane, and induce inflammatory changes in morphologic structure. These abnormal changes were improved after SF administration, which was manifested as alleviation of heightened microviscosity, increase of membrane fluidity, as well as the basically normalized pulmonary cellular structure under microscope. SF has a preventive effect against oxidized pulmonary injury induced by ozone, the action of which could be through scavenging oxygen free radicals, reducing lipid peroxide production, increasing membranous fluidity and mitigating inflammatory changes in cell structure.  
      Keywords:sodium ferulate;ozone;malondialdehyde;membranous fluidity;morphology   
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    • Wang Zhong-liang,Qian Shi-ming,Zhang Han-mei
      2006, 12(4): 301-305. DOI: 10.1007/s11655-001-0301-z
      Abstract:To observe the clinical efficacy of Xin’ anning Nasal Drop (XAND, 心安宁滴鼻剂) in treating coronary heart disease with unstable angina pectoris (CHD-UAP). Sixty patients with CHD-UAP were assigned, according to the randomizing number table, to two groups, the control group treated with conventional Western medicine, and the treated group treated with conventional Western medicine plus XAND. The clinical efficacy and the changes of S-T segment in resting EKG and total ischemia burden (TIB) in 24-h dynamic EKG were observed. The clinical efficacy, including the effect of angina alleviation, its initiation, and the effect of TCM syndrome score reduction, were significantly superior in the treated group to those in the control group (P<0.05 or P<0.01). The degree and extent of myocardial ischemia were significantly improved in both groups (P<0.01), but the improvement in the treated group was better than that in the control group (P<0.05). Moreover, it was worth mentioning that the immediate effect in the treated group was better than that in the control group, and the reduction of TIB, the improvement in heart rate and myocardial oxygen consumption (immediately after the first administration or by the end of the therapeutic course), and systolic blood pressure after treatment in the former were all superior to those in the latter, showing significant difference (P<0.05 or P<0.01). XAND has a quick effect in alleviating angina in patients with CHD-UAP, and it is worthy of furtherstudies and spreading in clinical practice.  
      Keywords:unstable angina pectoris;Xin’ anning Nasal Drop;Clinical Study   
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    • Dong Quan-ling,Wang Guo-nian
      2006, 12(4): 306-309. DOI: 10.1007/s11655-001-0306-7
      Abstract:To observe the effect of general anaesthesia with combination of acupuncture [conducted with Han’ s acupoint nerve stimulator (HANS) applied] and enflurance in radical operation of laryngocarcinoma (LC). Sixty patients with LC of grade I–II, classified according to the standard of American Society of Anesthesiologists (ASA), were assigned by randomizing number table to the control group and the tested group, 30 patients in each group. The control group received anaesthesia with enflurane alone for inducing and maintaining; the tested group was anaesthetized with enflurane like that given to the control group but also received additionally needling stimulation conducted by HANS. The dosage of enflurane used, the minimum effective concentration of enflurane in alveolar air (MACEnf) and the changes of heart rate (HR) as well as blood pressure (BP) in patients at different time points in the operational process were observed. As compared with those in the control group, in the tested group, both the MACEnf and the dosage of enflurane were reduced, with the difference between the two groups significant (P<0.01). The changes of HR and BP among different time points in the tested group were slight, and as compared with those in the control group at the corresponding time points, the difference was significant (P<0.05 or P<0.01). General anaesthesia with combination of enflurane and needling conducted by HANS applied in radical operation of LC has definite effect with less complication. Needling could be cooperated with narcotics, and so it could be taken as an auxiliary measure of anaesthesia for radical operation of LC.  
      Keywords:Han’ s acupoint nerve stimulator;anaesthesia with combination of acupuncture and drug;laryngocarcinoma;surgical operation;enflurane   
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    • Song Juan-juan,Yan Miao-e,Wu Xiao-ke,Hou Li-hui
      2006, 12(4): 312-316. DOI: 10.1007/s11655-001-0312-9
      Abstract:Polycystic ovarian syndrome (PCOS) is one of the most popular diseases that cause menstrual dysfunction and infertility in women. The present paper is a brief retrospection on the progress in treatment of PCOS caused infertility with integrative Chinese and Western medicine (ICWM). It can be seen from these materials that using traditional Chinese medicine (TCM) recipes formulated by Shen-replenishing herbs or acupuncture to reinforce Gan-Shen, regulate Chong-Ren Channels in treating PCOS, stable clinical efficacy could be obtained, with less adverse reaction, though the effect initiated somewhat late. Whereas, when Shen-replenishing recipe and acupuncture are combined with hormone or ovulation promoting drugs of Western medicine, the above-mentioned shortcomings would be overcome. So, this combined therapy is frequently used in clinical practice.  
      Keywords:polycystic ovarian syndrome;integrative Chinese and Western medicine therapy;traditional Chinese medicinal treatment;drug therapy   
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    • 2006, 12(4): 317-319. DOI: 10.1007/s11655-001-0317-4
      Keywords:Curcumin;gemcitabine;endometriosis;Hemangioma;Minocycline   
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