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Effectiveness and Safety of Chinese Medicine at Shenque (CV 8) for Primary Dysmenorrhea: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

  • Evidence-Based Integrative Medicine
  • Published:
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Abstract

Background

Primary dysmenorrhea (PD) is the most common complaint associated with menstruation and affects up to three-quarters of women at some stage of their reproductive life. In Chinese medicine, navel therapy, treatment provided at Shenque (CV 8), is used as a treatment option for PD.

Objective

To evaluate the effect of navel therapy on pain relief and quality of life in women with PD, compared with Western medicine (WM).

Methods

China National Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP), SinoMed and Wanfang Database, MEDLINE, the Cochrane Library, Embase, Web of Science, and the International Clinical Trial Registry of the U.S. National Institutes of Health were searched from their inceptions to April 1, 2021. Randomized controlled trials (RCTs) assessing therapeutic effects of navel therapy on PD were eligible for inclusion. RevMan 5.4 software was used for data analyses. The certainty of the evidence was assessed using the online GRADEpro tool.

Results

Totally 24 RCTs involving 2,614 participants were identified. Interventions applied to acupuncture point CV 8 included: herbal patching, moxibustion or combined navel therapy (using at least 2 types of stimulation). Compared to placebo, there was a significant effect in favor of navel therapy on reducing overall menstrual symptom scores at the end of treatment [mean difference: −0.82, 95% confidence interval (CI): −1.00 to −0.64, n=90; 1 RCT]. As compared with Western medicine, navel therapy had a superior effect on pain intensity as assessed by Visual Analogue Scale at the end of treatment [standardized mean difference (SMD): −0.64, 95% CI: −1.22 to −0.06, I2=80%, n=262; 3 RCTs]; on symptom resolution rate at 3-month follow-up (risk ratio: 1.94, 95% CI: 1.47 to 2.56, n=1527, I2=38%; 13 RCTs); and on global menstrual symptoms score at the end of treatment (SMD: −0.67, 95% CI: −0.90 to −0.45, I2=63%, n=990; 12 RCTs). Subgroup analyses showed either a better or an equivalent effect comparing navel therapy with Western medicine. No major adverse events were reported. The methodological quality of included trials was poor overall.

Conclusions

Navel therapy appears to be more effective than Western medicine in decreasing menstrual pain and improving overall symptoms of PD. However, these findings need to be confirmed by well-designed clinical trials with adequate sample size (Systematic review registration at PROSPERO, No. CRD42021240350)

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Acknowledgements

The authors greatly thank Dr. LIN Ke-ke from School of Nursing, Beijing University of Chinese Medicine, for her invaluable assistance with feedback on the manuscript; and GONG Yi for giving her advices on inclusion criteria (PICO), and subgroups, from the perspective of clinician. The authors also greatly thank the reviewers for feedback and comments on this paper.

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Authors and Affiliations

  1. Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100029, China

    Li-jiao Yan, Min Fang, Si-Jia Zhu, Zhi-jie Wang, Shi-bing Liang, Chen Shen, Nicola Robinson & Jian-ping Liu

  2. Department of Oncology, Shanxi Provincial Hospital of Traditional Chinese Medicine, Taiyuan, 030012, China

    Zhi-jie Wang

  3. Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, SO16 5ST, UK

    Xiao-yang Hu

  4. Research Design Service South Central, National Institute of Health Research, Southampton, SO16 6YD, UK

    Xiao-yang Hu

  5. School of Nursing, Beijing University of Chinese Medicine, Beijing, 100029, China

    Dou Wang

  6. Department of Nursing, Beijing Friendship Hospital, Beijing, 100050, China

    Dan Yang

  7. Institute of Health and Social Care, London South Bank University, London, SE10AA, UK

    Nicola Robinson

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  1. Li-jiao Yan
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  2. Min Fang
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Contributions

Liu JP and Yan LJ conceived and designed the review. Yan LJ, Fang M and Shen C were responsible for the searching, screening, and selection of trials. Fang M, Wang D and Yan LJ participated in the data extraction. Yan LJ and Zhu SJ were responsible for the risk of bias assessment. Yan LJ performed statistical analysis; Yan LJ and Liang SB completed certainty assessment of evidence using GRADE. Yan LJ drafted the manuscript. Yang D and Wang D assisted the writing of the manuscript. Fang M and Wang ZJ completed the PRISMA checklist. Liu JP, Robinson N, Hu XY and Wang ZJ were involved in critically revising the manuscript. All authors have read, revised, and approved the manuscript, including the authorship list.

Corresponding author

Correspondence to Jian-ping Liu.

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Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Supported by Innovation Team and Talents Cultivation Program of National Administration of Traditional Chinese Medicine (No. ZYYCXTD-C-202006), Longitudinal Development Funding of Beijing University of Chinese Medicine (No. 2021-ZXFZJJ-016), the National Institute for Health Research (No. SPCR-143) Shanxi Provincial Health Commission Project (No. 2020050)

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Yan, Lj., Fang, M., Zhu, SJ. et al. Effectiveness and Safety of Chinese Medicine at Shenque (CV 8) for Primary Dysmenorrhea: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Chin. J. Integr. Med. 29, 341–352 (2023). https://doi.org/10.1007/s11655-022-3319-z

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