JBMJournal of Biosciences and Medicines2327-5081Scientific Research Publishing10.4236/jbm.2024.123016JBM-131850ArticlesBiomedical&Life Sciences Application of Chinese Medicine Nursing Techniques in the Sequelae of Pelvic Inflammatory Diseases: A Review WeiWei1*LifengMa2Shanghai Seventh People’s Hospital, Shanghai, ChinaSchool of Nursing, Dali University, Dali, China05032024120318219219, February 202417, March 2024 20, March 2024© Copyright 2014 by authors and Scientific Research Publishing Inc. 2014This work is licensed under the Creative Commons Attribution International License (CC BY). http://creativecommons.org/licenses/by/4.0/

Sequelae of Pelvic Inflammatory Diseases (SPID) is a common and frequent disease in gynecology, which adversely affects women’s reproductive health and quality of life due to its prolonged course. In recent years, traditional Chinese medicine (TCM) in China has gradually shown its clinical advantages in the treatment of SPID. Therefore, the present review summarizes the etiology and pathogenesis of SPID, the evidence typology, and the clinical application effects of moxibustion, herbal retention enema, acupoint compresses, external application of traditional Chinese medicine, auricular pressure beans, tuina massage, traditional Chinese medicine gongfu, and other commonly used Chinese medicine nursing techniques, with the aim of providing references and experiences for the subsequent related studies.

Sequelae of Pelvic Inflammatory Diseases Chronic Pelvic Inflammatory Disease Chinese Medicine Care Review1. Introduction

Sequelae of pelvic inflammatory disease (SPID), also known as chronic pelvic inflammatory disease (CPID), is a common and frequent disease in gynecology [1] . It is a common and frequent disease in gynecology, and the detection rate is about 7% - 14% among married women in China [2] [3] . The lesions often involve the upper reproductive tract and its surrounding tissues, mainly including chronic

pelvic pain, recurrent inflammatory disease, infertility or ectopic pregnancy [4] . This disease is prolonged and difficult to cure, which not only seriously affects the reproductive health and quality of life of women of childbearing age, but also creates an economic burden for the family and society [5] .

Western medicine believes that the pathogenesis of SPID is closely related to pathogen infection [6] [7] and that antibiotic treatment is the mainstay [8] [9] [10] . However, there are shortcomings such as increased drug resistance in patients and dysbiosis. Surgery or assisted reproductive technology treatment chosen for pelvic inflammatory masses or infertility is prone to cause trauma and pain to patients [5] . In recent years, with the continuous deepening of Chinese medicine in the field of SPID, a large number of clinical practices have shown that Chinese medicine nursing techniques have obvious effects in reducing the pain of disease, improving local signs, and improving the quality of life, etc. [4] . In addition, according to the “Healthy China 2030” plan, it is necessary to give full play to the unique advantages of TCM and improve the health of key populations such as women and children. Currently, a large number of clinical studies have been conducted on the application of TCM nursing techniques to SPID. However, there is no relevant review to report. Therefore, we reviewed the etiology and pathogenesis of sequelae of pelvic inflammatory disease (SPID), evidence typing, and the application of common TCM nursing techniques in SPID, with a view to providing references and experiences for subsequent related studies.

2. Objective

The aim of this study was to summarize the clinical evidence on the efficacy and safety of TCM nursing techniques in the treatment of SPID and to provide reliable recommendations for physicians, patients, and policy decision makers.

3. Methodology3.1. Searching Databases

Search PubMed, China National Knowledge Infrastructure, Wan Fang Database, Chinese Scientific Journal Database, Chinese Biomedical Literatures Database, and other databases.

3.2. Inclusion Criteria

Patients diagnosed with SPID independent of race, age, status or education, marital status and economic status. Trials applying validated diagnostic criteria, such as WHO guidelines, Chinese guidelines for SPID diagnosis, and SPID treatment guidelines, will be included. The treatments fall within the scope of TCM nursing techniques.

4. Etiology and Evidence of Sequelae of Pelvic Inflammatory Disease

There is no record of the name of SPID in the ancient Chinese medical books, but according to the relevant symptoms and signs, it can be considered as the category of “Belt drop disease”, “Mass in the abdomen”, “Abdominal pain in women”, “Infertility” and other categories. The term “Below-the-belt syndrome” was first mentioned in Su Wen—Bone Empty Lecture, which means that a woman’s vaginal secretion is obviously increased or decreased, with abnormal color, texture and smell, accompanied by systemic or local symptoms, which is consistent with the current clinical term of Chinese medicine [11] . In the Ming Dynasty, the “Women’s Complete Recipes—Women’s Hernia Formula VIII” stated that “the disease of impediment in women is caused by dietary irregularities, cold and temperature disorders, qi and blood strain, weakness of the internal organs, wind and cold, and the cold enters into the abdomen, which is generated by the conjunction with blood” [12] . Therefore, Chinese medicine believes that the basic pathogenesis of SPID lies in the evil feeling during menstruation and postpartum period, anxiety and excessive thinking, or impurity in sexual intercourse, which leads to dampness-heat struggle, blockage of qi and blood, and poor blood circulation in the cellular veins, which leads to pain; and the condition of the disease is difficult to cure for a long time, and the depletion of qi and blood leads to the insufficiency of qi and blood in Chong Ren and Ren channels, which leads to the pain of hidden pain, and the pain of hidden pain is difficult to disappear [13] [14] . The common types of symptoms are Damp-Heat Stagnation, Qi Stagnation and Blood Stasis, Qi Deficiency and Blood Stasis, Kidney Deficiency and Blood Stasis, and Cold-Dampness and Stagnation [15] [16] [17] [18] .

5. Application of Chinese Medicine Nursing Techniques in the Sequelae of Pelvic Inflammatory Diseases

Chinese medicine is widely used in SPID, in addition to the commonly used internal administration of traditional Chinese medicine, a variety of TCM nursing external treatments can be used.TCM nursing techniques for SPID mainly include moxibustion, Chinese medicine retention enema, acupoints, external application of traditional Chinese medicine, and tuina therapy, which are particularly important in the treatment and care of SPID.

5.1. Moxibustion

Moxibustion is a traditional Chinese medicine external treatment by burning moxa leaves, so that the combination of heat and medicinal power, through the specific acupuncture points to the deep lesions of the tissue so as to play a therapeutic effect. The Introduction to Medicine says, “Where medicine is not enough and needles are not enough, moxibustion must be used [17] .” The Materia Medica from the New According to “Materia Medica From New”, moxa leaves are pure yang, which can warm the yin and yang of the twelve meridians, get rid of the cold and dampness in the uterus, and warm the uterus [19] . Therefore, moxibustion has been widely used in SPID, such as fine moxibustion, moxibustion of medicines, thunder fire moxibustion, heat-sensitive moxibustion, etc., which have been shown to significantly improve the symptoms and local signs of the patients, reduce pain, and thus improve the reproductive health and quality of life of SPID patients.

The inverted T-shaped spaced moxibustion was used to treat SPID patients with chronic pelvic pain by selecting the midepigastric to mid-pole points and the left and right uterine points, forming a “T”-shaped connecting line for moxibustion. The results suggested that the VAS score, local symptom score and quality of life score of lower abdominal and lumbosacral pain after the treatment of spaced moxibustion were better than those of the control group (P < 0.01), indicating that the inverted T-shaped spaced moxibustion combined with the western medicine can effectively improve the local pain symptoms of the patients, and it has a special significance for improving the quality of life of the patients [20] . Zhang Jieyi applied fine moxibustion therapy to patients with SPID of the qi stagnation and blood stasis type, placing rice grain-sized moxa pillars for moxibustion at qihai, guanyuan, uterus, and shuidao acupoints, etc. [21] . The results suggested that the Chinese medicine symptom and sign scores as well as the composite scores of the fine moxibustion group were lower than those of the moxa box group and the herbal medicine group after the treatment (P < 0.05), which indicated that fine moxibustion therapy had a good therapeutic efficacy and medium-term effects, and the therapeutic efficacy was more long-lasting. Han Yefen Combining thunder fire moxibustion with the method of meridian flow injection, we chose the time of You Shi (17:00 - 19:00), when the kidney meridian was flourishing, to treat SPID patients with renal deficiency and blood stasis, and the results suggested that the total effective rate of thunder fire moxibustion at You Shi could reach 92%, which could effectively improve the clinical efficacy of the patients, promote the hemodynamics of pelvic hemodynamics, and improve the blood circulation, so as to improve the quality of life of the patients [17] .

Moxibustion can improve the local signs and prognosis of SPID patients to a large extent [22] , but the current forms of moxibustion with varying efficacy still need to be further explored.

5.2. Traditional Chinese Medicine Retention Enema

Developed from the honey decoction guide of the Typhoid Fever Treatise, herbal retention enemas are one of the most commonly used modes of drug administration in gynecological disorders [23] . Due to the special physiological and anatomical position of women, the uterus is located in front of the rectum, and after the medicine is put in from the anus, it can be quickly dispersed in the pelvis through the absorption of the intestinal mucosa, and can reach the lesion site directly, so the Chinese medicine retention enema has a unique advantage in the treatment of pelvic diseases [24] .

Ma Lifeng Combining the Chinese medicine retention enema with the meridian flow injection method, it was found that the blood flow of the large intestinal meridian was most vigorous at dao time (05:00 - 07:00), and the treatment of CPID patients at this time could maximize drug absorption, with an effective rate of 100%, which was positively significant for reducing the serum inflammatory factor concentration of patients [25] . Hu Chunfang applied traditional Chinese medicine soup for internal use combined with traditional Chinese medicine enema for the treatment of SPID patients, and the results showed that the clinical symptoms and signs of the patients were effectively improved, and the cellular immune function and the level of inflammatory factors were regulated to a great extent [26] . The results were consistent with those of Xu Wenqiu’s study [27] . Traditional Chinese medicine retention enema can not only effectively inhibit serum inflammatory factors, the thermal effect of which can also promote blood circulation in pelvic tissues. Li Liling gave patients with SPID a combination of herbal retention enema and electromagnetic wave therapy, which effectively promoted cellular immune function and improved pelvic hemodynamics, with an overall effective rate of 92%, which was conducive to promoting the recovery of patients [28] . Although the above is a combination therapy, the positive effect of Chinese medicine retention enema should not be ignored.

Through the enema, the herbal medicine can enter the subrectal and anal veins, and enter the body circulation through the inferior vena cava, which not only improves the drug absorption concentration in the lesion site, effectively improves the blood circulation of local tissues, but also avoids the stimulation of the drug to the liver and gastrointestinal tract, which is worth further popularization and application.

5.3. Acupuncture Point Patching

The application of acupoint stickers has a long history, first recorded in the “fifty-two disease formula”, is the grinding of drugs made of pills, dispersions, creams and other forms, stickers in the disease on the corresponding acupoints, so as to achieve the role of disease prevention and treatment [29] . Modern medical practitioners have widely applied acupressure to obstetrics and gynecology diseases, which helps to improve the efficacy of treatment, as well as to reduce the adverse reactions caused by the use of antibiotics [23] .

Shi Wenhao’s study of CPID patients in the observation group, the total effective rate was 88.89%, suggesting that acupoint plastering has obvious efficacy in CPID patients, and it is a non-invasive operation, which is not easy for patients to cause trauma and pain, and the compliance is higher [30] . Liu Jie Combining oral Chinese medicine soup with umbilical therapy can improve the symptoms of cold pain or tingling in the lower abdomen and excessive discharge in patients with cold-damp stagnation type SPID, and the total effective rate (93%) is better than the total effective rate of oral Chinese medicine soup (83%) [31] .

Shen Que point is located in the umbilicus, is the most commonly used point in SPID patch therapy, can be through the meridian so that the drug through the whole body, giving full play to the dual advantages of acupuncture point drug treatment [30] . And the acupoint stickers are inexpensive, easy to operate, and have practical positive significance for the prevention and treatment of SPID.

5.4. External Application of Traditional Chinese Medicine

Under the guidance of Chinese medicine theory, the external application of Chinese medicine is to apply the medicine directly to the local lesion and the surrounding skin by rubbing or pasting to treat the disease [32] . It has the advantages of easy operation, high comfort, remarkable therapeutic effect and good patient compliance.

Lisa Li combined collapse therapy with traditional Chinese medicine was applied to treat patients with SPID, in which cumin, gunner’s ginger, aromatic herbs, Yuanhu, chickweed, red peony, safflower, and Turbinaria were made into a paste and then applied to the patients’ lower abdomen once a day for 6 weeks [33] . The results suggested that the patient’s symptoms such as abdominal pain (aggravated during menstruation) and cold limbs were significantly improved, and the effective rate (94%) was better than that of the Chinese herbal anti-inflammatory formula alone (84%). Perry Huang adding the external application of four yellow water honey on the basis of acupoint embedding for the treatment of CPID patients was able to significantly alleviate the pain symptoms of the patients, with an effective rate of 96% [34] . Li Yulin randomly divided elderly CPID patients into a control group (antibiotic group) and a research group (traditional Chinese medicine collapse enema group), the results showed that the total effective rate of the research group was 88.89% higher than that of the control group of 66.67%, and the recurrence rate of 2.22% was lower than that of the control group of 17.78%, which suggests that the combination of traditional Chinese medicine collapse and enema can effectively improve the patient’s local symptoms, systemic function, regulation of inflammatory factors and hemodynamic levels, as well as reduce the recurrence rate of the disease, and reduce the recurrence rate of the disease [35] .

External application of traditional Chinese medicine is not only effective, but also suitable for patients who are unwilling to take medicine or inconvenient to take medicine. However, fewer studies have been conducted on the external application of traditional Chinese medicine for different types of SPID, which need to be further explored.

5.5. Other Technologies5.5.1. Auricular Pressure Points for Beans

Auricular pressure bean is a common treatment method used in traditional Chinese medicine in China, which involves applying medicinal beans (Wang Bu Liuhang seeds) to the ear acupuncture points and then stimulating the points through hand movements such as kneading and pinching, which produces the sensations of acidity, numbness, distension, and pain, and thus transmits the signals to the corresponding foci to regulate the qi and blood, dredge the meridians and collaterals, and balance the effects of yin and yang. Tian Yun On the basis of internal administration of traditional Chinese medicine, acupoints were taken from pelvis, uterus, Shenmen, endocrine, liver and spleen, and auricular pressure bean therapy was added to be applied to patients with SPID, with an effective rate of 96.67%, which indicated that auricular pressure bean could effectively strengthen the therapeutic effect [36] . There was no obvious adverse reaction and high safety, which provides a new idea for the treatment of SPID and has high clinical popularization value.

5.5.2. Tui Na Massage

Tuina massage is a series of manipulative treatments performed by a healer on a patient’s body with reference to the distribution of meridians and acupoints in Chinese medicine theory. Zhu Yadie CPID patients with cold-damp stagnation were divided into the control group (western medicine treatment) and the experimental group (warm meridians and collaterals Tui Na massage method with western medicine treatment), and each week was one course of treatment, and a total of two courses of treatment, and scored the visual analog score (VAS) of pain, quantitative scale of Chinese medicine symptoms, and local signs and symptoms points and compared the efficacy of treatment. The results showed that the total effective rate of the test group was 84.38%, which was better than that of the control group in improving the efficacy of TCM and the comprehensive therapeutic effect, and it had a positive significance for the pain relief of cold-damp stagnation CPID patients [37] .

5.5.3. Traditional Chinese Medicine Gongfu

Traditional gong methods in Chinese medicine usually refer to physical and mental exercises that can strengthen the body, prevent and cure diseases, and prolong the life of the body and mind, including qigong, five birds’ play, taiji, and eight-duan brocade. Among them, Five-Animal Play is a kind of health art created by Hua Tuo based on the classical theory of Chinese medicine, which can promote the operation of qi and blood. The patients with SPID of qi stagnation and blood stasis type were divided into control group (oral treatment with traditional Chinese medicine) and treatment group (oral treatment with traditional Chinese medicine combined with Five-Animal Play), and the results suggested that the total effective rate of the treatment group was 93.33%, which indicated that the Five-Animal Play was not only suitable for daily health care, but also effective in alleviating the clinical symptoms and anxiety of the patients with SPID with a high level of therapeutic safety [38] . However, there are fewer reports of related types, which may lead to the limitation of efficacy, and more clinical practice is needed to continuously deepen the research.

6. Discussion

Existing studies have confirmed that TCM nursing techniques can effectively reduce SPID patients’ chronic pelvic pain, improve their blood circulation, local signs, and serum inflammatory factor levels, which is of positive significance to the reproductive health and quality of life of women of childbearing age in China. And most of the studies belong to a variety of TCM treatments combined or Chinese and Western medicine combined treatment methods, with high clinical promotion value. However, there is still some room for improvement in the current TCM nursing techniques for SPID: 1) The current types of TCM nursing techniques for SPID are more concentrated, and more diversified studies can be conducted in the future to continuously explore new TCM nursing techniques and methods suitable for application in SPID, so as to provide a solid foundation for subsequent studies. 2) Because of the large number of evidence-based types of SPID, it is necessary to treat according to the subtypes, and the sample size of the existing study is small, it is expected that there will be subsequent multi-center and large sample study control to further explore the effect of TCM nursing techniques applied in SPID. 3) There are no criteria for the operation of TCM nursing techniques applied in SPID, and there are differences in the specific measures of the same study type, which is not conducive to the development of the subsequent study. 4) It is necessary to pay attention to the acceptance of patients’ acceptance of TCM nursing and the related health education, and continuously improve the nursing staff’s level of knowledge and operation ability of Chinese medicine, in order to promote the subsequent development in community care and family care, so as to further carry forward the traditional culture of Chinese medicine. (In Chinese)

Conflicts of Interest

The authors declare no conflicts of interest regarding the publication of this paper.

Cite this paper

Wei, W. and Ma, L.F. (2024) Application of Chinese Medicine Nursing Techniques in the Sequelae of Pelvic Inflammatory Diseases: A Review. Journal of Biosciences and Medicines, 12, 182-192. https://doi.org/10.4236/jbm.2024.123016

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