Jung, Kim, Choi, Hwang, Yoon, and Park: A Survey on Korean Medicine Doctors’ Recognition and Treatment for Developing Korean Medicine Clinical Practice Guideline of Female Infertility
Original Article
The Journal of Korean Medicine 2022; 43(3): 122-138.
1Dept. of Obstetrics & Gynecology, College of Korean Medicine, Dong-Guk University
2Dept. of Korean Medicine Obstetrics and Gynecology, School of Korean Medicine, Pusan National University
Correspondence to: Dong-Il Kim, Dept. of Korean Medicine Obstetrics & Gynecology, Ilsan Dong-Guk University Korean Medicine Hospital, 27 Dongguk ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, Korea, Tel : +82-31-961-9060, Fax : +82-31-661-9339, E-mail: obgykdi@hanmail.net
Received July 20, 2022 Revised August 10, 2022 Accepted August 16, 2022
Abstract
Objectives
This study was conducted to develop a Korean Medicine(KM) Clinical Practice Guidelines(CPG) of female infertility. We conducted this questionnaire survey to reflect the experiences of Korean Medicine doctors(KMD) and clinical field in Korea.
Method
We sent a questionnaire survey to KMD belonging to the Association of Korean Medicine by e-mail. We received 665 responds, and analyzed the answers.
Results
51.2% of respondents knew the previously developed CPG of female infertility, and 18.3% actually used. 83.3% agreed about the necessity of CPG of female infertility, and 80.3% had practical use plan. 90.2% of respondents treated less than 5 infertility woman for a month. 22.7% of respondents treated 50% of patients with collaborative treatment of KM and Western medical treatments. The main age group of patients was ‘35~40 years’(54.7%), and the most common cause was unexplained infertility(61.7%). The most common pattern identification of female infertility patients was Kidney deficiency(55.4%). KMD used 'a combination of decoction of herbal medicine, acupuncture and moxibustion treatment' the most(43%), and 'a decoction of herbal medicine treatment alone' was next(35%). 84.2% conducted lifestyle modification education about diet, stress, exercise etc.
Conclusion
We figured out Korean Medicine doctors' recognition about CPG of female infertility, preference of treatments, and also characteristics of patients visiting Korean Medical clinics to make a practical CPG reflecting clinical situation.
Proportion of the patients with Western medical treatment of infertility during practice of Korean Medicine treatment
Fig. 2
Proportion of woman receiving treatment alone at Korean medical clinics
Fig. 3
The most common cause of female infertility patients treated with Korean Medical treatment alone or collaborative treatment with Western medical treatment
Fig. 4
A treatment of Korean Medicines that is performed when Korean Medical treatment is used alone or collaborative treatment with Western medical treatment are used
Table 1
General Characteristics of the Respondents
Variables
N
%
Gender (N=664)
Male
476
71.7
Female
188
28.3
Age (N=664)
20s
49
7.4
30s
229
34.5
40s
246
37.0
50s
113
17.0
≥60s
27
4.1
Clinical career (N=664)
< 5 years
84
12.7
5–10 years
186
28.0
10–15 years
127
19.1
15–20 years
106
16.0
20–25 years
81
12.2
25–30 years
41
6.2
≥ 30 years
39
5.9
Type of institution (N=664)
Korean Medicine clinic
483
72.7
Korean Medicine hospital (other)
71
10.7
Korean Medicine hospital (university-affiliated)
44
6.6
Gynecology specialized Korean Medicine clinic
23
3.5
Nursing hospital
19
2.9
Public health center
16
2.4
Hospital
5
0.8
Government agencies, Research institution
1
0.2
Other
2
0.3
Specialty (N=664)
Yes
181
27.3
No
483
72.7
Specialized Practitioner (N=181)
Internal Medicine
54
29.8
Acupuncture & Moxibustion
40
22.1
Gynecology
40
22.1
Ophthalmology, Otorhinolaryngology & Dermatology
13
7.2
Rehabilitation Medicine
12
6.6
Sasang Constitutional
11
6.1
Neuropsychiatry
6
3.3
Paediatrics
5
2.8
Table 2
Recognition and Utilization about Korean Medicine Clinical Practice Guidelines
Variables
N
%
Recognition and utilization about previously developed female infertility CPG* (N=664)
Didn’t know
324
48.8
Know
340
51.2
Very actively used
29
4.4
Actively used
92
13.9
Moderately used
157
23.6
Rarely used
37
5.6
Never used
25
3.8
Recognition and utilization about Previously Developed other CPGs (N=664)
Didn’t know
224
33.7
Know
440
66.3
Very actively used
30
4.5
Actively used
108
16.3
Moderately used
197
29.7
Rarely used
60
9.0
Never used
45
6.8
Necessity of developing female infertility CPG (N=664)
Certainly necessary
294
44.3
Necessary
259
39.0
Moderately necessary
107
16.1
Unnecessary
3
0.5
Certainly unnecessary
1
0.2
Practical use plan of female infertility CPG (N=664)
Very actively use
267
40.2
Actively use
266
40.1
Moderately use
122
18.4
Rarely use
7
1.1
Never use
2
0.3
CPG : Clinical Practice Guideline
Table 3
Current Status of Infertility Treatment of Korean Medicine Doctors
Variables
N
%
Clinical career for Infertility (N=664)
< 5 years
195
29.4
5–10 years
150
22.6
10–15 years
109
16.4
15–20 years
71
10.7
20–25 years
89
13.4
25–30 years
21
3.2
≥ 30 years
29
4.4
Average number of patients with infertility per month (N=664)
0
77
11.6
1
355
53.5
2
116
17.5
3
45
6.8
4
5
0.8
5–10
34
5.1
10–15
18
2.7
≥15
14
2.1
Average duration for treatment of patients with infertility (N=587)
1 month
23
3.9
2 months
44
7.5
3 months
277
47.2
4 months
24
4.1
5 months
7
1.2
6 months
169
28.8
≥7 months
43
7.3
Average visiting days of a patient with infertility per month (N=587)
≦ 1
111
18.9
2
133
22.7
3
49
8.3
4
132
22.5
≥5
162
27.6
Table 4
Characteristics of the Patients Visiting Korean Medical Clinics for Infertility
Variables
N
%
Main age group of patients with infertility
<30
16
2.7
30–35
196
33.4
35–40
321
54.7
≥40
54
9.2
Period of infertility
1–2 years
92
15.7
2–3 years
228
38.8
3–4 years
130
22.1
≥4 years
137
23.3
Cause of infertility
Ovulation disorders
107
18.2
Fallopian tube abnormalities
24
4.1
Uterine abnormalities
87
14.8
Unexplained
362
61.7
Others
7
1.2
Proportion of patients who have undergone gynecological examinations before visiting KM clinics
0–20 %
26
4.4
20–40 %
37
6.3
40–60 %
73
12.4
60–80 %
69
11.7
80–99%
232
39.6
100 %
150
25.6
KM : Korean Medical
Table 5
Diagnostic Aspects Applied to Infertility Patients
Variables
N
%
Experience and cause of request for cooperation with Obstetrics and Gynecology or infertility clinics
Didn't experience
440
75
Experienced
147
25
Cause (N=147)
infertility examination
109
74.1
medical treatment
25
17
patient's wants
13
8.8
Utilization of Korean medical tests
Not used
369
62.9
Used
218
37.1
Type of Korean medical test (N=218)
Heart Rate Variability
140
64.2
Bioelectrical Impedance Analyzer
116
53.2
Thermography
81
37.2
Yangdorak (Ryodoraku)
35
8.4
Pulse Analyzer
29
7.0
Other
14
6.4
Table 6
Pattern Identification of Patients with Infertility
Pattern Identification
N
%
Kidney deficiency
325
55.4
Stagnation of liver qi
297
50.6
Blood deficiency
288
49.1
Dampness-Phlegm
278
47.4
Blood stagnation
260
44.3
Damp-Heat
84
14.3
Other
18
3.1
Table 7
Acupuncture Points for Acupuncture and Moxibustion for Female Infertility Patients
Acupuncture point
KM treatment alone N(%)
KM & WM collaborative treatment N(%)
(N=426)
(N=412)
Acupuncture
SP6
305(71.6%)
299(72.6%)
CV4
222(52.1%)
221(53.6%)
ST36
155(36.4%)
149(36.2%)
SP9
136(31.9%)
143(34.7%)
LR3
130(30.5%)
115(27.9%)
CV6
125(29.3%)
128(31.1%)
SP10
100(23.5%)
91(22.1%)
CV12
95(22.3%)
88(21.4%)
EX-CA1
78(18.3%)
72(17.5%)
KI3
60(14.1%)
68(16.5%)
(N=359)
(N=341)
Moxibustion
CV4
320(89.1%)
300(88%)
SP6
86(24%)
86(25.2%)
BL23
75(20.9%)
73(21.4%)
胞門
30(8.4%)
28(8.2%)
SP11
25(7%)
26(7.6%)
KM : Korean medical, WM : Western medical
Table 8
Herbal Medicines for Female Infertility Patients
herbal medicine
KM treatment alone N(%)
KM & WM collaborative treatment N(%)
N=559
N=522
Decoction of herbal medicine
Jokyeongjongok-tang
387(69.2%)
343(65.7%)
Onkyungtang
274(49%)
253(48.5%)
Kwibi-tang
161(28.8%)
150(28.7%)
Gaeuljongok-tang
128(22.9%)
116(22.2%)
Yuglinju
82(14.7%)
73(14%)
Changbudodam-tang
72(12.9%)
61(11.7%)
(N=173)
(N=169)
Granulation or pill types of herbal medicine
Geijibokryunghwan
77(44.5%)
70(41.4%)
Onkyungtang
71(41%)
78(46.2%)
Gamisoyo-san
63(36.4%)
65(38.5%)
GamiKwibi-tang
60(34.7%)
68(40.2%)
Dangui-jakyak-san
47(27.2%)
-
Samul-tang
36(20.8%)
36(21.3%)
KM : Korean medical, WM : Western medical
Table 9
Lifestyle Modifications for Female Infertility Patients
N (N=494)
%
Diet
393
79.6
Stress
384
77.7
Exercise
352
71.3
Alcohol
338
68.4
Intercourse
311
63.0
Smoking
300
60.7
Caffeine
255
51.6
Other
11
2.2
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