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Cochrane Database of Systematic Reviews

Acupuncture for premenstrual syndrome (Protocol)

Yu J, Liu B, Liu Z, Welch V, Wu T, Clarke J, Smith CA

Yu J, Liu B, Liu Z, Welch V, Wu T, Clarke J, Smith CA.


Acupuncture for premenstrual syndrome.
Cochrane Database of Systematic Reviews 2005, Issue 2. Art. No.: CD005290.
DOI: 10.1002/14651858.CD005290.

www.cochranelibrary.com

Acupuncture for premenstrual syndrome (Protocol)


Copyright 2010 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
TABLE OF CONTENTS
HEADER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
ABSTRACT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
BACKGROUND . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
OBJECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
METHODS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
ADDITIONAL TABLES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
APPENDICES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
WHATS NEW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
HISTORY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
CONTRIBUTIONS OF AUTHORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
DECLARATIONS OF INTEREST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
SOURCES OF SUPPORT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Acupuncture for premenstrual syndrome (Protocol) i


Copyright 2010 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
[Intervention Protocol]

Acupuncture for premenstrual syndrome

Jinna Yu1 , Baoyan Liu2 , Zhishun Liu3 , Vivian Welch4 , Taixiang Wu5 , Jane Clarke6 , Caroline A Smith7

1 Acupuncture Department, Guang An Men Hospital of China Academy of Chinese Traditional Medicine, Beijing, China. 2 China

Academy of Traditional Chinese Medicine, Beijing, China. 3 Department of Acupuncture and Moxibustion, Chinese Academy of
Traditional Chinese Medicine, Beijing, China. 4 Centre for Global Health, Institute of Population Health, University of Ottawa,
Ottawa, Canada. 5 Chinese Cochrane Centre, Chinese Clinical Trial Registry, Chinese Evidence-Based Medicine Centre, INCLEN
Resource and Training Centre, West China Hospital, Sichuan University, Chengdu, China. 6 Obstetrics and Gynaecology, University
of Auckland, Auckland, New Zealand. 7 Centre for Complementary Medicine Research, The University of Western Sydney, Penrith
South DC, Australia

Contact address: Jinna Yu, Acupuncture Department, Guang An Men Hospital of China Academy of Chinese Traditional Medicine,
No. 5 Bei Xian Ge, Xuan Wu Qu, Beijing, 100053, China. ayujinnaa@sina.com.

Editorial group: Cochrane Gynaecology and Fertility Group.


Publication status and date: Edited (no change to conclusions), published in Issue 11, 2010.

Citation: Yu J, Liu B, Liu Z, Welch V, Wu T, Clarke J, Smith CA. Acupuncture for premenstrual syndrome. Cochrane Database of
Systematic Reviews 2005, Issue 2. Art. No.: CD005290. DOI: 10.1002/14651858.CD005290.

Copyright 2010 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

ABSTRACT

This is the protocol for a review and there is no abstract. The objectives are as follows:

To evaluate the effectiveness and safety of acupuncture or electroacupuncture in the treatment of women with premenstrual syndrome.

Comparisons between groups intended for treatment with any type of acupuncture and groups allocated to sham acupuncture, no
treatment, Chinese medicine, Western medicine or other treatments. The following hypotheses will be tested:

(1) acupuncture is superior to sham acupuncture or no treatment in treating PMS;

(2) acupuncture is superior to other treatments or Western medicine or Chinese medicine in treating PMS;

(3) there are less adverse events in the acupuncture group than in the Chinese medicine or Western medicine groups.

gories:
BACKGROUND
Premenstrual syndrome (PMS) is a group of symptoms that con- (1) behavioral symptoms including fatigue, insomnia, dizziness,
sistently occur in young and middle-aged women during the luteal changes in sexual interest, food cravings or overeating;
phase of the menstrual cycle. In order to diagnose PMS, the symp-
toms should abate when menstruation starts or stops and not re- (2) psychological symptoms including irritability, anger, depressed
cur until ovulation two weeks before the next period (Backstorm mood, crying and tearfulness, anxiety, tension, mood swings, lack
1991; Dickerson 2004). More than 200 premenstrual symptoms of concentration, confusion, forgetfulness, restlessness, loneliness,
have been recorded and are usually divided into three broad cate- decreased self-esteem, tension;
Acupuncture for premenstrual syndrome (Protocol) 1
Copyright 2010 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
(3) physical symptoms including headaches, breast tenderness and element alone was indicated by the highly significant high? Mg/
swelling, back pain, abdominal pain and bloating, weight gain, Ca ratio in blood cells in women with severe PMS. The signifi-
swelling of extremities, water retention, nausea, muscle and joint cantly lower calcium level in blood cells found in studies may pro-
pain (Dickerson 2004; Reid 1986). vide additional evidence that PMS may be involved in a calcium-
deficiency state or a metabolic maladjustment involving calcium
Premenstrual dysphoric disorder (PMDD) is a more severe form
(Shamberger 2003). One cross-sectional study reported that high
of PMS. It is a condition characterized by intense emotional symp-
intake of fats and low intake of foods with high concentration
toms that occur between ovulation and menstruation. Symptoms
of carbohydrate may be associated with premenstrual symptoms
associated with PMDD are similar to those experienced with PMS;
(Nagata 2004).
however, they are much more severe. Symptoms include severe de-
pression, irritability and/or mood swings which interfere with rela-
tionships, social functioning, and work or school (Bancroft 1993;
Medem 2004). PMDD should be diagnosed only when mood Description of the intervention
symptoms seriously impact on relationships and impair function- Many different treatments have been suggested as possible thera-
ing at work or school (Medem 2004). pies for PMS due to the uncertainty of its pathogenesis and the
range of its manifestations. Because serotonin has been implicated
It is reported that approximately 95% of women have one or
in the pathogenesis of PMS, luteal phase dosing of selective sero-
more premenstrual symptoms. Fifty percent of these women have
tonin reuptake inhibitors (SSRIs) have been tested in these dis-
slight symptoms, 30% have moderate symptom, with about 5%
orders (Freeman 2004; OBrien 2000). The U.S. Food and Drug
of women reporting severe PMS symptoms that disrupt their lives
Administration (FDA) has labelled fluoxetine (sarafem and ser-
in the two weeks before their periods (Hylan 1999). It is estimated
traline (Zoloft, Pfizer Inc.)) for the treatment of PMS (Halbreich
that only 3% to 8% of women are affected by PMDD (Medem
2003).
2004).
Ovarian function appears to play a fundamental role in PMS, ac-
cordingly, treatment strategies designed to suppress ovulation have
generally been found to be effective for treatment of menstru-
Description of the condition ally-related syndromes and symptoms. Gonadotrophin-releasing
The etiology of PMS is still not completely understood. Sex hor- hormone analogues (GnRHa) appear to be an effective treatment
mones produced by the corpus luteum are thought to be crucial of premenstrual syndrome (Backstrom 2003; Kouri 1998; Wyatt
since the cyclical nature of the symptoms disappears in anovula- 2004).
tory cycles. The theory that PMS might simply result from a rel- In other studies, women with PMS who practiced aerobic ex-
ative excess of either progesterone or oestrogen during the luteal ercise reported fewer symptoms than participants in the control
phase no longer seems tenable since progesterone, oestrogens and group (OBrien 2000; Steege 1993). Dietary restrictions or sup-
progestogens can induce similar symptoms to those seen in PMS; plements may also be useful in women with PMS (Kessel 2000;
the severity of symptoms is dose sensitive (Backstrom 2003). Moline 2000). Sodium restriction has been proposed to minimize
In recent years, it has been found that the sexual hormones are bloating, fluid retention, and breast swelling and tenderness. Caf-
neuroactive and modulate neural excitability and brain function. feine restriction is recommended because caffeine intake is related
Some progesterone metabolites, in particular allo pregnenolone, to premenstrual irritability and insomnia. A systematic review of
are GABA-A agonists, with anxiolytic and anticonvulsant prop- placebo-controlled trials of evening primrose oil suggested lack of
erties. By contrast, pregnenolone-sulphate and DHEAS-sulphate benefit in PMS, although mild relief was demonstrated in women
are anxiogenic and pro-convulsant (Reddy 2003). with breast tenderness (Budeiri 1996).
There is recent evidence that levels of oestrogens and progesterone A randomised placebo-controlled study reported there were sig-
affect the transport of serotonin in the CNS, profoundly affect- nificant improvements in the symptoms of negative feeling, pain,
ing the brain serotonergic system (Cameron 2004), and that, con- water retention, and total PMS symptoms in women receiving
versely, serotonin might affect ovarian levels of oestrogens and pro- qigong therapy compared to placebo controls (Jang 2004). Qigong
gesterone. consists primarily of meditation, relaxation, physical movement,
Some evidence suggests that an underlying serotonin deficiency mind-body integration, and breathing exercises. Practitioners of
makes women more sensitive to progesterone (OBrien 2000). De- qigong develop an awareness of qi sensations (energy) in their body
ficiencies in prostaglandins, which cause an inability to convert and use their mind to guide the qi. When the practitioners achieve
linoleic acid to prostaglandin precursors, may be related to the on- a sufficient skill level (master), they can direct or emit external qi
set of PMS (Daugherty 1998). Genetic factors also seem at work for the purpose of healing others.
as the concordance rate is two times higher in monozygotic twins Some studies also indicate Chinese herbs (particularly preparations
than in dizygotic twins (Kendler 1998). A more complex rela- containing the herbs Paeonia lactiflora and Dong Quai), home-
tionship between PMS and magnesium and calcium than either opathy, aromatherapy, reflexology, Gingko biloba, kava kava, black

Acupuncture for premenstrual syndrome (Protocol) 2


Copyright 2010 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
cohosh, and agnus castus can relieve the symptoms of PMS such tive in two studies (Li 2002, Liu 2002). The first study only used
as anxiety, depression and irritability (Jones 2003; NAPS 2004; Fuliu as the point, and the second study used Zhongwan, Qihai,
Tesch 2003). Practitioners of Western herbal medicine routinely Hegu, Zusanli, Sanyingjiao, Xuehai, Shenshu, and Yongquan as
use a group of herbs known for their hormonal modulation effect the main points. Headache during menstruation could also be
as core treatment for pre-menstrual symptoms. Vitex agnus castus treated by acupuncture, one study (Zhang 2001) selected Fengchi
(Chaste tree berries) is a particularly effective treatment for many and Zhengying as the points and another study (Sun 1999) used
forms of PMS. This plant has also been the object of several ran- Baihui, Qihai, Guanyuan, Zigong, Sanyingjiao, and Zusanli as
domised studies (Loch 2000). the acupuncture points, in conjunction with Chinese herbs. These
Other treatments for PMS, for which there is inconclusive ev- studies demonstrated that PMS symptoms may be alleviated by
idence, include cognitive behavioral therapy, relaxation therapy, acupuncture or acupuncture in conjunction with other means; a
vitamin B6, L-tryptophan, stress reduction, spironolactone, or a systematic review is required.
complex carbohydrate drink. Although evidence for relief of PMS
symptoms is inconclusive, it is reasonable to recommend these as
healthy lifestyle changes which may give people a more general
benefit (Douglas 2002; Girman 2003; Rapkin 2003).
OBJECTIVES
To evaluate the effectiveness and safety of acupuncture or elec-
Why it is important to do this review troacupuncture in the treatment of women with premenstrual syn-
drome.
Acupuncture is a form of therapy based on traditional Chinese
medicine (TCM) and dates back thousands of years. To bring Comparisons between groups intended for treatment with any
about healing it involves inserting fine needles into specific points type of acupuncture and groups allocated to sham acupuncture,
on the skin in order to stimulate corresponding meridians points, no treatment, Chinese medicine, Western medicine or other treat-
as defined by TCM theory. Other methods of stimulation of these ments. The following hypotheses will be tested:
points are also traditionally used, such as the burning of moxa (the
(1) acupuncture is superior to sham acupuncture or no treatment
plant Artemisia vulgaris or Mugwort) and applying pressure (acu-
in treating PMS;
pressure). Other methods developed more recently include elec-
tronic stimulation, laser acupuncture and medicament. The tra- (2) acupuncture is superior to other treatments or Western
ditional concepts involve the regulating of imbalances of qi (vital medicine or Chinese medicine in treating PMS;
energy) along with the theories of yin and yang, the five elements,
meridians, vital substances, pathogenic factors, and the eight prin- (3) there are less adverse events in the acupuncture group than in
ciple patterns (Beal 1999). As the use of acupuncture has become the Chinese medicine or Western medicine groups.
more prevalent in the West these theories have been developed to
fit in with a Western understanding of physiology, for example,
needling is thought to reduce local muscle tension or release pain- METHODS
killing endorphins (Green 2004). The temperature in the cor-
tex can be changed by electroacupuncture; the response could be
taken as the indication of the change in nervous activity (Zhang Criteria for considering studies for this review
1997). Recent data suggest that acupuncture has regionally spe-
cific, quantifiable effects on relevant brain structures. Acupunc-
ture may stimulate gene expression of neuropeptides (Kaptchuk
Types of studies
2002).
Based on this theory, acupuncture may have potential benefits for Randomised controlled trials will be considered without restric-
the premenstrual syndrome. There were more than 20 studies re- tion on language and publication types.
porting its effects in the treatment of premenstrual syndrome. One
study (You 1997) classified the patients into one group with yang
deficiency of the spleen and the kidney and another group with Types of participants
stagnation of the liver qi (the spleen, kidney and liver in TCM Women of reproductive age with one or more symptoms occurring
is different from in western medicine); it used Taichong, Taixi, periodically during 0 to 14 days before menstruation, for three or
Qihai, Ganshu, Tanzhong, and Sanyingjiao as the main acupunc- more menstrual periods, will be included. By thorough physical
ture points in the first group and Zusanli, Pishu, Shenshu, Taixi, examination and laboratory test, those who are confirmed to have
Sanyingjiao, Guanyuan (moxibustion) in another. Acupuncture medical problems such as hypothyroidism, hypoglycaemia or a
in treating edema during menstruation was also reported effec- tumour of the breast, brain or ovary will be excluded. Women

Acupuncture for premenstrual syndrome (Protocol) 3


Copyright 2010 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
addicted to drink or with an alcoholic habit will be excluded; This is a draft search strategy and will be adapted to include addi-
women with allergic reactions to acupuncture will also be excluded. tional search terms where necessary.
(4) We also intend to search for ongoing trials in the Meta-register
of Controlled Trials, which includes the Medical Research Council
Types of interventions Clinical Trials Directory and the National Research Register, as
The type of acupuncture could be body acupuncture, elec- well as many other registers on ongoing trials.
troacupuncture, scalp acupuncture, ear acupuncture, laser (5) We will try to identify additional studies by searching the
acupuncture and other acupuncture interventions see Table 1.The reference lists of relevant trials and reviews identified.
control intervention compared with acupuncture could be Chi- (6) Unpublished and on-going trials will be identified by corre-
nese medicine, Western medicine, sham acupuncture (placebo), spondence with authors.
no intervention, and any other interventions. Acupuncture ther- (7) Major acupuncture and obstetrics and gynaecology conferences
apy combined with other methods will also be included. proceedings and poster abstracts about this disease over the last
five years will be handsearched for further eligible studies.
(8) A search for side-effects studies will be carried out and contact
Types of outcome measures will be made with various adverse reaction reporting bodies.
(9) The Chinese Cochrane Centre is co-ordinating the hand-
(1) PMS scoring systems searching of a variety of Chinese journals. We will contact the
Any validated objective scoring system used for premenstrual Centre to obtain any handsearch results relevant to this review.
symptoms, such as the Moos Menstrual Distress Questionnaire or (10) Individual researchers working in the field, of unpublished
the Daily Symptom Report. ongoing trials, involved in confidential reports and raw data of
(2) Improvement of overall symptoms (as a dichotomous measure) published trials will be contacted.
If the above two outcome measures were not used in a study, we Additional key words of relevance may be identified during any
will also consider the outcome measures as following: of the electronic or other searches. If this is the case, electronic
records made by participants or doctors by chart or using visual search strategies will be modified to incorporate these terms. Stud-
analogue scales. ies published in any language will be included.
Severity of symptoms reported will be judged in accordance with External referees will be requested to check the completeness of the
the definitions of numerical scales used in the charts. search strategy. This is a draft search strategy and will be adapted
(3) Quality of life to include additional search terms where necessary.
The Health Related Quality of Life (HRQOL) or other validated
scales will be considered in this review.
(4) Adverse events
Events such as needle sickness, pneumothorax and so on will be
Data collection and analysis
recorded.
Study selection
YJ and LZ will select the trials to be included in the study. A quality
table will be used to record the quality of studies. According to
Search methods for identification of studies the empirical evidence (Jadad 1996; Juni 2001; Kjaergard 2001;
A comprehensive and exhaustive search strategy will be formulated Moher 1998; Schulz 1995), we will assess the methodological
in an attempt to identify all relevant studies regardless of language quality as described by the Cochrane Reviewers Handbook 4.2:
or publication status (published, unpublished, in press, and in (1) generation of the allocation sequence: adequate (computer-
progress). generated random numbers, table of random numbers, or similar)
(1) The Trials Registers of the Cochrane Menstrual Disorders and or inadequate (other methods or not described);
Subfertility Group and the Cochrane Complementary Medicine (2) allocation concealment: adequate (central independent unit,
Field will be searched. sealed envelopes, or similar) or inadequate (not described or open
(2) The Cochrane Central Register of Controlled Trials (CEN- table of random numbers or similar);
TRAL) on The Cochrane Library will be searched. (3) double blinding: adequate (identical sham acupuncture, or
(3) We will also search MEDLINE (January 1966 to present), EM- similar) or inadequate (not performed or different); and
BASE (January 1980 to present), Chinese Biomedical Database (4) follow up: adequate (number and reasons for dropouts and
(CBM) (January 1975 to present), China National Knowledge withdrawals described) or inadequate (number or reasons for drop-
Infrastructure (CNKI) (January 1994 to present), and the VIP outs and withdrawals not described).
Database (January 1989 to present). Based on these criteria, studies will be broadly subdivided into the
Search strategy for the above electronic database Appendix 1. following three categories.
A - all quality criteria met: low risk of bias.

Acupuncture for premenstrual syndrome (Protocol) 4


Copyright 2010 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
B - one or more of the quality criteria only partly met: moderate Data analysis
risk of bias. We will analyse the data using Review Manager (Version 5.0). We
C - one or more criteria not met: high risk of bias. will compare outcome measures for binary data using relative risks.
This classification will be used as the basis for subgroup analysis. For continuous data, we will use the weighted mean difference.
Additionally, we will explore the influence of individual quality If continuous data has been reported using geometric means, we
criteria in a sensitivity analysis. Each trial will be assessed indepen- will combine the findings on a log scale and report on the original
dently by two reviewers (YJ and LZ). Inter-rater agreement will scale. We will report medians and ranges in tables only. We will
be calculated using the Kappa statistic. In cases of disagreement, assess heterogeneity amongst trials by inspecting the forest plots
the third reviewer (WT) will be consulted and a judgement will and using the Chi square test for heterogeneity with a 10% level
be made based on consensus. of statistical significance. Where it is appropriate to pool data and
Data extraction heterogeneity is detected, we will use the random-effects model.
YJ and LZ will independently extract data using a piloted data We do not intend to combine results of trials with different com-
extraction form. We will extract data on study characteristics in- parator drugs or interventions. Potential bias of publication will
cluding methods, participants, interventions, and outcomes. We be tested for using the funnel plot or other corrective analytical
will resolve any disagreements by referring to the trial report and methods, depending on the number of clinical trials included in
through discussion, or by consulting the Cochrane Menstrual Dis- the systematic review (Egger 1997).
orders and Subfertility Group. If data from the trial reports are We intend to explore the following potential sources of hetero-
insufficient or missing, we will contact the authors for additional geneity using subgroup analyses or meta-regression because there
information. are clinical heterogeneity between them:
Where possible, we will extract data to allow an intention-to-treat (a) different types of acupuncture intervention;
analysis (the analysis should include all the participants in the (b) different preparations of intervention combined with acupunc-
groups to which they were originally randomly assigned). If the ture;
number randomised and the numbers analysed are inconsistent, (c) different control interventions;
we will calculate the percentage loss to follow up and report this (d) acupuncture points;
information in an additional table. For binary outcomes, we will (e) period of treatment.
record the number of participants experiencing the event in each Reasons for heterogeneity in studies will be explored and, if neces-
group of the trial. For continuous outcomes, for each group we sary, sensitivity analyses will examine the effects of excluding study
will extract the arithmetic means and standard deviations. If the subgroups, for example those studies with lower methodological
data are reported using geometric means we will extract standard quality.
deviations on the log scale. Medians and ranges will be extracted Non-controlled studies will be listed but not discussed further.
and reported in tables. Studies relating to adverse effects will be described qualitatively.

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on premenstrual symptoms in middle-aged women: a
Indicates the major publication for the study

ADDITIONAL TABLES
Table 1. Acupuncture Points

Acupuncture Points Alternative name

Hegu LI 4

Zusanli ST 36

Sanyinjiao SP 6

Xuehai SP 10

Ganshu BL 18

Pishu BL 20

Shenshu BL 23

Yongquan KI 1

Acupuncture for premenstrual syndrome (Protocol) 7


Copyright 2010 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Table 1. Acupuncture Points (Continued)

Taixi KI 3

Zhengying GB 17

Fengchi GB20

Taichong LR 3

Guanyuan RN 4

Zhongwan RN 12

Tanzhong RN 17

Baihui DU 20

Zigong EX-CA 1

Qihai RN 6

APPENDICES

Appendix 1. MEDLINE
#1. Premenstrual syndrome
#2. Syndrome, premenstrual
#3. Syndrome*, premenstrual
#4. Premenstrual tensions
#5. Tensions, premenstrual
#6. Tension, prem*
#7. PMT
#8. PMS
#9.or/1-8
B. Search Strategy to locate acupuncture interventions:
#10. acupuncture
#11. electroacupuncture
#12. body acupuncture
#13. acupuncture points
#14. ear acupuncture
#15. scalp acupuncture
#16. laser acupuncture
#17.abdomen-acupuncture
#18. or/#10-#17
Acupuncture for premenstrual syndrome (Protocol) 8
Copyright 2010 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
WHATS NEW

Date Event Description

20 September 2010 Amended Contact details updated.

HISTORY
Protocol first published: Issue 2, 2005

Date Event Description

6 November 2008 Amended Converted to new review format.

CONTRIBUTIONS OF AUTHORS
Yu Jinna: was responsible for drafting the protocol and will be responsible for searching for studies, data extraction, data analysis, and
data presentation.
Vivian Robinson: contributed to protocol development and will contribute to data analysis.
Liu Zhishun: will contribute to data analysis.
Liu Baoyan: will contribute to data analysis
Wu Taixiang: contributed to protocol development and will contribute to data analysis.

DECLARATIONS OF INTEREST
None known.

SOURCES OF SUPPORT

Internal sources
Guang An Men Hospital of China Academy of Traditional Chinese Medicine, China.

Acupuncture for premenstrual syndrome (Protocol) 9


Copyright 2010 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
External sources
Chinese Cochrane Center, Chinese Centre of Evidence-based Medicine, West China Hospital of Sichuan University, China.

Acupuncture for premenstrual syndrome (Protocol) 10


Copyright 2010 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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