Evaluation of Clinical Efficacy and Investigation of Mechanism of Action of Acupuncture Treatment

240 Pages·2012·3.06 MB·English

Evaluation of Clinical Efficacy and Investigation of
Mechanism of Action of Acupuncture Treatment in the
Management of Polycystic Ovarian Syndrome

Scholarship Candidate:
Dr Chi Eung Danforn Lim
BSs(Med) MBBS (UNSW), BHltSc(Complementary Med)(CSU), DCH(USyd), Clin Dip Pall Med(RACP)
MMed(Repro Health & Hum Genetics)(USyd), MAppSc(Acupuncture)(RMIT), MAppMgt(Health)(Newcastle),
RCMP(Acupuncture & Chinese Herbal Medicine), AFRACMA, AFCHSM, MACNEM, MACE, JP

Scholarship support awarded for this doctoral study:
South Western Sydney Clinical School Scholarship,
University of New South Wales, Australia
(2008-2011)

Principal Supervisor:
Professor Felix WS Wong
MBBS MD MMed FRANZCOG FRCOG
FRCS Ed FRCS Glas FHKCOG FHKAM

Co-Supervisor:
Associate Professor Anthony J O’Sullivan
MBBS MD FRACP

This thesis is submitted in 2012 to fulfil the requirement for the award of degree of
Doctor of Philosophy (Medicine) at the Faculty of Medicine, University of New South Wales, Australia
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Originality Statement
‘I hereby declare that this submission is my own work and to the best of my knowledge it
contains no materials previously published or written by another person, or substantial
proportions of material which have been accepted for the award of any other degree or
diploma at UNSW or any other educational institution, except where due acknowledgement is
made in the thesis. Any contribution made to the research by others, with whom I have worked
at UNSW or elsewhere, is explicitly acknowledged in the thesis. I also declare that the
intellectual content of this thesis is the product of my own work, except to the extent that
assistance from others in the project's design and conception or in style, presentation and
linguistic expression is acknowledged.’

Copyright Statement
‘I hereby grant the University of New South Wales or its agents the right to archive and to make
available my thesis or dissertation in whole or part in the University libraries in all forms of
media, now or here after known, subject to the provisions of the Copyright Act 1968. I retain all
proprietary rights, such as patent rights. I also retain the right to use in future works (such as
articles or books) all or part of this thesis or dissertation.

I also authorise University Microfilms to use the 350 word abstract of my thesis in Dissertation
Abstract International (this is applicable to doctoral theses only).

I have either used no substantial portions of copyright material in my thesis or I have obtained
permission to use copyright material; where permission has not been granted I have
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Authenticity Statement
‘I certify that the Library deposit digital copy is a direct equivalent of the final officially
approved version of my thesis. No emendation of content has occurred and if there are any
minor variations in formatting, they are the result of the conversion to digital format.’

Dr Chi Eung Danforn Lim

28th August, 2012
DECLARATION

I declare that this thesis contains no material that has been accepted for the award of any other degree or
diploma in any university. And that, to the best of my knowledge and belief, this thesis contains no
material previously published or written by any other persons, except where due reference is made in the
text of the thesis or the article has been published under my name at the peer reviewed journals. The
content of the thesis is the result of work that has been carried out since the official commencement date
of the approved research program.

I declare that all the work performed in this thesis are all my own work, except where due references and
acknowledgment are made. I declare that I have received formal education in Chinese medicine and
acupuncture through my postgraduate studies at RMIT University. I declare that I am a Registered
Chinese Medicine Practitioner in Victoria, Australia with good standing throughout this doctoral study
period and able to perform acupuncture without any restriction in Australia.

Chi Eung Danforn Lim
Registered Medical Practitioner, Medical Board of Australia
Registered Chinese Medicine Practitioner, Chinese Medicine Board of Australia

_______________________________
Date: __________________
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ACKNOWLEDGEMENTS
At the outset, I thank God for His abundant grace benevolent blessings and counsel that made this
research possible.

Becoming a competent and mature doctor is a long and challenging process. I have been very lucky to be
tutored under Professor Felix Wong and Associate Professor Anthony O’Sullivan, in particularly since
when I was an undergraduate medical student at the UNSW. First of all, I must thank my supervisors,
Professor Felix Wong and Associate Professor Anthony O’Sullivan for their invaluable time and
supervision throughout this study. In particular, I would like to further extend my appreciation towards
Professor Felix Wong for his inspiration, encouragement, guidance, advice and friendship throughout my
study for this degree. I am heartily thankful to him for offering me to commence my doctoral study since
my internship and also the ample opportunities that he has given me to view medicine and research in
many different ways. Without all their support, this thesis would not have been possible.

Being a medical graduate of the University of New South Wales, I am very fortunate to be able to
continue my PhD(Med) study at my alma mater. I would like to take this opportunity to express my
sincere gratitude towards South Western Sydney Clinical School for their generous support throughout
my candidateship by offering me a full scholarship. Furthermore, I would like to thank all the clinical
teachers and staff for their invaluable constructive comments throughout my internal reviews within the
School and enrolments each year, in particular to Professor Minoti Apte and Ms Claudia Calero.

Throughout the studies, I have been given a lot of assistance from my colleagues regarding to research
issues and publication matters. I would like to thank all my colleagues and friends for their patience and
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help throughout my studies, in particular to all the co-authors of my papers published in various journals,
as well as to my brother in law Professor Charlie Xue for his advice at the early stage of this research
study.

I would also like to thank all the teaching, clinical and laboratory staff at the Guangdong Women’s and
Children’s Hospital of the Guangzhou Medical University, China, for their countless support and
assistance in this collaboration to recruit subjects throughout this study. All these would not be possible
without the leadership of Professor Xiping Luo and Dr Xinlin Zhan throughout this study. In particularly,
I thanked Prof Xiping Luo’s participation in subject’s clinical visits, follow ups, and allocation of
research assistant. Furthermore, I thanked Dr Xinlin Zhan for performing the acupuncture for the subjects
recruited in their hospital.

Most importantly, I would like to take this opportunity to thank my parents, Dr Long Kiat Lim and Dr
Mee Led Hung, for their invaluable love, support and teaching throughout my life. They taught me how
to be a good doctor and also lead me to my Lord in heaven. They give me all they have and also the most
power that lines up my courage to face the various difficulties of life. Without their substantial and
unstinting love and support, nothing would have been possibly achieved.

There were a lot of changes in my life throughout this doctoral study. I have gone from a bachelor to
being a husband and later on becoming a father. I would also like to thank my wife, Dr Nga Chong Lisa
Cheng, for her unlimited support, patience, understandings and love throughout my studies. I am thankful
to my little boy, Enoch Lim, for his understanding throughout my studies that being a father I was not
able to spend a lot of time with him while preparing this thesis. I would like to thank my siblings, Dr Ki
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Fong Bailey Lim and Dr Ki Yuk Lam, for their devoted care which is always an excellent patronage to
me.

Last but not least, I convey my heartfelt thanks to all participants in this project for their understanding
and co-operation in providing sample amidst their physical and psychological impacts from PCOS and
making this a success.
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ABBREVIATIONS
ACTH Adrenocorticotrophic hormone
AES Androgen Excess Society
ASRM American Society of Reproductive Medicine
BBT Basal body temperature
b-hCG Beta - human chorionic gonadotropin
BMI Body mass index
CAH Congenital adrenal hyperplasia
CAM Complementary and alternative medicine
CM Chinese medicine
CMCRC Chinese Medicine Clinical Research Centre, Liverpool Hospital Sydney
CRF Corticotrophin-releasing factor
CV Conception vessel / Meridian in Acupuncture
CVD Cardiovascular disease
DHEAS Dehydroepiandrosterone sulphate
E2 Estradiol (Oestrogen)
ESHRE European Society of Human Reproduction and Embryology
FAI Free Androgen Index
FSH Follicular stimulating hormone
GIT Gastrointestinal tract
GnRH Gonadotropin-releasing hormone
hMG Human menopausal gonadotrophin
HPA axis Hypothalamic-pituitary-adrenal axis
HPG Hypothalamic-pituitary-gonadal
HPO Hypothalamic-pituitary-ovarian
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LH Luteinising hormone
MSG Monosodium glutamate
NIDDM Non-insulin dependent diabetes mellitus
NIH National Institute of Health
OCP Oral contraceptive pills
OGTT Oral glucose tolerance test
OHS Ovarian Hyperstimulation Syndrome
PCO Polycystic ovaries
PCOS Polycystic Ovarian Syndrome
RANZCR Royal Australian and New Zealand College of Radiologists
RCOG Royal College of Obstetricians and Gynaecologists, United Kingdom
RCTs Randomised controlled trials
r-FSH Recombinant follicular stimulating hormone
RUQ Right upper quadrant
SD Standard deviation
SHBG Sex hormone-binding globulin
SMD Standardised mean difference
T2DM Type 2 diabetes mellitus
TCM Traditional Chinese Medicine
u-FSH Purified follicular stimulating hormone
VAS Visual Analogue Scale
WHO World Health Organisation

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Related Publications / Conference Proceedings generated from this Thesis:
Published in SCI Journals:
1. LIM DCE, Chen W, Cheng LNC, Xue CC, Wong FWS, O'Sullivan AJ, Liu JP. Acupuncture for
polycystic ovarian syndrome. Cochrane Database of Systematic Reviews 2011, Issue 8. Art. No.:
CD007689. DOI: 10.1002/14651858.CD007689.pub2
2. LIM CED, Xue C, Liu, J, Wong WSF, O’Sullivan A. Acupuncture and PCOS, Cochrane
Collaboration Systematic Review, Issue 2, 2009 (Protocol)
3. LIM, CED, WONG, F. Current evidence of Acupuncture on PCOS. Gynecological
Endocrinology. 2010, Vol. 26, (6): 473-478
4. LIM, CED. Liu, JP, Cheng, N. Traditional Chinese Medicine for Gynaecological Diseases.
Australian Traditional Medicine Society Journal. 2011:17(1): 17-20
5. Zhang J, Zhou L, Tang L, Wu T, Lim CED. Chinese Herbal Medicine for sub fertile women with
PCOS, Cochrane Collaboration Systematic Reviews 2010, Issue 9. Art. No.: CD007535. DOI:
10.1002/14651858.CD007535.pub2..
6. Zhu X, Proctor M, Lim CED. Cochrane review of Acupuncture for female subfertility. Cochrane
Collaboration Systematic Review (Protocol Stage)
7. YII MF, LIM, CED, WONG F. PCOS in Adolescence. Gynaecological Endocrinology. 2009
25(10): 634-639
8. LIM, CED, WONG, F – Evaluation of Clinical Efficacy of Acupuncture Treatment on the
Management of Polycystic Ovarian Syndrome: A Pilot Study. J Alt & Comp Med Jan 08 S: 54
9. LIM, CED, WONG, F, CHENG, L – Traditional Chinese Medicine and Female Infertility: A
Review of Literature. J Alt & Comp Med Jan 08 S: 55

Published in Conference Proceedings:

1. (Abstract No. 28) LIM, CED, WONG, Wu Shun Felix. A study of Mechanism of Acupuncture
on the treatment of Polycystic Ovarian Syndrome (PCOS), Australian Acupuncture & Chinese
Medicine Association Conference 2005, Melbourne 13-15 May, 2005
2. (Abstract No. 47) LIM, CED, WONG, Wu Shun Felix. A study of Mechanism of Acupuncture
on the treatment of Polycystic Ovarian Syndrome (PCOS), Harmonisation of Traditional and
Modern Medicine An international symposium, Melbourne, Australia 12 – 14 December 2005
3. LIM, D, WONG, Felix. Effect of Acupuncture and Traditional Chinese Herbal Medicine on the
Treatment of Female Infertility, World Congress on Chinese Medicine, Hong Kong 23-25 Nov,
2006
4. LIM, D. Acupuncture & PCOS: RCT. First International Asia Pacific PCOS Meeting. University
of Hong Kong, Hong Kong (17-18 Jan, 2009)
5. LIM, D. Insulin Resistance in Chinese women with PCOS. Guangdong Maternal & Child Health
Conference, Guangdong Maternal & Child Health Hospital, Guangzhou Medical University,
China (July 2008)
6. WONG, Felix. LIM, D. Acupuncture & PCOS. RANZCOG Scientific Meeting. New Zealand
2009
7. Lim, D. Acupuncture & PCOS: RCT. Inaugural Chinese Medicine Academic Conference.
Sydney Australia. 2011

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Published in Australian Doctors’ newsletter as featured article:
1. Lim, D. Acupuncture promising for infertility in PCOS. Chinese Medicine Clinical Research
Centre, Liverpool Hospital. Available: http://www.mydr.com.au/womens-health/acupuncture-
promising-for-infertility-in-pcos via the Internet. Accessed 2009 Apr 23

Pending to be submitted for publication from this thesis once the degree is awarded:

2. LIM, CED, WONG, WSF. et al Acupuncture & PCOS: A RCT.
3. LIM, CED, WONG, WSF. et al A pilot experience of using acupuncture in PCOS.
4. LIM, CED, WONG, WSF. et al PCOS: What does Chinese women worry about ?
5. LIM, CED, WONG, WSF, et al Standardisation of PCOS Diagnosis in Chinese Medicine – A
diagnostic tool study

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