DISCUSSION
A perimenopausal syndrome is a common female disease typified by neurasthenia and neuropsychological symptoms, mainly caused by an alteration in the hormone levels around menopause11. According to traditional Chinese medicine, PPS falls into the category of hysteria and perimenopausal disorder. The leading causes include deficiency of kidney qi, stagnation of liver qi, internal disturbance of seven emotions, and stress, injuring qi and blood. There are many therapeutic approaches to handling PPS. According to research, standard acupuncture and electro-acupuncture can relieve the symptoms of menopause12. According to Zhuang medicine, ”heiq” (qi) and ”lwed ” (blood) play an essential role in female growth and development. When women are in perimenopause, it means the degeneration of their physical quality and body function. The decline in ”heiq” (qi) and ”lwed” (blood) will cause the disorder of qi and blood and finally lead to PPS. As a traditional external therapy, ZMTM can regulate qi and blood through acupoints to balance qi and blood, relieve symptoms, improve body health, and finally show good therapeutic efficacy9. Essential therapy tools include medicated thread made from many Zhuang herbs, e.g., Santalum album, musk, frankincense, and Argyreia acuta . It has a delicate smell and can achieve good therapeutic effects13. Qizhousi acupoints, Beiba acupoints, and other selected acupoints are characteristic acupoints in Zhuang medicine, mainly treating various gynecological diseases.
Perimenopausal syndrome correlates with changes in sex hormones. Therefore, the difference in sex hormones should be given close attention during treatment by the treating physicians. Furthermore, the physicians should examine the levels of luteinizing hormone (L.H.), stimulating follicle hormone (FSH), estradiol (E2), and other hormones to assist in the diagnosis and treatment of PPS14. This study indicates that rat estrogen levels decreased after perimenopause model induction and improved after ZMTM treatment. This effect of ZMTM was significant right from the 1st to the 6th cycle. However, its influence became notable from the 3rd cycle and was most meaningful and useful between the 5th and 6th cycles. E2 levels in the ZMTM group were significantly higher (p < 0.05) than the acupuncture group and model group, although slightly lower than the standard group.