Integrated traditional and Western medicine for treatment of depression based on syndrome differentiation: a meta-analysis of randomized controlled trials based on the Hamilton depression scale

Objective

To systematically review the benefits of integrated traditional and Western medicine therapies based on the Hamilton depression scale (HAMD) following syndrome differentiation of depression.

Methods

We searched six English and Chinese electronic databases for randomized clinical trials (RCTs) on integrated traditional and Western medicine for treatment of depression. Two authors extracted data and independently assessed the trial quality. RevMan 5 software was used for data analyses with an effect estimate presented as weighted mean difference (WMD) with a 95% confidence interval (CI).

Results

Seven RCTs with 576 participants were identified for this review. All trials were eligible for the meta-analysis and were evaluated as unclear or having a risk of bias. Meta-analysis showed, compared with Western medicine alone, integrated traditional and Western medicine based on syndrome differentiation could improve the effect of treatment represented by the HAMD [WMD=−2.39, CI (−2.96,−1.83), Z=8.29, P<0.00001]. There were no reported serious adverse effects that were related to integrated traditional and Western medicine based therapies in these trials.

Conclusions

Integrated traditional and Western medicine based therapies for the syndrome differentiation of depression significantly improved the HAMD, illustrating that combining therapies from integrated traditional and Western medicine for treatment of depression is better than Western medicine alone. However, further large, rigorously designed trials are warranted due to the insufficient methodological rigor seen in the trials included in this study.     

Medium- and long-term efficacy of ligustrazine plus conventional medication on ischemic stroke: a systematic review and meta-analysis

Objective

To evaluate the medium- to long-term efficacy of ligustrazine plus conventional medicine treating ischemic stroke.

Methods

Randomized controlled trials (RCTs) testing ligustrazine in the treatment of acute ischemic stroke were retrieved from Cochrane Library, PubMed, Excerpta Medica Database, Chinese Medical Journal Database, Chinese Biomedical Database, China National Knowledge Infrastructure Database, and Chinese Clinical Trial Register, and then identified by the inclusive and exclusive criteria. The quality of trials was assessed with the Cochrane Handbook 5.1, a risk of bias assessment tool. RevMan 5.1 was used for meta-analysis.

Results

Three RCTs involving 643 patients were included. Compared to conventional medicine treatment alone, ligustrazine plus conventional medicine treatment showed significant difference in reduction of stroke recurrence either at the end of 1-year follow-up [RR=0.42, 95% CI (0.18, 0.94), P< 0.05] or 3-years observation [RR=0.48, 95% CI (0.27, 0.83), P<0.05]. The ligustrazine group also showed higher survival rate [RR=1.67, 95% CI (1.02, 0.2.71), P<0.05] and significantly better effective rate [RR=1.28, 95% CI (1.10, 1.50), P<0.05] than that of the control group at the end of 1 year visit. Only one trial conducted safety assessment and no adverse events were reported. The methodological quality of all the trials included was generally poor.

Conclusion

The findings provided evidence that the combination of ligustrazine and conventional medication was medium- and long-term beneficial to the patients suffering ischemic stroke. But more RCTs of high quality are needed to further prove the efficacy and safety of using ligustrazine for ischemic stroke.     

Meta-analysis of the clinical effectiveness of traditional Chinese medicine formula Chaihu-Shugan-San in depression

Aim of study

Depression is a psychiatric disorder. Chaihu-Shugan-San (CSS) is a traditional Chinese medicine formula suggested in the treatment of depression, but its effectiveness and safety are not well defined. This meta-analysis aimed to assess the effectiveness and safety of CSS in depression therapy.

Materials and methods

The databases including MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, CNKI database, Wanfang Data and VIP Information were searched. Papers were reviewed systematically by two researchers and were analyzed using Cochrane software Revman 5.0.

Results

Ten randomized controlled trials comparing 835 subjects were included. Of these studies, seven studies used fluoxetine (20 mg, once a day), two used paroxetine (20 mg, once a day) and one used doxepin (25 mg, two times a day) as the antidepressant drugs. Meta-analyses revealed that CSS in combination with antidepressant drugs treatment significantly improved depressive symptoms (WMD = −3.56; 95% CI −5.09 to −2.03) and significantly increased effective rate (OR = 3.31; 95% CI 1.80–6.10) and recovery rate (OR = 2.32; 95% CI 1.61–3.34) compared with antidepressant drugs therapy. In addition, the efficacy of CSS as monotherapy was significantly better than antidepressants in improving depressive symptoms (WMD = −3.09; 95% CI −5.13 to −1.06) and in creasing effective rate (OR = 2.61; 95% CI 1.23–5.53). CSS was comparable to antidepressants in increasing recovery rate (OR = 1.83; 95% CI 0.84–3.98). No serious adverse events were reported in any of the included trials.

Conclusion

The present work supported that CSS was effective and safe in treating depressed patients. More full-scale randomized clinical trials with reliable designs are recommended to further evaluate the clinical benefit and long-term effectiveness of CSS for the treatment of depression.     

Clinical trials of traditional Chinese medicine in the treatment of diabetic nephropathy—A systematic review based on a subgroup analysis

Ethnopharmacological relevance

The purpose of this study is to systematically evaluate the efficacy of traditional Chinese medicine (TCM) decoctions with different ingredients in the treatment of diabetic nephropathy (DN).

Materials and methods

Papers obtained after the retrieval of randomized controlled clinical trials (RCTs) of TCM treatments of diabetic nephropathy through online database (e.g. Medline, CBM, CNKI, VIP, the online database of Chinese medicine, CDFD, CMFD, and CENTRAL FROM Cochrane Library, etc.) as well as research data in our library. They were published between January 2001 and December 2012. According to the categories of the main TCM ingredients, all the cases in the literature were divided into a liver–kidney YIN deficiency group, a QI-BLOOD YIN-and-YANG deficiency group, and a spleen–kidney YANG deficiency group. Stata 11.0 was applied for subgroup analysis.

Results

A total of 21 Chinese RCTs were included in this review. The Q values of the three groups were 13.18, 0.25 and 3.27, respectively, P>0.05, and thus, there was no clinical heterogeneity. The combined relative risk (RR) value and its 95% confidence interval were 1.48 (1.37, 1.60), 1.19 (1.06, 1.34), and 1.33 (1.19, 1.50), respectively, P<0.05.

Conclusions

Compared with the qi-blood yin-and-yang deficiency group and the spleen–kidney yang deficiency group, the liver–kidney yin deficiency group has better prospects in clinical application to ensure renal function during the treatment of DN, and this possibility is worthy of further study.     

Efficacy and safety of Traditional Chinese Medicine for the treatment of acquired immunodeficiency syndrome: a systematic review

Objective

To systematically review the efficacy and safety of Traditional Chinese Medicine (TCM) interventions, compared with control interventions (placebo or conventional Western medical therapy), in the treatment of acquired immunodeficiency syndrome (AIDS).

Methods

Electronic databases including PubMed, the Cochrane Library, China National Knowledge Infrastructure (CNKI), and Wanfang Data were searched to identify relevant randomized controlled trials (RCTs) published as of May 2012. Studies were selected according to the specified inclusion and exclusion criteria and then subjected to methodological quality assessment, data extraction, and meta-analysis according to the Cochrane Handbook for Systematic Reviews of Interventions.

Results

Twelve RCTs involving 881 patients with AIDS were included. Methodological quality assessment showed that two were high-quality, two were moderate-quality, and eight were low-quality. Meta-analysis showed that TCM interventions were associated with significantly reduced plasma viral load compared with placebo [odds ratio OR=2.46, 95% confidence interval CI (1.02, 5.94); P=0.04]. However, the reductions in plasma viral load significantly favored conventional Western medical therapy alone over integrated traditional Chinese and Western medical therapy [OR=0.16, 95% CI (0.05, 0.55); P=0.004]. Patients receiving TCM interventions had significantly higher CD4 + T lymphocyte counts compared with those on placebo [OR=2.54, 95% CI (1.40, 4.60); P=0.002]. In addition, TCM interventions were significantly more likely to have improved clinical symptoms [OR=2.82, 95% CI (1.85, 4.31); P < 0.00001]. TCM interventions conferred a similar risk of adverse events (AEs) compared with control interventions [OR=1.87, 95% CI (0.58, 6.01); P=0.29].

Conclusion

Current evidence suggests that TCM interventions are significantly more effective than placebo in reducing plasma viral load and increasing CD4+ T lymphocyte count in patients with AIDS. When compared with conventional Western medical therapy, TCM interventions were significantly less effective in reducing plasma viral load, although they were associated with a higher percentage of patients with improved symptoms. Patients receiving TCM interventions did not seem to be at an increased risk of AEs.     

Meta-analysis of Traditional Chinese Medicine in treating functional dyspepsia of liver-stomach disharmony syndrome

Objective

To systematically assess the clinical effectiveness of traditional Chinese medicine (TCM) in the treatment of functional dyspepsia (FD) of liver-stomach disharmony syndrome by meta-analysis.

Methods

Random controlled trials (RCTs) were retrieved from databases, including Pubmed, China national knowledge infrastructure, Wanfang Data, VIP Information, and the Cochrane Library. Trials were selected according to inclusion criteria. The effects of traditional Chinese medicine (TCM) versus prokinetic agents in the treatment of functional dyspepsia (FD) of liver-stomach disharmony syndrome were compared by meta-analysis. RevMan 5.0.24 was used for data analysis. The effective rate was assessed by odds ratios (ORs), and 95% confidence intervals (Cls) were calculated. The cure rate was analyzed by the Peto OR. Simple statistical analysis was chosen to assess the frequency of prescribed Chinese herbs in treating this syndrome.

Results

Thirteen trials were included, involving 1153 patients, and these were of poor methodological quality. Twelve studies mentioned the effective rate and cure rate. TCM therapy showed a better clinical effect rate compared with that with prokinetic agents [OR: 3.2, 95% CI (2.27, 4.51)]. The TCM group also had a better cure rate than that in the group of prokinetic agents [Peto OR: 2.26, 95% CI (1.61, 3.18)]. With regard to the frequency of Chinese herbs used in these 13 trials, Baishao (Radix Paeoniae), Chaihu (Radix Bupleuri), and Gancao (Radix Glycyrrhizae) were mostly prescribed, followed by Xiangfu (Rhizoma Cyperi), Zhishi (Fructus Aurantii Immaturus), Zhiqiao (Fructus Aurantii), Foshou (Citrus medica var.sarcodactylis), and Chenpi (Pericarpium Citri Reticulatae). No serious adverse effects were reported.

Conclusion

TCM therapy shows a superior effective rate and cure rate compared with those in prokinetic agents in the treatment of FD of liver-stomach disharmony syndrome. However, further strictly designed RCTs are required because of the poor quality of included trials.     

Safety and efficacy of Danqipiantan capsule for treatment of stroke: a systematic review

Objective

To evaluate the efficacy and safety of Danqipiantan capsule (DPC) for the treatment of stroke.

Methods

PubMed, China Science And Technology Journal Database, Wanfang Database, Chinese periodicals in the China National Knowledge Infrastructure, and the General Hospital of Tianjin Medical University's Library were searched until July 2012. Randomized controlled trials (RCTs) and observational studies that reported the use of DPC for treatment of stroke were selected.

Results

Eleven articles that included 12 RCTs, and 2 articles that included 3 observational studies were identified. A total of 2590 patients participated in the studies. We found that there was a significant statistical difference between DPC treatment groups and the control groups in terms of the effective rate [risk ratio (RR), 1.14; 95% confidence intervals (CI), 1.04, 1.25; P=0.01], Fugl-Meyer Assessment Scale [weighted mean difference (WMD), 9.77; 95% CI (4.84, 14.70); P=0.00], Barthel Index [WMD=6.40; 95% CI (3.15, 9.65)], and mean flow velocity [WMD= 5.79; 95% CI (1.64, 9.94)]. There were no significant differences for The National Institutes of Health Stroke Scale [WMD=0.60; 95% CI (− 1.09, 2.29)], visual field defects [left visual field: WMD= − 203.10; 95% CI (− 424.41, 18.21); right visual field: WMD= − 172.60; 95% CI (− 409.29, 64.09)] or the functional independence measure [WMD= − 7.90; 95% CI (− 16.64, 0.84)]. Seven articles that included eight RCTs reported the safety of DPC treatment. Two articles that included three observational studies also reported beneficial effects for DPC. Because the Chinese studies were of poor methodological quality, and most of the sample sizes were small, our analysis was likely affected by bias.

Conclusion

DPC has a beneficial effect and is relatively safe when used for the treatment of stroke.     

Effect of point application on chronic obstructive pulmonary disease in stationary phase and effects on pulmonary function: A systematic evaluation of randomized controlled trials

Objective

To evaluate clinical efficacy of point application or adjuvant therapy on chronic obstructive pulmonary disease in stationary phase and effects on pulmonary functions.

Methods

Computer retrieved CNKI, VIP, CBM and other databanks and manual operations retrieved correlative literatures to find randomized controlled trials (RCTs) about comparison between point application or adjuvant therapy and no-point-applications for treatment of chronic obstructive pulmonary disease in stationary phase in China. RevMan 5.0 software was used for Meta analysis.

Results

Among 3481 cases in the inclusive 32 RCTS, 1780 cases were in the test group and 1701 cases in the control group. Meta analysis indicated: 1) clinical efficacy: the groups containing point application therapy all were better than the groups of no-point-application; 2) force vital capacity (FVC): There was no statistically significant difference between the group of point application plus Western Medicine and the Western Medicine group; 3) force expiratory volume 1 (FEV1): The groups containing point application therapy were better than the no-point-application; 4) FEV1%: the groups of point application plus Western Medicine were better than the Western Medicine groups; 5) FEV1/FVC: there was a significant difference between the group of point application plus Chinese drugs and the group of Chinese drug.

Conclusion

Point application can increase clinical efficacy of chronic obstructive pulmonary disease in stationary phase in varying degrees, and different combinations of point application with Chinese drugs or Western Medicines have incomplete same actions in improvement of pulmonary function and therapeutic effect.     

Acupuncture therapy for angina pectoris: a systematic review

Objective

To assess the effectiveness and safety of acupuncture therapy for angina pectoris.

Methods

Randomized controlled trials (RCTs) concerned with acupuncture treatment of angina pectoris were identified by searching Academic Source Premier, MEDLINE, Science Citation Index Expanded, and three Chinese databases (China biology medicine database, China national knowledge infrastructure, and VIP database for Chinese technical periodicals). The valid data were extracted in accordance with our inclusion and exclusion criteria. The main outcomes of the included studies were synthesized using Revman 5.1.

Results

Twenty-one articles on 16 individual studies were included and evaluated as having high or moderate risk of bias according to the standards of the Cochrane Collaboration. Meta-analysis indicated that acupuncture combined with conventional drugs (ACCD) was superior to conventional drugs alone in reducing the incidence of acute myocardial infarction (AMI) [OR=0.18, 95% CI (0.04, 0.84), P=0.03]. Moreover, ACCD was superior to conventional drugs in the relief of angina symptoms [OR=4.23, 95% CI (2.73, 6.56), P<0.00001], and improvement of electrocardiography (ECG) [OR=2.61, 95% CI (1.83, 3.73), P<0.00001]. Acupuncture by itself was also superior to conventional drugs for angina symptoms [OR=3.59, 95%C/(1.76, 7.92), P=0.0004] and ECG improvement [OR=3.07, 95%CI (1.54, 6.10), P=0.001]. ACCD was superior to conventional drugs in shortening the time to onset of angina relief [WMD=−1.40, 95% CI (−1.65, −1.15), P< 0.00001]. However, the time to onset was significantly longer for acupuncture treatment than for conventional treatment alone [WMD=2.43, 95% CI (1.63, 3.23), P<0.000 01].

Conclusion

ACCD reduced the occurrence of AMI, and both acupuncture and ACCD relieved angina symptoms and improved ECG. However, compared with conventional treatment, acupuncture showed a longer delay before its onset of action. This indicates that acupuncture is not suitable for emergency treatment of heart attack. Owing to the poor quality of the current evidence, the findings of this systematic review need to be verified by more RCTs to enhance statistical power.     

The traditional Chinese medicine prescription patterns of Sjögren׳s patients in Taiwan: A population-based study

Ethnopharmacological relevance

Traditional Chinese medicines (TCM), when given for symptom relief, have gained widespread popularity among Sjögren?s patients. The aim of this study was to analyze the utilization of TCM among Sjögren?s patients in Taiwan.

Materials and methods

The usage, frequency of service, and the Chinese herbal products prescribed among Sjögren?s patients were evaluated in a cohort of 1,000,000 beneficiaries recruited from the National Health Insurance Research Database. The logistic regression method was employed to estimate the odds ratios (ORs) for utilization of a TCM.

Results

More than 90% of Sjögren?s patients received TCM out-patient services at least once during the study period. Patients with secondary Sjögren?s syndrome were more likely to seek TCM treatment than those with primary Sjögren?s syndrome. The aOR for those suffering from at least one rheumatologic disease was 1.56 (95% CI: 1.26–1.93), those with two rheumatologic diseases was 1.98 (95% CI: 1.29–3.04), while those with three or more rheumatologic diseases was 7.86 (95% CI: 1.09–56.58). Compared to Sjögren?s patients who used no medical treatment, the aOR for those who took one type of conventional medication was 1.55 (95% CI: 1.25–1.92), those who took two types was 1.98 (95% CI: 1.60–2.47) while those who took three or more types was 2.91 (95% CI: 2.20–3.84). Qi-Ju-Di-Huang-Wan (Lycium Berry, Chrysanthemum, and Rehmannia Pill) was the most frequently prescribed formula among Sjögren?s patients.

Conclusion

Qi-Ju-Di-Huang-Wan is the most commonly prescribed Chinese herbal formula for Sjögren?s syndrome and its effects should be taken into account by healthcare providers.     

Comparison of effectiveness and safety between granules and decoction of Chinese herbal medicine: a systematic review of randomized clinical trials

Background

The clinical use of Chinese herbal medicine granules is gradually increasing. However, there is still no systematic review comparing the effectiveness and safety of granules with the more traditional method of herbal decoctions.

Method

A literature search was conducted using China National Knowledge Infrastructure Databases (CNKI), Chinese Science and Technology Periodical Database (VIP), China Biomedical Database web (CBM), Wanfang Database, PubMed, and the Cochrane Library until March 10, 2011. Clinical controlled trials (CCTs) including randomized trials (RCTs) comparing the effectiveness and safety between Chinese herbal medicine granules and decoction were included. Two authors conducted the literature searches, and extracted data independently. The assessment of methodological quality of RCTs was based on the risk of bias from the Cochrane Handbook, and the main outcome data of trials were analyzed by using RevMan 5.0 software. Risk ratio (RR) or mean difference (MD) with a 95% confidence interval (CI) were used as effect measure.

Results

56 clinical trials (n = 9748) including 42 RCTs and 14 CCTs were included, and all trials were conducted in China and published in Chinese literature. 40 types of diseases and 15 syndromes of traditional Chinese medicine (TCM) were reported. Granules were provided by pharmaceutical companies in 13 trials. The included RCTs were of generally low methodological quality: 7 trials reported adequate randomization methods, and 2 of these reported allocation concealment. 10 trials used blinding, of which 5 trials used placebo which were delivered double blind (blinded participants and practitioners). 98.2% (55/56) of studies showed that there was no significant statistical difference between granules and decoctions of Chinese herbal medicine for their effectiveness. No severe adverse effects in either group were reported.

Conclusions

Due to the poor methodological quality of most of the included trials, it is not possible to reach a definitive conclusion whether both Chinese herbal medicine granules and decoctions have the same degree of effectiveness and safety in clinical practice, but this preliminary evidence supports the continued use of granules in clinical practice and research. Standardization of granules and further more rigorous pharmacological, toxicological and clinical studies are needed to demonstrate the equivalence with decoctions.     

Clinical curative effect of electroacupuncture combined with Zhizhukuanzhong Capsules for treating gastroesophageal reflux disease

Objective

To study the clinical curative effect, safety and mechanism of action of electroacupuncture combined with Zhizhukuanzhong capsules (ZZKZC) in treating gastroesophageal reflux disease (GERD).

Methods

A total of 480 patients with confirmed GERD were randomly divided into four groups: the electroacupuncture group, the ZZKZC group, the combined therapy group, and the control group, with 120 cases in each group. Each case in the electroacupuncture group was treated with electroacupuncture on Zusanli (ST 36), Zhongwan (CV 12), Neiguan (PC 6), Taichong (LR 3) and Gongsun (SP 4) once daily for 6 weeks. Each case in the ZZKZC group was treated with oral administration of 1.29 g ZZKZC three times daily. The combined therapy group had electroacupuncture and ZZKZC. The control group was given oral administration of 5 mg mosapride three times and 20 mg pantoprazole twice daily. The 24-hour intraesophageal total number of reflux episodes with pH <4 (or bilirubin absorbance ≥ 0.14), the number of long-term (≥5 min) reflux episodes, the percentage of upright time, the percentage of supine time, the percentage of total time of pH <4 (or bilirubin absorbance ≥0.14), endoscopic grading score, symptom score, quality of life score, and adverse reactions were observed before treatment, at the end of treatment and 54 weeks after treatment in the four groups.

Results

The 24-hour intraesophageal pH and bile reflux, endoscopic grading score and symptom score were all significantly decreased at the end of treatment in every group, while the scores of 8 dimensions of quality of life were all increased compared with those before treatment (P<0.01). All of these indices were better in the combined therapy group than those in the other groups (P<0.05). These indices did not significantly deteriorate in the combined therapy group and electroacupuncture group 54 weeks after treatment compared with the end of treatment (P>0.05); however, these indices all significantly deteriorated in the ZZKZC and control groups (P>0.05). The short and long-term total efficacy rates in the combined therapy group showed significant superiority to those in the other groups (P<0.05 or P<0.01). No serious adverse reactions were found in the four groups.

Conclusion

Electroacupuncture and ZZKZC play an important role in inhibiting intraesophageal acid and bile reflux, decreasing the endoscopic grading score, and alleviating the symptoms of gastroesophageal reflux to improve the quality of life. However, the effect of combined treatment is more effective, with better security and long-term efficacy, and therefore, this combination treatment is appropriate for clinical use.     

质子泵抑制剂联用西沙必利在治疗难治性支气管哮喘并胃食管反流病中的作用

目的　观察质子泵抑制剂联用西沙必利对难治性支气管哮喘并胃食管反流病的治疗作用。方法　采用随机、双盲、安慰剂对照方法,将87例难治性支气管哮喘并胃食管反流病患者分为治疗组(45例)和对照组(42例) ,治疗组在常规抗哮喘药物治疗的同时加服奥美拉唑和西沙必利,对照组加服安慰剂。记录患者的哮喘评分、胃食管反流症状持续时间,按需吸入二丙酸倍氯米松的剂量,按需吸入β2 受体激动剂的次数和测定患者的1s用力呼气容积占预计值百分比(FEV1 占预计值%) ,最大呼气容量百分比(PEF %)及PEF变异率的变化。结果　治疗后2组每天哮喘症状计分、胃食管反流症状持续时间比较有显著性差异(P <0 .0 1 ) ;治疗组按需吸入二丙酸倍氯米松的平均剂量显著减少(P <0 .0 1 ) ;按需吸入β2 受体激动剂的平均次数显著减少(P <0 .0 1 ) ;治疗后FEV1 占预计值%、PEF %及PEF变异率改善更明显(P <0 .0 1 )。结论　难治性支气管哮喘并胃食管反流病时,在抗哮喘药物进行治疗的基础上加用抗胃食管反流治疗,对难治性哮喘有明确的治疗作用。     

小陷胸汤及其加减方治疗胃食管反流疾病临床随机对照试验的系统评价

目的:系统评价国内小陷胸汤及其加减方治疗胃食管反流疾病的疗效,为其方治疗该病的推广应用提供理论依据。方法:搜集小陷胸汤及其加减方治疗临床随机对照试验文献,选择合格研究,应用Jadad评分法进行质量评价,运用异质性检验、Meta-分析、漏斗图分析等方法统计数据。结果:检索到符合纳入标准的临床对照试验文献11篇。Jadad评分普遍不高。纳入10项研究中:总有效率OR合并=3.58,其95%CI为(2.49,5.14)。可认为小陷胸汤及其加减方治疗胃食管反流疾病相对对照组而言有效。纳入4项研究中:一年复发率RR合并=0.36,其95%CI为(0.18,0.72)。可认为小陷胸汤及其加减方降低胃食管反流疾病一年复发率方面相对对照组而言更有效。总有效率纳入研究的漏斗图分析结果良好。结论:小陷胸汤及其加减方治疗胃食管反流疾病在总有效率方面相对对照组而言有效,特别是对比雷尼\法莫替丁、吗丁啉,无效研究对照组均含有奥美拉唑,在降低胃食管反流疾病一年复发率方面相对对照组而言更有效。加大该方比照雷尼/法莫替丁、吗丁啉的疗效研究,同时完善有效率指标、不良反应等的报道,重视对复发率的跟踪报道。     

Curative effect of heat-sensitive moxibustion on chronic persistent asthma: a multicenter randomized controlled trial

Objective

To compare the curative effects of heat-sensitive moxibustion with conventional drugs on chronic persistent asthma and seek a valuable therapy to replace Western Medicine.

Methods

The participants in this multi-center, randomized, and controlled study were randomly divided into two groups: group A (n=144), treated with heat-sensitive moxibustion (50 sessions) and group B (n=144), treated with Seretide (salmeterol 50 µg/fluticasone 250 µg, twice a day). The scores of asthma control test (ACT), forced expiratory volume in 1 second (FEV1), peak expiratory flow (PEF), and attack frequency were measured after 15, 30, 60, and 90 days of treatment. Patients followed up 3 and 6 months after treatment.

Results

There was a significant difference (P= 0.0002) in the ACT score and lung function between the two groups after 3 months of treatment and (P=0.000 03) during the follow-up visits. In addition, heat-sensitive moxibustion reduced attack frequency in the period from inclusion to the 6-month follow-up visit.

Conclusion

This study shows that heat-sensitive moxibustion may have a comparable curative effect to Seretide(salmeterol/fluticasone) on asthma.     

A meta-analysis of the efficacy and safety of traditional Chinese medicine formula Ganmai Dazao decoction for depression

Ethnopharmacological relevance

Ganmai Dazao (GMDZ) decoction is a traditional Chinese herbal formula commonly used for the treatment of depression. The objective of this study was to assess the efficacy and safety of GMDZ, either alone or as co-therapy, for depression.

Materials and methods

We systematically searched key databases (9 Chinese and 7 English) up until May 2013 for randomized controlled trials (RCTs). The primary outcomes were effective rate and self-rated or clinician-rated severity of depression. The secondary outcome was the occurrence of adverse events. Methodological quality of the RCTs was assessed by the Cochrane?s risk of bias assessment.

Results

Ten RCTs were included. All were written in Chinese and the methodological quality was generally low. Pooled analysis of 5 studies which compared GMDZ with antidepressants showed that GMDZ was significantly more efficacious than antidepressants in effective rate (risk ratio: 1.14, 95% CI: 1.02 to 1.27, P=0.02, I²=0%), but comparable in Hamilton Depression Rating Scale (HDRS) score (mean difference: −2.10, 95% CI: −4.62 to −0.41, P=0.10, I²=92%). With regard to the other 5 studies which compared GMDZ plus antidepressants with antidepressants alone, there was no significant difference in effective rate (risk ratio: 1.24, 95% CI: 0.99 to 1.55, P=0.07, I²=93%), but the end-point HDRS score was significantly lower in GMDZ antidepressants combination (mean difference: −4.25, 95% CI: −6.50 to −2.00, P=0.0002, I²=96%). Adverse events were more common with antidepressants than GMDZ (rate ratio: 0.52, 95% CI: 0.32 to 0.82, P=0.005, I²=37%) and in antidepressants alone compared to GMDZ antidepressants combination (rate ratio: 0.23, 95% CI: 0.08 to 0.68, P=0.08, I²=0%).

Conclusion

The overall results suggest that GMDZ has few side effects and the potential as an antidepressant. Adding GMDZ to antidepressants reduces side effects and enhances efficacy of antidepressants. However, due to the small number of studies and their limitations, further studies with better methodological quality and more comprehensive safety assessment are needed to determine the benefits and risks of GMDZ in the treatment of depression.     

益气活血法治疗稳定型心绞痛临床疗效的Meta分析

目的:对运用中医益气活血为原则治疗稳定型心绞痛的临床疗效进行系统评价,为中医药治疗稳定型心绞痛提供循证医学依据.方法:检索国家知识基础设施数据库(CNKI);中国学术期刊数据库(CSPD);中文科技期刊数据库(CCD),中文生物医学文献数据库(CBM),纳入以益气活血为治疗原则,观察组采用中西结合、以中医为主的治疗,对...     

潜镇化痰通络法治疗原发性癫痫的系统综述和荟萃分析

目的：综合评价中西医结合治疗原发性癫痫的临床效果。方法：检索中英文学术期刊数据库发表的关于中西医结合治疗原发性癫痫文献,并采用系统评价和meta分析方法进行分析。结果：本研究最终纳入临床研究11项共951例原发性癫痫患者。meta分析结果显示,中西医结合治疗组癫痫的临床效果总有效率（合并RR=1.18,95% CI：1.07-1.29,P < 0.01）、发病频次（合并WMD = -0.98,95% CI：1.56-0.40,P < 0.01）、心电图改善率（合并RR=1.28,95% CI：1.11-1.47,P < 0.01）均显著优于单纯西医治疗（对照组）。结论：基于潜镇通络法的中西医结合治疗原发性癫痫效果显著优于单纯西药治疗。