| Background and ObjectiveEczema is inflammation of the superficial dermis and epidermis caused by a variety of internal and external factors.It is a common disease and frequently-occurring disease in clinical practice.According to the course of disease and clinical characteristics,it can be divided into acute,subacute and chronic eczema.Hand is one of the most common parts of eczema.Chronic hand eczema skin lesions are usually characterized by skin hypertrophy,mossy change,scaling,chapping,hyperkeratosis,etc.The course of the disease is prolonged and stubborn,which seriously affects the quality of life of patients.Chinese medicine bath is one of the external treatment of traditional Chinese medicine,widely used in clinical,eczema and other dermatological diseases,has a good clinical effect.With the increasing research of Chinese medicine bath therapy in the treatment of eczema,the publication of relevant clinical literature is also increasing.This study by adopting the method of literature metrology the modern clinical research of Chinese medicine medicated bath in treatment of eczema of literature system,based on data mining technology analysis of Chinese medicine medicated bath in treatment of eczema prescription medication rule,and a systematic review and meta analysis methods to analyze the curative effect of Chinese medicine medicated bath in treatment of chronic eczema,for dipping clinical application provides the basis of the evidence-based medicine for the treatment of eczema.At the same time,the randomized controlled trial was used to observe the efficacy and safety of Yangxue Runfu decoction immersion bath in the treatment of chronic hand eczema(blood deficiency and wind-dryness syndrome),providing an effective and safe treatment method for the treatment of hand eczema with Chinese medicine.MethodsPart Ⅰ:Literature study on the treatment of eczema with Chinese medicine bath1.Bibliometric study on the treatment of eczema with Chinese medicine bathDatabases of CNKI,VIP,Wanfang,SinoMed,PubMed and Cochrane Library were searched.The retrieval time is from the database construction to December 31,2021.Descriptive statistical analysis was performed on the general data,subjects,interventions,control types and outcome indicators of the included literature.2.Study on the medication rule of Chinese medicine bath in treating eczema based on data miningThe database of Chinese medicine bath for eczema was established through literature retrieval,Data mining technology was used to analyze the medication frequency and high frequency distribution of drug odor,perform cluster analysis and association rule analysis,and analyze the medication law.3.Systematic review and meta-analysis of randomized controlled trials of Chinese medicine bath therapy for chronic eczemaRandomized controlled trials of TCM bath treatment for chronic eczema were systematically searched from CNKI,VIP,Wanfang,SinoMed,PubMed and Cochrane Library databases.The retrieval period was from database construction to August 31,2021.Two researchers independently conducted literature screening,data extraction and literature quality evaluation as required,and meta-analysis was conducted by Revman5.3 software.Part Ⅱ:Randomized controlled trial of Yangxue Runfu Decoction bath combined with Qingpeng ointment in the treatment of chronic hand eczema(blood deficiency and wind-dryness syndrome)A randomized controlled trial was used to study 76 patien ts with chronic hand eczema,and they were randomly divided into treatment group and control group,38 cases in each group.They were treated with Yangxue Moisturizing formula immersion bath combined with Qingpeng ointment and external qingpeng ointment alone.The course of treatment was 4 weeks.The clinical efficacy and safety of Yangxue Runfu Decoction combined with Qingpeng ointment in the treatment of chronic hand eczema were evaluated by observing hand eczema severity Index(HECSI)score,visual analog scale(VAS)score and skin disease quality of life index(DLQI)score.ResultsPart Ⅰ:Literature study on the treatment of eczema with Chinese medicine bath1.459 literatures were included,including 4 systematic reviews,291 randomized controlled trial studies,22 non-randomized controlled trial studies,140 case series studies and 2 case reports studies.All the included literatures were Chinese literatures.In general,the number of all the included literatures was on the rise year by year.The number of RCTS increased greatly,reaching the maximum in 2013,and then decreased to a certain extent.In recent years,there is still a certain increase.The level of evidence is steadily rising.The distribution of published journals and first authors and units is relatively scattered.In terms of financial support,most of the funds are not reported,and provincial and ministerial level funds account for the largest proportion of literature support funds marked with fund information.In terms of sample size,there are few large samples and multi-center studies in the included literature.In terms of the types of control measures,the clinical studies included a wide range of control measures,and the number of studies choosing conventional therapy or other medicinal bath therapy as the control is relatively average.The included literatures basically adopted observed clinically related indicators as outcome indicators.A few studies reported safety indicators,quality of life and laboratory indicators,and a few studies reported patient satisfaction,while economic indicators were almost not used.2.Chinese medicine bath for eczema is mainly cold and warm in nature,bitter,bitter and sweet in taste,liver,kidney,large intestine,bladder and spleen in nature,and cooling and removing dampness,dispelling wind and relieving itching,cooling blood and detoxifying,nourishing blood and activating blood.The high frequency drugs were divided into 7 categories by high frequency drug cluster analysis,and the most supported drug association rules were Fructus Kochiae-Sophora,Fructus Cnidii-Sophora,Cortex Phellodendri-Sophora.3.A total of 11 literatures were included with a sample size of 837,including 427 in experimental group and 410 in control group.The overall methodological quality of the included studies was not high.Meta-analysis results showed that the total effective rate of medicated bath(no specific site was specified)+conventional treatment was significantly better than conventional treatment(RR=1.26,95%CI[1.09,1.45],P=0.002),and the total effective rate of hand and foot bath+conventional treatment was significantly better than conventional treatment(RR=1.47,95%CI[1.30,1.66],P<0.00001),the total effective rate of sitting bath+conventional treatment was significantly better than that of conventional treatment(RR=1.20,95%CI[1.04,1.38],P=0.01),the total effective rate of hand and foot bath alone was significantly better than that of conventional treatment(RR=1.28,95%CI[1.01,1.62],P=0.04).Chinese medicine bath was superior to conventional treatment in improving itching degree score of patients with chronic eczema(MD=-0.49.95%CI(-0.79,-0.20),P=0.001).The recurrence rate of chronic eczema treated by drug bath was significantly lower than that of the control group(P<0.05),and there was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Part Ⅱ:Randomized controlled trial of Yangxue Runfu Decoction bath combined with Qingpeng ointment in the treatment of chronic hand eczema(blood deficiency and wind-dryness syndrome)35 cases were actually completed in the treatment group,36 cases were actually completed in the control group,and 71 cases were finally included.There were no significant differences in the general situation(gender,age,course of disease),HECSI,VAS and DLQI scores before treatment between the treatment group and the control group(P>0.05),which are comparable.Comparison within groups:HECSI score,erythema,papule,chap,scale score,VAS score and DLQI score in the treatment group and the control group were significantly decreased after treatment compared with before treatment,the differences were statistically significant(P<0.05),but there was no statistically significant difference in area score after treatment compared with before treatment(P>0.05).Comparison between groups:HECSI score and VAS score in the treatment group were significantly lower than those in the control group after treatment,the differences were statistically significant(P<0.05);There was no statistically significant difference in the improvement of erythema and papules between the two groups;the treatment group was significantly better than the control group in the improvement of chap and scaly symptoms and skin lesion area,the difference was statistically significant(P<0.05),and there was no statistically significant difference in DLQI score between the two groups after treatment(P>0.05).The total effective rate of the treatment group was 88.6%,and that of the control group was 66.7%,the difference was statistically significant(P<0.05),the curative effect of the treatment group was significantly better than that of the control group.There were no obvious adverse reactions in both groups during the treatment.The recurrence rate of the treatment group was 9.68%.The recurrence rate of control group was 29.17%,and there was no significant difference(P>0.05).ConclusionsPart Ⅰ:Literature study on the treatment of eczema with Chinese medicine bath1.The number of clinical research literatures on the treatment of eczema with Chinese medicine bath showed an increasing trend,and the number of RCT was the largest,with a relatively large increase in the number,and the level of evidence was gradually improving.In future studies,multi-center,large-sample and high-quality clinical studies are still needed to improve the reliability of research results.In addition to clinically related indicators,attention should be paid to observe safety indicators,patient satisfaction and economic indicators,so as to better evaluate the efficacy,safety and cost-effectiveness of treatment.By improving the quality of research methodology and research design,we should strengthen the publication and dissemination in core journals with high influence in related fields,and strengthen the widespread application and promotion in the world.2.Chinese medicine bath is mainly used in the treatment of eczema with bitter cold and simmering temperature.It is mainly used to clear heat and remove dampness,dispel wind and relieve itching,cool blood and detoxify,nourish blood and promote blood circulation,etc.The correlation degree of sophora,Fructus Cnidii,Fructus kochiae and Cortex Phellodendri was higher.Data mining technology was used to summarize and analyze the law of using Chinese medicine bath to treat eczema,so as to better guide clinical application.3.The efficacy of Chinese medicine bath alone or Chinese medicine bath combined with other conventional therapies in the treatment of chronic eczema was superior to conventional treatment,and the total effective rate,pruritus score and recurrence rate were significantly superior to the control group.There was no significant difference in the incidence of adverse reactions between the experimental group and the control group,and no serious adverse reactions occurred.Further affirmed the curative effect of Chinese medicine bath in treating chronic eczema,worthy of clinical promotion.Due to the low quality and limitations of the included literature,more reliable evidence-based medical evidence remains to be provided by large samples and high-quality randomized controlled trials in the future to guide clinical practice better.Part Ⅱ:Randomized controlled trial of Yangxue Runfu Decoction bath combined with Qingpeng ointment in the treatment of chronic hand eczema(blood deficiency and wind-dryness syndrome)Yangxuemu decoction bath combined with Qingpeng ointment and qingpeng ointment alone can significantly relieve the skin lesions,itching symptoms and quality of life of patients with chronic hand eczema.The curative effect of Yangxuemifu decoction combined with Qingpeng ointment was significantly better than that of qingpeng ointment alone,especially in improving the symptoms of chapping,scaling,pruritus and skin lesion area,and in improving the erythema,papules and patients’ quality of life,the two groups had the same curative effect.Yangxue Runfu decoction bath combined with Qingpeng ointment in the treatment of chronic hand eczema has significant clinical efficacy,high safety and low recurrence rate,which is worthy of clinical application. |
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