Traditional Chinese Medicine (TCM) Or Combined Traditional Chinese And Western Medicine Treated The Psoriasis: A Systematic Review Of Randomized Controlled Trials Or Controlled Clinical Trials

[background]It has a long history for the Traditional Chinese Medicine (TCM) to treat the psoriasis and accumulates a great deal of clinical experience. With the combination of several herbs, it has positive curative effect, low side effect, yet the curative period is long. Combing traditional Chinese and western medicine can shorten the curative period and alleviate the side effect which has been invoked by the pure western medicine. It improves the curative efficiency and outweighs the shortcomings taken by the west medicine. Yet the TCM Science has not emphasized so much on the research method, the research method and evaluation measure are not standard, all that has brought doubt on the result and repetition of the results and the results are not admitted by the foreign medical scientists which has blocked the TCM to be popular in the world. However, the results and the methods of the Evidence-based Medicine (EBM) and Systematic Review(SR) are accepted and highly praised by more and more professional and medical decision_makers, especially the Meta Data have been recognized step by step in the world, which may greatly improve the TCM to enter a more prosperous history.[objective]to know the literature situation on the psoriasis treated by TCM and Combined Traditional Chinese and Western Medicine, to evaluate the validity and security systemically of the psoriasis treated by TCM or Combined Traditional Chinese and Western Medicine.[method]1.The object of studyto collect the clinical reference study literature published or unpublished from 1978-11.2004. Literature colletion:(1).Chinese Biology Medical disc(CBMdisc); (2). Traditional Chinese Medicine (TCMLRS);(3). Chinese science and technology periodical disc of national southwest central committee ;(4). . we contact the author or organization in order to get the literature of unpublished (gray literature); (5). in order not to omit some important data, we search the following journals: Chinese Journal of Dermatology, Journal of Clinical Dermatology, Journal of Traditional Chinese Medicine, Chinese Journal of Leprosy and Skin Diseases, Modern Traditional Chinese Medicine, Chinese Journal of information on traditional Chinese medicine, Journal of Beijing University of Traditional Chinese Medicine, New Journal Of Traditional Chinese Medicine, Acta Universitatis Traditions Medicalis Sinensis Pharmacologiaeque Shanghai, Journal of Sichuan Traditional Chinese Medicine.2. The contents and methods of study2.1 The evaluation of Controlled Clinical Trial literatural designal quality on the psoriasis treated by TCM or Combined Traditional Chinese and Western Medicine. 2.1.1 The inclusion criteria of literature include(1)the raw data published or unpublished. (2) the content concerning on the treatment of the psoriasis. (3) the analytical data is complete, it has one control group at least. (4) the study contained adequate samples and was statistically analyzed. 2.1. 2 The methods of studyAccording to the clinical epidemiology/DME"s principle and methods, we designed the unitive systematic review table of the treatment on psoriasis by TCM and Combined Traditional Chinese and Western Medicine. On the basis of the inclusion criteria or exclusion criteria, reference situation, sample size, the group balance, the use of the control drugs, random situation, blind method, the method of the statistics, standardization of the control factors, curative judgment index, the analysis of the drop out or lost, the record or analysis of the side effect, the rationality of the conclusion, we compute the percentage of all kinds of situation and do a evaluation; 2. 2 The Meta_Analysis on the psoriasis treated by TCM and Combined TraditionalChinese and Western Medicine2.2.1 The inclusion criteria of literature include:(1) the major treated measure is Randomized Controlled Trial or Controlled Clinical Trial by TCM and Combined Traditional Chinese and Western Medicine; (2) the first diagnosis is psoriasis(there is correlative diagnostical criteria);(3) the inclusion case is inpatient or outpatient; (4) there is commonly or valid pertinence therapy as comparison; (5) there are preferably equilibrium and compare among groups ;(6) there is normative critical index of curative effect.2.2.2 The methods of studywith the Revman 4.2.5 software, we do the meta analysis, sensibility of the different design, sensibility analysis between the random factor and fix factor model, then we draw the funnelplot and analyze the bias on the publication, [results]1. The evaluation of Controlled Clinical Trial literatural designal quality on the psoriasis treated by TCM and Combined Traditional Chinese and Western Medicine.After searching for the three databases and reading special topics, we got 427 literature. There are 69 literature which suit for the inclusion criteria. There are 10 literature which adopted the non-randomized studies, the word of the "random" appeared there in the the following 59 ones, 11 literatures adopted the false random method according to the clinical order. 6 literatures used the simple random method (random number table), All the literatures havenot described the concealment of the random allocation; Among them there are 32 literatures(46. 38%)which were regarded as balances within the group. Some literatures have inferred simply the situation on the group such as age , gender, course of the disease et al. More literatures have not compared the balance within the groups , and others have not conceived the situation of the groups. There were 16 literatures(23. 19%)which adapted the diagnosis standard of the TCM and West Medicine. There were 29 literatures(42. 03%) which did not have definite TCM diagnosis standard, they did not have west medicine diagnosis standard. 9 Literatures did have definite, proper inclusion and exclusion criteria, 38 literatures did not have any description on the inclusion criteria;44 literatures did not have the description on the exclusion criteria. None of the literature have notexplained to compute the sample size, the determination of the concealment of the allocation and the rely-of the patients, the analysis of the purpose; only 3 literatures have inferred the " blind method" . Most of the studies have analyzed the data with statistical method, only 4 did not .26 literatures (37. 68%) have correctly analyzed the data with proper statistical method, there are 50. 72%of the total literatures which just gave the p value and no description on the statistical method. There were 69 literature which concerned the study on TCM or Combined Traditional Chinese and Western Medicine. On the standard of the control durgs, we evaluated them from the composition of the Radix, form of prepared drugs, dose, usage, period of treatment, the approach of feedmedicine and the medicament accord degree with certificate. We selected the best standard which have 13 literature(18.84%), the next have 35(50.72%) and the average have 15 literatures(21. 74%), there were 6 literature(8. 70%) we think the standard is bad or we did not know how to evaluate them. Most of the literatures(94. 20%) have the judgment standard on the effect of the curation , there were 311iteratures(44.93%) which adapted the state standard , the 29 literatures (42.03%) which adapted the standard made by themselves; None of the standard is admitted by the international experts; 4 literature(5.80%) did not have definite criteria on the effect of the curation. 18 literatures (26.09%) did not give side-effect, only 5.08% of the inclusion literatures did give the description of the side-effect. 10.14% of the literature's conclusion are based on the index of the curation criteria and statistical results. 2.90% literature have combined the extrapolation conclusion with the represent of the samples.2. The Meta_Analysis on the psoriasis treated by TCM and Combined Traditional Chinese and Western Medicine.Based on the 10 TCM and Combined Traditional Chinese and Western Medicine literature (control group: diyin tablet). The Meta_Analysis result of curation of psoriasis is :0R=2. 71, 95%CI[1. 76, 4.15]; 0R=2.43, 95CI[1. 53, 3.93] based on the 8 TCM literatures; 0R=4. 39,95%CI [3.16,6.16] based on the 11 TCM literature(qindai pill/capsule). OR=0. 06, 95%CI[0.03, 0.12] based on the analysis of 6 TCM literature in the curation of side-effect(dry symptom of mouth)caused by the psoriasis(control grouprdiyin tablet); 0R=0. 03, 95%CI[0.01,0.19] based on the analysis of 6 TCM literature in the curation of side-effect(dry symptom of the skin)caused by the psoriasis(control...