Meta-Analysis Of Shugan Hewei Therapy For Bile Reflux Gastritis And Its Medicine Characteristics

Study one: Meta-analysis of Shugan Hewei Therapy for the treatment of bile reflux gastritisObjective: The purpose of this paper is to evaluate the clinical efficacy and safety of Shugan Hewei therapy in treating bile reflux gastritis.Methods: We searched English and Chinese databases in China Knowledge Network（CNKI）,China Biomedical Literature Service（CBM）,Wan Fang（Wan Fang）database,Pub Med,Cochrane Library,and EMBASE from January 01,2016 to January 01,2022.A thorough search was performed for clinical randomized controlled studies on the treatment of bile reflux gastritis with Shugan Hewei therapy.Basing on the inclusion and exclusion criteria,two members independently screened qualified literatures,evaluated the literature quality,and extracted data information.Meta-analysis is performed in Rev Man5.3 software,and finally the results of system evaluation are expounded and discussed.Results: A total of 2973 patients with biliary reflux gastritis were included in 32 literature articles,including 917 cases in the Shugan Hewei therapy group and 948 cases in the control group,551 cases in the Shugan Hewei therapy combined with Western medicine conventional treatment group,and 554 cases in the control group.The results of meta-analysis showed that the treatment of BRG by the Shugan Hewei therapy improved the clinical comprehensive efficacy（OR=3.58,95% CI [2.47,5.21],Z=6.70,P<0.00001）,TCM symptom efficacy（OR=3.95,95% CI [2.60,6.01],Z=6.42,P<0.00001）,TCM syndrome integral（WMD=-4.27,95% CI [-6.26,-2.27],Z=4.20,P<0.0001）,gastroscopic efficacy（OR=3.52,95% CI [2.18,5.67],Z=5.15,P<0.00001）,gastroscopic mucosa（OR=3.47,95% CI [1.67,7.21],Z=3.34,P=0.0008<0.01）and bile reflux（OR=3.72,95% CI[1.52,9.14],Z=2.87,P=0.004<0.01）,Motilin levels（WMD=49.99,95%CI [22.92,77.06],Z=3.62,P=0.0003<0.01）have obvious advantages over conventional treatment in Western medicine.The Shugan Hewei therapy improve major TCM symptoms such as stomachache（WMD =-0.85,95% CI [-1.11,-0.59],Z=6.38,P<0.00001）,bloating of the stomach（WMD=-0.93,95% CI [-1.02,-0.84],Z=19.46,P<0.00001）,belching（WMD=-0.56,95% CI [-0.76,-0.35],Z=5.25,P<0.00001）,acid regurgitation（WMD=-0.56,95% CI [-0.71,-0.41],Z=7.24,P<0.00001）,loss of appetite（WMD=-0.44,95% CI[-0.54,-0.33],Z=8.10,P<0.00001）,dry and bitter mouth（WMD=-0.75,95% CI[-1.01,-0.48],Z=5.53,P<0.00001）,constipation（WMD =-0.31,95% CI [-0.50,-0.13],Z=3.37,P=0.0008<0.01）,rashness（WMD=-0.50,95% CI [-0.67,-0.32],Z=5.45,P<0.00001）are significantly better than conventional treatment in Western medicine.Compared with conventional treatment of Western medicine,the Shugan Hewei therapy have obvious advantages in improving the comprehensive clinical efficacy（OR=3.05,95% CI [2.13,4.36],Z=6.09,P<0.00001）,and motilin level（WMD=49.06,95% CI [39.76,58.35],Z=10.34,P<0.00001）.The Shugan Hewei therapy combined with conventional Western medicine treatment have obvious advantages over the conventional treatment group of Western medicine in improving the main TCM symptoms such as stomachache（WMD=-0.45,95% CI [-0.78,-0.12],Z=2.66,P=0.008<0.01）,bloating of the stomach（WMD=-0.50,95% CI [-0.68,-0.32],Z=5.50,P<0.00001）,but have obvious advantages over the conventional treatment group of Western medicine（WMD=-2.56,95% CI [-5.06,-0.06],Z=2.00,P=0.05>0.01）was comparable to that of the control group,and the difference is not statistically significant.In terms of clinical safety,all studies did not have serious adverse reactions,none of them affected treatment,the Shugan Hewei therapy could significantly reduce the incidences of adverse reactions in patients with BRG（OR=0.24,95% CI [0.12,0.47],Z=4.14,P<0.0001）,while the combination of the Shugan Hewei therapy and Western medicine treatment group could not be further analyzed due to insufficient literature.Conclusion: Compared with Western medicine alone,the Shugan Hewei therapy,or combined with western medicine treatment,have obvious advantages in the treatment of biliary reflux gastritis,with definite efficacy and fewer adverse reactions.Given the generally low quality of the literature contained in the present study,the above conclusions still need to be justified by more high-quality studies.Study two: Analysis of the use of Shugan Hewei therapy in the treatment of bile reflux gastritisObjective: To collate and count the information of Chinese herbal medicines in the literature of bile reflux gastritis treated with Shugan Hewei therapy,and to summarize the characteristics of the prescription in the treatment of bile reflux gastritis for clinical reference.Methods: The information of Chinese herbal medicines in the literature of bile reflux gastritis treated with Shugan Hewei therapy was collated and counted,and then summarized into Excel to establish a database.Finally,frequency analysis,cluster analysis and correlation analysis were utilized to analyze the characteristics of prescriptions for the treatment of bile reflux gastritis.Results: The total number of herbal medicines involved in the treatment of this disease was 82,and the top 15 most frequently used were: Chai Hu,Gan Cao,Bai Shao,Chen Pi,Huang Lian,Zhi Ke,Yu Jin,Huang Qin,Zhi Shi,Yan Husuo,Fu Lin,Xiang Fu,Ban Xia,Mu Xiang,and Hai Piaoxiao.The total number of medicine classes used in the treatment of this disease was 20,and the top 5 most frequently used were: qi-regulating medicine,qi-supplementing medicine,phlegm-transforming medicine,blood-activating medicine,and heat-clearing medicine.Through cluster analysis,12 pairs of drug combinations were obtained;through association analysis,20 rules were obtained for the main drug combinations such as Xuan Fuhua–Dai Zheshi–Ren Shen,Huang lian-Wu Zhuyu,Chai Hu-Chen Pi-Bai Shao,and Huang Qin-Chai Hu.Conclusion: This analysis basically reflected the prescription characteristics of Shugan Hewei therapy in the treatment of bile reflux gastritis.Chai Hu,Gan Cao,Bai Shao,Chen Pi,and Huang Lian are the main drugs used.Qi-flow regulating herbal medicine,qi-tonifying drugs,and phlegm-transforming drugs are widely used in the treatment of bile reflux gastritis by Shugan Hewei therapy.Xuan Fuhua–Dai Zheshi–Ren Shen,Huanglian-Wu Zhuyu,Chai Hu-Chen Pi-Bai Shao,and Huang Qin-Chai Hu are the commonly used drug combinations in the treatment of bile reflux gastritis by Shugan Hewei therapy.