| Objective:This study is based on the theory of"homotherapy for heteropathy",using systematic evaluation and Meta analysis,to evaluate the effectiveness and safety of the treatment of chronic atrophic gastritis,functional dyspepsia,irritable bowel syndrome,to provide a reference for clinical prescription selection,at the same time,enrich the theory of"treating different diseases together".Methods:The Chinese database mainly includes the National Knowledge Network of China(CNKI),Wanfang(Wan Fang),China Biomedical Literature Database(CBM)and VIP Chinese Technology Journal(VIP).The English database mainly includes Pub Med,Excerpta Medica Database and Cochrane Library.These seven big data were retrieved from the beginning of the database to December 2021 published clinical RCTs on Pinelliae Decoction for Purging Stomach-Fire and the treatment of chronic atrophic gastritis,functional dyspepsia and irritable bowel syndrome.Literature was screened according to inclusion and exclusion criteria to determine the final inclusion and extract relevant data.Re Man5.3 software was used to analyze the data by statistics,and the relevant results are expressed by drawing forest maps.If the number of documents included in the outcome indicators is more than five,the publication bias of the literature should be analyzed by drawing the funnel map.If the heterogeneity obtained by Meta analysis is too large,the sensitivity analysis of the source of heterogeneity and the analysis of subgroups are required.Results:According to the literature search strategy,63 RCT articles included in this systematic review ranging from 2004 to 2021.Two papers,remaining 61 are journal papers;24 chronic atrophic gastritis(CAG),27 functional dyspepsia(FD),12 irritable bowel syndrome(IBS),2112 patients in CAG,including 1056,1658 FD,1378,1280 control group and 1110 patients in IBS,including 594 and 516 in the control group.The Meta-analysis results indicate that:1.Whether the treatment of chronic atrophic gastritis is used alone or combined with western medicine,its overall response rate is higher than that of western medicine and proprietary Chinese medicine alone:Pinelliae Decoction for Purging Stomach-Fire added and reduced combined with western medicine I~2=0%,RR=1.25,95%CI[1.18,1.33],Z=7.08,P<0.00001;Pinelliae Decoction for Purging Stomach-Fire and simple use of Western medicine:Clinical Guidelines for New Chinese Medicine Drugs subunit I~2=0%,RR=1.29,95%CI[1.14,1.47],Z=3.91,P<0.0001;Efficacy Criteria for the Diagnosis of TCM Diseases subunit I~2=32%,RR=1.26,95%CI[1.17,1.36],Z=6.12,P<0.00001;Compared with Chinese patent medicine I~2=28%,RR=1.37,95%CI[1.22,1.53],Z=5.51,P<0.00001.2.Pinelliae Decoction for Purging Stomach-Fire combined with Western medicine or used alone is better to improve the HP conversion rate of patients with CAG:United Western medicine I~2=0%,RR=1.27,95%CI[1.14,1.41],Z=4.34,P<0.0001;Simply use pinellia diarrhea heart soup compared with western medicine class I~2=0%,RR=1.65,95%CI[1.29,2.11],Z=4.03,P<0.0001.3.Pinelliae Decoction for Purging Stomach-Fire added and minus combined with western medicine or used alone to improve the syndrome of epigastric distension and pain in CAG patients than the use of western medicine alone:Combined Western class I~2=32%,SMD=-2.01,95%CI[-2.23,-1.80],Z=18.40,P<0.00001;Pinellia diarrhea heart soup add and minus contrast western medicine I~2=47%,P=0.17,SMD=-0.86,95%CI[-1.21,-0.51],Z=4.84,P<0.00001.4.Pinelliae decoction for purging stomach-fire plus and minus combined with western medicine treatment in the improvement of CAG patients is better than the use of western medicine alone,however,there is no difference with Chinese patent medicine:combined western medicine class I~2=32%,SMD=-1.85,95%CI[-2.06,-1.64],Z=17.38,P<0.00001;comparison with Chinese patent medicine can only conduct descriptive analysis,so a reliable conclusion cannot be drawn.5.The combination of western medicine or the treatment of CAG patients of lack of appetite and numb to react alone can only be used in descriptive analysis,so no reliable conclusion can be drawn.6The gastric discomfort of patients with CAG can only be analyzed in descriptive analysis,so a reliable conclusion cannot be drawn.7.Pinelliae decoction for purging stomach-fire addition and subtraction combined with western medicine treatment is better than the use of western medicine alone in CAG patients:Combination class I~2=73%,SMD=-0.92,95%CI[-1.41,-0.44],Z=3.77,P=0.0002<0.05.8.The total response rate of Pinelliae Decoction for Purging Stomach-Fire patients with combination with FD was higher than that of western medicine alone:The total response rate of Pinelliae Decoction for Purging Stomach-Fire plus and subtraction combined with western medicine treatment was divided into two subgroups based on the different efficacy determination criteria,Diagnosis and Treatment Plan of Integrated Traditional Chinese and Western Medicine with Functional Dyspepsia subunit I~2=0%,RR=1.32,95%CI[1.17,1.49],Z=4.44,P<0.00001;Clinical Guiding Principles for New Traditional Chinese Medicine Drugs subunit I~2=0%,RR=1.16,95%CI[1.05,1.28],Z=3.03,P=0.002<0.059.Compared with the total clinical response rate of FD patients treated with western medicine,it was divided into two subgroups according to different efficacy determination criteria,Diagnosis and Treatment Plan of Integrated Traditional Chinese and Western Medicine subunit I~2=0%,RR=1.16,95%CI[1.06,1.26],Z=3.35,P=0.0008<0.05;Clinical Guidelines for New Chinese Medicine Drugs subunit I~2=15%,RR=1.24,95%CI[1.18,1.30],Z=8.23,P<0.00001.10.Pinelliae Decoction for Purging Stomach-Fire plus and subtraction is better than the use of western medicine alone in improving the clinical symptoms of FD patients:Pinelliae Decoction for Purging Stomach-Fire plus and minus combined with western medicine class I~2=0,RR=1.24,95%CI[1.18,1.30],Z=8.23,P<0.00001,the comparison of the soup and the simple use of western medicine can only be a descriptive analysis,so a reliable conclusion cannot be drawn.11.Pinelliae Decoction for Purging Stomach-Fire for Purging Stomach-Fire combined with western medicine group can improve the clinical efficacy of IBS patients:I~2=40%,RR=1.50,95%CI[1.39,1.62],Z=10.42,P<0.00001.12.Pinelliae Decoction for Purging Stomach-Fire and western medicine group can reduce the recurrence rate in IBS patients:I~2=0%,RR=0.35,95%CI[0.22,0.56],Z=4.37,P<0.0001.13.Adverse effects analysis:Among the 24 studies included in CAG treatment,only 3studies reported multiple adverse reactions including nausea,diarrhea and constipation during the treatment.One adverse reaction occurred in Pinelliae Decoction for Purging Stomach-Fire plus and minus combined with western medicine intervention,which could not be analyzed.The remaining two studies were compared with western medicine treatment,the combined effect size I~2=0%,RR=0.11,95%CI[0.01,0.86],Z=2.10,P=0.04<0.05,it shows that the incidence of adverse reactions in CAG alone is lower compared with western medicine alone;Among the 27 studies included in FD,only 1 described the occurrence of adverse reactions,including 1 case with increased stool number in patients,2 abdominal pain and dizziness in western medicine group,none of the remaining 26 studies did mention adverse effects;Of the 12 studies included in treating IBS,only one described the occurrence of adverse reactions,with three mild diarrhea in the trial group and five diarrhea in the control group,the remaining 11 items did not mention the adverse reactions.Overall,the safety of pinellia diarrhea heart soup for clinical treatment is better.Conclusion:1.In this study,we confirmed the effectiveness of the efficiency,HP turning rate and recurrence rate of chronic atrophic gastritis,functional dyspepsia and irritable bowel syndrome through systematic evaluation,and preliminarily analyzed the CAG,FD of the soup,and IBS;2.Pinelliae Decoction for Purging Stomach-Fire for purging stomach-fire whether used alone or combined with western medicine in the improvement of CAG Chinese medicine syndrome epigastric pain,depression,hiccups,acid belching is better than the simple use of western medicine;The efficiency of clinical symptoms combined with western medicine in the treatment of FD is better than the use of western medicine alone;3.The simple use of Pinelliae Decoction for Purging Stomach-Fire in the treatment of CAG,improve the full of boredom,food and noisy acid reflux,a reliable conclusion can not be obtained due to the large heterogeneity of the combined results;4.Based on modern experimental research and Chinese medicine method research,Pinelliae Decoction for Purging Stomach-Fire can treat CAG,FD,IBS have evidence to follow;5.When used alone and combined with western medicine for CAG,FD and IBS,only a few studies showed adverse effects,but no serious adverse events and high safety. |
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