| BaekgroundGout is a urine metabolic abnormality caused by increasing uric acid synthesis of a kind of metabolic disease. If it cannot get effective treatment for a long time, easy to development for tophus sedimentation, joint deformation, gouty nephropathy. And hypertension, hyperlipidemia, atherosclerosis, obesity, closely are related to the occurrence of insulin resistance. As the rising living standard of people, the disease presents older tendency and younger tendency of the disease. At present, the prevention and treatment of gout has become the important and hot topic in the field of medicine. Western medicine treatment of gout mainly uses anti-inflammatory analgesic and control of uric acid as the main means. There are more concerns on medication, such as needing to take medicine for a long time, the adverse drug reactions, patients can’t insist, easy to relapse after drug withdrawal. Many patients even present to cardiovascular disease, and kidney disease. Chinese medicine treatment of gout has a long history. And the characteristics of TCM syndrome differentiation and treatment, the characteristics of flexible compatibility of traditional Chinese medicine formulae, dispersion gels, etc, making the Chinese medicine treatment of gout has significant advantages. With modern clinical research method into the research field of Chinese medicine, a lot of use of traditional Chinese medicine treatments of gout clinical research extensively developed. And objectively reporting has obtained the good curative effects. Chinese medicine treatment of gout can reduce adverse drug reactions caused by western medicine treatment, reduce the recurrence. But a lot of literatures exists the problems such as widespread random and sample. It also lacks comprehensive system, careful analysis of the clinical evidence to assemble.Objective Based on randomized controlled trials of traditional Chinese medicine treatment of gout, this paper is in order to achieve the following purposes:(1) given scientific and standardized evaluation of the efficacy and safety of intervention of traditional Chinese medicine gout in the angle of evidence-based medicine.(2) Given scientific evaluation on methodology used on the randomized controlled trial of traditional Chinese medicine treatment of gout. Correctly evaluate its efficacy and clinical trial design, will provide clues and ideas for future research and improve the quality of traditional Chinese medicine treatment on gout. And even to provide the reference on methodology in line with international standards.(3) For drug analysis into the study of the literature.MethodThis paper search randomized controlled trials of Traditional Chinese Medicine treatment of Gout in the Chinese biomedical literature database (CBM), China academic literature network publishing pool (CAJD), China journal full-text database (CNKI knowledge network of China), Chinese biomedical database (VIP), Wan Fang Zhonghua medical association journal database, PubMed, Embase database Medicine database, Cochrane collaboration center registration database, medical electronic journal database from OVid platform from its built library to the day in January2014. Retrieval words for Gout, gouty arthritis, Chinese Medicine, combined Chinese and western Medicine, Chinese Medicine, Chinese Herbal Medicine, Gout, Traditional Chinese Medicine, Herbal Medicine, Chinese patent Medicine. Keywords retrieval combined with free retrieval. Filter meets the requirements of clinical randomized controlled trials, USES the Cochrane collaboration (RewMan)5.2.3requires software quality evaluation and Meta analysis. To have a complete description of the82articles included in the literature, the formulas used EpiData3.1establish database, adopt the method of double entry input data. Using statistical analysis software SPSS19.0frequency statistics analysis.Results1. for external use Meta analysis of traditional Chinese medicine treatment of gout. Eventually14RCT literatures, including980cases of patients with gout. Treatment group are the external use traditional Chinese medicine (TCM), including lotions, paste, powder, the control group of western medicine. It is the same for outside use for dosing methods helped him Lin emulsion, and for oral dosing of colchicines, not Piano alcohol. Meta analysis showed that:Chinese medicine are better than western medicine group in the clinical total effective rate and index of joint pain, joint tenderness, swelling, disturbance index of these improvements in clinical symptoms and signs and laboratory indexes C-reactive protein, blood uric acid to improve aspects and so on seven indicators; Two groups shown in blood sedimentation, adverse reaction index. Amount of adverse reaction, the effect of traditional Chinese medicine and western medicine group, mainly show mild rash.2. The Meta analysis of oral Chinese medicine treatment of gout. Participants included44researches, a total of3242patients with gout. Oral Chinese medicine treatment of gout in blood sedimentation, C-reactive protein and blood uric acid level improved are better than pure western medicine treatment. In the aspect of clinical total effective rate, as compared with traditional Chinese medicine (TCM) colchicines in traditional Chinese medicine (TCM) as compared with non-steroidal anti-inflammatory drugs in the study of group, no significant statistical differences between traditional Chinese medicine (TCM) and colchicines, non-steroidal anti-inflammatory drug treatment of gout effect is remarkable. Combined traditional Chinese and western medicine treatment in clinical total effective rate, blood sedimentation, C-reactive protein and blood uric acid level are superior to pure western medicine treatment. Incidence of adverse reactions, traditional Chinese medicine, combined Chinese and western medicine group was significantly better than pure western medicine group. Treatment group shows defecating thinning, dyspepsia, western medicine group with nausea and gastrointestinal discomfort, blood system, liver and kidney impairment. Individual cases could not be tolerated, out of the control test.3. The Meta analysis of traditional Chinese medicine for external use combined oral treatment of gout. Tests included27studies,2212patients with gout. Tips:Meta analysis with gout acute drug resistance by grouping (non-steroidal anti-inflammatory drugs-colchicines) and uric acid drugs (not Piano alcohol, benzene bromide Malone) comparison, combination of statistical analysis. The joint Chinese medicine internal and external or combined traditional Chinese and western medicine treatment of gout in the total effective rate, joint swelling, blood sedimentation, c-reactive protein, blood uric acid are superior to western medicine. By contrast, the difference was statistically significant. In the degree of joint pain relief, activity on the obstacle to improve the degree of joint Chinese medicine internal and external treatment or combine traditional Chinese and western medicine therapy and pure western medicine treatment. There was no statistically significant difference. On the adverse reaction, oral medicine combined advantages far outweigh the western medicine for external use only. Combined effect of the OR=0.11,95%confidence internal was [0.06,0.20], significant difference. Low incidence of adverse reaction of TCM external therapy were mostly mild rashes, dyspepsia. The western medicine group with a greater incidence of adverse reactions, and various performance, appear nausea, vomiting, abdominal pain, diarrhea and other gastrointestinal reaction and even liver kidney function and blood system damage.4. Chinese medicine treatment of gout drug analysis. Participants included224kinds of traditional Chinese medicine (TCM), frequency of1141times. Including internal and formula contains127kinds of Chinese medicine, using frequency of801times. External use formula contains97kinds of Chinese medicine, using frequency is340times. In the treatment of gout for external use formula, the highest using frequency was golden yellow cream, top ten Chinese medicine as:turmeric, rhizoma coptidis, cortex philodendra, rhubarb, angelica dehurica magnolia bark, borneol, radix scutellariae, rhizome atractylodis, and radix trichosanthis. In medicine, the highest formula of frequency was four wonderful pill or add and subtract in four wonderful scattered as the basic party prescriptions. Among the top10for:Chinese material medical in turn for coax seed, cortex philodendra, achyranthes, glabrous greenbrier rhizome, sichuan Bi Xie, radix paeoniae rubra, rhizoma alismatis, prevention, honeysuckle stem, cassia twig.Conclusion1. Chinese medicine treatment of gout in a separate external use, single oral and external use combined oral overall on the curative effect and reduce the incidence of adverse reactions which are superior to western medicine alone. In improving clinical symptoms and signs, to reduce the acute phase of C reactive protein and reduce the incidence of adverse reactions on advantage is obvious.2. Chinese medicine treatment of gout of common clinical research on the methodology of stochastic method report is incomplete. The blind method is difficult to implement, loss of exit patients lost to follow-up situation, not conduct sample size estimation, curative effect, limitations, published sex bias, and other issues. These are directly responsible for the comprehensive judging curative effect of traditional Chinese medicine the imperfect of the evidence. Therefore, clinical researchers reported before the implementation of clinical trial design, results should be study and training of evidence-based medicine. And on curative effect, evaluation index should be based on varies selection and purpose of treatment. With the help of quality of life scale to solve the problems that fuzzy evaluation of traditional Chinese medicine, narrow and strong subjectivity.3. On the drug use analysis, external use traditional Chinese medicine are used to clear heat and dry wet, clear heat antidote, promoting blood circulation to remove blood stasis drugs. These drugs in local play a clear heat anti-inflammatory, acetanilide detumescence, and improve local circulation. And also to improve heat swelling pain symptoms. Internal and water permeability dampness, promoting blood circulation to remove blood stasis drugs and heat of poison. At the same time do not ignore the importance of application of invigorate the circulation of goods, with meridian dredging, the toxin factor without attachment.4. The efficacy and safety of the traditional Chinese medicine treatment of gout, visible, has a broad clinical application prospect. It is necessary to combine the characteristics of TCM, to improve quality, which can widely clinical trial for confirmation. For the research of Chinese medicine will make the contribution on the world in the future. |
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