Literature Research And Meta-analysis Of Suanzaoren Decoction In The Treatment Of Insomnia

objective1.Through the study of ancient literature,ancient physicians with jiaweisuanzaoren Decoction in treatment of insomnia with the pathogenesis of fish syndrome differentiation characteristics and advantages are summarized;jiaweisuanzaoren Decoction in the clinical application experiences of the essence are mined.Therefore,references for modern clinical application are provided.2.The use of literature and methods of evidence-based medicine,theoretical study of literature research and clinical literature of modern clinical treatment of insomnia with jiaweisuanzaoren decoction,summarize the syndrome differentiation of jiaweisuanzaoren Decoction for the treatment of insomnia and type,evaluation of curative effect of Jiawei Suanzaoren Decoction on different classification of insomnia,provide experience and evidence for clinical.Method1.Ancient literature researchAs the main source of literature retrieval in the ancient library of China,the cloud Library of the normal university is searching for the original works and searching the relevant information manually.In the"cloud" of ancient Chinese Medicine Library Normal University were modeled respectively by "insomnia,neurasthenia,insomnia and other key word retrieval,mainly adopts computer retrieval,such as encountered questionable provisions were searched by searching the original work related information verification.According to the pathogenesis and differentiation of the medical records,the classification,feasibility,academic views and related treatment methods were sorted out and described.2.Modern literature research2.1 Theoretical literature researchIn the China Journal Net(CNKI),Wanfang database,VIP database and overseas Chinese academic journal net,respectively with jiaweisuanzaoren decoction,insomnia syndrome type "as the keyword search,time selection from 2005~2016 related articles.From the essence of contemporary artists on the experience of using jiaweisuanzaoren decoction,analysis of modern medicine on the etiology and pathogenesis of insomnia and the clinical application of jiaweisuanzaoren Decoction syndrome characteristics and drug law,summarize the basic dialectical treatment of the disease jiaweisuanzaoren Decoction type and clinical thinking.2.2 Meta-analysisOn the basis of the above database,a clinical randomized controlled trial of clinical research literature screening.2.2.1 Develops retrieval strategiesThe electronic search full-text database China journals from 2005 to2017(CNKI),VIP database(Chinese journal database,VIP),Wanfang periodical database(Wanfang),Cochrane Library,Medline and Pubmed,the key words of "jiaweisuanzaoren Decoction" and "Suanzaoren Decoction","insomnia","insomnia in","insomnia","sleep disorder" and "sleepless" and so on,to retrieve information about jiaweisuanzaoren Decoction in treatment of insomnia with pathogenesis and syndrome differentiation belongs to the literature of RCTs.2.2.2 Establishes inclusion and exclusion criteriaOnly the random sampling test(RCTs)accorded with the inclusion and exclusion criteria was selected.Only the study on the efficacy and safety of the modified wild jujube seed decoction was included,and only the other physiological indexes were excluded.The study included 3 kinds of clinical trials,including modified wild jujube seed soup,western medicine,flavored wild jujube soup,traditional Chinese medicine,flavored wild jujube decoction,and traditional Chinese medicine.2.2.3 Methodology of inclusionCochrane system evaluation method,statistical software Rev Man 5.2for statistical analysis.First of all,the heterogeneity of each study was tested,and P < 0.1 was used as the test level.When there is no statistical heterogeneity between studies using fixed effect model;if there is statistical heterogeneity between studies as much as possible tofind out the sources of heterogeneity,as there is no clinical or methodological heterogeneity,the random effects model.Merge analysis.Continuous variables using standardized mean difference(SMD),the classification of variables using odds ratio(odds ratio OR),the two effects were indicated by 95%CI and P is less than or equal to 0.05 was considered statistically significant difference.If there is a distinct clinical heterogeneity between studies,if subgroup analysis is necessary,careful analysis is necessary if descriptive analysis is selected.When necessary,sensitivity analysis is used to test the stability of the results.Results1.Retrieval results: 690 papers were retrieved from this study,690 of which were retrieved by Chinese electronic databases.After the literature was duplicated and the criteria did not meet the inclusion criteria,the remaining 51 articles need to be read further.After carefully reading the text,10 articles were excluded.At last,there were 41 articles included in the literature.There were 3657 patients who met the inclusion criteria for analysis.2.Baseline characteristics analysis:2.1 Included in the year of publicationThis study included literature published between qualified is 2005-2017 years,seen from the figure,the literature published in 2009 and2013 two small peaks,published most of the year is 2013,reached 8,followed by 2015 and 2016,both 6,ranked third in 2009,published 5papers.2.2 Control group treatmentThe treatment method of 41 articles included in this study were reported in the control group,the 41 study in the treatment of control group for western medicine,seen from the figure,the control group intervention is the largest use of estazolam(SURAZEPAM),accounting for44%,followed by diazepam(Anne tablets),accounting for 22%.2.3 Sandard features of clinical efficacyThe clinical efficacy of modified wild jujube seed soup was reported in 41 literatures.According to the "guiding principle" Chinese medicine clinical research development of efficacy standard of 9 articles,according to the "standard" standard of curative effect of TCM syndrome diagnosis and treatment of the 5 articles,1 articles were in accordance with the amount of SPIECGEL 6 according to the international general provisions of the table to determine the efficacy of 1,according to the "standard practice of traditional Chinese medicine curative effect" in psychiatry insomnia and evaluate the efficacy of 1,according to the Chinese Medical Association Society of Neurology and psychiatry to level4,the remaining 24 articles formulated by the standard of curative effect did not clearly indicate the source.2.4 Classification of insomniaThere are 26 categories of research reports of insomnia with 41 items included in the literature.There are reports of climacteric insomnia with 6 articles,accounting for 15% of all documents,reports of hyperthyroidism insomnia has 5 articles,accounting for 12% of all documents,reports of liver blood deficiency(including liver yin deficiency)with 4 references for insomnia,all the literature of the 10%,other reported insomnia classification there are post stroke insomnia,insomnia and so on after hepatitis B.2.5 Outcome indicatorsThe 41 study included in the report,all the clinical curative effect,in addition to clinical research,also included all the outcomes of the18 articles,6 articles reported separately the Pittsburgh sleep quality index(PSQI),there are 5 separate articles reported sleep quality SPIEGEL Questionnaire,no articles were reported separately the sleep quality of the SSRS scale,2 reported the Pittsburgh sleep quality rating scale(PSQI)and SSRS sleep quality scale,there are 5 papers report PSQI and SPIEGEL sleep quality scale.2.6 Characteristics of adverse reactionsIn the literature there are 5 articles reporting adverse reactions,statistical results for the control group there were 46 cases of intervention group,there were 1 cases of adverse reactions in the control group,including: dizziness,nausea,fatigue,leukopenia,liver dysfunction and so on;the intervention group appeared adverse for abdominal distension.3.Index effect evaluationCompared with the routine western medicine,the modified wild jujube kernel decoction is more effective in the treatment of insomnia.Among the three scoring indexes of PSQI,SPIECGEL and SSRS,heterogeneity among literatures was found,and subgroup analysis was carried out.In a subgroup analysis,found jiaweisuanzaoren Decoction on insomnia of liver blood deficiency syndrome,insomnia in climacteric women in PSQI score and SPIEGEL score improved significantly better than the control group,the score of meta in hyperthyroidism insomnia analysis remains to be studied.4.Publication bias analysisThe potential publication bias by using Beggar's analysis,ratio analysis results in the intervention group and control group curative effect as abscissa and the thought log(OR)drawing funnel as ordinate,according to the 41 articles included,most of the research results show that the literature does not exist in the centralized distribution,publication bias.Form the relative symmetry,the individual articles appear bias,overall,the funnel plot showed normal distribution,existence of publication bias is less likely.Conclusion1.Through the ancient literature and the study found that the use of Suanzaoren Decoction on insomnia in the profound historical development,in successive dynasties continuously according to the clinical practice of continuous accumulation of experience and theory,and has been quite mature in the clinical practice and theory.2.Based on the modern literature on jiaweisuanzaoren Decoction in the treatment of insomnia related literature research found that modern medicine of jiaweisuanzaoren Decoction in the treatment of insomnia pathogenesis from the total liver blood deficiency,mind dystrophy,disease can involve the viscera,mainly in the "heart","liver two dirty" on the dialectical,jiaweisuanzaoren for the treatment of insomnia type is not from the heart and liver blood deficiency,hyperactivity of fire due to Yin deficiency.In Suanzaoren Decoction for drug modified housing,according to the clinical experience,and prescription for zhizichi decoction,ganmaidazao decoction,Wendan Decoction,and herbs is cut with countless changes according to evidence.3.Using meta analysis method,through the retrieval of 2005-2017 years of relevant literature,into the standard randomized controlled trial,the modified jujube seed soup treatment of various insomnia clinical efficacy evaluation.The results showed that the modified wild jujube seed soup was better than the conventional western medicine in the treatment of insomnia.Among the three scoring indexes of PSQI,SPIECGEL and SSRS,heterogeneity among literatures was found,and subgroup analysis was carried out.In a subgroup analysis,found in the control group of Jiawei Suanzaoren Decoction on insomnia of liver blood deficiency syndrome,female climacteric insomnia is superior,the score of meta in hyperthyroidism insomnia analysis remains to be studied.Thyroid function in clinical hyperthyroidism,female climacteric syndrome in TCM syndrome of yin deficiency syndrome had higher incidence,which verified the jiaweisuanzaoren Decoction in the treatment of insomnia with TCM clinical syndrome type is divided on bias,more suitable for the liver blood deficiency(liver yin deficiency),Yindeficiency syndrome etc.,has certain guiding significance to the clinical.