Method Of Fortify The Spleen And Tonify Qi To Secure The Exterior For The Treatment Of Chronic Urticaria:A Systematic Review

Objective:To evaluate the efficacy, relapse and safety of method of fortify the spleen and tonify qi to secure the exterior for the treatment of chronic urticaria.Methods:Databases of the Cochrane library, Pub Med, Embase, CNKI, CQVIP, Wanfang, CBM were searched from their respective inceptions to 10th July,2015. Search terms included condition (urticaria), interventions (CHM) and study types (randomised controlled trials, RCTs). RCTs comparing the method of fortify the spleen and tonify qi to secure the exterior with other interventions for the treatment of chronic urticaria were included.Data was extracted into Excel and analysed following the Cochrane Handbook for Systematic Reviews of Interventions 5.1.0. Meta analysis was conducted using the Cochrane Review Manager 5.3 (Rev Man 5.3). The law of the method of fortify the spleen and tonify qi to secure the exterior for the treatment of chronic urticaria was analysed through Traditional Chinese Medicine Inheritance Support System, including herbs frequency, prescription study based on association rules, and new formula evolution.Results:17 RCTs on the method of fortify the spleen and tonify qi to secure the exterior for the treatment of chronic urticaria were included in the review. 15 of them were included in the meta-analysis. A total of 1712 participants were involved in the 17 RCTs.15 studies included in the meta-analysis involved 1517 participants with chronic urticaria. Meta-analysis showed higher efficacy of treatment group comparing with control group (P<0.05) or equivalent efficacy between them (P>0.05). And also the treatment group suggested having a lower relapse rate compared to the controlled one, with significance (P<0.05). The method of fortify the spleen and tonify qi to secure the exterior for the treatment of chronic urticaria in CHM showed a equivalent effective rate compared to antihistamines (RR:1.03;95% CI:0.92-1.15), in the meanwhile, the CHM groups showed a lower relapse rate (RR:0.37;95% CI:0.24-0.59); The method of fortify the spleen and tonify qi to secure the exterior for the treatment of chronic urticaria in CHM combined with antihistamines showed a higher effective rate, compared with antihistamine group (RR:1.21;95% CI:1.15-1.28), and the treatment group showed a lower relapse rate (RR:0.32;95% CI:0.25-0.41). The most commonly used herbs were Astragalus membranaceus (Huangqi), Atractylodes macrocephala Koidz (Baizhu), Saposhnikovia divaricata (Fangfeng). The most commonly used herb combinations were "Astragalus membranaceus (Huangqi) & Saposhnikovia divaricata (Fangfeng)", "Astragalus membranaceus (Huangqi) & Atractylodes macrocephala Koidz (Baizhu) " and "Atractylodes macrocephala Koidz (Baizhu) & Saposhnikovia divaricata (Fangfeng) ". Two new formula were found, they were "Tribulus terrestris L (Jili), Glycyrrhiza uralensis Fisch. (Gancao) Polygonum multiflorum Thunb. (Shouwuteng), Angelica sinensis (Danggui), Schizonepeta tenuifolia Briq. (Jingjie), Paeonia lactiflora Pall. (Baishao)" and "Angelica sinensis (Danggui), Atractylodes macrocephala Koidz (Baizhu), Paeonia lactiflora Pall. (Baishao), Glycyrrhiza uralensis Fisch. (Gancao), Ligusticum chuanxiong Hort. (Chuanxiong), Bombyx mori Linnaeus. (Jiangcan) "Conclusion:The method of fortify the spleen and tonify qi to secure the exterior for the treatment of chronic urticaria showed superior or equivalent efficacy and lower relapse rate compared with control group. However, the results should be interpreted with caution due to the low quality of the studies.