A Meta-analysis Of The Treatment Of Ulcerative Colitis With Spleen Strengthening,heat Clearing And Humidity Combined With Western Medicine

Background:Ulcerative colitis(UC)is a common and frequently-occurring clinical disease,belonging to the category of inflammatory bowel disease.IBD).At present,the medical community has not reached a consensus on the pathogenesis and pathogenesis of UC,which is a chronic non-specific inflammatory disease with unclear etiology.The disease is common in developed countries such as Europe and the United States,but studies in recent ten years show that the incidence rate of ulcerative colitis in China is also rising year by year.Due to the chronic,lifelong and relapsing course of the disease and the higher risk of UC patients suffering from colon malignant tumor than normal people,the disease is gradually becoming one of the hot spots in digestive research.For UC,western medicine treatment mainly includes oral amino acid salicylic acid,glucocorticoid,immunosuppressive agent,biological agent and other ascending drugs as well as surgical treatment.Despite the latest treatment methods such as fecal bacteria transplantation and stem cell therapy,western medicine treatment is mainly symptomatic treatment,and the toxic and side effects caused by long-term application of western medicine treatment and high treatment cost also make it difficult for patients to accept.Traditional Chinese medicine(TCM)has the advantages of small side effects,simple operation,low price,low recurrence rate and the like in long-term application on the principle of syndrome differentiation and treatment and macro adjustment of the state of the human body,so that TCM has a good application prospect in the treatment of UC.A large number of clinical studies show that the combination of traditional Chinese medicine and western medicine has a good clinical effect in the treatment of UC.There is a saying in "Synopsis Golden Chamber" in ancient China:"There is heat in the large intestine,so diarrhea." However,it is also pointed out in "Required Readings for Medical Professionals":"Diarrhea is caused by dampness,and dampness is caused by spleen deficiency."After a large number of clinical studies,researchers of modern traditional Chinese medicine believe that the pathogenesis evolution of ulcerative colitis mainly has three typical periods.Damp-heat accumulation in large intestine(excess syndrome)in active phase,spleen deficiency with damp-heat or cold-dampness(deficiency-excess mixed)in chronic intermission phase,and spleen-kidney qi-blood deficiency(deficiency syndrome)in severe phase of chronic remission phase,of which spleen-deficiency damp-heat type in chronic intermission phase is more typical.The latest data research shows that the treatment of UC is mainly based on the drugs of invigorating spleen and qi.clearing heat and eliminating dampness.On this basis,it is combined with the drugs of soothing liver and regulating qi,warming yang and tonifying deficiency,promoting blood circulation and nourishing blood.It can be seen that invigorating spleen,clearing heat and eliminating dampness are the main treatment methods of TCM for UC.At present,there is still a lack of meta-analysis on the treatment of UC by strengthening spleen,clearing heat and transforming dampness with western medicine.Objective:This paper comprehensively collects and strictly screens RCT documents comparing the treatment of UC with traditional Chinese medicine in tonifying spleen and Clearing heat and eliminating dampness method combine with western medicine,and further systematically evaluates the efficacy of the treatment of UC with traditional Chinese medicine and western medicine,so as to provide demonstration basis for future clinical application.Methods:According to meta-analysis,the Chinese literature database(CNKI,Wanfang,VIP,CBM)and English literature database(Pubmed?Cochrane Library?Embase)were searched.According to the established inclusion and exclusion criteria,the documents that meet the inclusion criteria were strictly screened out.The quality of the included documents was evaluated according to Jadad scale and Cochrane bias risk evaluation method.Then the relevant data were extracted,and the data were grouped and compared and statistically analyzed by Statal5.1 software.Results:In this study,a total of 1128 patients with ulcerative colitis were included in 15 literatures.The included literatures were classified and counted according to outcome indicators,and 11 outcomes were Meta-analyzed.The research results of curative effect comparison show that OR=1.22,95%CI=[1.02-1.46],Z=2.15(P=0.032<0.05);The research results of total symptom scores showed SMD=-1.26.95%CI=[-2.08-0.45],Z=3.03(P=0.002<0.05);The results of abdominal pain symptoms showed SMD=-1.93,95%CI=[-2.93-0.92],Z=3.74(P<0.001);The results of diarrhea symptoms showed SMD=-1.60,95%CI=[-2.34-0.86],Z=4.23(P<0.001);The research results of severe symptoms after acute stroke showed SMD=-1.52,95%CI=[-2.68-0.36],Z=2.56(P=0.010<0.05);The research results of purulent stool symptoms showed SMD=-2.20,95%CI=[-3.31-1.10],Z=3.92(P<0.001);The mucosal score under colonoscopy showed SMD=-0.92,95%CI=[-1.79-0.04],Z=2.05(P=0.041<0.05);The research results of serum TNF-? showed SMD=-5.31,95%CI=[-7.39-2.88],Z=4.46(P<0.001);The research results of serum CRP level showed SMD=-5.16,95%CI=[-7.61-2.70].Z=4.11(P<0.001).The above outcome indicators showed statistically significant difference between the treatment group and the control group,and the treatment group was superior to the control group.The research results of serum IL-6 show that SMD=-3.42,95%CI=[-8.14-1.30],Z=1.42(P=0.156>0.05)there is no significant difference in reducing serum IL-6 between the treatment group and the control group In terms of safety,the research results of adverse reactions show that OR=0.71,95%CI=[0.31-1.621),Z=0.80(P=0.422>0.05).there was no significant difference in safety between the treatment group and the control group.Conclusion:The research results of this analysis show that the clinical effective rate and total symptom score of UC treated by traditional Chinese medicine combined with western medicine for invigorating spleen and clearing heat and resolving dampness,as well as relieving abdominal pain,diarrhea,tenesmus and purulent stool symptoms,recovering intestinal damaged mucosa,reducing serum TNF-? inflammatory factor and serum CRP levels,are superior to western medicine alone,but there is no significant difference between the two methods in reducing serum IL-6 inflammatory factor.In terms of safety,there is no significant difference between the combination of traditional Chinese and western medicine for strengthening spleen,clearing heat and eliminating dampness and the simple application of western medicine.At present,the traditional Chinese medicine prescriptions for strengthening spleen,clearing heat and eliminating dampness commonly used in clinical treatment of ulcerative colitis are Shaoyao Decoction,Gegen Qinlian Decoction,Shenling Baizhu Powder,Pulsatilla Decoction,Xiangsha Liujunzi Decoction,Tongxie Yaofang,Xianglian Pill,etc.Commonly used drugs are Coptis chinensis,Radix Scutellariae,Codonopsis pilosula,Poria,Atractylodes,Radix,Radix Paeoniae Alba,Coix Seed,Licorice,Tangerine,Amomum,Yam,Pulsatilla,Phellodendron.Astragalus,Pueraria Root,Radix Sophora,Sophora,Angelica,Atractylodes,Radix Yu et al.The overall quality of the literature included in this study is low,the sample size is small,and the heterogeneity is large.The research results still need further verification.At present,the combination of traditional Chinese and western medicine treatment of UC still has the shortcomings of insufficient standardization and objectification of TCM syndrome differentiation,it also includes low degree of standardization,insufficient pharmacological research,lack of multi-center,large sample,high-quality research.TCM treatment is mainly aimed at mild to moderate UC patients,the treatment of severe or complex UC patients still needs to be actively explored and studied.