| Objective:Through a cross-sectional survey of clinical departments,the current situation of the application of dermatology in the treatment of herpes zoster in the hospital of traditional Chinese medicine was investigated.From the perspective of patients' willingness,we analyzed the factors that may affect the patients' choice of traditional Chinese medicine therapy.This study was aimed to retrieve database in both English and Chinese traditional.We aimed to make a summary and analyze the traditional Chinese medicine in the treatment of herpes zoster randomized clinical trials to understand the research trends of herpes zoster in therapy of traditional Chinese medicine and to summarize the research trends and characteristics of reporting.Through systematic review and meta-analysis,we searched the domestic and foreign databases of randomized clinical trials on the treatment of herpes zoster.We evaluated the effectiveness and safety of fire needling in the treatment of herpes zoster.Method:A cross-sectional study of current clinical practiceWe conducted a cross-sectional study of adults(18 years and older)with shingles.The gender,age,physical type,pathogenic factors,condition(area of skin lesion recovery,degree of pain relief,whether post-neuralgia),treatment experience since the onset of the disease,and information of seeking medical treatment intention were investigated.Epidata 3.1 software was used to establish database and data entry control program.The trial operation of the database,stable,perfect lock into the database;Input the collected data;After logical check and manual check,lock the statistical analysis database.SPSS 22.0 software was used for statistical analysis.Mean,standard deviation and median were selected for statistical description of measurement data according to data distribution.The counting data were used to calculate the frequency and percentage of each item for statistical description.Logistics regression analysis was used to analyze the influence of factors such as gender,age,whether or not they had ever been sick,and the location of the disease on the patients' willingness to use TCM for intervention.Literature review of randomized clinical trials and systematic reviewLiterature on randomized clinical trials of traditional Chinese medicine in the treatment of herpes zoster was searched comprehensively and systematically to select the studies that met the inclusion and exclusion criteria,extract and collect data.Retrieval methods:clinical trial registries in China biomedical literature database,China knowledge network,VIP,Wanfang data,PubMed,Cochrane Library,literature on randomized clinical trials of traditional Chinese medicine in the treatment of herpes zoster from the establishment of the database to November 2018.Inclusion criteria:subjects:herpes zoster patients.There is no limit to acute stage or sequela stage.Intervention/exposure:various treatment measures under the guidance of traditional Chinese medicine theory,including traditional Chinese medicine decoction,single Chinese medicine,proprietary Chinese medicine,traditional Chinese medicine extract,acupuncture(body acupuncture,electroacupuncture,head acupuncture,fire needling,ear acupuncture,etc.),cupping,bloodletting,external medicine,etc.The type of drug use is not limited,oral,external use,intravenous injection,etc.The intervention dose,frequency and course of treatment are required to be reported.TCM decoction should be reported to the main prescription,and acupuncture therapy should be reported to the main acupoint.Study type:randomized clinical trial.Outcome indicators:this study did not limit the outcome indicators,but summarized and sorted out the outcome indicators reported in the literature.Literature screening:a randomized clinical trial on the treatment of herpes zoster with traditional Chinese medicine was screened,and the randomized clinical trials on the treatment of herpes zoster with fire needling was kept separately.The bibliographies retrieved from six databases were imported into the document management software NoteExpress3.2,the retrieval results of each database were combined,and repeated literatures between libraries were deleted.Two researchers independently carried out the preliminary screening of the literature,the full text was downloaded and the full text was screened,and the cross-check was finally confirmed to be included in the study.Data extraction:1)the following information was extracted from the randomized clinical trials on the treatment of herpes zoster with traditional Chinese medicine.Patient information:age,sex,disease stage,disease site.Type of intervention control:type of intervention measures,type of control measures.Outcome indicators:outcome indicators and relevant results.2)the following information was extracted from the randomized clinical trials on the treatment of herpes zoster by fire needling.Intervention measures,control measures,course of treatment,outcome measurement time was recorded.Patient information:including age,sex,disease stage,herpes zoster location.Risk assessment items for bias in randomized clinical trials include random sequence generation methods,allocation concealment,blind method settings,incomplete outcome reports,selective outcome reports,and other biases.We extracted the outcome indicators.Quality of literature evaluation:the fire needling for herpes zoster randomized clinical trials were evaluated using the Cochrane risk assessment tool(the Cochrane risk of bias).There are a total of seven items to high,medium and low risk of bias:the random sequence,random conceals,blinding,ending evaluators blind method,the incomplete report,selective end,other bias(affected by factors such as drug companies fund grant of bias),Data collation:1)randomized clinical trial on the treatment of herpes zoster with traditional Chinese medicine were classified and counted the types and courses of drugs according to drug treatment or non-drug treatment.The intervention type and course of treatment were counted for non-drug therapy.The frequency and percentage(%)of publications were calculated.2)TSA software was applied to conduct a cumulative meta-analysis of the data in a randomized controlled clinical trial of fire needling for the treatment of herpes zoster.Hazard ratio(RR)was used for dichotomy variables,and MD and 95%confidence interval(95%CI)were used for continuity variables.The test was selected for the heterogeneity test.When there was significant heterogeneity(P<0.10 for the heterogeneity test),the subgroup analysis was conducted from the perspectives of intervention type and disease course.If there was still significant heterogeneity in the subgroup analysis,the combined effect value was calculated by using the random effect model.TSA analysis was performed on the pooled data of major outcome measures(total effectiveness).If there were more than 10 articles in the subgroup,the publication bias was analyzed by inverted funnel plot.Result:Investigation on the clinical application of traditional Chinese medicine in the treatment of herpes zosterA total of 128 patients,including 56 males and 72 females,were collected for this study.The age distribution is between 28 and 90 years old,mainly middle-aged and elderly people over 50 years old,accounting for about 85.9%.104 patients were treated with oral Chinese medicine,accounting for the largest proportion.Seventy patients received TCM non-drug therapy,including body acupuncture,electroacupuncture,cupping,bloodletting and fire needling.The distribution of patients with different constitutions tended to be consistent in the acute stage and the sequelae stage,and the patients with mild constitutions were the most;Secondly,Yin deficiency constitution accounts for 26.17%in acute stage and 28.57%in sequelae stage.From the perspective of patients'willingness to visit,elderly patients with shingles disease,female,and over 65 years old tend to use oral Chinese medicine.Current status of randomized controlled clinical study on TCM treatment of herpes zosterA total of 689 articles and 741 randomized clinical trials were included.683 articles(683/689,99.13%)were published in Chinese and 6 articles(6/689,0.87%)were published in English.Non-drug therapy of traditional Chinese medicine(acupuncture,cupping,fire needling,stab winding cupping,plum needle and moxibustion,etc.),the joint intervention in the included studies frequency up to 372,the largest number of ac upuncture combined intervention,26.61%(99/372),fire needling combined intervention times,17.74%(66/372),involving the outcome indicators are as follows:the curative effect,pain,skin lesions,the quality of life,symptom integral,serological indexes,emotional change,follow-up,patients satisfaction,security.Systematic review and meta-analysis of randomized clinical trial of fire needling for herpes zosterA total of 34 articles were included,including 2544 patients.Only one of the literatures was modere risk bias,and 26 of them were high risk bias.Total effective rate(the proportion of the number of people cured and improved in the total number):fire needling combined with traditional Chinese medicine was 1.09 times higher than that of TCM alone(RR 1.09,95%CI 1.02,1.17,I2=0%).fire needling combined with western medicine was 5.57 times higher than that of western medicine alone(RR 5.57,95%CI 2.69,11.54,I2=0%).Pain relief degree(VAS score change):combined with western medicine,combined with TCM are better to relive pain than using them alone.Fire needling is better than acupuncture,western medicine or topical ointment in reliving pain.The incidence of fire needling was lower than that of neuralgia(PHN)after the intervention of western medicine:one study reported a follow-up of 30 days,the incidence of PHN of fire needling was 3.3%,and the incidence of PHN of western medicine was 26.7%,with statistical difference between the two groups.In terms of skin lesion recovery,the recovery time of fire needling group was shorter than that of acupuncture group,(days)(MD-1.96,95%CI-2.58,-1.34).In one study,adverse events were reported as stomach discomfort,which was considered to be not closely related to fire needling,and no other adverse events were reported.Conclusion:Through investigate the clinical application of traditional Chinese medicine in the treatment of herpes zoster,we come to the conclusion that sequelae stage patients,recurrent patients,female patients and over 65 years old patients using oral Chinese medicine accounted for a higher proportion.The results obtained in this study can provide references for future studies on the willingness of TCM patients in dermatology.In recent years,a large number of randomized clinical trials on the treatment of herpes zoster with traditional Chinese medicine have been published.From the perspective of the number of studies,the number of studies on the treatment of herpes zoster with traditional Chinese medicine is more than that on the treatment of acute stage patients,suggesting that the clinical efficacy of the treatment of herpes zoster with traditional Chinese medicine may be better.There are still some problems and challenges in the clinical study of traditional Chinese medicine in the treatment of herpes zoster,such as the selection of control measures and outcome indicators.It is expected that this study can provide references for subsequent studies and provide enlightenment for the design and implementation of clinical studies in the future.Combined with fire needling treatment in pain relief has advantages in improving the clinical cure rate.The use of fire needling compared with hand acupuncture has advantages in promoting herpes skin lesions recovery time(stop blister,scab,desiccations)has a better effect:can shorten the recovery time of herpes skin lesions.However,due to the inadequate sample size,it is still necessary to conduct high-quality randomized clinical trials that report the detailed and standardized treatment process of fire needling with clear outcome indicators for verification. |
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