Systematic Review Of The Efficacy And Safety Of Traditional Chinese Medicine In The Treatment Of Psoriasis Vulgaris And Analysis Of Medication Rules

Objective:To systematically assess the efficacy and safety of external application of Chinese herbal medicine(ex-CHM)in the treatment of psoriasis vulgaris(PV),and to analyze the prescription regularities,in order to provide evidence-based medicine for further clinical application and promotion.Methods:Different search portals,including the CNKI,SinoMed,WanFang,VIP,clinicaltrials,Cochrane Library and CENTRAL,PubMed,were searched for randomized controlled trials(RCTs)that compared the ex-CHM with other treatments for PV,with available data as of November 25,2020.The Cochrane risk of bias assessment was used to evaluate the quality of included studies.The Review Manager 5.3 software was used for analysis.Results:37 RCTs involving 4108 participants were included,of which 31 RCTs qualified for the meta-analysis.The results showed that,compared with the placebo,CHM ointment had higher effective rate(RR=2.27,95%CI[1.59,3.24],P<0.00001)and could improve psoriasis area severity index(PASI)better(MD=-1.65,95%CI[-2.44,-0.87],P<0.0001).There was no statistic difference between CHM ointment and Western medicine in the effective rate.The addition of CHM fumigation to other therapies including NB-UVB,oral CHM,and external application of Western medicine showed a higher effective rate(RR=1.37,95%CI[1.27,1.47],P<0.00001)and lower adverse reaction rate.CHM bath had a higher effective rate than placebo(RR=1.42,95%CI[1.04,1.93],P=0.03).The addition of CHM bath to other therapies had a higher effective rate(RR=1.25,95%CI[1.19,1.32],P<0.00001)and lower PASI(MD=-3.27,95%CI[-4.03,-2.50],P<0.00001).CHM bath could also decrease the adverse reactions of phototherapy and improve the dermatology life quality index(DLQI)(P<0.05).Descriptive analysis showed that,in four studies,few participants in the experimental groups experienced slightly oppressed discomfort and dizziness during the fumigation process.One study showed that CHM bath could reduce the recurrence rate of NB-UVB.In a study,CHM external washing showed equivalent effects to calcipotriol ointment and had fewer adverse reactions.Another study showed that CHM fumigation combined with external washing had better results than using acitretin alone and could reduce the adverse reaction of gastrointestinal discomfort.The results of the medication rule analysis:A total of 174 prescriptions were extracted,involving a number of 179 CHM.The three most frequently used CHM were Radix Sophora Flavescens(Ku shen),Cortex Dictamni(Bai xian pi)and Cortex Phellodendri Chinensis(Huang bai).The five CHM combinations most frequently used were Radix Sophora Flavescens(Ku shen)-Cortex Dictamni(Bai xian pi),Radix Sophora Flavescens(Ku shen)-Fructus Cnidii(She chuang zi),Radix Sophora Flavescens(Ku shen)-Fructus Kochiae(Di fu zi),Cortex Dictamni(Bai xian pi)-Fructus Kochiae(Di fu zi),Cortex Dictamni(Bai xian pi)-Salvia miltiorrhiza(Dan shen).Finally,four core combinations were obtained:?Radix Angelica Sinensis(Dang gui)-Peppermint(Bo he)-Sulphur(Liu huang)-Borneol(Bing pian)-Hydnocarpus(Da feng zi)-Rheum Officinale(Da huang),?Radix Sophora Flavescens(Ku shen)-Rhizoma Smilacis Glabrae(Tu fu ling)-Cortex Dictamni(Bai xian pi)-Radix Rehmanniae(Sheng di huang)-Fructus Kochiae(Di fu zi)-Fructus Cnidii(She chuang zi),?Radix Arnebiae(Zi cao)-Cortex Dictamni(Bai xian pi)-Cortex Moutan(Mu dan pi)-Oldenlandia diffusa(Bai hua she she cao)-Radix Sophora Flavescens(Ku shen)-Rhizoma Smilacis Glabrae(Tu fu ling),?Cortex Phellodendri Chinensis(Huang bai)-Radix Sophora Flavescens(Ku shen)-Salvia miltiorrhiza(Dan shen)-Cortex Dictamni(Bai xian pi)-Rhizoma Coptidis(Huang lian)-Fructus Cnidii(She chuang zi).Conclusion:The ex-CHM have shown some advantages in improving efficacy,reducing adverse reactions,decreasing recurrence rate and improving the quality of life in the treatment of PV,especially CHM ointment,CHM bath and CHM fumigation.However,the methodological issues of the included studies and possible publication bias need to be considered in the interpretation of the findings.According to the data mining results,blood-activating and stasis-removing drugs,heat-clearing and damp-drying drugs are mostly used,suggesting that dampness and blood stasis are important in the pathogenesis of PV.The core combinations can provide references for clinical selection of prescriptions and new ideas for further research.