| ObjectiveTo systematically evaluate the clinical efficacy and safety of nourishing blood and moistening dryness(NBMD)in the treatment of psoriasis with blood dryness syndrome(PBDS),analyze the prescription regularities,in order to provide evidence-based medical evidence for clinical decision-making and guide the rational drug use.MethodsDatabases of PubMed,Cochrane Library,Embase,CINAHL,CBM,CNKI,VIP and Wanfang were searched from their respective inception to November 27,2021.The retrieval strategy was formulated around "the subjects of the study were psoriasis,the intervention measures were traditional Chinese medicine(TCM),and the research type was clinical randomized controlled trials".Randomized trials evaluating NBMD for PBDS were collected.The risk of bias assessment tool provided by Cochrane Handbook 6.1 was used to evaluate the quality of included studies.Statistical analysis was performed using RevMan V.5.4 software.Excel and SPSS software were used to analyze and incorporate drug use rules,which mainly included frequency of TCM use,meridian of sexual taste,common drug pairs and core combinations.ResultsA total of 13,706 related literatures were retrieved.17 RCTs involving 1503 participants were included,of which 16 RCTs qualified for meta-analysis.Meta-analysis results showed that,firstly,the effective rate(PASI60)of TCM combined with phototherapy(RR=1.50,95%CI[1.31,1.73],P<0.00001)and the improvement degree of PASI score(MD=-8.12,95%CI[-10.06,-6.18],P<0.00001)were better than phototherapy.There was no significant difference in the incidence of adverse reactions(RR=2.42,95%CI[0.64,9.06],P=0.19).Secondly,compared with external use of western medicine,the effective rate(PASI60)(RR=2.10,95%CI[1.16,3.81],P=0.01)and the improvement degree of PASI score(MD=-4.94,95%CI[-5.54,-4.34],P<0.00001)of internal TCM combined with external use of western medicine were better.Thirdly,compared with external use of western medicine,there was no statistical difference in effective rate(PASI60)(RR=1.23,95%CI[0.99,1.51],P=0.06)and improvement degree of PASI score(MD=-1.06,95%CI[-2.81,0.70],P=0.24)of external use of TCM combined with western medicine.However,the incidence of adverse reactions(RR=0.24,95%CI[0.06,0.93],P=0.04)was lower than that of western medicine.Fourthly,the effective rate of PASI60(RR=1.41,95%CI[1.13,1.75],P=0.002)of internal TCM was higher than that of internal/external western medicine,and the improvement degree of PASI score(MD=-3.05,95%CI[-5.59,-0.51],P=0.02)was better than inter western medicine,but there was no statistical difference in the incidence of adverse reactions(RR=0.09,95%CI[0.00,2.28],P=0.15).Fifthly,there was no significant difference in the effective rate of PASI60(RR=1.32,95%CI[0.87,2.01],P=0.19)between internal TCM combined emollient and internal western medicine combined emollient,but the improvement degree of PASI score was better(MD=-1.15,95%CI[-1.68,-0.61],P<0.0001).Sixthly,there was no significant difference in the effective rate(PASI60)(RR=1.17,95%CI[0.88,1.55],P=0.29)and the incidence of adverse reactions(RR=0.15,95%CI[0.02,1.21],P=0.07)between acitretin and TCM combined with acitretin.Seventhly,the effective rate(PASI70)(RR=2.10,95%CI[1.06,4.19],P=0.03)of TCM was higher than that of western medicine.Results of descriptive analysis showed that,the recurrence rate of TCM combined with western medicine was lower than that of western medicine.The results of the medication rule analysis showed that,Rehmannia glutinosa(Di huang)and Angelica sinensis(Dang gui)were the two most frequently used TCM,and Rhizoma smilacis glabrae(Tu fu ling),Suberect spatholobus stem(Ji xue teng)and Glycyrrhiza(Gan cao)were the third most frequently used.The top three most frequently used TCM were cold,warm and flat,the five tastes were bitter,sweet and spicy,and the meridian was liver,lung and spleen.Association rule analysis showed that the most supported drug pairs were Angelica sinensis(Dang gui)-Rehmannia glutinosa(Di huang).The keratin rules were Rehmannia glutinosa(Di huang)-Rhizoma smilacis glabrae(Tu fu ling)Angelica sinensis(Dang gui)and Rehmannia glutinosa(Di huang)-Suberect spatholobus stem(Ji xue teng)-Angelica sinensis(Dang gui).Cluster analysis showed that the two core combinations were Rehmannia glutinosa(Di huang)Angelica sinensis(Dang gui)-Rhizoma smilacis glabrae(Tu fu ling)-Salvia miltiorrhiza(Dan shen)-Ophiopogon(Mai dong)-Suberect spatholobus stem(Ji xue teng)-Cortex dictamni(Bai xian pi),Ligusticum wallichii(Chuan xiong)-Radix astragali(Huang qi)-Polygonum multiflorum(He shou wu)-Glycyrrhiza(Gan cao).ConclusionsThe current evidence shows that,compared with western medicine,TCM with the effect of NBMD can improve the clinical efficacy of PBDS,and can reduce the recurrence rate.However,due to the limitations of the number and quality of the included studies,the above conclusions need to be verified by more large-sample and high-quality studies.The analysis results of medication regularity can provide reference for clinical medication and new ideas for future research. |
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