| Over the years, traditional Chinese medical science has proceeded many osteoarthritis related clinical trials such as effective traditional Chinese medicine, symptoms and signs classification, randomized controlled trials and so on. There have been lots of literatures about clinical trial of traditional Chinese medicine treatment. However, few studies focus on rules of property of drugs and dose study. Therefore, the current research comprehensively collected and analyzed literatures about clinical trial of traditional Chinese medicine treatment of knee osteoarthritis. Moreover, researcher also combined the data mining method and evidence-based medicine in order to deeply examine TCM syndromes, core drugs, and dosage analysis of knee osteoarthritis. The efficacy and safety of traditional Chinese treatment and medicine of knee osteoarthritis were also evaluated. The present study aims to establish the theoretical basis of traditional Chinese treatment and medicine of knee osteoarthritis and provide references to clinical trial.Objective:Analysis and Discussion Chinese medicine treatment of knee osteoarthritis of the drug laws and clinical drug efficacy.Methods:In this research, researcher collected:a) literatures about Chinese medical internal treatment of knee osteoarthritis from 1994 to 2014 and b) research on Chinese medical external treatment of knee osteoarthritis published from January,2000 to December,2014. The name and the dosage of the compound prescription of traditional Chinese medicine were collected and arranged. The TCM Inheritance system was used to conduct the frequency analysis, correlation analysis, and cluster analysis of the medicine. The most frequently used medicine is provided and the core medicine and new prescription are also offered in this study. The researcher also collected all randomized controlled trials of internal traditional Chinese and Western medicine of knee osteoarthritis and used RevMan 5.2 to conduct meta-analysis in order to examine the heterogeneity. And select the appropriate model based on the heterogeneity of the results of the effect model.Effect of outcome indicators for odds ratio, with 95% confidence intervals.Results:① 273 prescriptions including 260 oral intake medicine,8 pills, and 5 powders and covering 219 kinds of traditional Chinese medicine were collected in this research. All medicines were applied total 3345 times. The tonic medicine was used the most, which takes up 33.95%, followed by blood-activating and stasis-resolving medicinal, which takes up 21.09%. The medicine for rheumatism takes the third place, which accounts for 19.98%, followed by superficies-resolving formula, formula for diuresis and diffusing dampness, heat-clearing formula, calming the liver to stop endogenous wind, apophlegmatisant, and so on. The top fifteen frequently used medicines are Chinese angelica, Licorice, radix achyranthis bidentatae, radix paeoniae alba, eucommia ulmoides, radix angelicae pubescentis,Rehmannia, ligusticum wallichii, loranthus parasiticus, radix clematidis, Caulis Spatholobi, poria cocos, Gentiana, teasel root, Astragalus, and so forth. Medicines applied in this research are mainly for liver, kidney, spleen. The characteristics of most of them are warm, sweet, bitter, and pungent. Through Inductive analysis, the researcher found that all core medicines are based on Duhuo Jisheng decoction. The basic prescription which was added or subtracted other elements becomes another new prescription.② 146 external medicines including 180 traditional Chinese medicines were collected. All medicines were applied total 1769 times. The medicine for rheumatism was used the most, which takes up 36.46%. As for the second place, blood-activating and stasis-resolving medicinal takes up 29.68%, followed by Relieving drugs, tonic, warm inside, antipyretic, hemostatic, expectorant drugs, and so on. The top fifteen frequently used medicines are Speranskia herb, Safflower, Lycopodium herb, Radix clematidis, Frankincense, myrrh, Aconitum, Aconitum、Achyranthes、Angelica、Erythrina bark、 Ramulus Cinnamomi、Rhizoma Ligustici Chuanxiong、Radix Angelicae Pubescentis、 Radix Saposhnikoviae, and so forth. Though the analysis of the vast statistic, we draw the conclusion that:Drugs mainly used were those belonging to liver, spleen and kidney in channel, and warm in nature and acrid and bitter in flavor. Through inductive analysis found that all prescription drug core composition is of shujinhuoxue decoction or haitongpi decoction, and the new recipe is the modified experience prescription of the basic classical prescription of that.③ By analyzing 260 oral medication, the flavor of the average drug was 12±3.16, the whole dose was 166.79±57.88g, while analyzing 146 topical prescription medication, the flavor of the average drug was 12.12±4.26, the whole dose was 248.39±261.19g. There is more average in the average herb ingredients, but the whole external prescription dose drop sharply, and because of its dosage forms of powder, the doses of external dressing herbs are high. The dose distribution of the first fifteen oral medication is that:Angelica,6～30g, commonly used for 10～15g; licorice,3～15g,5 ～10g in common; Angelica,6～40g,10～15g in common; Herba taxilli,6～30g, commonly used for 15g,20g, or 30g; Chuanxiong,6～30g, commonly used for 10g, 15g; Radix Paeoniae Alba,6～30g, commonly used 10～30g; Eucommia,6～20g, commonly used for 10～15g; Radix Rehmanniae,9～40g, commonly used for 15g; Poria,6～20g, commonly used for 15g; Achyranthes bidentata 6-30g, commonly used for 10 or 15g; Achyranthes bidentata,10～24g, commonly used for 15g; Gentiana,5～30g, commonly used for lOg or 15g; Clematis,8～30g, commonly used for 15g; Caulis Spatholobi, commonly used for 15g or 30g; Dipsacus,9～30g, commonly used for 15g; Astragalus,6～150g, commonly used for 30g. ④ The participants included 35 RCT, involving a total of 3735 cases. Meta analysis result showed that the comparative difference of the efficiency was statistically significant [OR=3.07,95% CI:(2.39-3.94)] by comparing the clinical curative effect between traditional Chinese medicine and Western medicine. There was statistical significant difference in the adverse reaction of 2 groups of drugs [OR=0.13 and 95% CI:(0.08-0.19)]; Funnel plot is approximately symmetrical.Conclusion:The main internal medicines of knee osteoarthritis are tonic medicine, blood-activating and stasis-resolving medicinal, and medicine for rheumatism. On the other hand, the main external medicines of knee osteoarthritis are medicine for rheumatism and blood-activating and stasis-resolving medicinal. First, these results show that the compatibility rules of prescriptions of knee osteoarthritis used by modern doctors. Secondly, the results also indicates that the reasons of causing knee osteoarthritis are weak liver and kidney, blockage of cold damp and blood. Methods like supplementing and boosting the liver, kidney, and blood, dispelling cold and eliminating dampness, activating blood and resolving stasis can be used to treat knee osteoarthritis. The efficacy of treating knee osteoarthritis, traditional Chinese medicine is better than Western medicine. Moreover, the adverse reactions of traditional Chinese medicine are less than Western medicine. However, because the number of samples is not enough in this research, larger randomized controlled samples still need to be conducted for further research to prove the reliability. |
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