Systematic Review The Efficacy Of Traditional Chinese Medicine And Integrated Traditional Chinese And Western Medicine In The Treatment Of Menopausal Depression And Preliminary Analyse The Medication Rules

Objective: Systematic evaluated the clinical efficacy of TCM and integrated Chinese and western medicine in the treatment of menopausal depression to provide evidence for the treatment of menopausal depression with traditional Chinese medicine combined with western medicine.Through data mining technology was used to analyze the medication rules of the included literature to obtained high-frequency drugs,excavate the common drug pairs,angle drugs,drug combinations,and cluster prescriptions of high-frequency drugs,and preliminarily understood and explored the prescription drug rules for the treatment of menopausal depression,to provide some reference for clinical drug use and the development of new prescription of related traditional Chinese medicine.Methods: Computer searched CNKI,Wanfang,VIP,CBM,PubMed,Embase,and Cochrane Library database for all randomized controlled trials of Chinese medicine or combination of Chinese medicine and Western medicine in the treatment of menopausal depression until July 18,2020.Screened out the literature that meets the criteria,and Hamilton depression rating scale(HAMD)score,Kupperman scale(KMI)score,Pittsburgh sleep quality scale(PSQI)score,the incidence of adverse events,follow-up situation and laboratory indicators were collected as statistical data.Laboratory indexes were endocrine hormone indexes: follicle-stimulating hormone(FSH)level,luteinizing hormone(LH)level,estradiol(E2)level,and monoamine neurotransmitter indexes: serotonin(5-HT)level,noradrenaline(NE)level.According to the bias risk assessment tool provided by the Cochrane Collaboration and the Jadad scale,the quality of the included literature was evaluated.Rev Man5.3 was used for statistical analysis of the data,and Stata12.0 was used for quantitative analysis of publication bias.Based on data mining technology,SPSS Statistics21.0 and SPSS Modeler18.0 were used to analyze the medication regularity of the included studies.Results: The retrieval results: a total of 914 studies were detected,and 35 studies were finally included,including 9 studies of Chinese medicine VS western medicine group and 26 studies of the combination of Chinese and western medicine VS western medicine group.Meta-analysis results:(1)Meta-analysis Chinese medicine VS western medicine group Compared with western medicine treatment,TCM treatment:(1)Had more advantages in improving clinical efficiency(OR=1.98,95%CI=(1.32,2.98),Z=3.31,P=0.0009);(2)There was no significant advantage in lowering HAMD scores(SMD=-0.19,95%CI=(-0.53,0.16),Z=1.07,P=0.29);(3)Could effectively reduce KMI scores(SMD=-1.40,95%CI=(-2.23,-0.56),Z=3.28,P=0.001)and PSQI scores(SMD=-2.01,95%CI=(-2.53,-1.49),Z=7.58,P <0.00001);(4)There was no obvious advantage in reducing the levels of FSH and LH,while the effect of increasing the level of E2 was better,(SMD=-0.37,95%CI=(-0.78,0.05),Z=1.72,P=0.09),LH(SMD=-0.09,95%CI=(-0.34,0.15),Z=0.74,P=0.46),E2(SMD=1.05,95%CI=(0.27,1.82),Z=2.65,P=0.008);(5)There was no obvious advantage in increasing the levels of 5-HT and NE,5-HT(SMD=0.00,95%CI=(-0.24,0.25),Z=0.02,P=0.99),NE(SMD=0.15,95%CI=(-0.13,0.42),Z=1.04,P=0.30);(6)Had a low incidence of adverse reactions(OR=0.21,95%CI=(0.10,0.45),Z=3.99,P<0.0001).(2)Meta-analysis of the combination of Chinese and western medicine VS western medicine group Compared with western medicine treatment,the combined treatment of Chinese and western medicine:(1)Had more advantages in improving clinical efficiency(OR=4.38,95%CI=(3.21,5.97),Z=9.34,P<0.00001);(2)Could effectively reduce HAMD scores(SMD=-1.50,95%CI=(-1.97,-1.03),Z=6.23,P<0.00001),KMI scores(SMD=-2.01,95%CI=(-2.93,-1.09),Z=4.26,P<0.0001)and PSQI scores(SMD=-1.93,95%CI=(-3.07,-0.80),Z=3.34,P=0.0008);(3)The effect of decreasing FSH,LH and increasing E2 was better,FSH(SMD=-1.28,95%CI=(-1.84,-0.72),Z=4.49,P < 0.00001),LH(SMD=-0.60,95%CI=(-0.95,-0.25),Z=3.40,P=0.0007),E2(SMD=0.68,95%CI=(0.03,1.32),Z=2.06,P=0.04);(4)The therapeutic effect of increasing5-HT and NE levels was better,5-HT(SMD=1.46,95%CI=(0.87,2.05),Z=4.85,P<0.00001),NE(SMD=1.45,95%CI=(0.89,2.01),Z=5.06,P<0.00001);(5)Had a low incidence of adverse reactions(OR=0.32,95%CI=(0.18,0.60),Z=3.62,P=0.0003).The results of the descriptive analysis: the analysis of the follow-up of the two groups found that the number of relapses of TCM is less than that of western medicine;The number of relapses in the combination of Chinese and western medicine was less than that in the western medicine treatment.The results of analysis of medication rule: The top 5 traditional Chinese medicines in the frequency of use were Bupleurum,Radix Curcumae,Tuckahoe,Radix Paeoniae Alba and Angelica Sinensis;The top 5 categories of drugs were tonify deficiency medicine(33.83%),heat-clearing drugs(11.98%),calming drugs(9.88%),activating blood circulation herbs(9.28%)and diaphoretic drugs(8.68%).In the analysis of drug association rules,the first two drug pairs were Bupleurum →Poria Cocos and Bupleurum → Angelica;The first two famous herbs were Cortex Moutan + Bupleurum → Radix Curcumae,Cortex Albiziae + Radix Curcumae → Bupleurum;The first two groups were Cortex Moutan + Radix Curcumae + Bupleurum → Cortex Albiziae,Cortex Albiziae +Radix Curcumae + Bupleurum → Cortex Moutan.Cluster analysis of high-frequency drugs resulted in 6 drug groups,C1: Bupleurum,Angelica Sinensis,Ligusticum Chuanxiong,Jujube kernel and Rhizoma Anemarrhenae;C2: Radix Curcumae,Paeonia Lactiflora,Glycyrrhiza,Rehmannia Glutinosa,Cortex Albiziae,Cortex Moutan,Radix Acanthoanacis Senticosi;C3: Poria Cocos,Rehmannia Glutinosa,Cornus Officinalis,Uncaria,Coptis;C4: lily,Caulis Polygoni Multiflori,Cassia Twig,keel,Codonopsis;C5: Honey-Hired Licorice Root,Epimedium;C6: Tangerine Peel.Conclusion:(1)Compare with western medicine treatment,the TCM therapy,and combination of Chinese and western therapy has certain advantages in improving the clinical effective rate and reducing KMI score and PSQI score;The number of relapses he traditional Chinese medicine,and combined treatment of Chinese medicine and western medicine was small.(2)Compare with western medicine treatment,the combined treatment of Chinese and western medicine shows better efficacy in regulating the level of monoamine neurotransmitters,disturbance of estrogen and lowering the score of HAMD.The efficacy of Chinese medicine treatment is equivalent to that of western medicine treatment.(3)Through data mining of the include prescriptions,the drug use summarized,and the common drug pairs,angle drugs,drug groups and cluster prescriptions of high-frequency drugs are mined,to provide a certain analysis idea of drug use rules for the treatment of menopausal depression by traditional Chinese medicine.The combined treatment of Chinese and Western medicine can improve clinical efficiency,improve the clinical symptoms and reduce adverse reactions in patients with menopausal depression,which provides a reference for the combined treatment of Chinese and Western medicine in the treatment of menopausal depression.However,the quality of the included studies is not high,and the results should be treated with caution.Prospective,multi-center,large-sample,high-quality randomized controlled trials should be carried out to verify the clinical efficacy.