| Objective:A systematic review and meta-analysis of trials for treating lumbar disc herniation using Chinese medicine was carried out to evaluate the effectiveness and safety of Chinese medicine.Meanwhile,the commonly used Chinese herbs in the included trials were analyzed and summarized,to provide a valuable reference for the treatment of lumbar disc herniation using Chinese medicine.Methods:1.The literature for the treatment of lumbar disc herniation using Chinese medicine,published in databases from 1997 to 2017 were retrieved;2.According to the inclusion and exclusion criteria,the required literature were selected,and the quality of which was evaluated,and information was extracted,in which the outcome measurements included total effective rate,IL-1 β,TNF-α,VAS score,JOA score,ODI,EMG fibrillation wave and adverse reactions;3.A systematic review and meta-analysis was carried out using Revman 5.3 software,to evaluate the safety and efficacy of Chinese medicine in the treatment of lumbar disc herniation;4.The formulas rules of the Chinese herbs used in the included trials were analyzed and summarized.Results:31 studies were included in this systematic review and meta-analysis.29 studies reported total effective rate as outcome measurement,the meta-analysis result showed OR=3.04,95% CI [2.20,4.20],Z=6.77,P<0.00001,demonstrating the effective rate in the treatment group was higher than that in the control group.6 studies reported VAS score,and the meta-analysis showed MD=-0.95,95% CI [-1.61,-0.3],P=0.004,indicating a lower VAS score in the treatment group.5 studies used JOA score as outcome measurement,the results showed MD =2.20,95% CI [0.96.3.44],P=0.0005,demonstrating a higher value of JOA scores in the treatment group.2 studies reported ODI,the result showed MD =0.95,95% CI[-1.59,3.49],Z=0.73,P=0.46,indicating no significant difference between the two groups.1 trial reported the significantly lower serum levels of IL-1β and TNF-α in the treatment group,and the improvement of EMG-fibrillation also showed advantage in the treatment group(P<0.05).The incidence of adverse reactions was reported in 4 studies,the meta-analysis showed OR=1.20,95% CI [0.96,3.44],Z=0.41,P=0.68,indicating no significant difference between the two groups.In addition,herbal prescription rule showed the most frequently used herbs in the treatment of lumbar intervertebral herniation were tonic herbs which were used for 143 times,accounting for 29% of the total frequency,followed by herbs of promoting blood circulation and removing blood stasis,herbs of dispeling wind wet through meridian,herbs for exterior-releasing,and the frequency was 124,91 and 42 times,accounting for 25.2%,18.5%,and 8.5% of the total frequency,respectively.Conclusion:Chinese medicine compound for the treatment of lumbar disc herniation had better effectiveness than control group in improving the total effective rate,decreasing pain scores,improving clinical symptoms and signs,increasing lumbar function,decreasing serum IL-1 β and TNF-α level,and improving neurological function,but there was no significant difference in the incidence of adverse reactions and ODI scores between Chinese medicine group and the commonly used western medicine.The effective Chinese herbal formulae included in the study were additions and subtractions of the recipes such as Duhuo Jisheng decoction,ShenTong Zhu Yu decoction,Sheng Yu decoction,and Wu Tou decoction.According to the results of frequency analysis of traditional Chinese medicines,the Chinese herbs commonly used for the treatment of lumbar disc herniation were Achyranthes bidentata,Angelica sinensis,Radix Glycyrrhizae,Radix Salviae Miltiorrhizae,Rhizoma Chuanxiong,Carthamus tinctorius,Eucommia ulmoides,Rehmannia glutinosa,and Mulberry parasitic.The most commonly used Chinese herbs were herbs of tonifying the liver and kidney,followed by those of promoting blood circulation and removing stasis,dispeling wind wet through meridian.,invigorating qi and blood,and dispelling exogenous pathogens. |
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