| Objective:Study 1:Meta analysis was used to evaluate the comprehensive efficacy and safety of traditional Chinese medicine combined with external treatment in the intervention of chronic heart failure,the law of traditional Chinese medicine and the law of external treatment,so as to provide some evidence-based medical evidence for the clinical intervention of traditional Chinese medicine combined with external treatment in chronic heart failure.Study 2:The clinical data of patients with congestive heart failure treated in the second Department of Cardiology,the First Affiliated Hospital of Heilongjiang University of traditional Chinese medicine from January 2020 to January 2022 were analyzed retrospectively.Summarize the characteristics of chronic heart failure,syndrome differentiation,prescription selection and application of external treatment,so as to provide data support for the intervention of traditional Chinese medicine combined with external treatment in heart failure.Methods:Study 1:All the literatures on the intervention of traditional Chinese medicine combined with external therapy in heart failure from the establishment of the database to January 2022 were comprehensively searched by computer.Then the retrieved literatures were screened.Finally,the quality of the document is evaluated through the evaluation guidelines of Cochrane and revman54.1 Meta analysis software.Study 2:102 hospitalized cases of heart failure were sorted and recorded,and statistical methods were used to analyze the age,gender,onset solar terms,basic diseases,TCM syndrome types,distribution of cardiac function,frequency of use of traditional Chinese medicine,frequency of use of basic prescriptions,frequency of use of external treatment and so on.Result:Study 1:there were 22 literatures in line with this study.A total of 2 219 patients with chronic heart failure were included in this study,all of which were RCTs.Meta analysis was conducted on the final included literature,and the following results were obtained:1.Total clinical effective rate:combined effect I~2=0%,RR=1.21,95%CI=[1.15,1.27],Z=7.68,P<0.00001.The results were statistically significant,indic ating that the total clinical effective rate of traditional Chinese medicine combined with external treatment in the intervention of chronic heart failure is better than that of Western medicine alone.2.LVEF:combined effect I~2=42%<50%,MD=6.52,95%CI=[5.81,7.23],Z=17.98,P<0.00001.The results were statistically significant,indicating that the intervention of traditional Chinese medicine combined with external treatment in chronic heart failure is better than western medicine alone in improving LVEF.3.BNP/NT-pro BNP:combined effect I~2=96%>50%,P<0.00001.The source of heterogeneity could not be determined by sensitivity analysis and subgroup analysis.4.6-minute walk test:combined effect I~2=96%>50%,P<0.00001.The source of heterogeneity could not be determined by sensitivity analysis and subgroup analysis.5.LVEDD:combined effect I~2=22%<50%,MD=-5.18,95%CI=[-5.96,-4.39],Z=13.00,P<0.00001.The results were statistically significant,indicating that the intervention of traditional Chinese medicine combined with external treatment in chronic heart failure is better than western medicine alone in improving LVEDD.6.LVDS:combined effect I~2=0%,MD=-6.25,95%CI[-6.97,-5.52],Z=16.92,P<0.0001.The results were statistically significant,indicating that the intervention of traditional Chinese medicine combined with external treatment in chronic heart failure was better than that of Western Medicine alone.7.Among the 22 literatures included,only one reported adverse reactions,including sinus bradycardia,hypotension,gastrointestinal reactions and so on.Due to the lack of literature on adverse reactions,we can not get a definite conclusion.8.The frequency of external therapy used in the included literature is in order of magnitude:Acupoint Application:7 times,exercise therapy:6 times(Baduanjin:1 time,rehabilitation training/rehabilitation exercise:2 time s,respiratory exercise:1 time,aerobic exercise:2 times),acupuncture:3 times,moxibustion:2 times,ear point seed pressing/ear acupuncture/ear point pressing method:2 times,warm acupuncture:1 time,foot bath:1 time.9.In the literature on acupuncture,moxibustion and acupoint application,the top five are Xinshu 8 times,Tanzhong 6 times,Neiguan 5 times,She nshu 3 times and Shenque 3 times.10.The traditional Chinese medicines used in the 40 included literatures were mainly Astragalus membranaceus(16 times),Poria Cocos(15 times),Salvia miltiorrhiza(12 times),roasted licorice(11 times),aconite(10 times),ginseng(19 times),Cinnamon Twig(9 times),Atractylodes macrocephala(8times),Ligusticum chuanxiong(7 times),wild jujube kernel(3 times),Zhul ing(2 times),Achyranthes bidentata(2 times),etc.11.Literature quality analysisAfter the quality evaluation of the 22 RCT literatures using traditional Chinese medicine combined with external treatment,it was found that the quality of the literature was generally low.Most studies did not specify the random distribution mode,distribution concealment,the implementation of blind method and the reasons for falling off or losing follow-up,resulting in the reduction of the credibility and credibility of the research results.Study 2:1.This study shows that the number of patients over 75 years old is the largest.In the two age groups of<55 years old and 55-64 years old,the number of men is more than that of women,and in the other age groups,the number of women is more than that of men.2.This study shows that the hospitalization rate of patients with heart failure in winter(40.20%)is higher than that in the other four seasons,and the proportion of severe cold,heavy snow,beginning of spring,winter solstice and mild cold in the 24 solar terms is the top five.3.This study shows that among the basic diseases of patients with heart failure,coronary heart disease(69.61%),hypertension(66.67%)and arrhythmia(52.94%)ranked the top three respectively.4.This study shows that there is a certain correlation between the distribution of TCM Syndrome Types and the classification of cardiac function.That is,from the stage of qi deficiency and blood stasis,Qi and yin deficiency,phlegm turbidity,and then to the stage of Yang deficiency and flooding,the grade of cardiac function also increases gradually.In cardiac function class II,the incidence of Qi deficiency and blood stasis syndrome was the highest(37.5%),followed by Qi Yin deficiency and blood stasis syndrome(31.25%),Qi deficiency and blood stasis syndrome in cardiac function class II I accounted for the highest proportion(52.27%),followed by Qi and yin deficiency syndrome(22.73%),Yang deficiency and water flooding syndrome in cardiac function class IV accounted for the highest proportion(30.95%),followed by phlegm and turbid lung syndrome(26.19%).5.This study shows that among the 107 traditional Chinese medicines sorted out,the top 60 are used frequently.The top five tonic drugs used in this study are:Licorice,astragalus,angelica,Atractylodes macrocephala,Radix Paeoniae Alba.The medicine for promoting blood circulation and removing blood stasis is peach kernel,safflower,Ligusticum chuanxiong,Salvia miltior rhiza,Yujin,etc;The drugs for diuresis and dampness are as follows:Tingli seed,Poriacocos,big belly skin,plantain seed and mulberry white skin;Expectorant,antitussive and antiasthmatic drugs:Trichosanthes,winter flower,Fritillaria thunbergii,etc;Tranquilizing drugs:Polygala tenuifolia,cypress ke rnel,sour jujube kernel,Poria,Albizzia bark,Polygonum multiflorum vine,etc;Warm medicine:Cinnamon,dried ginger,etc.6.This study shows that the top five frequencies of commonly used traditional Chinese medicine in the heart failure Qi deficiency and blood stasis syndrome are:Astragalus 37 times,licorice 37 times,safflower 35 times,peach kernel 35 times and Angelica 34 times.The top five distributions of the frequency of traditional Chinese medicine in patients with Qi Yin deficiency and blood stasis syndrome of heart failure are:Ophiopogon japonicus 23times,Schisandra chinensis 20 times,Angelica sinensis 19 tim es,Ligusticum chuanxiong 19 times and Salvia miltiorrhiza 18 times.The top five distributions of the frequency of traditional Chinese medicine used by the patients with phlegm turbidity blocking lung syndrome of heart failure are:20 times of Trichosanthes,18 times of licorice,15 times of winter flower and 12 times of Fritillaria thunbergii.The top five distributions of the frequency of traditional Chinese medicine used by the patients with the syndrome of Yang deficiency and water flooding in heart fa ilure are:18 times of licorice,15 times of Poria cocos,15 times of Tinglizi,13 times of cinnamon and 12 times of mulberry bark.7.This study showed that 154 prescriptions were included,including Yangxin Dingchuan Decoction 53 times(34.42%),Xuefu Zhuyu Decoction 26 times(16.88%),Shengmai Powder 18 times(11.69%),Zhenwu Decoction 16 times(10.39%),Tingli Dazao Xiefei Decoction 10 times(6.49%),Baoyuan Decoction 9 times(5.84%),Sanzi Yangqin Decoction 6 times(3.90%),Zaoboling 6 times(3.90%),Gualou Xiebai Banxia Decoction 5 times(3.25%)and Taohong Siwu Decoction 5 times(3.25%).8.This study shows that among the patients with heart failure,the frequency of acupoint application(94.12%)and traditional Chinese medicine smearing(94.12%)is the highest,followed by ear point seed pressing(39.22%),moxibustion(9.80%),partition moxibustion(8.82%),and the least is Qin needle(5.88%).9.This study shows that the number of TCM syndrome types treated with single external treatment combined with internal administration of traditional Chinese medicine is the least,accounting for 5.88%of the total number,followed by double external treatment combined with internal administration of traditional Chinese medicine,accounting for 35.29%of the total number,while there are the largest number of patients treated with triple therapy combined with external treatment of traditional Chinese medicine,accounting for 56.86%of the total number.Among them,single therapy combined with traditional Chinese medicine was used for Qi deficiency and blood stasis syndrome and Qi Yin deficiency and blood stasis syndrome,both of which were2;The maximum number of patients with Qi deficiency and blood stasis syndrome treated with external treatment combined with traditional Chinese medicine:12;The maximum number of patients with Yang deficiency and water flooding syndrome treated with triple external treatment combined with internal administration of traditional Chinese medicine:20.10.This study shows that the top five acupoints used frequently in acu point application are Tanzhong,Neiguan,Xinshu,Zusanli and Ximen.The selected auricular points are:heart,small intestine,subcortical cardiovascular system,sympathetic,Shenmen and heart point.The acupoints with the first five frequencies of use in moxibustion are Neiguan,Tanzhong,Xinshu,Shenmen and Feishu.Conclusion:Study 1:From the results of meta-analysis,it can be concluded that:1.The total clinical effective rate,LVEF,LVEDd and LVDS of CHFT reated with traditional Chinese medicine combined with external treatment are better than those treated with western medicine alone.Through descriptive analysis,it is suggested that the intervention of traditional Chinese medicine combined with external treatment in CHF is superior to the basic treatment of Western medicine alone in improving the level of BNP or NT pro BNP and 6-minute walk test,and has significant advantages in clinical practice.2.In terms of adverse reactions of CHF Treated with traditional Chinese medicine combined with external treatment,there are few relevant data,and no definite conclusion can be reached.3.In clinical practice,the five most commonly used external treatment methods of traditional Chinese medicine combined with external treatment in the intervention of CHF are:acupoint application,exercise therapy,acupuncture,moxibustion,ear point seed pressing/ear acupuncture/ear point pressing.4.In clinical practice,the five commonly used acupoints for acupuncture,moxibustion and Acupoint Application in CHF intervention with traditional Chinese medicine combined with external treatment are:Xinshu,Tanzhong,Neiguan,Shenmen and Shenshu.5.In clinical practice,the most commonly used 10 traditional Chinese medicines in the intervention of CHF with traditional Chinese medicine combined with external treatment are:Astragalus membranaceus,Poria cocos,Sal via miltiorrhiza,roasted licorice,aconite,ginseng,Cinnamon Twig,Atractylo des macrocephala,Ligusticum chuanxiong,and semen ziphi Spinosae,which are mainly traditional Chinese medicines of Supplementing Qi and restoring Yang,activating blood circulation and removing blood stasis,promoting water and detumescence,nourishing heart and calming nerves.Study 2:From the retrospective analysis of the medical records of 102 patients,it can be concluded that:1.The incidence rate of CHF in men before 65 years old is higher than that in women,and the incidence rate in women after 65 years old is hig her than that in men.The incidence rate of the patients was higher in winter and spring.2.The most common basic diseases:coronary heart disease,hypertension,arrhythmia.3.There is a correlation between each TCM syndrome type and cardiac function classification.The majority of patients with Qi deficiency and blood stasis syndrome in cardiac function class II and III,and the majority of patients with Yang deficiency and water flooding syndrome in cardiac function class IV.4.Astragalus membranaceus,licorice,safflower,peach kernel and Angelica sinensis are frequently used in Qi deficiency and blood stasis syndrome;The frequency of using Ophiopogon japonicus,Schisandra chinensis,Angelica sinensis,Ligusticum chuanxiong,Salvia miltiorrhiza in the syndrome of deficiency of both qi and Yin and blood stasis is more;The frequency of using Trichosanthes kirilowii,Glycyrrhiza uralensis,Amomum villosum and Fritillar ia thunbergii in the syndrome of phlegm stagnating in the lung was higher;The frequency of applying licorice,Poria cocos,drab seed,cinnamon,mulberry bark,etc.in the syndrome of Yang deficiency and water flooding is more.5.This deficiency syndrome is often treated with tonics,such as Yangxin Dingchuan decoction,Shengmai Powder,zaoboling,etc;The standard demonstration mainly focuses on removing blood stasis,promoting water and resolving phlegm,such as Xuefu Zhuyu Decoction,Zhenwu Decoction,Tingli Dazao xiefei decoction,Baoyuan decoction,Sanzi Yangqin decoction,Gualou Xie bai Banxia Decoction and Taohong Siwu Decoction.6.acupoint application and traditional Chinese medicine smearing are used more frequently in various TCM syndrome types.The most commonly used acupoints in acupoint application are Tanzhong,Neiguan,Xinshu,Zusanli and Ximen.The most commonly used ear points in ear point seed pressing are:heart,small intestine,subcortical cardiovascular system,sympathetic,Shenmen and heart point.The most commonly used acupuncture points in moxib ustion are Neiguan,Tanzhong,Xinshu,Shenmen and Feishu.7.the number of patients with Yang deficiency and water flooding syndrome who use triple external treatment combined with internal administration of traditional Chinese medicine is the largest,which may be related to the serious condition of patients with Yang deficiency and water flooding syndrome,and the number of patients who use triple external treatment combined with internal administration of traditional Chinese medicine is the largest in all TCM syndrome types,which may be related to the serious condition of patients with CHF and the lingering death. |
