Meta-analysis And Medication Rule Analysis Of Oral Chinese Herbal Decoctions In The Treatment Of Crohn's Diseas

Objective:To conduct a meta-analysis of randomized controlled trials of oral Chinese herbal decoction in the treatment of Crohn’s disease,evaluate its efficacy and safety,and explore the selection and medication rules of oral Chinese herbal decoction in the treatment of Crohn’s disease in modern literature,providing reference for clinical treatment of Crohn’s disease.Methods:(1)Databases including Pub Med,Cochrane Library,China National Knowledge Infrastructure(CNKI),China Biology Medicine disc(CBM),Wanfang Data,and VIP Chinese Science and Technology Periodical Database were searched for studies on oral Chinese herbal decoction for the treatment of Crohn’s disease,with a search period from database inception to August 31,2022.Eligible studies were selected based on inclusion criteria,and data extraction and quality evaluation were performed on included studies.Data analysis was conducted using Rev Man 5.4.1 software.(2)Literature on the treatment of Crohn’s disease with oral Chinese herbal decoction was searched from CNKI,CBM,Wanfang Data,and VIP Chinese Science and Technology Periodical Database,including randomized controlled trials and expert summaries.A database was established using medical case cloud platform,and data mining methods were used to analyze the drugs.Results:(1)Through searching,18 studies were ultimately included,involving 1239 patients.Meta analysis results showed that the clinical effective rate of oral Chinese herbal decoction combined with conventional Western medicine in the treatment of Crohn’s disease(RR =1.13,95% CI=[1.05,1.22],P=0.0009),changes in CDAI scores(SMD=1.08,95% CI=[0.53,1.63],P=0.0001),endoscopic performance effective rate(RR = 1.26,95% CI=[1.10,1.46],P=0.001),and changes in CRP(SMD=0.53,95% CI=[0.53,1.29],P<0.0001),Changes in ESR(SMD=1.29,95% CI=[0.83,1.76],P<0.0001),TNF-α The changes(SMD=0.92,95%CI=[0.66,1.18],P<0.0001)were superior to conventional Western medicine treatment.The incidence of adverse reactions during the treatment process was 3.66% in the oral Chinese herbal decoction combined with conventional Western medicine treatment group,and 7.93% in the conventional Western medicine treatment group.(2)Through Document retrieval and screening,a total of 62 articles on the treatment of CD with oral Chinese herbal decoction were collected,including 66 prescriptions and 186 Chinese herbs.The results showed that the top 10 drugs with higher frequency of use were Atractylodes macrocephala,licorice,Codonopsis pilosula,Poria cocos,Paeonia lactiflora,Coptis chinensis,Angelica sinensis,Coix seed,tangerine peel,and Astragalus membranaceus.The four qi of medicine are mainly warm,calm,and slightly cold.The five flavors of medicine are sweet,bitter,and pungent.In terms of drug meridians,medication mainly focuses on the spleen,stomach,and lung meridians.Through correlation analysis,traditional Chinese medicine can be divided into four categories: Ju 1 is licorice,Ju 2 is Codonopsis pilosula,Atractylodes macrocephala,and Poria cocos,Ju 3 is roasted licorice,dried ginger,Angelica sinensis,and Astragalus membranaceus,and Ju 4 is Huanglian,Muxiang,White peony,Coix seed,and tangerine peel.Through the Complex network analysis of drugs,it was concluded that the core drug combinations included: Atractylodes macrocephala,Poria cocos,Codonopsis pilosula,liquorice,white peony,Coix lachryma seed,tangerine peel,astragalus membranaceus,coptis,angelica,yam,woodincense,roasted liquorice,and dried ginger.Conclusion:(1)In terms of systematic evaluation,this study conducted a meta-analysis of modern literature on the treatment of Crohn’s disease through oral Chinese herbal decoction.The results showed that the combination of oral Chinese herbal decoction and conventional Western medicine treatment has better clinical efficacy,lower CDAI score,better endoscopic performance,and better physicochemical indicators compared to conventional Western medicine treatment,In terms of safety evaluation,oral traditional Chinese medicine decoction has also shown good safety.(2)In terms of medication pattern analysis,this study conducted data mining on the formulas of oral Chinese herbal decoction for treating Crohn’s disease.It was found that from the perspectives of medication frequency,correlation analysis,cluster analysis,etc.,oral Chinese herbal decoction for treating CD mainly focuses on strengthening the spleen,supplementing qi and dispelling dampness,while also taking into account the lungs and stomach.Clinical medication is mainly warm,mild,and slightly cold,and the five flavors are mainly sweet,bitter,and spicy.However,there is less literature included in this study.We look forward to more and more complete cases of CD treated by traditional Chinese medicine in the future,and on this basis,we will strengthen the basic research on the treatment of CD by the Active ingredient of traditional Chinese medicine alone,drug pairs,and prescriptions,so that traditional Chinese medicine can play a more important role in treating CD.