Efficacy and safety of oral Chinese patent medicines combined with conventional western medicines in the treatment of lumbar disc herniation: a network Meta-analysis

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Author: REN Woxing ^1, ² DING Lipeng ^1, ² LU Jiehang ^1, ² GE Haiya ^1, ² LIU Yongming ^1, ² WANG Zhengming ^1, ²  ZHAN Hongsheng ^1, ²

Affiliation: 1. Shi's Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China 2. Institute of Traumatology & Orthopedics, Shanghai Academy of Traditional Chinese Medicine, Shanghai 201203, China

Keywords: Chinese patent medicine Lumbar disc herniation Network Meta-analysis Randomized clinical trial

DOI: 10.12173/j.issn.1005-0698.202401032

Reference: REN Woxing, DING Lipeng, LU Jiehang, GE Haiya, LIU Yongming, WANG Zhengming, ZHAN Hongsheng.Efficacy and safety of oral Chinese patent medicines combined with conventional western medicines in the treatment of lumbar disc herniation: a network Meta-analysis[J].Yaowu Liuxingbingxue Zazhi,2024, 33(6):666-677.DOI: 10.12173/j.issn.1005-0698.202401032.[Article in Chinese]  Copied

Abstract
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Abstract

Objective To systematically review the efficacy and safety of different oral Chinese patent medicines combined with conventional western medicines in the therapy of lumbar disc herniation (LDH).

Methods PubMed, Embase, Cochrane Library, Medline, CNKI, WanFang data, VIP and SinoMed databases were electronically searched to collect randomized clinical trials (RCTs) on oral Chinese patent medicines combined with conventional western medicines in the treatment of LDH from the inception to April 10, 2023. Two reviewers independently screened the literature, extracted data, and evaluated the risk of bias of included studies. Network Meta-analysis was then performed by Stata 17.0 and RevMan 5.4 softwares.

Results A total of 26 RCTs were included, involving 16 Chinese patent medicines with a total sample size of 2 448 cases. The network Meta-analysis results showed that 13 Chinese patent medicines combined with conventional western medicines had better effects than conventional western medicines alone. Among them, in terms of a better VAS score, the top three interventions were Jingyaokang capsules+ conventional western medicine>Yaobitong capsules+conventional western medicine>Huoxue Zhitong capsules+conventional western medicine; in terms of a better Japanese Orthopaedic Associationl (JOA) score, the top three interventions were Qufeng Zhitong capsules+conventional western medicine>Yaobitong capsules+conventional western medicine>Luchuan Huoluo capsules+conventional western medicine; in terms of the clinical effective rate, the top three interventions were Luchuan Huoluo capsules+conventional western medicine>Xianling Gubao capsules+conventional western medicine>Tongzhi Surunjiang capsules+conventional western medicine; in terms of safety, no serious adverse drug reactions occurred in all studies, and the overall incidence of adverse drug reactions in the oral Chinese patent medicines combined with conventional western medicines group was lower than that in the conventional western medicines group.

Conclusion The combination of oral Chinese patent medicines and conventional western medicines has been shown to improve the clinical efficacy of LDH. Among these, Yaobitong capsules stand out for its ability to reduce VAS score, improve JOA score ranking, and increase the effective rate. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusions.

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1.中华医学会骨科学分会脊柱外科学组, 中华医学会骨科学分会骨科康复学组. 腰椎间盘突出症诊疗指南 [J]. 中华骨科杂志, 2020, 40(8): 477-487. DOI: 10.3760/cma.j.cn121113-20200402-00213.

2.Deyo RA, Loeser JD, Bigos SJ. Herniated lumbar intervertebral disk[J]. Ann Intern Med, 1990, 112(8): 598-603. DOI: 10.7326/0003-4819-112-8-598.

3.王嘉熙, 孔祥豪, 郭代红, 等. 5 597例非甾体抗炎药的不良反应报告分析[J]. 药物流行病学杂志, 2021, 30(7): 457-461. [Wang JX, Kong XH, Guo DH, et al. Analysis of 5 597 reports of adverse reactions to NSAIDs[J]. Chinese Journal of Pharmacoepidemiology, 2021, 30(7): 457-461.] DOI: 10.19960/j.cnki.issn1005-0698.2021.07.006.

4.Wang Y, Dai G, Jiang L, et al. The incidence of regression after the non-surgical treatment of symptomatic lumbar disc herniation: a systematic review and meta-analysis[J]. BMC Musculoskelet Disord, 2020, 21(1): 530. DOI: 10.1186/s12891-020-03548-z.

5.国家中医药管理局, 编. 中医病证诊断疗效标准[M]. 南京: 南京大学出版社, 1994: 219.

6.李雨芯,熊俊,张政,等. 中药系统评价/Meta分析报告规范(PRISMA-CHM)解读[J]. 中国循证医学杂志, 2023, 23(11): 1351-1359. [Li YX, Xiong J, Zhang Z, et al. Interpretation of the PRISMA extension for Chinese herbal medicine review(PRISMA-CHM)[J]. Chinese Journal of Evidence-Based Medicine, 2023, 23(11): 1351-1359.] DOI: 10.7507/1672-2531.202303057.

7.董永强, 袁波, 何鑫东,等. 腰痹通治疗腰椎间盘突出症效果观察[J]. 中国乡村医药, 2017, 24(24): 48-49. [Dong YQ, Yuan B, He XD, et al. Observation on the therapeutic effect of Yaobitong on lumbar disc herniation[J]. Chinese Journal of Rural Medicine and Pharmacy, 2017, 24(24): 48-49.] DOI: 10.3969/j.issn. 1006-5180.2017.24.027.

8.陈坚样, 陆文杰, 陈仲夷, 等. 腰痹通联合西药治疗腰椎间盘突出症疗效观察[J]. 中华中医药学刊, 2015, 33(7): 1771-1773. [Chen JY, Lu WJ, Chen ZY, et al. Lumbar disc herniation of Yaobitong capsule combined with western medicine[J]. Chinese Archives of Traditional Chinese Medicine, 2015, 33(7): 1771-1773.] DOI: 10.13193/j.issn.1673-7717.2015.07.071.

9.张拥军, 林奋强, 卫玉光. 腰痹通联合甲钴胺治疗腰椎间盘突出症的效果评价[J]. 中国当代医药, 2018, 25(5): 151-153. [Zhang YJ, Lin FQ, Wei YG. Effect evaluation of Yaobitong combined with mecobalamin in the treatment of lumbar disc herniation[J]. China Modern Medicine, 2018, 25(5): 151-153.] DOI: 10.3969/j.issn. 1674-4721.2018.05.050.

10.隋晓辉. 腰痹通胶囊治疗腰椎间盘突出症患者的临床疗效[J]. 中国药物经济学, 2020, 15(12): 62- 65. [Sui XH. Clinical efficacy of Yaobitong capsule in the treatment of lumbar disc herniation[J]. China Journal of Pharmaceutical Economics, 2020, 15(12): 62-65.] DOI: 10.12010/j.issn.1673-5846.2020.12.014.

11.钟导强, 罗丽群. 腰痹通胶囊联合甘露醇及地塞米松治疗早期腰椎间盘突出症的疗效观察[J]. 内蒙古中医药, 2019, 38(7): 72-73. [Zhong DQ, Luo LQ. Observation on the therapeutic effect of Yaobitong capsules combined with mannitol and dexamethasone in the treatment of early lumbar disc herniation[J]. Nei Mongol Journal of Traditional Chinese Medicine, 2019, 38(7): 72-73.] DOI: CNKI:SUN:NZYY.0.2019-07-050.

12.吴小平. 腰痛宁胶囊治疗腰椎间盘突出症疗效观察[J]. 现代中西医结合杂志, 2006, 15(7): 898-898. [Wu XP. Observation on the therapeutic effect of Yaotongning capsules on lumbar disc herniation[J]. Modern Journal of Integrated Traditional Chinese and Western Medicine, 2006, 15(7): 898-898.] DOI: 10.3969/j.issn.1008-8849.2006.07.044.

13.邢淑芳, 李树霞, 丁静, 等. 腰痛宁胶囊治疗腰椎间盘突出症的疗效观察[J]. 中国药房, 2011, 22(48): 4556-4557. [Xing SF, Li SX, Ding J, et al. Efficacy observation of Yaotongning capsule in the treatment of lumbar disc herniation[J]. China Pharmacy, 2011, 22(48): 4556-4557.] DOI: CNKI:SUN:ZGYA.0.2011-48-019.

14.车玥琛, 张哲, 车月玫. 腰痛宁胶囊联合塞来昔布治疗腰椎间盘突出症的临床研究[J]. 现代药物与临床, 2019, 34(10): 3123-3126. [Che YC, Zhang Z, Che YM. Clinical study on Yaotongning capsules combined with celecoxib in treatment of lumbar disc herniation[J]. Drugs & Clinic, 2019, 34(10): 3123-3126.] DOI: 10.7501/j.issn.1674-5515.2019.10.050.

15.王旭光, 周景民, 朱瑞达. 腰痛宁胶囊联合复方倍他米松注射液治疗腰椎间盘突出症的临床效果观察[J]. 首都食品与医药, 2020, 27(19): 87-88. [Wang XG, Zhou JM, Zhu RD. Clinical observation on the treatment of lumbar intervertebral disc herniation with Yaotongning capsules combined with compound betamethasone injection[J]. Capital Medicine, 2020, 27(19): 87-88.] DOI: 10.3969/j.issn.1005-8257.2020.19.063.

16.段小锋, 陈俊君. 仙灵骨葆胶囊联合地奥司明治疗腰椎间盘突出症的临床研究[J]. 现代药物与临床, 2016, 31(8): 1236-1240. [Duan XF, Chen JJ. Clinical study on Xianling Gubao capsules combined with diosmin in treatment of lumbar disc herniation[J]. Drugs & Clinic, 2016, 31(8): 1236-1240.] DOI: 10.7501/j.issn.1674- 5515.2016.08.027.

17.李明, 王伟卓, 王丹, 等. 仙灵骨葆胶囊联合地奥司明治疗腰椎间盘突出症的临床效果[J]. 临床医学研究与实践, 2019, 4(10): 136-138. [Li M, Wang WZ, Wang D, et al. Clinical effect of Xianling Gubao capsule combined with diosmin in the treatment of lumbar disc herniation[J]. Clinical Research and Practice, 2019, 4(10): 136-138.] DOI: 10.19347/j.cnki.2096-1413.201910053.

18.王照平, 何嘉, 杨亚军, 等. 通滞苏润江胶囊治疗腰椎间盘突出症及对自身免疫功能的影响[J]. 大医生, 2019, 4(16): 116-117. [Wang ZP, He J, Yang YJ, et al. Effect of Tongzhi Surunjiang capsules on lumbar disc herniation and autoimmunity[J]. DOCTOR, 2019, 4(16): 116-117.] https://d.wanfangdata.com.cn/periodical/dysh201916058.

19.李欣艳. 通滞苏润江胶囊治疗腰椎间盘突出症的临床观察[J]. 吉林医学, 2019, 40(1): 86-87. [Li XY. The clinical efficacy of Tongzhi Su Runjiang capsule in the treatment of lumbar disc herniation[J]. Jilin Medical Journal, 2019, 40(1): 86-87.] DOI: 10.3969/j.issn.1004-0412.2019.01.036.

20.胡红卫, 华雨, 胡泊. 颈腰康胶囊与双氯芬酸钠治疗腰椎间盘突出症的临床效果及对腰椎功能的影响[J]. 黑龙江中医药, 2020, 49(6): 3-4. [Hu HW, Hua Y, Hu P. Clinical effects of Jingyaokang capsules and diclofenac sodium in the treatment of lumbar disc herniation and their impact on lumbar spine function[J]. Heilongjiang Journal of Traditional Chinese Medicine, 2020, 49(6): 3-4.] https://www.cnki.com.cn/Article/CJFDTotal-HLZY202006003.htm.

21.钟涛, 齐保闯, 向前生. 颈腰康胶囊联合双氯芬酸钠治疗腰椎间盘突出症的临床研究[J]. 现代药物与临床, 2019, 34(12): 3712-3715. [Zhong T, Qi BC, Xiang QS. Clinical study on Jingyaokang capsules combined with diclofenac sodium in treatment of lumbar disc herniation[J]. Drugs & Clinic, 2019, 34(12): 3712-3715.] DOI: 10.7501/j.issn.1674-5515.2019.12.047.

22.董文. 痹祺胶囊联合甘露醇加地塞米松早期治疗腰椎间盘突出症的可行性分析[J]. 医学理论与实践, 2021, 34(3): 441-443. [Dong W. Feasibility analysis of early treatment of lumbar disc herniation with Biqi capsules combined with mannitol and dexamethasone[J]. The Journal of Medical Theory and Practice, 2021, 34(3): 441-443.] DOI: 10.19381/j.issn.1001-7585.2021.03.037.

23.邓祖国, 朱敬静. 独活寄生丸联合布洛芬缓释胶囊治疗寒湿型腰椎间盘突出症临床效果观察[J]. 现代中西医结合杂志, 2016, 25(7): 770-773. [Deng ZG, Zhu JJ. Observation on the clinical effect of Duhuo Jisheng pill combined with Ibuprofen sustained-release capsules in the treatment of cold dampness type lumbar disc herniation[J]. Modern Journal of Integrated Traditional Chinese and Western Medicine, 2016, 25(7): 770-773.] DOI: 10.3969/j.issn.1008-8849.2016.07.030.

24.曹闲雅, 匡浩铭, 苏翔,等. 恒古骨伤愈合剂治疗腰椎间盘突出症肾虚血瘀证的临床研究[J]. 湖南中医药大学学报, 2020, 40(12): 1548-1552. [Cao XY, Kuang HM, Su X, et al. Clinical study on osteoking for lumbar intervertebral disc herniation with kidney deficiency and blood stasis syndrome[J]. Journal of Traditional Chinese Medicine University of Hunan, 2020, 40(12): 1548-1552.] DOI: 10.3969/j.issn.1674-070X.2020.12.021.

25.耿磊, 李校阳, 刘洪峰. 活血通脉片联合新癀片治疗腰椎间盘突出症临床研究[J]. 中西医结合研究, 2014, (6): 313-314. [Geng L, Li XY, Liu HF. Clinical study on the combination of Huoxue Tongmai tablets and Xinhuang tablets in the treatment of lumbar disc herniation[J]. Research of Integrated Traditional Chinese and Western Medicine, 2014, (6): 313-314.] DOI: 10.3969/j.issn.1674-4616.2014.06.014.

26.吴继来. 活血止痛胶囊联合甲钴胺胶囊治疗急性腰椎间盘突出症的临床疗效[J]. 临床合理用药杂志, 2016, 9(6): 70-71. [Wu JL. Clinical efficacy of Huoxue Zhitong capsules combined with methylcobalamin capsules in the treatment of acute lumbar intervertebral disc herniation[J]. Chinese Journal of Clinical Rational Drug Use, 2016, 9(6): 70-71.] DOI: 10.15887/j.cnki.13-1389/r.2016.06.037.

27.祝孟坤, 李新军, 代耀军, 等. 金天格胶囊联合地奥司明治疗腰椎间盘突出症的临床研究[J]. 现代药物与临床, 2022, 37(2): 354-358. [Zhu MK, Li XJ, Dai YJ, et al. Clinical study on Jintiange capsules combined with diosmin in treatment of lumbar disc herniation[J]. Drugs & Clinic, 2022, 37(2): 354-358.] DOI: 10.7501/j.issn.1674-5515.2022.02.024.

28.张景瑜. 鹿川活络胶囊治疗腰椎间盘突出症临床研究[J]. 河南中医, 2017, 37(4): 666-668. [Zhang JY. The clinical research into lumbar disc herniation treated with Luchuan Huoluo capsules[J]. Henan Traditional Chinese Medicine, 2017, 37(4): 666-668.] DOI: 10.16367/j.issn.1003-5028.2017.04.0236.

29.王婷. 盘龙七片联合洛芬待因治疗寒湿型腰椎间盘突出症的临床疗效[J]. 临床合理用药杂志, 2019, 12(3): 21-22. [Wang T. Clinical effect of Panlongqi tablets combined with ibuprofen and codeine phosphate tablets in treating cold-humid lumbar disc protrusion[J]. Chinese Journal of Clinical Rational Drug Use, 2019, 12(3): 21-22.] DOI: 10.15887/j.cnki.13-1389/r.2019.03.010.

30.刘献强, 唐臻一, 王博韬, 等. 祛风止痛胶囊联合甲钴胺治疗腰椎间盘突出症的临床研究[J]. 现代药物与临床, 2022, 37(5): 1066-1070. [Liu XQ, Tang ZY, Wang BT, et al. Clinical study on Qufeng Zhitong capsules combined with mecobalamin in treatment of lumbar disc herniation[J]. Drugs & Clinic, 2022, 37(5): 1066-1070.] DOI: 10.7501/j.issn.1674-5515.2022.05.026.

31.高瑞. 舒筋健腰丸联合双氯芬酸钠治疗腰椎间盘突出症的疗效观察[J]. 航空航天医学杂志, 2021, 32(6): 694-695. [Gao R. Observation on the efficacy of Shujin Jianwu pills combined with diclofenac sodium in the treatment of lumbar intervertebral disc herniation[J]. Journal of Aerospace Medicine, 2021, 32(6): 694-695.] DOI: 10.3969/j.issn.2095-1434.2021.06.033.

32.何鹏宇, 齐峰, 宋华,等. 藤黄健骨胶囊联合注射用骨瓜提取物治疗老年腰椎间盘突出症[J]. 中国老年学杂志, 2021, 41(19): 4283-4286. [He PY, Qi F, Song H, et al. Tenghuang Jiangu capsules combined with cervus and cucumis polypeptide for injection for the treatment of lumbar intervertebral disc herniation in the elderly[J]. Chinese Journal of Gerontology, 2021, 41(19): 4283-4286.] DOI: 10.3969/j.issn.1005-9202.2021.19.039.

33.闫海威. 腰痹通胶囊治疗腰椎间盘突出症的近期疗效及其对炎性因子的影响[J]. 临床合理用药杂志, 2022, 15(1): 114-116. [Yan HW. The short-term therapeutic effect of Yaobitong capsules on lumbar disc herniation and its impact on inflammatory factors[J]. Chinese Journal of Clinical Rational Drug Use, 2022, 15(1): 114-116.] DOI: 10.15887/j.cnki.13-1389/r.2022.01.037.

34.斯乐婷, 倪鸿飞, 李倩, 等. HPLC-CAD法同时测定腰痹通胶囊中5种皂苷含量[J]. 药学学报, 2020, 55(10): 2449-2453. [Si LT, Ni HF, Li Q, et al. Simultaneous determination of five saponins in Yaobitong capsule by HPLC-CAD[J]. Acta Pharmaceutica Sinica, 2020, 55(10): 2449-2453.] DOI: 10.16438/j.0513-4870.2020-1129.

35.唐朝辉,曹亮,丁岗,等. 腰痹通胶囊对大鼠腰椎神经根压迫致腰椎间盘突出模型药效及炎性因子的影响[J]. 中国实验方剂学杂志, 2015, 21(5): 155-158. [Tang CH, Cao L, Ding G, et al. Efficiency and influence of inflammatory cytokines by Yaobitong capsule in rat lumbar disc herniation model[J]. Chinese Journal of Experimental Traditional Medical Formulae, 2015, 21(5): 155-158.] DOI: 10.13422/j.cnki.syfjx.2015050155.

36.张元萍, 仇锦林. 不同炮制工艺独活中4种香豆素类成分的定量分析[J]. 中国药师, 2020, 23(8): 1659-1662. [Zhang YP, Qiu JL. Quantitative analysis of four coumarins in Angelica pubescens Radix with different processing methods[J]. Chinese Pharmacist, 2020, 23(8): 1659-1662.] DOI: 10.3969/j.issn.1008-049X.2020.08.046.

37.廖禹程, 丁一, 王文军,等. 基于网络药理学探讨独活镇痛的分子作用机制[J]. 中国药师, 2021, 24(1): 1-6. [Liao YC, Ding Y, Wang WJ, et al. Molecular mechanism of pain-alleviating effect of Angelicae pubescentis radix based on network pharmacology[J]. Chinese Pharmacist, 2021, 24(1): 1-6.] DOI: 10.3969/j.issn.1008-049X.2021.01.001.

38.裴媛,马贤德,易杰,等. 独活香豆素对帕金森病模型大鼠抗氧化功能及谷氨酸含量的影响[J]. 中国老年学杂志, 2014, 34(5): 1272-1274. [Pei Y, Ma XD, Yi J, et al. Effects of duchenne coumarin on antioxidant function and glutamate content in rats modeled with Parkinson's disease[J]. Chinese Journal of Gerontology, 2014, 34(5): 1272-1274.] DOI: 10.3969/j.issn.1005-9202.2014.05.055.