Abstract
Objective Lumbar disc herniation (LDH) is based on the degenerative changes of the intervertebral disc. Many drugs are used to treat and prevent LDH, including Western medicine and Chinese medicine. Duhuo Jisheng Decoction (DHJSD) is one of the most classic Chinese medicine prescriptions. The purpose of our meta-analysis is to evaluate the efficacy and safety of modified DHJSD in the treatment of LDH. Methods We searched multiple databases including PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI) databases, Wanfang Database, and Chinese Scientific Journal Database (VIP) to identify studies that met the inclusion criteria. This meta-analysis was registered at INPLASY with reference number ID: INPLASY202060053. Results Fourteen randomized controlled trials (RCTs) were identified, including 1560 patients. This meta-analysis showed that the total effective rate and cure rate of modified DHJSD are higher than those of diclofenac sodium enteric-coated tablets (total effective rate: RR = 1.18, 95% CI: 1.12 to 1.25, P < 0.0001, I2 = 0%; cure rate: RR = 1.60, 95% CI: 1.30 to 1.97, P < 0.00001, I2 = 2%), diclofenac sodium enteric-coated tablets plus ibuprofen and indomethacin (total effective rate: RR = 1.23, 95% CI: 1.11 to 1.37, P=0.0001, I2 = 0%; cure rate: RR = 1.58, 95% CI: 1.22 to 2.04, P=0.0005, I2 = 0%), and diclofenac sodium sustained-release capsule (total effective rate: RR = 1.49, 95% CI: 1.27 to 1.74, P < 0.00001, I2 = 0%; cure rate: RR = 10.07, 95% CI: 3.29 to 30.88, P < 0.00001, I2 = 5%). Modified DHJSD was also better than Western medicine (MD = −1.56, 95% CI: −2.42 to −0.70, P=0.0004, I2 = 74%) in terms of visual analogue scale (VAS) scores. Three RCTs showed no adverse events in the modified DHJSD group, but adverse events existed in the Western medicine group. Conclusion This meta-analysis showed that modified DHJSD had a more favorable effect on the treatment of LDH than Western medicine, and there were no obvious adverse events. More high-quality RCTs are needed to complement existing conclusions.
Highlights
Lumbar disc herniation (LDH) can lead to physical deterioration, long-term back and leg pain, neurological deficits, and socioeconomic problems due to the large medical costs associated with treatment [1]
LDH belongs to the category of “low back pain” and “Bizheng” in traditional Chinese medicine (TCM) theory [2]. e main treatment principle of TCM is to promote blood circulation, remove blood stasis, and strengthen bones
In order to obtain all the literature related to our research, first of all, two researchers independently used the keywords combined with free words to search multiple databases according to Cochrane Collaboration guidelines, such as PubMed (1966 to June 1, 2020), Embase (1990 to June 1, 2020), the Cochrane Library (1990 to June 1, 2020), China National Knowledge Infrastructure (CNKI) databases (1990 to June 1, 2020), Wanfang Database (1990 to June 1, 2020), and Chinese Scientific Journal Database (VIP) (1990 to June 1, 2020)
Summary
Lumbar disc herniation (LDH) can lead to physical deterioration, long-term back and leg pain, neurological deficits, and socioeconomic problems due to the large medical costs associated with treatment [1]. LDH belongs to the category of “low back pain” and “Bizheng” (pain caused by wind, cold, and dampness) in traditional Chinese medicine (TCM) theory [2]. E main treatment principle of TCM is to promote blood circulation, remove blood stasis, and strengthen bones. Most LDH cases can achieve good results through conservative treatment, including medication, physical therapy, and steroid injection [1]. Medical treatment includes Western medicine and TCM. Chinese medicine has a good clinical effect in the treatment of LDH [17, 18]. According to the theory of TCM, DHJSD is mainly used to treat joint pain syndrome, which has the effects of eliminating stagnation, removing blood stasis, nourishing the kidney and liver, and invigorating Qi and blood [20]
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