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Journal of Chinese Integrative Medicine ›› 2010, Vol. 8 ›› Issue (10): 917-927.doi: 10.3736/jcim20101003

• Systematic Review • Previous Articles     Next Articles

Integrated traditional Chinese and Western medicine versus Western medicine in treatment of arteriosclerosis obliterans: A systematic review of randomized controlled trials

 Xue-mei Youa, Xiao Qina, Zhi-yong Dongb, Guan-liang Wangb   

  1. a Department of Hepatobiliary Surgery, the First Affiliated Hospital, Guangxi Medical University, Nanning 530021, Guangxi Province, China
    b Department of Traditional Chinese Medicine, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
  • Received:2010-03-09 Accepted:2010-05-07 Online:2010-10-20 Published:2010-10-15

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Background

The conventional therapy for arteriosclerosis obliterans (ASO) is Western medicine. However, it has some adverse effects and does not respond to some patients, and it is also very expensive.
Objective

To evaluate the efficacy of integrated traditional Chinese (TCM) and Western medicine (WM) in treatment of ASO.
Search strategy

Electronic and manual searches were conducted and the searches ended on May 20, 2009.
Inclusion criteria

We included randomized controlled trials (RCT) evaluating integrated TCM and WM (as treatment group) versus WM used alone (as control group), and no language limits were set.
Data extraction and analysis

Selection of trials for inclusion, assessment for methodological quality, data extraction and data syntheses were conducted according to protocol of a Cochrane systematic review by the authors.
Results

Thirteen RCT were included, which encompassed a total of 968 patients. The results showed that all of the 13 included trials did not report mortality rate of ASO. The studies displayed that the amputation rate in the treatment group was lower than that in the control group, but there was no statistical significance. Ten studies adopted inefficiency analysis and 2 of them showed that the ineffective rate in the treatment group was lower than that in the control group, and the relative risk (RR) and 95% CI were 0.36 [0.13, 0.99]. We performed descriptive analysis on other 8 studies; analyses of secondary outcomes such as intermittent claudication, ankle brachial index, high-density lipoprotein (HDL), and low-density lipoprotein (LDL) showed that integrated TCM and WM therapy was more effective than WM treatment alone; one study showed that WM was better than integrated TCM and WM therapy in decreasing the content of fibrinogen. All of the included trials did not report any critical adverse reactions occurred in the treatment group.
Conclusion

The current evidence shows that integrated TCM and WM therapy is safe and effective in treating ASO, and tends to reduce amputation rate, improve intermittent claudication, decrease the levels of fibrinogen, HDL and LDL, and increase ankle brachial index, without obvious adverse reactions. Due to the low methodological quality of trials included, more prospective, multicenter, large-scale, high-quality RCTs are needed.

Key words: Integrated traditional Chinese and Western medicine, Arteriosclerosis obliterans, Systematic review, Meta-analysis

Figure 1

Flow diagram of literature retrieval and selection"

Table 1

Characteristics of included studies"

Study ID Participant [Cases(male/female)] Intervention Treatment course Outcome
Control Treatment Control Treatment
Li 2003[14] 92 (80/12) 92 (80/12) Buffered aspirin
tablet and urokinase		 Kangmai Injection
plus control
interventions		 30 days Total effective rate and immunity erythrocyte index
Zhao 2008[15] 37 (33/4) 43 (38/5) Lovastatin, aspirin,
and prostaglandin E1		 Huoxue Wenmai
Tang plus control
interventions		 180 days Clinical symptom score; total
effective rate, blood lipid,
hemorheology, colour Doppler, and adverse reactions
Li 2004[16] 28 (27/1) 28 (26/2) Vasodilation,
thrombolysis, and
prescriptions for
lowering blood lipids and sugar		 Gubu Tang and
Danggui Sini Tang
plus control
interventions		 15-30 days Total effective rate
Wang 1999[17] 30 (25/5) 30 (25/5) Prostaglandin E1,
venoruton and
low-molecular-weight dextran		 Compound traditional
Chinese herbal
medicine plus control interventions		 60-90 days Total effective rate, and the
levels of endothelin-1, nitric
oxide, apolipoprotein and HDL
Mou 2002[18] 36 (26/10) 56 (48/8) Prostaglandin E1,
venoruton and
low-molecular-weight dextran		 Wentong Tang plus
control interventions		 60-90 days Total effective rate, effective
rate of different stage and
grade, main symptoms and
signs, hemorheology, ABI, and
skin temperature
Wu 2008[19] 32 (26/6) 32 (27/5) Prostaglandin E1 Wenjing Fumai Tang
plus control
interventions		 66 days Total effective rate, improvement of inner diameter, plaque area and intima thickness of vessel, and clinical symptom score
Li 2008[20] 28 (20/8) 30 (22/8) Prostaglandin E1 Danhong Injection
plus control
interventions		 14 days Total effective rate,
hemorheology, Doppler of
femoral artery, and adverse
reactions
Wang 2008[21] 36 (no
report of
the gender
ratio)		 31 (no
report of
the gender ratio)		 Defibrase, aspirin,
lovastatin and
pentoxifylline		 Danhong Injection
plus control
interventions		 10 days Total effective rate,
hemorheology, and adverse
reactions
Wang 2008[22] 15 (11/4) 17 (12/5) Warfarin Liuchong Capsule
plus control
interventions		 180 days Incidence rate of intermittent
claudication, amputation rate,
hemorheology, patency rate of
artificial blood vessel one year
after operation, and adverse
reactions
Zhuang 2007[23] 18 (no
report of
the gender
ratio)		 20 (no
report of
the gender
ratio)		 Low-molecular-weight heparin, and
warfarin		 Refined Xuefu
Capsule plus control
interventions		 90 days Clinical effects, and patency
rate of artificial blood vessel one
year after operation
Chan 2008[24] 58 (no
report of
the gender
ratio)		 63 (no
report of
the gender
ratio)		 Prescriptions for
controlling plasma
glucose, vasodilators, and debridement
therapy		 Qizhi Gubu Capsule
plus control
interventions		 28-84 days Total effective rate, blood lipid,
hemorheology, and adverse
reactions
Mao 2003[25] 30 (24/6) 30 (25/5) Prescriptions for
controlling plasma
glucose and actovegin		 Honghua Injection
plus control
interventions		 20 days Total effective rate, blood lipid
and plasma glucose,
hemorheology, and adverse
reactions
Han 2007[26] 28 28 Prescriptions for
controlling plasma
glucose, aspirin and
prostaglandin E1		 Leigongteng powder
plus control
interventions		 84 days Symptoms and signs, lesion
nature of crura vesse, and the
levels of APO and HDL

Table 2

Quality assessment of included studies"

Study ID Method of
randomization		 Allocation
concealment		 Blinding Incomplete
outcome data
addressed		 Selective
reporting		 Other bias
Li 2003[14] Random number
table		 Unclear Unclear Unclear Yes Unclear
Zhao 2008[15] Drawing lots Yes Unclear Unclear Yes Unclear
Li 2004[16] Drawing lots Unclear Unclear Unclear Yes Unclear
Wang 1999[17] Unclear Unclear Unclear Unclear Yes Unclear
Mou 2002[18] Unclear Unclear Unclear Unclear Yes Unclear
Wu 2008[19] Computer
randomization		 Unclear Single blind
method		 Unclear Yes Unclear
Li 2008[20] Unclear Unclear Unclear Unclear Yes Unclear
Wang 2008[21] Unclear Unclear Unclear Unclear Yes Unclear
Wang 2008[22] Drawing lots Unclear Unclear Unclear Yes Unclear
Zhuang 2007[23] Computer
randomization		 Unclear Unclear Unclear Yes Unclear
Chan 2008[24] Unclear Unclear Unclear Unclear Yes Unclear
Mao 2003[25] Unclear Unclear Unclear Unclear Yes Unclear
Han 2007[26] Unclear Unclear Unclear Unclear Yes Unclear

Figure 2

Descriptive analysis of amputation rates in integrated traditional Chinese and Western medicine group and Western medicine group"

Figure 3

Meta-analysis of inefficiency rates in integrated traditional Chinese and Western medicine group and Western medicine group"

Figure 4

Descriptive analysis of inefficiency rates in integrated traditional Chinese and Western medicine group and Western medicine group"

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[3] Zhi-chun Jin. Problems in establishing clinical guideline for integrated traditional Chinese and Western medicine. Journal of Chinese Integrative Medicine, 2008, 6(1): 5-8
[4] SUN Ming-yu, ZUO Jian, DUAN Ji-feng, HAN Jun, FAN Shi-ming, ZHANG Wei, ZHU Li-fang, YAO Ming-hui. Antitumor activities of kushen flavonoids in vivo and in vitro. Journal of Chinese Integrative Medicine, 2008, 6(1): 51-59
[5] Min Cheng, Qiong Feng, Shu-wen Qian, Hui Gao, Cui-qing Zhu. Preliminary assay of p-amyloid binding elements in heart-beneficial recipe. Journal of Chinese Integrative Medicine, 2008, 6(1): 68-72
[6] Ning-qun Wang, Liang-duo Jiang, Zong-xing Li. Research progress in asthma-related quality of life. Journal of Chinese Integrative Medicine, 2008, 6(1): 93-97
[7] Jing-yuan Mao, Chang-xiao Liu, Heng-he Wang, Guang-li Wei , Zhen-peng Zhang, Jie Xing, Wang Xian liang , Ying-fei Bi . Effects of Shenmai Injection on serum concentration and pharmacokinetics of digoxin in dogs with heart failure. Journal of Chinese Integrative Medicine, 2010, 8(11): 1070-1074
[8] Zhi-mei Wang, Bin Zhang. A study on translation of ellipses in Huangdi Neijing from perspective of hermeneutic theory. Journal of Chinese Integrative Medicine, 2010, 8(11): 1097-1100
[9] Gui Yu, Jie Wang. Thinking on building the network cardiovasology of Chinese medicine. Journal of Chinese Integrative Medicine, 2012, 10(11): 1206-1210
[10] Pedro Saganha João, Doenitz Christoph, Greten Tobias, Efferth Thomas, J. Greten Henry. Qigong therapy for physiotherapists suffering from burnout: a preliminary study. Journal of Chinese Integrative Medicine, 2012, 10(11): 1233-1239
Journal of Integrative Medicine, ISSN: 2095-4964 CN 31-2083/R
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