Table of Contents
Disclaimer v
Foreword vii
Purpose of the Monograph xi
Authors and Contributors xv
Members of the Advisory Committee and Panel xvii
Professor Charlie Changli Xue, PhD xix
Professor Chuanjian Lu, MD xxi
Acknowledgements xxiii
List of Figures xxxi
List of Tables xxxiii
1 Introduction to Chronic Urticaria 1
Definition of Urticaria 1
Clinical Presentation and Subtypes of Chronic Urticaria 1
Epidemiology 2
Burden 3
Risk Factors 3
Pathological Processes 3
Diagnosis 5
Management 6
Pharmacological 6
Non-Pharmacological 8
Prognosis 8
Limitations of Conventional Therapy 9
References 10
2 Chronic Urticaria in Chinese Medicine 13
Introduction 13
Aetiology and Pathogenesis 13
Syndrome Differentiation and Treatments 14
Oral Chinese Herbal Medicine Treatment Based on Syndrome Differentiation 15
Exterior Heat Syndrome 15
Exterior Cold Syndrome 15
Dampness-heat in Stomach and Intestine 17
Defense-exterior Insecurity 18
Dual Deficiency of qi and Blood 19
Qi-Blood Stagnation and Stasis 20
Blood Deficiency and Wind-dryness 20
Topical Chinese Herbal Medicine Treatment 21
Acupuncture Therapies and Other Chinese Medicine Therapies 22
Other Management Strategies 23
References 24
3 Classical Chinese Medicine Literature 25
Introduction 25
Search Terms 26
Search Procedure and Data Coding 26
Data Analysis Procedure 27
Search Results 28
Citations Related to Urticaria 29
Definitions of Urticaria and Aetiology 29
Chinese Herbal Medicine 30
Frequency of Treatment Citations by Dynasty 30
Symptoms Described in Treatment Citations 31
Treatment with Chinese Herbal Medicine 31
Most frequent formulae in possible urticaria citations 31
Most frequent herbs in possible urticaria citations 32
Most frequent formulae in most likely urticaria citations 32
Most frequent herbs in most likely urticaria citations 38
Discussion 39
Acupuncture and Related Therapies 40
Discussion 40
Classical Literature in Perspective 41
References 42
4 Methods for Evaluating Clinical Evidence 43
Introduction 43
Search Strategy 44
Inclusion Criteria 45
Exclusion Criteria 47
Outcomes 47
Risk of Bias Assessment 48
Statistical Analyses 50
Assessment Using Grading of Recommendations Assessment, Development and Evaluation 50
References 52
5 Chinese Herbal Medicine 55
Introduction 55
Previous Systematic Reviews 56
Characteristics of Chinese Herbal Medicine Clinical Studies 56
Randomised Controlled Trials of Chinese Herbal Medicine 58
Risk of Bias 63
Disease Activity: Urticaria Activity Score 64
Health-related Quality of Life: Dermatology Life Quality Index 64
Effective Rate 65
Relapse Rate 67
Symptom Severity Reduction Index 68
Assessment Using Grading of Recommendations Assessment, Development and Evaluation 70
Chinese herbal medicine vs. second-generation antihistamines 72
Chinese herbal medicine as integrative medicine vs. second-generation antihistamines 72
Randomised Controlled Trial Evidence for Individual Formulae 72
Randomised Controlled Trial Evidence from Formulae Commonly Used in Clinical Practice 79
Frequently Reported Herbs in Meta-Analyses Showing Favourable Effect 80
Safety of Chinese Herbal Medicine in Randomised Controlled Trials 80
Controlled Clinical Trials of Chinese Herbal Medicine 83
Controlled Clinical Trial Evidence for Individual Formulae 84
Controlled Clinical Trial Evidence for Formulae Commonly Used in Clinical Practice 85
Safety of Chinese Herbal Medicine in Controlled Clinical Trials 85
Clinical Evidence from Non-Controlled Studies 85
Non-Controlled Studies of Individual Formulae 86
Non-Controlled Studies of Formulae Used in Clinical Practice 86
Safety of Chinese Herbal Medicine in Non-Controlled Studies 87
Summary of Chinese Herbal Medicine Clinical Evidence 88
References 89
6 Pharmacological Actions of the Frequently Used Herbs 91
Introduction 91
Experimental Studies on Fang Feng 91
Experimental Studies on Gan Cao 92
Experimental Studies on Dang Gui 93
Experimental Studies on Jing Jie 94
Experimental Studies on Huang Qi 94
Experimental Studies on Di Huang 95
Experimental Studies on Bai Zhu 95
Experimental Studies on Bai Shao 96
Experimental Studies on Chan Tui 97
Experimental Studies on Bai Xian Pi 97
Experimental Studies on Mu Dan Pi 98
Experimental Studies on Herbal Formulae 99
Summary of Pharmacological Actions of the Common Herbs 100
References 100
7 Clinical Evidence for Acupuncture and Related Therapies 107
Introduction 107
Previous Systematic Reviews 108
Characteristics of Acupuncture and Related Therapies Clinical Studies 108
Randomised Controlled Trials of Acupuncture and Related Therapies 110
Risk of Bias 110
Acupuncture 111
Acupuncture alone 112
Acupuncture as integrative medicine 112
Acupuncture plus moxibustion as integrative medicine 112
Frequently reported acupuncture points in meta-analyses showing favourable effect: acupuncture 113
Assessment using GRADE 113
Acupuncture versus second-generation antihistamines 113
Acupuncture as integrative medicine vs. second-generation antihistamines 116
Moxibustion 116
Moxibustion alone 116
Assessment using GRADE 116
Randomised Controlled Trial Evidence for Interventions Commonly Used in Clinical Practice 118
Clinical Evidence from Controlled Clinical Trials 118
Clinical Evidence from Non-Controlled Studies 118
Non-Controlled Trial Evidence for Interventions Commonly Used in Clinical Practice 118
Summary of Acupuncture and Related Therapies Clinical Evidence 119
References 119
8 Clinical Evidence for Combination Therapies 121
Introduction 121
Randomised Controlled Trials of Combination Therapies 121
Risk of Bias 123
Results of Combination Therapies 124
Safety of Combination Therapies 124
Summary of Combination Therapies Evidence 124
9 Summary and Conclusions 127
Introduction 127
Chinese Herbal Medicine 128
Chinese Herbal Medicine Formulae in the Contemporary and Classical Literature, and Clinical Studies 129
Acupuncture and Related Therapies 132
Acupuncture Therapies in the Contemporary and Classical Literature, and Clinical Studies 133
Implications for Practice 133
Implications for Research 135
Clinical Trial Design 136
References 137
Appendix 1 All Included Clinical Studies 139
Glossary 151
Index 165
