ABSTRACT
Objective: Aconitum has a wide range of pharmacological activities, but its clinical toxic dose is close to the therapeutic dose. Puji Fang, as the greatest prescription book in China, analyzes and studied Aconitum herbal medicines prescriptions in Puji Fang used for children, and summarizes the rules and characteristics of children's medication for Aconitum Chinese medicine, so as to provide guidance for the clinical application of Aconitum herbal medicines in children. Method: Aconitum herbal medicines prescriptions in Puji Fang used for children were collected and organized to establish a prescription data sheet for Aconitum herbal medicines, for the purpose of statistics and analysis of Aconitum herbal medicines, their dosage, dosage form, indications and processed products. Result: A total of 300 children prescriptions containing Aconiti Lateralis Radix Praeparata, Aconiti Radix, Aconiti Kusnezoffii Radix, Aconitum carmichaelii and Tianxiong in Puji Fang were collected, and 64.45% of the prescriptions were based on Aconiti Lateralis Radix Praeparata. There were 13 types of diseases, mainly including severe convulsion, chronic spleen convulsion, vomiting and diarrhea. The prescriptions with a medicinal dose of Aconitum herbal medicines below 3 g accounted for 95.10% of the recorded dose. Children's Aconitum herbal medicines prescriptions were mainly for oral administration, 48.33% were pills, and the dosage of pills was higher than that of powder and decoction. There were 169 prescriptions for the use of processed products, accounting for 54.17%, 170 prescriptions with a specially administered medicine method, and those taken with "rice soup" occupied the highest proportion. Conclusion: Children's Aconitum medicines prescriptions account for a small proportion in the prescriptions of Puji Fang and a lighter dose, with differences in the dosage between different formulas. This article provides a reference for the safe and effective use of Aconitum medicines by studying the application of Aconitum medicines in children's prescriptions. It is necessary to establish a clinical warning of aconitum herbal medicines in the aspects of drug delivery based on syndrome differentiation, strict control of dosage and course of treatment, emphasis on compatibility, medication contraindications, and strengthened clinical drug monitoring.
ABSTRACT
To analyze the efficacy and safety of the combination therapy of Aconitum and Western medicine in the treatment of rheumatoid arthritis (RA) by Meta-analysis, and provide evidence for its clinic application for RA. The random clinical trials (RCTs) regarding the combination therapy for treating RA were retrieved in the database of China National Knowledge Infrastructure database, China Science and Technology Journal database, WanFang, Chinese Biomedical Medical Database, PubMed, and Cochrane Library up to July 2017. According to the given inclusion criteria, 8 RCTs involving 659 participants were included, and the included RCTs could be further divided into three subgroups according to the herb type, which were Aconiti Radix (Chuanwu) subgroup (6RCTs), Aconiti Kusnezoffii Radix (Caowu) subgroup (1RCT), and Chuanwu-Caowu subgroup (1RCT). The Meta-analysis results indicated that as compared with Western medicine, the combined use of Aconitum and Western medicine, no matter Chuanwu, Caowu or Chuanwu-Caowu subgroups, could improve the total effective rate of RA (6RCTs, RR=1.19, 95%CI [1.10, 1.28], <0.000 01), (1 RCT, RR=1.43, 95%CI [1.18, 1.73], =0.000 2), (1 RCT, RR=1.27, 95%CI [1.02, 1.58], =0.03) respectively. The combined use of Aconitum and Western medicine was also effective on the number of joint swelling, duration of morning stiffness, patients' handgrip, and the erythrocyte sedimentation rate, C-reactive protein and rheumatoid factor. However, its action was not significant on joint tenderness. And also, in the included RCTs, there were 34 cases of adverse drug reactions/events (ADR/ADE) in the Chuanwu subgroup, while 86 cases in the Western medicine control group. The ADR/ADE incidence was even more lower in Chuanwu-Caowu subgroup, but no difference between Caowu subgroup and Western medicine group. Based on the included RCTs, the combined use of Aconitum and Western medicine could achieve more satisfying efficacy and lower ADRs incidence for RA as compared with Western medicine alone. However, due to the limitation in the not-high quality of included RCTs and the lack of large-scale multi-center research, the results still need to be further validated in the clinic application.