痔の止血に対する中薬（中医学の薬草療法）
Abstract
Background
Haemorrhoids is a common perianal disease, which often causes haematochezia. Besides a surgical operation or minimally invasive treatment, a variety of traditional Chinese medicinal herbs (TCMHs) have been used to treat bleeding haemorrhoids.
Objectives
To assess the effectiveness of traditional Chinese medicinal herbs for stopping bleeding from haemorrhoids and the adverse effects caused by these herbs.
Search methods
We searched the Cochrane Colorectal Cancer Group Trials Register, Cochrane Central Register of Contolled Trials (CENTRAL) (The Cochrane Library), MEDLINE, EMBASE, CMCD (Chinese Medicine Conference Disc) and CBMD (Chinese Bio‐Medicine Disc).
Selection criteria
All randomised clinical trials (RCTs) of Chinese herbs for bleeding haemorrhoids were included.
Data collection and analysis
Two authors independently extracted the data, which were analysed using RevMan 5.0 software. We estimated the relative risk for dichotomous data and calculated the weighted mean difference for continuous data.
Main results
Nine trials involving 1822 patients with bleeding haemorrhoids were identified. The included trials were generally not of high quality and used one TCMH preparation compared with another TCMH preparation (Type I) (five trials) or western medicines (Type II) (four trials). We could not pool the data to perform a meta‐analysis as only two of the included trials used the same intervention or comparison.
In the nine trials, TCMHs showed a statistically significant difference for the improvement in the general curative effects or total grade of symptoms in six trials (P < 0.05; P < 0.01), of hematochezia in three trials (P < 0.05; P < 0.001), and of inflammation of perianal mucosa in one trial (P < 0.05). The adverse effects reported were not serious and were scarce.
Authors' conclusions
This review did not provide strong evidence concerning the effectiveness of TCMHs for stopping bleeding from haemorrhoids. Most of the included studies were of low quality and there was a scarcity of eligible trials and numbers of participants. Limited, weak evidence showed that some herbal formulae, when including Radix Sanguisorbae, Radix Rehmanniae, Fructus Sophorae, Radix Angelicae Sinensis, Radix Scutellariae, etc., may alleviate some symptoms caused by haemorrhoids. These include hematochezia, congestive haemorrhoidal cushions and inflammation of perianal mucosa in the short term. Well‐designed clinical trials are required urgently before any confident conclusions can be drawn about the value of TCMHs for stopping bleeding from haemorrhoids.
At present, the evidence is not enough that clinical practice should be changed immediately on the basis of these results.
一般語訳
痔の止血に対する中薬（中医学の薬草療法）（TCMH）の確かなエビデンスは存在しないが、中薬が痔の症状の一部を軽減するという限定されたエビデンスが存在する。
痔は、一般的な肛門周囲の疾患で重症段階に進行すると、血便、肛門周囲の炎症、肛門周囲の静脈脱出または嵌頓を容易に引き起こす。外科手術または低侵襲性治療のほかに、中国では痔の出血に対して多数の患者にさまざまな中薬（中医学の薬草療法）が使用されている。中薬は痔に有効で代替治療の選択肢となる可能性がある。しかし、本レビューの一次調査では、痔の止血に対する中薬の有効性に関して強固なエビデンスは得られなかった。対象となった研究の数が少なく、質も低かった。限定された弱いエビデンスから、Radix Sanguisorbae、Radix Rehmanniae、Fructus Sophoraeなどの中薬が痔の症状の一部を軽減する可能性が示された。短期間軽減される可能性がある症状は、血便および痔核の鬱血などである。メタアナリシスを行って最終的な結論を下すには、標準化された試験をさらに実施する必要がある。
