Efficacy and dispensing patterns of TCM-acupuncture combinations in vascular dementia treatment: a meta-analysis and data mining analysis

Objectives: To evaluate the clinical efficacy of the combination of acupuncture and medicine for vascular dementia (VD) treatment, and to analyze and summarize the relevant association rules.

Methods: A systematic search of Chinese and English databases such as CNKI, VIP, Wanfang, Embase, PubMed, Cochrane Library, and Web of Science was performed along with a manual search to screen for randomized controlled trials that met the inclusion and exclusion criteria that were published over a period from January 1, 2000, to July 31, 2023. Literature quality assessment and meta-analysis were performed using the Cochrane Handbook for Systematic Reviews of Interventions and RevMan 5.4 to explore the efficacy of TCM-acupuncture combination therapy and conventional Western medical therapy for VD treatment, as well as assess relevant improvements in MMSE, ADL, and HDS scale scores. A study database was created by entering the required data into MS Excel. The PROSPERO registration number for this systematic evaluation is CRD42023458282. High-use-frequency drugs and acupoints were screened for by using frequency statistics, and the nature of their categories was recorded separately. The source database was then imported into SPSS (version 26.0.0.2) and IBM SPSS Modeler (version 18.0) to elucidate high-use-frequency TCM drugs and acupoints for VD treatment.

Results: Eighteen randomized controlled clinical trials with a total of 1617 participants were finally included. The meta-analysis results suggested that treatment combining traditional Chinese medicine (TCM) with acupuncture performed better in terms of efficacy and clinical improvement of related outcome indicators [OR = 2.54, 95% CI (1.98, 3.26), P < 0.05]. Twenty-four prescription drug groups and 18 acupuncture prescriptions were extracted from the 18 included studies. The following results were obtained: (1) The drugs with the highest use frequency were Acori Tatarinowii Rhizoma, Glycyrrhizae Radix Et Rhizoma, and Salviae Miltiorrhizae Radix Et Rhizoma; high-use-frequency tonifying herbs; and sweet, warm, and liver meridian-attributing drugs. (2) The acupoints with the highest use frequency were Baihui, Sishencong, and Zusanli, often applied on the head, face, and Du meridian points, as well as on high-use-frequency crossing acupoints. (3) The high-use-frequency drugs and acupoints could be clustered into four categories each. (4) The strongest associations were noted for the drug pairs Polygalae Radix-Glycyrrhizae Radix Et Rhizoma and Polugoni Multiflori Radix-Acori Tatarinowii Rhizoma, as well as the acupoint pairs Sishencong-Baihui and Zusanli-Baihui.

Conclusion: TCM drugs combined with acupuncture demonstrated considerable clinical efficacy for VD treatment. The TCM-based treatment of VD mostly starts from the liver meridian and the Du meridian, with the use of more sweet and warm herbs and crossing acupoints. The general principles of treatment include smoothening the flow of qi and blood, tonifying the liver and kidneys in TCM, and enhancing the patient's mood and cognitive function.