Efficacy and safety of Di-Tan Decoction for treating post-stroke neurological disorders:a systematic review and Meta-analysis of randomized clinical trials

The management of post-stroke complications plays an important role in the quality of life.Di-Tan Decoction(DTD;涤痰汤)is a widely used traditional Chinese medicine.This study incorporated systematic review and meta-analysis to evaluate the efficacy of DTD in post-stroke neurological disorders.Randomized clinical trials(RCTs)were searched from English,Chinese and Korean electronic medical databases,by including the keywords"Di-Tan Tang","Di-Tan Decoction","Scour Phlegm Decoction","stroke",and"RCT.Each RCT included control(placebo,conventional therapy,or Western medicine)and experimental(DTD treatment)groups.For patients inflicted with stroke for 1-6 weeks,the outcomes of post-stroke neurological disorders were measured by scales for post-stroke symptoms and were classified as"completely healed","markedly effective","effective"and"ineffective".Totally,11 RCTs(n=490 controls and n=502 DTD subjects)were selected from 210 articles identified in the initial search.A metaanalysis of evaluation criteria in post-stroke symptoms revealed that the overall odds ratio(ORs)for alleviating post-stroke neurological disorders were 0.30-fold lower(95%CI=0.21-0.43)in the DTD group than the control(Western medicine)group(P<0.00001).Moreover,regardless of the type of stroke diagnostic scale applied(including NFA,HDS,and NIHSS),the overall post-stroke symptoms determined were less severe in the DTD group(n=219)than the control group(n=217).No adverse effects of DTD were observed in the 11 RCTs reviewed.All 11 studies used an appropriate method for randomization of subjects to evaluate the risk of bias(ROB),and 7 studies included allocation concealment as well as blinding of patients and practitioners.High-risk ROB was included in6 RCTs.No significant publication bias was derived from the funnel plot.Our results indicate that the administration of DTD alone,and DTD in combination with Western medicine,exert greater efficacy for post-stroke complication therapy,than Western medicine administered alone.More rigorous and regulated studies are required to confirm the therapeutic efficacy of DTD for post-stroke neurological disorders.disorders.