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3TMR Integrative Nursing  2018, Vol. 2 Issue (4): 178-185    DOI: 10.12032/TMRIN20180808
Jinhuang powder for the treatment of diabetic foot ulcers: an updated meta -analysis with power analysis and trial sequential analysis
Li Ma1, Li-Juan Yi2, Xu Tian3,*()
1School of Nursing, Guizhou Medical University, Guizhou, China
2School of Nursing, Hunan Traditional Chinese Medical College, Zhuzhou, Hunan, China
3Department of Gastroenterology, Chongqing University Cancer Hospital & Chongqing Cancer Hospital, Chongqing, China;
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This work comprehensively investigated the potential of Jinhuang powder in treating diabetic foot ulcers by using head to head meta-analysis and trial sequential analysis techniques.

Editor’s summary

Diabetic foot ulcers remain an intractable problem in clinical practice. The value of modern medical technologies is limited for diabetic foot ulcers (DFUs), however traditional medicine has potential of treating it.


Background: Traditional Chinese Medicines (TCM) had been indicated to benefit for the chronic non-infectious diseases, such as cancers, hypertension, primary dysmenorrheal, etc. Although randomized controlled trials (RCTs) had been conducted, there was still the controversy on the efficacy of Jinhuang powder for diabetic foot ulcers (DFUs). Objective: This systematic review aimed to objectively evaluate the potential of Jinhuang powder for DFUs. Methods: Seven databases (CNKI, Chongqing VIP, Wanfang database, CBM, the Cochrane Library, PubMed and Web of Science) were searched to retrieve RCTs up to December, 2016; and the relevant references of the eligible studies were screened. According to the eligible criteria, the literature was screened; data were extracted; and then the methodological quality was assessed. The meta-analysis, power analysis and trial sequential analysis (TSA) were performed by using Meta analyst software (version beta 3.13), Stata 12.0, Power and Precision statistical software package (Biostat) and TSA software (version 0.9), respectively. Results: Finally, three RCTs with 198 participants were included. The results of meta-analysis showed that there were statistically significant differences between groups in (1) the cure rate (RR, 1.25; 95% CI. 1.10 to 1.41; P = 0.00) and (2) the wound healing time (SMD, -3.404; 95% CI, -5.821 to -0.987; P = 0.00). Three trials presented more than 80% power with 0.05 α-errors in both outcomes and the power of two meta-analyses to pool different outcomes presented more than 95%. The TSA showed that the summary results were certain. Conclusion: The external application with Jinhuang powder was an effective and cost-effective therapy for DFUs. The power analysis and TSA showed that the efficacy of Jinhuang powder dressing for the treatment of DFUs is conclusive.

Key wordsJinhuang powder      Diabetic foot ulcers      Meta-analysis      Systematic review      Trial sequential analysis     
Published: 25 December 2018
Corresponding Authors: Tian Xu     E-mail:
Cite this article:

Li Ma, Li-Juan Yi, Xu Tian. Jinhuang powder for the treatment of diabetic foot ulcers: an updated meta -analysis with power analysis and trial sequential analysis. 3TMR Integrative Nursing, 2018, 2(4): 178-185. doi: 10.12032/TMRIN20180808

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Figure 1: Flow chart of literature retrieval and trial selection.
Author Country Age (years) Interventions Outcomes
Study group Control group
Cui 2011 China 51 - 71 Jinhuang Powder Route treatment Curative ratio, Healing time to ulcer
Jia (1) 2010 China 60.3 ± 11.2 Jinhuang Powder Route treatment Curative ratio, Healing time to ulcer
Jia (2) 2010 China 61.1 ± 10.8 Jinhuang Powder Route treatment Curative ratio, Healing time to ulcer
Ma 2011 China 42 - 75 Jinhuang Powder Route treatment Curative ratio
Table 1 Characteristics of 4 trials identified in the literature search
Figure 2: Percentage of risk of bias authors' judgments.
Figure 3: Risk of bias summary authors' judgments. Question mark, plus sign and minus sign represents unclear, low and high risk of bias respectively.
Figure 4: Meta-analysis on curative ratio between Jinhuang powder and control groups.
Figure 5: Meta-analysis on the ulceration healing time between Jinhuang powder and control groups.
Figure 6: Trial sequential analysis for meta-analysis on total effective rate between study and control groups.
Figure 7: Trial sequential analysis for meta-analysis on the wound healing time between study and control groups.
Figure 8: Egger's funnel plot of publication bias.
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