CHINESE HERBAL MEDICINE

Chinese Herbal medicine (CHM) is a technique of traditional Chinese medicine that originated more than 2000 years ago.  Along with research into the underlying biology and increasingly wide clinical use of CHM, clinical research on Chinese Herbal Medicine has also grown. Given the big interest in Chinese Herbal Medicine, evidence based practice and policy making require systematic reviews of  available randomised controlled trials. Since 2015, more than 1400 systematic reviews and meta-analyses of randomised controlled trials on CHM have been published. 

 A short outline of promising results from recently published systematic reviews and meta-analyses of Chinese herbal medicine for several  diagnoses: 

Hashimoto’s thyroiditis:A systematic review and network-analysis demonstrates that Chinese herbal medicine might improve Hashimoto’s thyroiditis by reducing thyroid antibody levels TPOAb and TGAb (98.3%, 94.4%, and 87.3%, respectively) and by improving symptom scores.

 Luo J, Zhou L, Sun A, Yang H, Zhang P, Liu K, Yu X, Lin Y, Huang Y, Han L. Herbal medicine for Hashimoto’s thyroiditis: A systematic review and network meta-analysis. J Ethnopharmacol. 2024 Apr 6;323:117663. doi: 10.1016/j.jep.2023.117663. Epub 2024 Jan 3. PMID: 38181936

 Post-viral fatigue (19 studies with 1921 patients): A current systematic review found that the participation of CHM can improve the symptoms of post-viral fatigue and some immune indicators. Results of individual trial or meta-analysis showed that CHM was better than no treatment (MD = -0.80 scores, 95%CI -1.43 to -0.17 scores, P = 0.01, 60 participants, 1 trial), placebo (MD = -1.90 scores, 95%CI -2.38 to -1.42 scores, P<0.00001, 184 participants, 1 trial), placebo on basis of rehabilitation therapy (MD = -14.90 scores, 95%CI -24.53 to -5.27 scores, P = 0.02, 118 participants, 1 trial) or drugs (MD = -0.38 scores, 95%CI -0.48 to -0.27 scores, I2 = 0%, P<0.00001, 498 participants, 4 trials) on relieving fatigue symptoms assessing by Traditional Chinese Medicine fatigue scores. Trials compared CHM plus drugs to drugs alone also showed better effect of combination therapy (average MD = -0.56 scores). In addition, CHM may improve the percentage of CD4 T lymphocytes and reduce the level of serum IL-6 (MD = -14.64 scores, 95%CI 18.36 to -10.91 scores, I2 = 0%, P<0.00001, 146 participants, 2 trials).

Hu LY, Cai AQ, Li B, Li Z, Liu JP, Cao HJ. Chinese herbal medicine for post-viral fatigue: A systematic review of randomized controlled trials. PLoS One. 2024 Mar 21;19(3):e0300896. doi: 10.1371/journal.pone.0300896. PMID: 38512808; PMCID: PMC10956782.

Pediatric adenoid hypertrophy (13 RCTs with 1038 patients): Compared with western medicine treatment, Chinese herbal medicine significantly improved clinical efficacy (RR = 1.33, 95% CI [1.24,1.43]), and significantly decreased adenoidal/nasopharyngeal  (A/N) ratio (MD = -0.04,95%CI [-0.05,-0.03]). Chinese herbal medicine also prominently improved the quality of life (MD = -4.77,95%CI [-8.35,-1.20]). Meanwhile, it dramatically improved snoring (MD = -0.46,95%CI [-0.62,-0.30]); mouth breathing (MD = -0.52,95%CI [-0.66,-0.39]); nasal obstruction (MD = -0.56,95%CI [-0.68,-0.45]). Conclusion: Chinese herbal medicine has good clinical efficacy and safety on pediatric adenoid hypertrophy, which need to be confirmed by high quality, multiple-centre, large sample randomized controlled trials.

Sun YL, Zheng HT, Tao JL, Jiang MC, Hu CC, Li XM, Yuan B. Effectiveness and safety of Chinese herbal medicine for pediatric adenoid hypertrophy: A meta-analysis. Int J Pediatr Otorhinolaryngol. 2019 Apr;119:79-85. doi: 10.1016/j.ijporl.2019.01.022. Epub 2019 Jan 19. PMID: 30684690.

 Primary dysmenorrhea (9 studies, with 647 patients): Cinnamon, fennel and ginger effectively relieved pain intensity ( (cinnamon  vs. placebo: WMD = 1.815, 95% CI = 1.330–2.301; fennel vs. placebo: WMD = 0.528, 95% CI = 0.119–6.829; ginger vs. placebo: WMD = 2.902, 95% CI = 2.039–3.765), and pain duration compared to placebo.

Xu Y, Yang Q, Wang X. Efficacy of herbal medicine (cinnamon/fennel/ginger) for primary dysmenorrhea: a systematic review and meta-analysis of randomized controlled trials. J Int Med Res. 2020 Jun;48(6):300060520936179. doi: 10.1177/0300060520936179. PMID: 32603204; PMCID: PMC7328489.

 Female infertility (18 RCTs, with 2,662 participants) : The meta-analysis revealed that the effect of herbal medicine led to a significant increase in pregnancy rates compared to the placebo treatment. Cuscuta Sm. (Tusizi) is the most commonly used herb for treating female infertility, followed by Angelica sin. Rd. (Danggui) and Cyperus Rh. (Xiangfuzi). These herbs were mainly used to treat patients with kidney deficiency or kidney deficiency combined with blood stasis or Phlegm-dampness on the TEAM pattern. Adverse events in the included studies were generally mild and infrequent.

Hyun JY, Jung HS, Park JY. Herbal therapeutics for female infertility: A systematic review and meta-analysis. J Ethnopharmacol. 2024 Jan 30;319(Pt 2):117258. doi: 10.1016/j.jep.2023.117258. Epub 2023 Sep 29. PMID: 37778518.

 Depression (10 RCTs with 835 participants):  Of these studies, seven studies used fluoxetine (20 mg, once a day), two used paroxetine (20 mg, once a day) and one used doxepin (25 mg, two times a day) as the antidepressant drugs. Meta-analyses revealed that Chaihu Shugan san formula (CSS) in combination with antidepressant drugs treatment significantly improved depressive symptoms (WMD=-3.56; 95% CI -5.09 to -2.03) and significantly increased effective rate (OR=3.31; 95% CI 1.80-6.10) and recovery rate (OR=2.32; 95% CI 1.61-3.34) compared with antidepressant drugs therapy. In addition, the efficacy of Chaihu Shugan san formula  as monotherapy was significantly better than antidepressants in improving depressive symptoms (WMD=-3.09; 95% CI -5.13 to -1.06) and in creasing effective rate (OR=2.61; 95% CI 1.23-5.53). CSS was comparable to antidepressants in increasing recovery rate (OR=1.83; 95% CI 0.84-3.98). No serious adverse events were reported in any of the included trials.  More full-scale randomized clinical trials with reliable designs are recommended to further evaluate the clinical benefit and long-term effectiveness of CSS for the treatment of depression.

Wang Y, Fan R, Huang X. Meta-analysis of the clinical effectiveness of traditional Chinese medicine formula Chaihu-Shugan-San in depression. J Ethnopharmacol. 2012 Jun 1;141(2):571-7. doi: 10.1016/j.jep.2011.08.079. Epub 2011 Sep 12. PMID: 21933701.

 Post-stroke Insomnia: 24 RCTs with 1942 participants.  Post-stroke insomnia is a highly prevalent complication after stroke. Current evidence of psychotropic drug use for PSI management is scarce and indicates harmful adverse events.  Asian Herbal Medicine leads to statistically significant benefits in sleep quality. It also appears to be safer than psychotropic drugs in terms of AEs. The methods used for RCTs were poor, and the quality of evidence assessed was graded “low” or “moderate.” The findings of this review indicate that the use of Asian Herbal medicine as a monotherapy may have potential benefits in Post-stroke Insomnia treatment when administered as an alternative to conventional medications. However, considering the methodological quality of the included RCTs, clinical evidence is uncertain. Further, well-designed RCTs are required to confirm these findings.

Kim SH, Lim JH. Traditional East Asian Herbal Medicine for Post-Stroke Insomnia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Int J Environ Res Public Health. 2022 Feb 3;19(3):1754. doi: 10.3390/ijerph19031754. PMID: 35162777; PMCID: PMC8834856.