An updated systematic review and meta-analysis of efficacy and safety of Chinese herbal medicine for treating atopic dermatitis.

BACKGROUND: This systematic review evaluated the Chinese herbal medicine (CHM) for treating atopic dermatitis (AD). METHODS: PubMed, EMBASE, the Cochrane library, the Wanfang database, and China National Knowledge Infrastructure (CNKI) were searched for relevant randomized controlled trials (RCTs) from inception to December 2021. Overall recovery rate, disease/symptom severity scoring, quality of life (QoL), recurrence rate, and incidence of adverse events (AEs) were evaluated. STATA SE 14.0 software was used for statistical analysis. RESULTS: 17 RCTs involving 1624 patients were eligible. CHM was associated with a higher overall recovery rate (risk ratio [RR] = 1.15, 95% confidence interval [CI]: 1.05, 1.26, p = .003) and decreased recurrence rate (odds ratio [OR] = 0.19, 95% CI: 0.07, 0.55, p = .002), both confirmed by sensitivity analyses. CHM could decrease scoring atopic dermatitis index (MD = -0.61, 95% CI: -1.12, -0.11, p = .017), however, sensitivity analysis revealed non-robustness. No significant differences were found between the CHM and the control group in Eczema Area and Severity Index, QoL, and the incidence of AEs. CONCLUSIONS: CHM was effective for treating AD as it could improve the overall recovery rate and decrease the recurrence rate. More studies are required to validate the potential of CHM on disease/symptoms severity and QoL.

Conventional disease-modifying anti-rheumatic drugs combined with Chinese Herbal Medicines for rheumatoid arthritis: A systematic review and meta-analysis.

Rheumatoid Arthritis (RA) remains a major global public health challenge. Disease-modifying anti-rheumatic drugs (DMARDs) are standard therapeutic drugs for RA. Conventional DMARDs (c-DMARDs) are a subgroup of approved synthetic DMARDs. The c-DMARDs experienced lesser response with longer disease duration or drug exposure, and unwanted adverse events (AEs). The combination treatments (CTs) of c-DMARDs and Chinese Herbal Medicines (CHMs) were often used in RA clinical trials for increasing the therapeutic effectiveness and reducing the AEs. This systematic review aimed to evaluate the efficacy and safety of the CTs for RA. Databases were searched from inception to October 2020 for identification of randomized controlled trials (RCTs) that investigated the CTs in the management of RA. Twenty-three RCTs with 2,441 participants were included. The assessments and analyses found CTs improved American College of Rheumatology (ACR) 20 (RR: 1.33, 95% CI [1.21, 1.45], 10 studies, n=1,075) and alleviated AEs (RR: -0.40, 95% CI [-0.30, -0.53], 19 studies, n=2,011) in comparison with c-DMARDs. The CTs also significantly improved RA symptoms and patient-reported outcomes; reduced disease activity score (DAS) 28, serum acute-phase reactants and RA biomarkers. The five most commonly used herbs in included studies were Angelicae Sinensis Radix, Paeoniae Radix Alba, Cinnamomi Ramulus, Glycyrrhizae Radix et Rhizoma, and Clematidis Radix et Rhizoma. Pharmacological studies indicated these CHMs could contribute to the outcomes. The integrated CHMs potentially increased the overall effectiveness of c-DMARDs and alleviated AEs in management of RA. Large sample and rigorously designed RCTs are required for future studies.

Estimated Number of Acupuncture Practitioners in Mainland China in 2018: Multiperspectives.

Background and Objective: Acupuncture and Oriental medicine are widespread, practiced in >183 countries and regions. As such, it has played an important role in the world health care system. However, there are no official statistics available on the number of acupuncture practitioners in China. The aim of this study is to calculate the number ranges of acupuncture practitioners in China in 2018. Materials and Methods: In total, 33.708 million was used as the total number of patient visits for acupuncture in 2018 in China. This number was calculated using the data released by the National Administration of Traditional Chinese Medicine (China), in which the average daily workload of all acupuncture practitioners in China was 134,832 patient visits. Acupuncture practitioners in China are part of Chinese Medicine doctors (CMDs) at the physician level, called "acupuncture doctors." This number 134,832 was divided by the workload of a single doctor of acupuncture, which was 19.4 or 7.0 patient visits per day. These numbers were from a survey by the authors. There are also the numbers 16.0 or 9.4 patient visits per day; these numbers were calculated from the salary level of acupuncture practitioners at 10,000 Yuan per month (providing the doctor's net income was 30% or 50% in his/her gross income). From these 2 sources, the authors then obtained 2 sets of ranges of acupuncture practitioners in China in 2018. There were 9,927 CMDs in 49 big hospitals, of which 619 were acupuncture practitioners; the ratio of acupuncture practitioners to the whole of all CMDs was 6.23%. Using this ratio multiplied by the whole number of CMDs in 2018, then the number of acupuncture practitioners in China in 2018 could be obtained as well. Results: Calculating based on the workload, the range of acupuncture practitioners in China in 2018 was from 6,950 to 19,262. Calculating based on the salary level, the range was 10,618 to 17,697. Calculating based on the ratio of the number of acupuncture practitioners to the whole population of CMDs, the number was 28,360. Conclusions: The reasonable range of acupuncture practitioners in China in 2018 was 10,618 to 17,697, with a median of 14,157. Considering that some acupuncture practitioners are also engaged in teaching, research, and management, the mentioned number is enlarged by 30% to produce 18,404, which would be reasonable. It was also concluded that the density of acupuncture practitioners was 1.31 per 100,000 residents.

Chinese herbal medicine for COVID-19: Current evidence with systematic review and meta-analysis.

BACKGROUND: There is currently no drug or therapy that cures COVID-19, a highly contagious and life-threatening disease. OBJECTIVE: This systematic review and meta-analysis summarized contemporary studies that report the use of Chinese herbal medicine (CHM) to treat COVID-19. SEARCH STRATEGY: Six electronic databases (PubMed/MEDLINE, Cochrane Library, ScienceDirect, Google Scholar, Wanfang Data and China National Knowledge Infrastructure) were searched from their beginning to May 15, 2020 with the following search terms: traditional Chinese medicine, Chinese medicine, Chinese herbal medicine, COVID-19, new coronavirus pneumonia, SARS-CoV-2, and randomized controlled trial. INCLUSION CRITERIA: Randomized controlled trials (RCTs) from peer-reviewed journals and non-reviewed publications were included. Further, included RCTs had a control group that was given standard care (SC; such as conventional Western medicine treatments or routine medical care), and a treatment group that was given SC plus CHM. DATA EXTRACTION AND ANALYSIS: Two evaluators screened and collected literature independently; information on participants, study design, interventions, follow-up and adverse events were extracted, and risk of bias was assessed. The primary outcomes included scores that represented changes in symptoms and signs over the course of treatment. Secondary outcomes included the level of inflammatory markers, improvement of pneumonia confirmed by computed tomography (CT), and adverse events. Dichotomous data were expressed as risk ratio or hazard ratio with 95% confidence interval (CI); where time-to-event analysis was used, outcomes were expressed as odds ratio with 95% CI. Continuous data were expressed as difference in means (MD) with 95% CI, and standardized mean difference (SMD) was used when different outcome scales were pooled. RESULTS: Seven original studies, comprising a total of 732 adults, were included in this meta-analysis. Compared to SC alone, CHM plus SC had a superior effect on the change of symptom and sign score (-1.30 by SMD, 95% CI [-2.43, -0.16]; 3 studies; n = 261, P = 0.03), on inflammatory marker C-reactive protein (CRP, mg/L; -11.82 by MD, 95% CI [-17.95, -5.69]; 5 studies; n = 325, P = 0.0002), on number of patients with improved lung CT scans (1.34 by risk ratio, 95% CI [1.19, 1.51]; 4 studies; n = 489, P < 0.00001). No significant adverse events were recorded in the included RCTs. CONCLUSION: Current evidence shows that CHM, as an adjunct treatment with standard care, helps to improve treatment outcomes in COVID-19 cases.

Controversial conclusions from two randomized controlled trials for acupuncture's effects on polycystic ovary syndrome or in vitro fertilization support.

Two reports of trials investigating the potential effect of acupuncture in increasing live birth rate (LBR) in women with polycystic ovary syndrome (PCOS) or those undergoing in vitro fertilization (IVF) were published by Journal of American Medical Association in 2017 and 2018 respectively. The trial investigators did not recommend acupuncture for the women with PCOS or IVF based on their findings. This paper raises the concern that the findings that acupuncture did not increase LBR for women with PCOS or undergoing IVF may be the result of methodological flaws in the studies and unintended bias such as use of an invalid control intervention and underestimation of the true acupuncture effect. Therefore, their findings may not be a valid reflection of acupuncture's effect in improving LBR in women with these clinical conditions.

Chinese herbal medicine for atopic eczema: an overview of clinical evidence.

Atopic eczema (AE), or atopic dermatitis, is a common inflammatory skin disease. As conventional medicines for moderate and severe AE patients have been reported to be associated with unwanted side effects, many patients with AE have sought other therapies. Chinese herbal medicine (CHM) is one of the most commonly used complementary therapies with a long history of being applied for the treatment of AE. Clinical evidence for CHM for AE in systematic reviews and randomised controlled trials (RCTs) published from 2013 to 2016 was reviewed. Findings from the Cochrane systematic review suggested that oral use of a CHM formulation may improve health-related quality of life (HRQoL) of children with moderate or severe AE. The benefit on improvement of AE requires further high-quality clinical studies.

[Is acupuncture ineffective in treating infertility associated with polycystic ovary syndrome? A reanalysis of data on the clinical trial by WU Xiaoke's team published on JAMA].

WU Xiaoke, Stener-Victorin and Richard Legro's team published a randomized clinical trial entitled Effect of acupuncture and clomiphene in Chinese women with polycystic ovary syndrome: a randomized clinical trial in JAMA on June 27, 2017. Their conclusion is "this finding does not support acupuncture as an infertility treatment in such women". We found that the trial design had serious flaws and that the results could not lead to the conclusion. Based on the reanalysis for the study data and those published in other medical journals recently from the team, it was found that acupuncture plus clomiphene or control acupuncture plus clomiphene had more excellent live birth rate, ovulation rate and cumulative ovulation rate than clomiphene alone, with statistical and clinical significance. The conclusion of the trial is potentially incorrect.

Acupuncture is Effective for Chronic Knee Pain: A Reanalysis of the Australian Acupuncture Trial.

Context • In the October 2014 issue of the Journal of the American Medical Association (JAMA), Hinman et al published the results of an Australian clinical trial on acupuncture in a paper entitled "Acupuncture for Chronic Knee Pain: A Randomized Clinical Trial" (JAMA report), in which they concluded that neither acupuncture nor laser acupuncture had any greater effects than sham laser acupuncture for pain or function for patients aged 50 y and older with moderate-to-severe knee pain. That study has been criticized extensively by international scholars for its validity because serious methodological flaws existed throughout the study's design, implementation, and conclusions. Objective • The current study intended to re-examine the prior study's conclusions about the efficacy of acupuncture for chronic knee pain. Design • The current research team performed a reanalysis of relevant data from the JAMA report. Intervention • The original study included 4 groups: (1) an acupuncture group, which received needle acupuncture, inferred by the current authors to have been set up to be a positive control in the original study; (2) a laser acupuncture group, which received laser acupuncture; (3) a sham laser acupuncture group, which received sham laser acupuncture and acted as the negative controls for the laser acupuncture intervention; and (4) a control group, which received conventional care but no acupuncture or laser treatments. The study lasted 12 wk. Outcome Measures • The measures included evaluations in the following areas: (1) poststudy modifications-an evaluation of the consistency of the JAMA report with the study's intentions as identified for a grant that was originally approved and funded by the Australian National Health and Medical Research Council (NHMRC) in 2009, as indicated in the study's trial registration, and as compared with the published protocols and to the study's originally stated objectives; (2) high heterogeneity-an assessment of the heterogeneity among the 4 groups for the overall outcome related to pain; (3) ineffectiveness of laser acupuncture-an analysis of laser acupuncture's efficacy for chronic knee pain as stated in the JAMA report, using effect size (ES); (4) effectiveness of acupuncture-a reanalysis of acupuncture's efficacy for chronic knee pain in comparison with the original analysis in the JAMA report, using ES; and (5) acupuncture after data adjustment-a new analysis of acupuncture's efficacy for chronic knee pain using data from the original study that was discussed in the JAMA report, using ES, with an estimation after data adjustment and elimination of the dilution effect of the Zelen design. Results • Contrary to a general impression that acupuncture was the focus, laser acupuncture was the primary intervention tested in the actual study, "Laser Acupuncture in Patients With Chronic Knee Pain: A Randomized, Placebo Controlled Trial." The study discussed in the JAMA report was neither a truly randomized, controlled trial (RCT) for acupuncture nor was it an appropriately designed, randomized study in general. High heterogeneity was found among its groups in the evaluation of overall pain in patients. Both the ES of 0.60 that had been set by Hinman et al for the minimal clinically important difference (MCID) and the resulting interpretation of results in the JAMA report were not appropriate. Using the original study's criteria of efficacy, the reanalysis has confirmed that the laser acupuncture was not effective, whereas the acupuncture was found to be moderately effective for chronic knee pain (P < .05) for both overall pain and function at 12 wk, with an ES of 0.58, or after the adjustment of the data, with an ES of 0.67. Conclusions • The JAMA study was neither a conventional RCT nor an appropriately randomized trial, and its results are probably invalid. The ES of 0.60 for the MCID that was used in the JAMA study and the resulting explanation were not appropriate. Even with an ES of 0.60 for the MCID, acupuncture remained effective after data adjustment. Consequently, compared with conventional care, acupuncture treatment was found to be moderately effective for chronic knee pain in patients aged 50 y and older.

Chinese herbal medicine granules (PTQX) for children with moderate to severe atopic eczema: study protocol for a randomised controlled trial.

BACKGROUND: Atopic eczema or atopic dermatitis is a chronic inflammatory skin disease. Current conventional medical treatment for moderate and severe atopic eczema is not satisfactory. There is promising evidence derived from randomised clinical trials to support the clinical use of Chinese herbal medicine in the management of atopic eczema. However, the available evidence is compromised by the high risk of bias associated with most of the included trials. Therefore, well-designed and adequately powered randomised clinical trials are needed. The primary aim of this trial is to evaluate the efficacy and safety of oral ingestion of an oral Chinese herbal formula (Pei Tu Qing Xin granules; PTQX) in children aged between 6 and 16 years with moderate to severe atopic eczema. METHODS/DESIGN: We have designed a randomised, double-blind, placebo-controlled, two-arm, parallel clinical trial with 12 weeks of treatment and a 4-week follow-up period. A pilot study with 30 participants will be conducted at the RMIT University in Australia to determine the feasibility of the full-scale randomised clinical trial (N = 124). Eczema Area and Severity Index score will be the primary outcome. Secondary outcome measures include change in symptoms using the Patient-Oriented Eczema Measure, the Children's Dermatology Life Quality Index and the use of concomitant medicines. Safety parameters include report of adverse events and pathology tests during the trial period. DISCUSSION: Key elements for conducting a high-quality randomised clinical trial have been addressed in this protocol. Findings from the proposed trial will provide critical evidence regarding Chinese herbal medicine treatment for atopic eczema. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry Identifier: ACTRN12614001172695. Date of Registration: 7 November 2014.

Topical application of Chinese herbal medicine for atopic eczema: a systematic review with a meta-analysis.

BACKGROUND: Atopic eczema (AE) affects 10-20% of children in industrialised countries. OBJECTIVE: This review systematically evaluated the effects and safety of topical use of Chinese herbal medicine (CHM) for AE. METHODS: Randomised controlled trials on topical use of CHM were identified through searching electronic databases. Their risk of bias was assessed. Meta-analysis was conducted by employing the RevMan 5.2 software. RESULTS: Ten studies involving 1,058 participants were included. These studies had high risk of bias in randomisation, blinding and outcome data. Meta-analysis showed that topical applications of CHM were superior to conventional medications in total effectiveness rate (risk ratio 1.19; 95% confidence interval 1.04 to 1.36). No significant difference was observed in overall skin lesion score (standardised mean difference -0.05; 95% confidence interval -0.88 to 0.78) compared to corticosteroid creams. CONCLUSIONS: There was no conclusive evidence to demonstrate that topical application of CHM for AE was superior to other control interventions due to methodological weaknesses of the included randomised controlled trials.

Chinese herbal medicine for atopic eczema.

BACKGROUND: Chinese herbal medicine (CHM) has been increasingly used for atopic eczema. A previous version of this Cochrane review published in 2004 found some evidence of a possible benefit for oral ingestion of CHM for eczema, but the results were inconclusive and the evidence needs to be updated. We have expanded the scope of this review to include an assessment of the topical and oral effects of CHM for eczema. OBJECTIVES: To assess the effects of oral ingestion and topical applications of CHM for the management of eczema in children and adults. SEARCH METHODS: We searched the following databases up to September 2012: the Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library (2012, Issue 8), MEDLINE (from 1946), EMBASE (from 1974), AMED (from 1985), LILACS (from 1982), and CINAHL (from 1981). We searched the following from inception: SCOPUS, HERBMED, ProQuest, CQVIP, CNKI, and Wanfang Data. We also searched trials registers, handsearched conference proceedings, checked the reference lists of all included and excluded studies and review articles for further references to relevant trials, and contacted experts in Chinese medicine for unpublished studies. SELECTION CRITERIA: All randomised controlled trials (RCTs) in children and adults with eczema comparing CHM to placebo; no intervention; active controls, including acupuncture; or conventional medicines. DATA COLLECTION AND ANALYSIS: Two authors selected the RCTs, extracted data, and assessed quality independently. We contacted study authors for missing data. We collected adverse events from the included studies. MAIN RESULTS: We included 28 studies, with a total of 2306 participants. We assessed most of the studies at high 'risk of bias', particularly in blinding of participants and personnel, and there was substantial inconsistency between studies, so any positive effect of CHM must be treated with caution. We did not include the four studies from the previous version in this review, because they investigated a CHM product that has been withdrawn from the market since 2004.Four studies (three oral and one topical) compared CHM to placebo. Pooled data from 2 studies showed the total effectiveness rate in the CHM group was higher (by risk ratio (RR) 2.09, 95% confidence interval (CI) 1.32 to 3.32; 2 studies; n = 85), and the itching visual analogue score (VAS) in the CHM group was 1.53 lower (by standardised mean difference (SMD), 95% CI 2.64 to 0.41; 2 Studies; n = 94) than the placebo group, where a lower VAS score indicates reduced itch. One study of 85 participants with moderate to severe eczema who received an oral CHM formula for 12 weeks reported a quality of life (QoL) score 2.5 lower in the CHM group (by difference in means (MD), 95% CI 4.77 to 0.23; 1 study; n = 85) than the placebo group, where a lower score indicates better QoL.  Twenty-two studies and 1 arm from a study with a 4-arm parallel controlled design compared CHM (5 oral, 6 topical, and 12 mixed oral and topical) to conventional medicines. The total effectiveness rate in the CHM groups was superior (RR 1.43, 95% CI 1.27 to 1.61; 21 studies; n = 1868; very low quality evidence), and the itching VAS in the CHM groups was 0.83 lower (SMD, 95% CI 1.43 to 0.22; 7 studies; n = 465) than the comparators.Two studies compared combined oral and topical CHM to the same oral CHM formula alone. The total effectiveness rate in 1 study was not statistically significant (RR 1.13, 95% CI 0.78 to 1.63; 1 study; n = 20). In the other study, the itching VAS in the CHM group was 1.05 lower (MD, 95% CI 1.75 to 0.35; 1 study; n = 23) than the control group.With regard to side-effects, four studies did not give any report of adverse events. The other 24 studies reported minor adverse events, which were reversed soon after stopping CHM. One participant withdrew from one trial because of exacerbation of their condition after using the CHM intervention.Eight studies received government funding. AUTHORS' CONCLUSIONS: We could not find conclusive evidence that CHM taken by mouth or applied topically to the skin could reduce the severity of eczema in children or adults.Well-designed, adequately powered RCTs are needed to evaluate the efficacy and safety of CHM for managing eczema.