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Journal of Chinese Integrative Medicine ›› 2012, Vol. 10 ›› Issue (11): 1211-1228.doi: 10.3736/jcim20121104

• Systematic Review • Previous Articles     Next Articles

Systematic review and meta-analysis of randomized controlled trials of integrative medicine therapy for treatment of chronic severe hepatitis

Hui-min Liu1,2, Xian-bo Wang2, Yu-juan Chang2, Li-li Gu2   

  1. 1. Beijing University of Chinese Medicine, Beijing 100029, China
    2. Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
  • Received:2012-06-01 Accepted:2012-06-26 Online:2012-11-20 Published:2018-11-15

Background: Chronic severe hepatitis is a critical disease with high mortality. Currently, effective drugs and therapy still lack. Comprehensive and supportive treatment, artificial liver and liver transplantation are the main therapies. A great number of studies on traditional Chinese medicine (TCM) in many ways combined with Western medicine treatment for chronic severe hepatitis have been reported, but the efficacy and safety still lack systematic evaluation.

Objective: To evaluate the efficacy and safety of integrative medicine therapy for chronic severe hepatitis.

Search strategy: Literature was searched from PubMed, the Cochrane Library, the China National Knowledge Infrastructure Database, the Chongqing VIP Chinese Science and Technology Periodical Database, the Chinese Biomedical Literature Database and Wanfang Database. The time limitation ran from the commencement of each database to February 29, 2012.

Inclusion criteria: Randomized controlled trials (RCTs) testing Chinese herbal medicine (CHM) combined with Western medicine (comprehensive and supportive treatment or artificial liver plasma exchange) against Western medicine were included.

Data extraction and analysis: Two authors collected and extracted data independently. The methodological quality of literature was assessed by risk of bias table from Cochrane Collaboration and the data were analyzed by RevMan 5.1 software. Heterogeneity of the included studies was checked by Chi-square test. The efficacy measure was relative risk (RR) or mean difference with a 95% confidence interval (CI).

Results: A total of 45 RCTs involving 4 449 patients with chronic severe hepatitis were included. Quality of all included trials was low. The oral CHM, enema and combined TCM with either Western medicine or plasma exchange were superior to Western medicine alone in improving total effective rate and reducing mortality with significant differences. In laboratory parameters, the integrative medicine treatment group was better than Western control group in reducing the total bilirubin and alanine aminotransferase, but two groups showed equal efficacy in lowering aspartate aminotransferase activity. The oral Chinese medicine combined with Western medicine or plasma exchange was better than Western medicine used alone in improving albumin synthesis and coagulation function, but Chinese medicine enema had no significant effect on the level of plasma albumin. The main side effects of the treatment group were abdominal pain, diarrhea and other intestinal symptoms after enema, while adverse reactions of the control group were mainly due to the plasma exchange.

Conclusion: Integrated Chinese and Western medicine can promote the recovery of liver function and coagulation function, and reduce the mortality rate of patients with chronic severe hepatitis. However, due to a lower quality of clinical trials published in Chinese journals, the evidence is insufficient to prove the superiority of integrative therapy. Further well-designed, multicenter, large-sample RCTs are still needed to evaluate the beneficial effects of CHM.

Key words: TCM WM therapy, TCM therapy, Chinese herbal medicine, hepatitis, chronic, severe, review, systematic, meta-analysis

Figure 1

Flow diagram of literature search and screening of integrative medicine therapy in the treatment of chronic severe hepatitis CNKI: China National Knowledge Infrastructure Database; VIP: Chongqing VIP Chinese Science and Technology Periodical Database; CBM: Chinese Biomedical Literature Database. RCTs: randomized controlled trials."

Table 1

Characteristics and methodological quality of included trials"

Study Sample size
(n1/n2)
Gender
(male/female)
Age (means
or range, years)
Treatment
duration (weeks)
Follow-up Methodology
quality
Gu CL 2006[6] 47 (20/27) 41/6 T: 34; C: 32 6 No Low
Wang JP 2009[7] 126 (63/63) 96/30 46.5 4 No Low
Qiu H 2007[8] 95 (46/49) 74/21 T: 39.8; C: 38.5 12 No Low
Li J 2011[9] 962 (667/295) ND ND 8 Yes High
Gao JR 1999[10] 47 (26/21) ND 40.02 8 No Low
Li JY 2011[11] 70 (33/37) 62/8 T: 43; C:46 4 No Low
Hu XY 2008[12] 75 (38/37) 58/17 T: 42.23; C: 40.78 6 Yes Low
Li ZZ 2009[13] 108 (67/41) 89/19 T: 41.2; C: 39.8 4 Yes High
Li Q 2006[14] 75 (45/30) 64/11 T: 44.5; C: 43.1 4 No Low
Deng X 2004[15] 70 (35/35) 65/5 T: 36.7; C: 38.2 4 No Low
Zhu QJ 2009[16] 82 (44/38) 76/6 T: 44.55; C: 47.87 4 No Low
An TJ 2005[17] 80 (40/40) 69/11 T: 38; C: 37 4 No Low
Huang JQ 2006[18] 120 (60/60) 102/18 T: 42.06; C: 43.76 6 No Low
Ma RH 2010[19] 40 (20/20) 31/9 20 to 68 4 No Low
Song AJ 2010[20] 60 (31/29) 45/15 T: 38.7; C: 40.8 8 No Low
Fu HL 2004[21] 54 (28/26) 43/11 T: 37.2; C: 37.9 6 No Low
Luo XL 2001[22] 68 (35/33) 49/19 T: 41; C: 39 4 No Low
Li F 2006[23] 65 (35/30) 44/21 T: 36; C: 34 8 No Low
Zeng DX 2004[24] 64 (32/32) 41/23 T: 38.7; C: 37.5 8 No Low
Zhang WW 2005[25] 88 (43/45) 77/11 T: 38; C: 35 4 No Low
Sun KW 2006[26] 43 (22/21) 36/7 T: 35.1; C: 32.7 4 No High
Xu QY 2011[27] 104 (52/52) 89/15 T: 43; C: 41 4 No Low
Xing JS 2006[28] 71 (36/35) 52/19 T: 39.5; C: 40.1 6 No Low
Guo JC 2006[29] 60 (30/30) 54/6 26 to 58 4 No Low
Li WY 2009[30] 120 (60/60) 88/32 37.7 4 No Low
Shi WZ 2008[31] 60 (30/30) 54/6 36.0 4 No Low
Wu QK 2009[32] 63 (32/31) 42/21 T: 45.2; C: 44.3 4 No Low
Feng HL 2009[33] 50 (25/25) 30/20 41.78 4 No Low
Wang LD 2000[34] 125 (65/60) ND ND 4 No Low
Li Z 2011[35] 42 (21/21) 35/7 T: 26 to 55; C: 27 to 54 4 No Low
Zhang NN 2009[36] 55 (28/27) 48/7 T: 42.36; C: 39.19 4 Yes Low
Liu P 2009[37] 86 (43/43) 72/14 T: 38.05; C: 43.45 6 No Low
Hu JH 2010[38] 111 (55/56) 87/24 T: 43.89; C: 46.46 4 Yes Low
Gong GY 2009[39] 86 (43/43) 71/15 21 to 60 8 No Low
Zhou T 2006[40] 99 (52/47) 70/29 T: 48.3; C: 50.6 2 No Low
Wang H 2010[41] 65 (33/32) 43/22 T: 31.9; C: 31.3 4 No Low
Qiu H 2008[42] 150 (50/50/50) 127/23 28 to 64; 24 to 64; 24 to 64 8 No Low
Chen B 2012[43] 165 (84/81) 142/23 T: 21 to 65; C: 23 to 64 8 Yes High
Liu X 2010[44] 80 (40/40) 54/26 T: 42.5; C: 43.4 4 No Low
Ruan QF 2011a[45] 86 (45/41) 81/5 T: 41.6; C: 42.5 8 No Low
Lin H 2009[46] 60 (30/30) 56/4 T: 40.8; C: 39.1 4 No Low
Ruan QF 2011b[47] 76 (39/37) 71/5 T: 42.18; C: 42.78 4 No Low
Zhao WX 2011[48] 60 (30/30) 49/11 T: 18 to 70; C: 24 to 73 4 No Low
Huang XJ 2008[49] 46 (26/20) 40/6 T: 35.1; C: 34.7 4 No Low
Li Q 2010[50] 90 (45/45) 85/5 T: 40.7; C: 39.7 6 No Low

Table 2

Interventions and outcomes of included studies"

Study Intervention Control Outcome measure
Gu CL 2006[6] Oral Chinese herbal medicine plus WMT WMT TBIL, PTA, effective rate
Wang JP 2009[7] Tuihuang Qinggan Decoction plus WMT WMT Effective rate
Qiu H 2007[8] Jiedu Huayu Granule plus WMT WMT Mortality, MELD score
Li J 2011[9] Oral Chinese herbal medicine plus WMT WMT Mortality, survival rate, complication rate, ALT, AST, TBIL, DBIL, PTA, TP, ALB, symptom score, effective rate, MELD score, side effects, endotoxin
Gao JR 1999[10] Oral Chinese herbal medicine plus WMT WMT Effective rate
Li JY 2011[11] Yiqi Yangyin Decoction plus WMT WMT Effective rate, TBIL, PTA, blood ammonia,
endotoxin, symptom score
Hu XY 2008[12] Qinggan Jiedu Decoction plus WMT WMT ALT, TBIL, PTA, ALB, CHE, creatine, MELD, complication rate, effective rate
Li ZZ 2009[13] Sanjun Tuihuang Decoction plus WMT WMT Effective rate, ALT, TBIL, PTA, CHE, ALB, survival rate, side effects
Li Q 2006[14] Zhonggan Mixture plus WMT WMT TBIL, PTA, PT, ALB, effective rate
Deng X 2004[15] Chishao Chengqi Decoction plus WMT WMT Mortality, PTA, PT, ALT, TBIL, ALB, TNF-α, endotoxin, side effects, TC
Zhu QJ 2009[16] Danhuang Decoction plus WMT WMT Effective rate, PTA, ALT, TBIL, ALB, complication rate
An TJ 2005[17] Shaodan Chengqi Decoction plus WMT WMT ALT, AST, TBIL, PTA, ALB
Huang JQ 2006[18] Kangganshuai Decoction plus WMT WMT Effective rate, symptoms and signs, PTA, ALT, AST, TBIL, ALB, complication rate
Ma RH 2010[19] Oral Chinese herbal medicine plus WMT and plasma exchange WMT ALT, AST, TBIL, PTA, ALB, TP, effective rate
Song AJ 2010[20] Oral Chinese herbal medicine plus WMT WMT Effective rate, ALT, TBIL, PTA, CHE
Fu HL 2004[21] Dangfei Lining Capsule plus WMT WMT ALT, TBIL, PT
Luo XL 2001[22] Oral Chinese herbal medicine plus WMT WMT ALT, TBIL, PT, TC, ALB, GGT, effective rate, complication rate
Li F 2006[23] Oral Chinese herbal medicine plus WMT WMT PTA, TBIL, effective rate
Zeng DX 2004[24] Shengdahuang Capsule plus WMT WMT ALB, TBIL, PTA, survival rate, complication rate, symptoms and signs
Zhang WW 2005[25] Yanhuanglian and Breviscapine Injection plus WMT WMT plus
Yinzhihuang
TBIL, PTA, effective rate
Sun KW 2006[26] Wenyang Jianpi Decoction plus WMT Jiedu Huayu Decoction
plus WMT
ALT, TBIL, PTA, ALB, effective rate, side effects
Xu QY 2011[27] Tongchang Qinggan Decoction plus WMT WMT Effective rate
Xing JS 2006[28] Oral Chinese herbal medicine plus WMT WMT TBIL, PTA, effective rate
Guo JC 2006[29] Chinese herbal medicine enema plus WMT WMT ALT, TBIL, CHE, PT, blood ammonia, ALB, effective rate
Li WY 2009[30] Chinese herbal medicine enema plus WMT WMT TBIL, ALT, ALB, PTA, blood ammonia,
endotoxin, survival rate
Shi WZ 2008[31] Chinese herbal medicine enema plus WMT WMT ALT, TBIL, PT, ALB, CHE, endotoxin,
TNF-α, IL-2, IL-6
Wu QK 2009[32] Chishao Chengqi Decoction enema plus WMT WMT Effective rate, symptom score, PT, ALT,
TBIL, ALB, side effects
Feng HL 2009[33] Chinese herbal medicine enema plus WMT and plasma exchange WMT Endotoxin, symptom score, PTA, TNF-α, blood ammonia, complication rate, side effects
Wang LD 2000[34] Dahuang enema plus WMT WMT ALT, TBIL, PT, ALB, GLO, A/G, effective
rate, complication rate
Li Z 2011[35] Chinese herbal medicine enema plus WMT WMT CHE, ALT, AST, TBIL, blood ammonia, PT
Zhang NN 2009[36] Ganlu Xiaodu Pill, Chinese herbal medicine enema plus WMT WMT Effective rate, ALB, GLO, ALT, AST,
TBIL, DBIL, PTA
Liu P 2009[37] Oral Chinese herbal medicine, Chinese herbal medicine enema plus WMT WMT ALT, AST, TBIL, DBIL, PTA, ALB,
symptom score, effective rate, side effects
Hu JH 2010[38] Oral Chinese herbal medicine, Guanchang Yihao (enema) plus WMT WMT Mortality, TBIL, PTA, symptom score,
effective rate
Gong GY 2009[39] Shuqingwan, Chinese herbal medicine enema plus WMT WMT Mortality, survival rate, ALT, TBIL, PTA, ALB
Zhou T 2006[40] Kaiqiao Chengqi Decoction plus WMT WMT plus lactulose
(enema)
Symptoms and signs, blood ammonia, PT,
LPS, ALT, AST, TBIL, ALB
Wang H 2010[41] Ganshen Qingdu Decoction, Chinese herbal medicine enema plus WMT WMT Effective rate, symptom score, PTA, ALT, TBIL, ALB, endotoxin, TNF, blood ammonia
Qiu H 2008[42] Jiedu Huayu Granule, Danshen Injection and Kuhecang Injection, and Chinese herbal medicine enema plus WMT WMT TBIL, PTA, CHE, symptom score, complication
rate, side effects
Chen B 2012[43] Oral Chinese herbal medicine, Chinese herbal medicine enema plus WMT WMT Mortality, TBIL, PTA, ALB, symptom score, effective rate, complication rate, side effects
Liu X 2010[44] Zhonggan Mixture, plasma exchange plus WMT Plasma exchange
plus WMT
ALT, TBIL, PTA, ALB, effective rate
Ruan QF 2011a[45] Oral Chinese herbal medicine, plasma
exchange plus WMT
Plasma exchange
plus WMT
ALT, ALB, TBIL, PTA, TC, symptom
score, effective rate
Lin H 2009[46] Zhonggan Mixture, plasma exchange plus WMT Plasma exchange
plus WMT
ALT, AST, TC, TBIL, PTA, PT, ALB,
symptom score, effective rate
Ruan QF 2011b[47] Yinshao Guiqi Decoction, plasma exchange plus WMT Plasma exchange
plus WMT
TBIL, TC, PTA, ALT, ALB, symptom
score, effective rate
Zhao WX 2011[48] Yiqi Huoxue Granule, plasma exchange plus WMT Plasma exchange
plus WMT
ALT, TBIL, PTA, CHE, side effects
Huang XJ 2008[49] Yinchen Zhufu Decoction, plasma
exchange plus WMT
Plasma exchange
plus WMT
TBIL, PTA, ALB, effective rate, complication
rate, side effects
Li Q 2010[50] Zhonggan Mixture, plasma exchange plus WMT Plasma exchange
plus WMT
ALT, AST, TBIL, PTA, PT, ALB, symptom
score, effective rate, complication rate

Table 3

Analysis of overall clinical efficiency"

Trial Number of trials Intervention (n/N) Control (n/N) RR [95% CI] P value
Oral Chinese herbal medicine plus
WMT vs WMT
13 412/525 229/462 1.58 [1.43, 1.75] <0.000 01
Chinese herbal medicine enema plus
WMT vs WMT
5 158/215 106/208 1.44 [1.23, 1.69] <0.000 01
Comprehensive treatment of TCM plus WMT vs WMT 6 203/262 157/259 1.28 [1.14, 1.44] <0.000 01
Chinese herbal medicine injection plus WMT vs WMT 1 31/43 22/45 1.47 [1.04, 2.10] 0.03
Oral Chinese herbal medicine, plasma exchange plus WMT vs plasma exchange
plus WMT
6 173/225 117/213 1.39 [1.22, 1.59] <0.000 01
Meta-analysis 31 977/1 270 631/1 187 1.45 [1.36, 1.54] <0.000 01

Table 4

Analysis of clinical mortality rate"

Trial Number of trials Intervention (n/N) Control (n/N) RR [95% CI] P value
Oral Chinese herbal medicine plus
WMT vs WMT
5 53/221 98/191 0.49 [0.38, 0.64] 0.000 01
Chinese herbal medicine enema plus
WMT vs WMT
1 19/60 32/60 0.59 [0.38, 0.92] 0.02
Comprehensive treatment of TCM plus WMT vs WMT 5 60/260 94/257 0.63 [0.48, 0.82] 0.0006
Meta-analysis 11 132/541 224/508 0.56 [0.47, 0.67] <0.000 01

Tables 5

Analysis of total bilirubin level"

Trial Number of trials MD [95% CI] P value
Oral CHM plus WMT vs WMT
Dangfei Lining Capsule plus WMT vs WMT 1 -34.80 [-66.37, -3.23] 0.03
Shaodan Chengqi Decoction plus WMT vs WMT 1 82.16 [52.97, 111.35] <0.000 01
Chinese medicine plus WMT vs WMT 1 -32.90 [-42.81, -22.99] <0.000 01
Qinggan Jiedu Decoction plus WMT vs WMT 1 -269.7 [-328.57, -210.83] <0.000 01
Danhuangfang plus WMT vs WMT 1 -45.43 [-87.29, -3.57] 0.03
Sanjun Tuihuang Decoction plus WMT vs WMT 1 -42.60 [-65.77, -19.43] 0.0001
Yiqi Yangyin Decoction plus WMT vs WMT 1 -19.90 [-74.94, 35.14] 0.48
CHM plus WMT vs WMT 1 -89.79 [-120.43, -59.15] <0.000 01
Zhonggan Mixture plus WMT vs WMT 1 -111.86 [-149.25, -74.47] <0.000 01
CHM plus WMT vs WMT 1 -41.80 [-146.14, 62.54] 0.41
Chishao Chengqi Decoction plus WMT vs WMT 1 -73.21 [-104.05, -42.37] <0.000 1
Jiedu Huayu Granule plus WMT vs WMT 1 -35.20 [-69.31, -1.09] 0.05
Chinese medicine plus WMT vs WMT 1 -19.70 [-22.19, -17.21] <0.000 01
Kangganshuai fufang plus WMT vs WMT 1 -46.60 [-86.41, -6.79] 0.02
Wenyang Jianpi Decoction plus WMT vs Jiedu Huayu
Decoction plus WMT
1 -0.40 [-1.01, 0.20] 0.19
Meta-analysis 15 -21.85 [-24.20, -19.50] 0.000 2
CHM enema plus WMT vs WMT
Dachengqi Decoction plus WMT vs WMT 1 -0.48 [-1.15, 0.19] 0.16
Chinese medicine plus WMT vs WMT 1 2.11 [1.52, 2.69] <0.000 01
Chinese medicine plus WMT vs WMT 1 -1.38 [-1.95, -0.82] <0.000 01
Chinese medicine plus WMT vs WMT 1 -1.38 [-1.95, -0.82] <0.000 01
Shengdahuang Decoction plus WMT vs WMT 1 -0.07 [-0.42, 0.28] 0.68
Chishao Chengqi Decoction plus WMT vs WMT 1 -2.12 [-2.74, -1.49] <0.000 01
Chinese medicine plus WMT vs WMT 1 -1.24 [-1.63, -0.84] <0.000 01
Kaiqiao Chengqi Decoction plus WMT vs WMT plus lactulose (enema) 1 -0.47 [-0.87, -0.07] 0.02
Dachengqi Decoction plus WMT vs WMT 1 -1.76 [-2.22, -1.30] <0.000 01
Meta-analysis 9 -0.59 [-0.76, -0.42] <0.000 01
Comprehensive treatment of TCM plus WMT vsWMT
CHM, Guanchang Yihao (enema) plus WMT vsWMT 1 -0.21 [-0.59, 0.16] 0.27
Ganshen Qingdu Decoction, CHM (enema) plus WMT vs WMT 1 -2.33 [-2.97, -1.69] <0.000 01
Shuqingwan, CHM (enema) plus WMT vs WMT 1 -0.98 [-1.43, -0.53] <0.000 01
Oral CHM, CHM enema plus WMT vs WMT 1 -0.86 [-1.18, -0.54] <0.000 01
Jiedu Huayu Granule, Danshen Injection and Kuhuang
Injection, CHM (enema) plus WMT vs WMT
1 -0.86 [-1.27, -0.45] <0.000 01
Meta-analysis 5 -0.85 [-1.03, -0.66] <0.000 01
CHM Injection plus WMT vs WMT
Yanhuanglian and Breviscapine Injection plus WMT vs WMT plus Yinzhihuang Injection 1 -74.11 [-93.36, -54.86] <0.000 01
Oral CHM, plasma exchange plus WMT vs plasma exchange plus WMT
Zhonggan Mixture, plasma exchange plus WMTvs plasma exchange plus WMT 3 -41.70 [-58.40, -25.00] 0.03
CHM, plasma exchange plus WMT vs plasma exchange plus WMT 1 -52.00 [-87.78, -16.22] 0.004
Yinshao Guiqi Decoction plasma exchange plus WMT vs plasma exchange plus WMT 1 -36.60 [-56.99, -16.21] 0.004
CHM, plasma exchange plus WMT vs plasma exchange plus WMT 1 4.30 [-70.53, 79.13] 0.91
Yiqi Huoxue Granule, plasma exchange plus WMTvs plasma exchange plus WMT 1 -78.40 [-159.61, 2.81] 0.06
Meta-analysis 7 -37.76 [-48.22, -27.29] <0.000 01

Tables 6

Analysis of albumin level"

Trial Number of trials MD [95% CI] P value
Oral CHM plus routine WMT vs WMT
Qinggan Jiedu Decoction plus WMT vs WMT 1 3.72 [0.92, 6.52] 0.009
Wenyang Jianpi Decoction plus WMT vs WMT 1 0.90 [-1.31, 3.11] 0.42
Danhuangfang plus WMT vs WMT 1 2.71 [0.45, 4.97] 0.02
Sanjun Tuihuang Decoction plus WMT vs WMT 1 1.30 [0.17, 2.43] 0.02
Zhongganheji plus WMT vs WMT 1 0.64 [-0.81, 2.09] 0.39
Kangganshuai Fufang plus WMT vs WMT 1 1.50 [-0.09, 3.09] 0.07
Chishao Chengqi Decoction plus WMT vs WMT 1 3.51 [1.14, 5.88] 0.004
Meta-analysis 7 1.58 [0.93, 2.23] <0.000 01
CHM enema plus WMT vs WMT
Chishao Chengqi Decoction plus WMT vs WMT 1 0.37 [-0.13, 0.87] 0.15
Kaiqiao Chengqi Decoction plus WMT vs WMT 1 -0.16 [-0.55, 0.24] 0.43
Chinese medicine plus WMT vs WMT 1 -0.14 [-0.50, 0.21] 0.43
Dangfei Lining Capsule plus WMT vs WMT 1 0.64 [0.28, 1.00] 0.000 5
Chinese medicine plus WMT vs WMT 1 1.21 [0.65, 1.76] <0.000 1
Chinese medicine plus WMT vs WMT 1 0.12 [-0.39, 0.62] 0.65
Meta-analysis 6 0.32 [-0.08, 0.72] 0.12
Comprehensive treatment of TCM plus WMT vs WMT
Ganshen Qingdu Decoction, CHM (enema) plus WMTvs WMT 1 2.10 [0.60, 3.60] 0.008
Shuqingwan, CHM (enema) plus WMT vs WMT 1 5.10 [1.06, 9.14] 0.02
Oral CHM, CHM (enema) plus WMT vs WMT 1 1.40 [0.21, 2.59] 0.02
Meta-analysis 3 1.84 [0.94, 2.75] <0.000 1
Oral CHM, plasma exchange plus WMT vs plasma exchange plus WMT
CHM, plasma exchange plus WMT vs plasma exchange plus WMT 1 0.26 [-0.16, 0.69] 0.22
Zhonggan Mixture, plasma exchange plus WMT vsplasma exchange plus WMT 3 1.60 [-0.22, 3.41] 0.09
Yinchen Zhufu Decoction, plasma exchange plus WMT vs plasma exchange plus WMT 1 0.84 [0.23, 1.46] 0.007
Meta-analysis 5 1.13 [0.16, 2.10] 0.02

Tables 7

Analyses of alanine aminotransferase and aspartate aminotransferase levels"

Trial Number of trials MD [95% CI] P value
Lower ALT level
Oral CHM plus routine WMT vs WMT
Dangfei Lining Capsule plus WMT vs WMT 1 -0.58 [-1.13, -0.04] 0.04
Chinese medicine plus WMT vs WMT 1 -1.89 [-2.50, -1.28] <0.000 01
Qinggan Jiedu Decoction vs WMT 1 -0.48 [-0.94, -0.02] 0.04
Danhuangfang plus WMT vs WMT 1 -0.38 [-0.82, 0.06] 0.09
Sanjun Tuihuang Decoction plus WMT vsWMT 1 -0.34 [-0.73, 0.05] 0.09
CHM plus WMT vs WMT 1 -0.88 [-1.38, -0.38] 0.0005
Chishao Chengqi Decoction plus WMT vsWMT 1 -1.21 [-1.72, -0.70] <0.000 01
Chinese medicine plus WMT vs WMT 1 -2.45 [-3.29, -1.61] <0.000 01
Kangganshuai Decoction plus WMT vs WMT 1 0.07 [-0.28, 0.43] 0.69
Wenyang Jianpi Decoction plus WMT vs WMT 1 -0.01 [-0.61, 0.58] 0.96
Meta-analysis 10 -0.77 [-1.18, -0.35] 0.0003
CHM enema plus WMT vs WMT
Chishao Chengqi Decoction plus WMT vsWMT 1 -2.80 [-3.50, -2.09] <0.000 01
Chinese medicine plus WMT vs WMT 1 0.03 [-0.33, 0.39] 0.88
Chinese medicine plus WMT vs WMT 1 -0.52 [-1.04, -0.01] 0.05
Chinese medicine plus WMT vs WMT 1 -0.52 [-1.04, -0.01] 0.05
Dachengqi Decoction plus WMT vs WMT 1 -1.75 [-2.22, -1.29] <0.000 01
Kaiqiao Chengqi Decoction plus WMT vs WMT 1 -0.41 [-0.81, -0.01] 0.05
Meta-analysis 6 -0.97 [-1.70, -0.24] 0.01
Comprehensive treatment of TCM plus WMT vsWMT
Ganshen Qingdu Decoction, CHM (enema) plus WMT vs WMT 1 -2.34 [-2.98, -1.70] <0.000 01
Shuqingwan, CHM (enema) plus WMT vsWMT 1 -0.94 [-1.39, -0.49] <0.000 1
Meta-analysis 2 -1.62 [-3.00, -0.25] 0.02
Oral CHM, plasma exchange plus WMT vsplasma exchange plus WMT
Zhonggan Mixture, plasma exchange plus WMT vs plasma exchange plus WMT 3 -0.78 [-1.43, -0.13] 0.02
CHM, plasma exchange plus WMT vs plasma exchange plus WMT 1 0.06 [-0.39, 0.51] 0.78
Yinshao Guiqi Decoction, plasma exchange plus WMT vs plasma exchange plus WMT 1 -0.28 [-0.79, 0.23] 0.29
Yiqi Huoxue Granule, plasma exchange plus WMT vs plasma exchange plus WMT 1 -0.74 [-1.24, -0.24] 0.004
Meta-analysis 6 -0.55 [-0.96, -0.14] 0.009
Lower AST level
Oral CHM plus WMT vs WMT
Shaodan Chengqi Decoction plus WMT vsWMT 1 0.51 [0.07, 0.96] 0.02
Chinese herb medicine plus WMT vs WMT 1 -0.78 [-1.43, -0.14] 0.01
Kangganshuai Decoction plus WMT vs WMT 1 0.58 [0.21, 0.94] 0.001
Meta-analysis 3 0.15 [-0.57, 0.87] 0.47
CHM enema plus WMT vs WMT
Kaiqiao Chengqi Decoction (enema) plus WMTvs WMT 1 -0.40 [-0.80, -0.01] 0.05
Oral CHM, plasma exchange plus WMT vsplasma exchange plus WMT 0 0 0
Zhonggan Mixture, plasma exchange plus WMT vs plasma exchange plus WMT 1 -0.23 [-0.64, 0.19] 0.28
Zhonggan Mixture, plasma exchange plus WMT vs plasma exchange plus WMT 1 -0.12 [-0.62, 0.39] 0.65
Meta-analysis 2 -0.18 [-0.50, 0.14] 0.26

Tables 8

Analysis of prothrombin activity improvement"

Trial Number of trials MD [95% CI] P value
Oral CHM plus WMT vs WMT 1 1 1
Chinese medicine plus WMT vs WMT 1 16.90 [11.24, 22.56] <0.000 01
Chinese medicine plus WMT vs WMT 1 7.93 [2.00, 13.86] 0.009
Danhuangfang plus WMT 1 16.75 [10.69, 22.81] <0.000 01
Sanjun Tuihuang Decoction plus WMT vs WMT 1 8.90 [4.85, 12.95] <0.000 01
Yiqi Yangyin Decoction plus WMT 1 5.90 [-4.95, 16.75] 0.29
CHM plus WMT 1 18.83 [0.96, 36.70] 0.04
Zhongganheji plus WMT 1 4.90 [1.93, 7.87] 0.001
Chinese medicine plus WMT 1 12.00 [-1.55, 25.55] 0.08
Chishao Chengqi Decoction plus WMT vs WMT 1 11.10 [5.94, 16.26] <0.000 1
Jiedu Huayu Granule plus WMT 1 10.60 [3.23, 17.97] 0.005
Kangganshuai Fufang plus WMT 1 12.20 [4.74, 19.66] 0.001
Meta-analysis※ 11 9.41 [7.72, 11.09] <0.000 1
CHM enema plus WMT vs WMT 1 1 1
Dachengqi Decoction plus WMT 1 3.07 [-0.60, 6.74] 0.1
Chinese medicine plus WMT 1 16.10 [10.34, 21.86] <0.000 01
Chinese medicine plus WMT 1 28.23 [19.21, 37.25] <0.000 01
Meta-analysis 3 9.09 [6.16, 12.02] <0.000 1
Comprehensive treatment of TCM plus WMT vs WMT 1 1 1
Ganshen Qingdu Decoction, CHM (enema) plus WMT 1 15.44 [9.41, 21.47] <0.000 01
CHM, Guanchang Yihao (enema) plus WMT 1 -6.00 [-10.46, -1.54] 0.008
Shuqingwan, CHM (enema) plus WMT 1 9.50 [2.44, 16.56] 0.008
Jiedu Huayu Granule, Danshen Injection and Kuhuang Injection, CHM (enema) plus WMT 1 22.10 [15.06, 29.14] <0.000 01
Oral CHM, CHM (enema) plus WMT 1 11.20 [9.78, 12.62] <0.000 01
Meta-analysis 5 10.29 [9.02, 11.56] <0.000 01
CHM Injection plus WMT vs WMT 1 1 1
Yanhuanglian and Breviscapine Injectionplus WMT vs WMT plus Yinzhihuang Injection 1 17.24 [1.91, 32.57] 0.03
Oral CHM, plasma exchange plus WMT vs plasma exchange plus WMT 1 11 1
Zhonggan Mixture, plasma exchange plus WMT 2 4.30 [-8.76, 17.36] 0.52
CHM, plasma exchange plus WMT 1 0.90 [-3.79, 5.59] 0.71
Yinshao Guiqi Decoction, plasma exchange plus WMT 1 5.41 [0.18, 10.64] 0.04
Yinchen Zhufu Decoction, plasma exchange plus WMT 1 0.80 [-10.94, 12.54] 0.89
Meta-analysis 5 2.83 [-0.41, 6.08] 0.009

Figure 2

Mortality rate in RCTs of integrative medicine therapy for chronic severe hepatitis: a funnel plot analysis"

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