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Journal of Chinese Integrative Medicine ›› 2009, Vol. 7 ›› Issue (10): 913-928.doi: 10.3736/jcim20091003

• Systematic Review • Previous Articles     Next Articles

Compound Chinese herbal medicines, Chinese herbal drugs and their active extracts for treatment of chronic hepatitis C: A systematic review and meta-analysis of randomized clinical trials

 Xian-kui Qina,Mei Hanb,Jian-ping Liub,c   

  1. a Outpatient Clinic of Peopled Liberation Army Unit 96819, Beijing 100853, China
    b Center for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100029, China
    c National Research Center in Complementary and Alternative Medicine,University of Troms0,Troms0 N-9296,Norway
  • Received:2009-08-10 Accepted:2009-08-28 Online:2009-10-20 Published:2009-10-15
  • Contact: Jian-ping Liu E-mail:jianping_l@hotmail.com

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Background: The conventional therapy for chronic hepatitis C is the combination of interferon-alpha and ribavirin. However, it has some adverse effects and does not response to some patients, and it is also very expensive. Objective: To assess the efficacy and safety of Chinese medicinal herbs for chronic hepatitis C virus infection. Search strategy: Electronic and manual searches were conducted and the search ended in July 2009. Inclusion criteria: We included randomized clinical trials testing Chinese herbal medicine vs placebo, non-specific treatment, antiviral treatment, or Chinese herbal medicine combined with antiviral treatment vs antiviral treatment alone. Data extraction and analysis: Selection of trials for inclusion, assessment of methodological quality, data extraction and data syntheses were conducted according to the protocol of a Cochrane systematic review by the authors.
Results: Fifty-one randomized trials (involving 3 678 patients) with various methodological quality were included. The studies published in English had good quality, while studies published in Chinese were of poor quality. The pooled results showed that Chinese herbal medicine alone or in combination with antiviral treatment was generally better than non-specific treatment, or antiviral treatment alone, and herbal medicine appeared equal to antiviral treatment regarding comprehensive clinical effect in terms of symptoms, liver function and virological response. Regarding virological response including loss of serum hepatitis C virus (HCV) RNA and anti-HCV antibodies, herbal medicine was better than non-specific treatment, equal to antiviral treatment, and the combination of herbs and antiviral treatment was better than antiviral treatment alone. Similar positive findings were found for liver function improvement. Adverse effects were observed among herbal injections and interferon treatment, and few cases had severe adverse effects. Conclusion: Herbal medicines included in this review have effects in improving symptoms, liver function, and loss of HCV markers in patients with chronic hepatitis C. However, for majority of the included trials were published in Chinese and had low quality, the promising effects from some herbs need to be confirmed in rigorous clinical trials, and the design and reporting of trials should follow international standards.

Key words: Traditional Chinese herbal drug, Chronic hepatitis C, Systematic review, Meta-analysis, Randomised clinical trials

Table 1

Characteristics and methodological quality of included studies"

Study Gender
(male/female)		 Age
(years)		 Methodology
quality		 Course of treatment (weeks) Follow-up
(months)
Batey 1998[7] 24/16 40.6 High 24 0
Buzzelli 1993[8] 6/14 53 High 1 0
Chen 1998[9] NA NA Low 20 12
Chen 2005[10] NA NA Low 24 24
Dai 2008[11] 51/18 43.2 Low 24-48 0
Du 2007[12] 30/22 32 Low 24 6
Fu 2003[13] 56/34 35 Low 24 0
Gan 2000[14] 18/12 8.5 (1.5-13) Low 24 0
Gan 2003[15] 22/16 NA Low 12 0
Guan 1999[16] 61/31 43.5 Low 12 0
Guo 2008[17] 39/21 18-60 Low 12 0
Han 2005[18] NA 3-13 Low 24 6
Han 1997[19] 42/14 35 Low 24 12
Hong 2002[20] 54/24 42.7 Low 12 0
Hong 2004[21] 46/24 33.6 Low 24 6
Jakkula 2004[22] 31/14 18-70 High 12 1-2
Jiang 1999[23] 23/17 12-54 Low 12 0
Jing 2002[24] 26/7 31.8 Low 24 0
Li 1997[25] 286/134 38.5 Low 16 0
Li 1998[26] 24/19 43.7 Low 12 0
Li 2007[27] 21/17 36.8 Low 12 0
Li 2006[28] 21/19 37.9 Low 24 0
Li 2005[29] 54/14 40.7 Low 24 0
Li 2008[30] 20/23 46.8 Low 48 6
Lin 2006[31] 24/16 18-63 Low 24 0
Liu 1998[32] 50/24 6.8 Low 24 0
Liu 2005[33] 17/20 56 Low 12 3
Lu 1995[34] 39/25 40.9 Low 12 6-24
Ma 2008[35] 27/19 31.8 Low 24 6
Mollison 2006[36] 58/33 41.7 High 24 6
Niu 2008[37] 23/17 37.1 Low 24 0
Pei 1996[38] 51/25 37.5 Low 24 12
Raymond 1998[39] 30/8 47.5 High 12 3
Ren 2001[40] 41/25 39.4 Low 24 6
Ren 2003[41] 33/12 36.8 Low 12 0
She 2008[42] NA NA Low 24 24
Sun 2003[43] 142/25 38.9 Low 24 6
van Rossum 1999[44] 45/9 47 High 4 28
Wang 2008[45] NA 54.4 Low 12 0
Wang 2009[46] 130/116 50 Low 48 0
Wu 2008[47] 30/21 34.9 Low 8 0
Wu 2003[48] NA NA Low 24 24
Xiao 2005[49] 26/26 37.5 Low 24 6
Xiao 1999[50] 29/30 45 Low 20 3
Xu 2001[51] 36/24 4.8 Low 24 0
Xu 2008[52] 40/46 32-73 Low 12 0
Yin 2002[53] 70/24 31.8 Low 26 0
Yin 2004[54] NA 16-63 Low 24 0
Yu 2007[55] 24/19 43.7 Low 12 0
Yu 1995[56] 51/27 26 Low 2 6-12
Zhou 2001[57] 123/69 38.9 Low 24 6

Table 2

Interventions and outcomes of included studies"

Study Intervention Outcome measure
Control Treatment
Batey 1998[7] Placebo CH-100 HCV-RNA, liver function, side effects
Buzzelli 1993[8] Placebo Silybin Liver function, hematology and renal function
Chen 1998[9] α-interferon Bingganling Symptoms, liver function, HCV-RNA, side effects
Chen 2005[10] α-2b interferon Oxymatrine plus α-2b interferon Liver function, HCV-RNA
Dai 2008[11] α-2b interferon Xiaochaihu decoction Symptoms, liver function, HCV-RNA
Du 2007[12] α-2b interferon Ganlu Xiaodu Dan plus α-2b
interferon		 Symptoms, liver function, HCV-RNA
Fu 2003[13] α-interferon Yiqi Guyin Huoxue Jiedu therapy Symptoms, liver function, anti-HCV antibody
Gan 2000[14] α-interferon Liganling plus α-interferon; Liganling Liver function, HCV-RNA
Gan 2003[15] Glucurolactone plus
vitamin		 Oxymatrine Liver function, HCV-RNA, liver
fibrosis, side effects
Guan 1999[16] α-interferon Qingbuyin Symptoms, liver function, anti-HCV, side effects
Guo 2008[17] Interferon Herbal prescription oxymatrine plus interferon Symptoms, liver function, side effects
Han 2005[18] α-2b interferon Oxymatrine plus α-2b interferon;Oxymatrine Liver function, HCV-RNA, side effects
Han 1997[19] Interferon Binggan capsule Symptoms, liver function, HCV-RNA, anti-HCV, side effects
Hong 2002[20] Diammonium glycyrrihizinate Binggan-Ⅰ Liver function, liver fibrosis
Hong 2004[21] α-interferon Binggan-Ⅰ Symptoms, liver function, HCV-RNA
Jakkula 2004[22] Placebo Herbal prescription Quality of life, liver function,
HCV-RNA, side effects
Jiang 1999[23] Ribavirin plus
diammonium glycyrrihizinate		 Yizhu decoction Symptoms, liver function,
HCV-RNA
Jing 2002[24] α-2b interferon Xiaochaihu decoction plus α-2b
interferon		 Symptoms, liver function, HCV-RNA, side effects
Li 1997[25] α-interferon Jiawei Sanshen decoction Symptoms, liver function, anti-HCV
Li 1998[26] Vitamin Oxymatrine Liver function, HCV-RNA, side effects
Li 2007[27] Compound embryonic bovine liver extract tablets Binggan oral liquid plus compound embryonic bovine liver extract tablets Symptoms, liver function, liver fibrosis
Li 2006[28] α-2a interferon Jianpi Bushen formula Liver function, HCV-RNA, liver fibrosis
Li 2005[29] α-1b interferon Oxymatrine Symptoms, liver function, HCV-RNA, side effects
Li 2008[30] α-2b interferon plus ribavirin Oxymatrine plus Shugan Jianpi formula Liver function, HCV-RNA
Lin 2006[31] α-2b interferon Oxymatrine plus α-2binterferon Liver function, HCV-RNA
Liu 1998[32] Bifendatatum plus thymosin Liganling Symptoms, liver function, HCV-RNA
Liu 2005[33] Liver protective drug Oxymatrine Symptoms, liver function, anti-HCV
Lu 1995[34] α-interferon Chinese herbal medicine plus
α-interferon		 Symptoms, liver function, anti-HCV
Ma 2008[35] α-interferon Xiaochaihu decoction plus α-interferon Liver function, HCV-RNA
Mollison 2006[36] Placebo Prescription CH100 Quality of life, liver function, HCV-RNA, side effects
Niu 2008[37] α-2b interferon Yigan Yin Symptoms, liver function, HCV-RNA
Pei 1996[38] α-interferon Binggan decoction Symptoms, liver function, HCV-RNA, anti-HCV
Raymond 1998[39] Placebo Prescription CTF Liver function, HCV-RNA, side effects
Ren 2001[40] No intervention Qinggan granule; Bushen granule; Symptoms, liver function, HCV-RNA, liver tissue pathology
Ren 2003[41] α-1b interferon Jiedu Hugan granule plus
α-1b interferon		 Symptoms, liver function, anti-HCV,
side effects
Study Control Treatment Outcome measure
She 2008[42] Liver protective drug Oxymatrine Symptoms, liver function,
HCV-RNA, side effects
Sun 2003[43] α-interferon Qinggan granule Symptoms, liver function,
HCV-RNA, side effects
van Rossum 1999[44] Placebo Glycyrrihizinate 80 mg;glycyrrihizinate
160 mg; glycyrrihizinate 240 mg		 Liver function, HCV-RNA,
side effects
Wang 2008[45] Liver protective drug Oxymatrine Liver function, HCV-RNA,
side effects
Wang 2009[46] α-interferon plus ribavirin Chinese herbal medicine plus α-interferon
plus ribavirin; Chinese herbal medicine		 Liver function, HCV-RNA, anti-HCV
Wu 2008[47] Glutathione Dahuang Zhechong pills plus glutathione Symptoms, liver function, liver fibrosis
Wu 2003[48] α-2b interferon Prescription plus α-2b interferon Liver function, HCV-RNA,
side effects
Xiao 2005[49] Interferon Jianpi Huoxue formula Liver function, HCV-RNA,
liver fibrosis
Xiao 1999[50] α-interferon Ganshu capsule plus α-interferon; Ganshu capsule Liver function, HCV-RNA
Xu 2001[51] Interferon Liganling syrup plus interferon; Liganling syrup Liver function, HCV-RNA
Xu 2008[52] Glutathione plus inosine Oxymatrine Liver function, HCV-RNA,
liver fibrosis
Yin 2002[53] α-1b interferon plus ribavirin;α-1b interferon Bingganning granule Symptoms, liver function,
HCV-RNA, side effects
Yin 2004[54] α-1b interferon Oxymatrine plus α-1b interferon Liver function, HCV-RNA,
liver fibrosis, side effects
Yu 2007[55] Vitamin Oxymatrine Liver function, HCV-RNA,
side effects
Yu 1995[56] Glucolactone plus Yiganling Yiergan decoction Symptoms, liver function, length
of stay in hospital
Zhou 2001[57] Interferon Bingganning granule Symptoms, liver function,
HCV-RNA, liver fibrosis

Table 3

Analyses of clinical comprehensive effects"

Trials Number
of trials		 Control
(n/N)		 Intervention
(n/N)		 RR [95% CI] P value
Chinese herbal medicine vs antiviral drugs
Xiaochaihu decoction vs α-2b interferon 1 24/33 28/36 1.07 [0.81, 1.40] 0.63
Qingbuyin vs α interferon 1 25/46 34/46 1.36 [0.99, 1.86] 0.06
Yiqi Guyin Huoxue Jiedu Chinese medicine vs α-interferon 1 8/30 56/60 3.50 [1.93, 6.36] < 0.000 1
Binggan-Ⅰ vs α-interferon 1 24/30 30/40 0.94 [0.73, 1.21] 0.62
Jiawei Sanshen decoction vs α-interferon 1 49/60 353/360 1.20 [1.06, 1.35] 0.003
Oxymatrine vs α-1b interferon 1 23/30 28/38 0.96 [0.73, 1.26] 0.78
Chinese medicine vs α-interferon 1 21/32 29/32 1.38 [1.05, 1.82] 0.02
Yigan Yin vs α-2b interferon 1 15/20 16/20 1.07 [0.76, 1.49] 0.71
Jianpi Bushen formula vs α-2a interferon 1 17/20 25/32 0.92 [0.71, 1.19] 0.52
Bingganning granule vs interferon 1 37/52 98/140 0.98 [0.80, 1.21] 0.88
Meta-analysis* 10 243/353 697/804 1.14 [0.99, 1.31] 0.07
Chinese herbal medicine vs non-specific treatment
Binggan oral liquid plus compound embryonic bovine liver
extracts vs compound embryonic bovine liver extracts		 1 13/18 18/20 1.25 [0.90, 1.72] 0.17
Liganling vs bifendatatum plus thymosin 1 4/40 11/34 3.24 [1.13, 9.24] 0.02
Oxymatrine capsule vs liver protective drug 1 7/19 17/18 2.56 [1.41, 4.67] 0.003
Meta-analysis* 3 24/77 46/72 1.92 [1.39, 2.64] <0.000 1
Chinese herbal medicine plus antiviral drugs vs antiviral drugs
Ganlu Xiaodu Dan plus α-2b interferon vs α-2b interferon 1 18/24 23/28 1.10 [0.82, 1.46] 0.53
Chinese medicine plus α-interferon vs α-interferon 1 19/26 16/21 1.04 [0.75, 1.46] 0.81
Jiedu Hugan granule plus α-1b-interferon vs α-1b-interferon 1 12/15 26/30 1.08 [0.81, 1.45] 0.56
Meta-analysis 3 49/65 65/79 1.07 [0.90, 1.28] 0.42

Table 4

Analyses of antiviral response"

Trials Number
of trials		 Control
(n/N)		 Intervention
(n/N)		 RR [95% CI] P value
Loss of serum HCV-RNA
Compared with placebo
Chinese medicine CH-100 vs placebo 1 0/8 0/14 Not estimable
Diammonium glycyrrihizinate vs placebo 1 0/14 0/43 Not estimable
Complete thymic formula vs placebo 1 0/18 0/20 Not estimable
Compared with non-specific treatment
Oxymatrine injection vs glucurolactone plus vitamin 1 1/18 9/20 8.10 [1.13, 57.82] 0.04
Oxymatrine injection vs vitamin 2 2/36 16/34 8.47 [2.10, 34.12] 0.003
Oxymatrine injection vs liver protective drug 1 1/30 3/30 3.00 [0.33, 27.23] 0.33
Oxymatrine injection vs glutathione plus inosine 1 2/33 11/32 5.67 [1.36, 23.61] 0.02
Oxymatrine capsulevsliver protective drug 1 1/19 10/18 10.56 [1.50, 74.33] 0.02
Liganling vs bifendatatum plus thymosin 1 4/40 11/34 3.24 [1.13, 9.24] 0.03
Meta-analysis 7 12/190 58/180 5.17 [2.87, 9.31] <0.000 01
Compared with antiviral drugs
Chinese medicine prescription vs α-interferon 1 2/32 4/32 2.00 [0.39, 10.16] 0.40
Bingganling vs α-interferon 1 8/25 13/31 1.31 [0.65, 2.65] 0.45
Bingganning vs α-1b interferon 1 12/32 17/32 1.42 [0.81, 2.46] 0.22
Bingganning vs interferon 1 33/52 73/140 0.82 [0.63, 1.07] 0.14
Binggan- I vs α-interferon 1 12/30 10/40 0.63 [0.31, 1.25] 0.18
Ganshu capsule vs α-interferon 1 4/21 6/20 1.58 [0.52, 4.77] 0.42
Jiawei Sanshen decoction vs α-interferon 1 14/60 245/360 2.92 [1.83, 4.64] < 0.000 01
Jianpi Bushen formula vs α-2a interferon 1 12/20 4/32 0.21 [0.08, 0.56] 0.002
Jianpi Bushen formula vs α-2a interferon 1 11/40 3/40 0.27 [0.08, 0.90] 0.03
Liganling vsinterferon 2 15/33 6/18 0.73 [0.35, 1.56] 0.42
Oxymatrinevs α-2b interferon 1 2/8 2/8 1.00 [0.18, 5.46] 1.00
Oxymatrine injectionvs α-1b interferon 1 17/30 15/38 0.70 [0.42, 1.15] 0.16
Xiaochaihu decoction vs α-2b interferon 1 15/33 17/36 1.04 [0.62, 1.73] 0.88
Yigan Yin vs α-2b interferon 1 11/20 3/20 0.27 [0.09, 0.83] 0.02
Bingganning granule vs α-1b interferon plus ribavirin 1 19/30 17/32 0.84 [0.55, 1.28] 0.42
Oxymatrine plus Shugan Jianpi formula vs α-2b interferon plus ribavirin 1 10/18 12/25 0.86 [0.48, 1.54] 0.62
Chinese medicine prescription vs α-interferon plus ribavirin 1 19/80 16/82 0.82 [0.46, 1.48] 0.51
Yizhu decoction vs glycyrrhizine plus ribavirin 1 11/20 18/20 1.64 [1.07, 2.50] 0.02
Meta-analysis* 19 232/564 275/773 0.84 [0.68, 1.03] 0.09
Chinese herbal medicine plus antiviral drugs compared with antiviral drugs
Binggan capsule plus interferon vs interferon 1 8/26 16/30 1.73 [0.89, 3.38] 0.11
Binggan decoction plus α-interferon vs α-interferon 1 9/30 35/46 2.54 [1.43, 4.49] 0.001
Glycyrrhizine plus α-2b interferon vs α-2b interferon 1 10/26 19/30 1.65 [0.94, 2.87] 0.08
Ganlu Xiaodu Dan plus α-2b interferon vs α-2b interferon 1 8/24 14/28 1.50 [0.76, 2.95] 0.24
Ganshu capsule plus α-interferon vs α-interferon 1 4/21 6/20 1.58 [0.52, 4.77] 0.42
Jiedu Hugan granule plus α-1b interferon vs α-1b interferon 1 6/15 20/30 1.67 [0.85, 3.26] 0.13
Oxymatrine plus α-2b interferon vs α-2b interferon 1 2/8 4/9 1.78 [0.44, 7.25] 0.42
Oxymatrine injection plus α-1b interferon vs α-1b interferon 1 12/36 21/36 1.75 [1.02, 3.00] 0.04
Liganling plus interferon vs interferon 2 15/33 21/39 1.18 [0.74, 1.90] 0.48
Xiaochaihu decoction plus α-2b interferon vs α-2b interferon 1 7/15 13/18 1.55 [0.84, 2.85] 0.16
Xiaochaihu decoction plus α-interferon vs α-interferon 1 7/23 12/23 1.71 [0.83, 3.56] 0.15
Chinese medicine plus α-interferon vs α-interferon 1 15/26 14/21 1.16 [0.74, 1.81] 0.53
Chinese medicine prescription plus α-interferon plus ribavirin vs
α-interferon plus ribavirin		 1 19/80 28/84 1.40 [0.86, 2.30] 0.18
Meta-analysis 14 122/363 223/414 1.58 [1.33, 1.87] <0.000 01
Loss of serum HCV-RNA (follow-up)
Compared with antiviral drugs
Oxymatrine plus Shugan Jianpi formula vs α-2b interferon plus
ribavirin (6 months )		 1 4/18 10/25 1.80 [0.67, 4.84] 0.24
Bingganning vs α-1b interferon plus ribavirin (6.5 months ) 1 14/30 11/32 0.74 [0.40, 1.36] 0.33
Bingganning vs α-1b interferon (6.5 months ) 1 6/32 11/32 1.83 [0.77, 4.36] 0.17
Oxymatrine injection vs α-1b interferon (6 months ) 1 12/30 14/38 0.92 [0.50, 1.69] 0.79
Jianpi Bushen formula vs α-2a interferon (6 months ) 1 7/20 2/32 0.18 [0.04, 0.78] 0.02
Qinggan granule vs α-1b interferon (6 months ) 1 19/40 39/127 0.65 [0.43, 0.98] 0.04
Bingganning granule vs interferon (6 months ) 1 23/52 67/140 1.08 [0.76, 1.54] 0.66
Oxymatrine vsα-2b interferon (6 months ) 1 1/8 1/8 1.00 [0.07, 13.37] 1.00
Meta-analysis 8 62/150 123/345 0.97 [0.77, 1.22] 0.80
Chinese herbal medicine plus antiviral drugs compared with antiviral drugs
Oxymatrine plus α-2b interferon vs α-2b interferon (24 months ) 2 8/44 25/49 2.81 [1.42, 5.55] 0.003
Glycyrrhizine plus α-2b interferon vs α-2b interferon (24 months ) 1 7/26 8/30 0.99 [0.42, 2.36] 0.98
Ganlu Xiaodu Dan plus α-2b interferon vs α-2b interferon (6 months ) 1 7/24 13/28 1.59 [0.76, 3.34] 0.22
Xiaochaihu decoction plus α-interferon vs α- interferon (6 months ) 1 6/23 11/23 1.83 [0.82, 4.12] 0.14
Meta-analysis 5 28/117 57/130 1.84 [1.26,2.68] 0.002
Loss of serum anti-HCV antibody
Compared with non-specific treatment
Binggan oral liquid plus compound embryonic bovine liver extract
tablets vs compound embryonic bovine liver extract tablets		 1 1/18 3/20 2.70 [0.31, 23.69] 0.37
Compared with antiviral drugs
Qingbuyin vs α-interferon 1 4/46 10/46 2.50 [0.84, 7.40] 0.10
Jiawei Sanshen decoction vs α-interferon 1 14/60 245/360 2.92 [1.83,4.64] <0.000 01
Yiqi Guyin Huoxue Jiedu medicine vs α-interferon 1 5/30 35/60 3.50 [1.53, 8.01] 0.003
Meta-analysis 3 23/136 290/466 2.98 [2.04,4.36] <0.000 01
Chinese herbal medicine plus antiviral drugs compared with antiviral drugs
Binggan capsule plus interferon vs interferon 1 8/26 16/30 1.73 [0.89, 3.38] 0.11
Binggan decoction plus α-interferon vs α-interferon 1 9/30 35/46 2.54 [1.43, 4.49] 0.001
Xiaochaihu decoction plus α-2b interferon vs α-2b interferon 1 6/15 11/18 1.53 [0.74, 3.14] 0.25
Meta-analysis 3 23/71 62/94 2.02 [1.39,2.93] 0.000 2

Table 5

Analyses of liver function parameters"

Trials Number of trials MD [95% CI] P value
Lower ALT levels (U/L)
Compared with placebo
Silybin vs placebo 1 –8.00 [–17.51, 1.51] 0.10
Complete thymic formula vs placebo 1 –26.00 [–87.91, 35.91] 0.41
Chinese medicine CH-100 vs placebo 1 –20.00 [-54.73, 14.73] 0.26
Meta-analysis 3 –9.21 [–18.28, –0.13] 0.05
Compared with non-specific treatment
Oxymatrine injection vs glutathione plus inosine 1 4.10 [–4.51, 12.71] 0.35
Dahuang Zhechong pills plus liver protective drug vs liver protective drug 1 –63.70 [–65.79, –61.61] < 0.000 01
Oxymatrine injection vs liver protective drug 1 –30.58 [–51.27, –9.89] 0.004
Binggan oral liquid plus compound embryonic bovine liver extracts vs
compound embryonic bovine liver extracts		 1 –21.64 [–38.71, –4.57] 0.01
Binggan-I vs diammonium glycyrrihizinate 1 2.80 [–5.41, 11.01] 0.50
Meta-analysis 5 –55.61 [–57.56, –53.66] < 0.000 01
Compared with antiviral drugs
Liganling vs interferon 2 10.99 [–0.35, 22.33] 0.06
Binggan-I vsα-interferon 1 3.04 [–0.29, 6.37] 0.07
Jiawei Sanshen decoction vsα-interferon 1 –33.13 [–40.93, –25.33] < 0.000 01
Jianpi Bushen formula vs α-2a interferon 2 8.09 [–3.64, 19.83] 0.18
Qinggan granule vs α-1b interferon 1 1.90 [–10.53, 14.33] 0.76
Oxymatrine injection vs α-1b interferon 1 0.66 [–2.02, 3.34] 0.63
Bingganning vs interferon 1 11.38 [–1.05, 23.81] 0.07
Yigan Yin vs α-2b interferon 1 4.55 [–10.25, 19.35] 0.55
Meta-analysis* 10 0.66 [–2.02, 3.34] 0.59
Chinese herbal medicine plus antiviral drugs compared with antiviral drugs
Ganshu capsule plus α-interferonvs α-interferon 1 –18.35 [–44.00, 7.30] 0.16
Oxymatrine plus α-2b interferon vs α-2b interferon 1 –16.00 [-21.83, –10.17] < 0.000 01
Ganlu Xiaodu Dan granule plus α-2b interferon vs α-2b interferon 1 –8.44 [–11.92, –4.96] < 0.000 01
Oxymatrine injection plus interferon vs interferon 1 –18.20 [–32.87, –3.53] 0.02
Liganling plus interferon vs interferon 2 –3.94 [–12.86, 4.98] 0.39
Xiaochaihu decoction plus α-2b interferon vs α-2b interferon 1 –31.50 [–76.34, 13.34] 0.17
Jiedu Hugan granule plus α-1b interferon vs α-1b interferon 1 –19.28 [–35.29, –3.27] 0.02
Oxymatrine injection plus α-1b interferon vs α-1b interferon 1 –4.58 [–15.29, 6.13] 0.40
Meta-analysis 9 –10.15 [–12.79, –7.51] < 0.000 01
ALT level at follow-up (U/L)
Compared with antiviral drugs
Qinggan granule vs α-1b interferon (6 months ) 1 2.84 [–1.88, 7.56] 0.24
Jianpi Huoxue prescription vs α-2a interferon (6 months ) 1 11.10 [–16.39, 38.59] 0.43
Bingganning vs interferon (6 months ) 1 3.90 [–6.67, 14.47] 0.47
Meta-analysis 3 3.21 [–1.05, 7.47] 0.14
Chinese herbal medicine plus antiviral drugs compared with antiviral drugs
Oxymatrine plus α-2b interferon vs α-2b interferon (24 months ) 1 –17.20 [–23.18, –11.22] < 0.000 01
Lower AST level (U/L)
Compared with placebo
Silybin vs placebo 1 –24.60 [–34.28, –14.92] < 0.000 01
Complete thymic formula vs placebo 1 –5.00 [–51.21, 41.21] 0.83
Meta-analysis 2 –23.78 [–33.25, –14.30] < 0.000 01
Compared with non-specific treatment
Binggan oral liquid plus compound embryonic bovine liver extracts vs
compound embryonic bovine liver extracts		 1 0.56 [–14.88, 16.00] 0.94
Oxymatrine injection vs liver protective drug 1 –33.48 [–51.27, –15.69] 0.00 02
Meta-analysis 2 –14.07 [–25.73, –2.41] 0.02
Compared with antiviral drugs
Binggan-I vsα-interferon 1 5.28 [0.41, 10.15] 0.03
Jianpi Bushen formula vs α-2a interferon 2 13.56 [3.32, 23.79] 0.009
Yigan Yin vs α-2b interferon 1 5.55 [–8.64, 19.74] 0.44
Bingganning granule vs interferon 1 3.67 [–1.65, 8.99] 0.18
Oxymatrine injection vs α-1b interferon 1 1.20 [–1.24, 3.64] 0.34
Qinggan granule vs α-1b interferon 1 5.20 [-5.00, 15.40] 0.32
Jiawei Sanshen decoction vs α-interferon 1 -29.28 [-37.54, -21.02] < 0.000 01
Meta-analysis 8 1.17 [–0.71, 3.04] 0.22
Chinese herbal medicine plus antiviral drugs compared with antiviral drugs
Ganlu Xiaodu Dan plus α-2b interferon vs α-2b interferon 1 –10.25 [–15.55, –4.95] 0.000 1
Oxymatrine injection plus interferon vs interferon 1 –12.70 [–33.67, 8.27] 0.24
Jiedu Hugan granule plus α-1b interferon vs α-1b interferon 1 –9.80 [–28.23, 8.63] 0.30
Oxymatrine injection plus α-1b interferon vs α-1b interferon 1 4.72 [–5.99, 15.43] 0.39
Meta-analysis 4 –7.70 [–12.19, –3.21] 0.000 8
AST level at follow-up (U/L)
Compared with antiviral drugs
Jianpi Huoxue formula vs α-2a interferon (6 months ) 1 3.50 [–23.93, 30.93] 0.80
Bingganning granule vs interferon (6 months ) 1 3.61 [–3.93, 11.15] 0.35
Qinggan granule vs α-1b interferon (6 months ) 1 –8.31 [–18.59, 1.97] 0.11
Meta-analysis 3 –0.37 [–6.31, 5.56] 0.90
Lower TBIL level (μmol/L) 1 –0.22 [–0.30, –0.14] < 0.000 01
Compared with placebo
Silybin vs placebo 1 –18.30 [–20.74, –15.86] < 0.000 01
Compared with non-specific treatment
Binggan oral liquid plus compound embryonic bovine liver extracts vs
compound embryonic bovine liver extracts		 1 –0.51 [–3.82, 2.80] 0.76
Oxymatrine injection vs glutathione plus inosine 1 2.20 [–4.27, 8.67] 0.50
Dahuang Zhechong pills plus liver protective drug vs liver protective drug 1 1.10 [–1.83, 4.03] 0.46
Meta-analysis 3 –0.74 [–1.53, 0.05] 0.07
Compared with antiviral drugs
Yigan Yin vs α-2b interferon 1 –0.51 [–3.82, –2.80] 0.76
Jianpi Huoxue formula vs α-2a interferon 1 1.10 [–1.83, 4.03] 0.46
Jianpi Bushen formula vs α-2a interferon 1 –0.10 [–0.86, 0.66] 0.08
Meta-analysis 3 –0.05 [–0.77, 0.67] 0.90
Chinese herbal medicine plus antiviral drugs compared with antiviral drugs
Oxymatrine plus α-2b interferonvs α-2b interferon 1 –17.47 [–20.00, –14.94] < 0.000 01
Ganlu Xiaodu Dan plus α-2b interferon vs α-2b interferon 1 –0.10 [–0.86, 0.66] 0.80
Jiedu Hugan granule plus α-1b interferon vs α-1b interferon 1 –0.60 [–1.41, 0.21] 0.15
Meta-analysis 3 –11.99 [–13.60, –10.37] < 0.000 01
TBIL level at follow-up (μmol/L)
Oxymatrine plus α-2b interferon vs α-2b interferon (6 months ) 1 –5.77 [–8.13, –3.41] < 0.000 01

Figure 1

Funnel plot of Chinese herbal medicine compared with antivirals in the treatment of chronic hepatitis C for the outcome of loss of serum HCV RNA"

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