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

Figures & data

Figure 1. The process of retrieval and selection of eligible studies. CNKI: China National Knowledge Infrastructure.

Table 1. Baseline characteristics of 17 included studies.

Study ID	Country	Simple size I/C	Diagnosis	Regimen I/C	Detailed ingredients of CHM protocol	Age (mean or range) I/C	Gender, male, n (%)	Disease duration I/C	Follow-up (week)	Outcomes
Kobayashi et al. (18)	Japan	37/40	AD	Hochu-ekki-to (Chinese name: Bu-Zhong-Yi-Qi Tang); 7.5 g/day	Astragali radix (16.7%), Atractylodis lanceae rhizoma (16.7%), Ginseng radix (16.7%), Angelicase radix (12.5%), Bupleuri radix (8.3%), Zizyphi fructus (8.3%), Aurantii nobilis pericarpium (8.3%), Glycyrrhizae radix (6.3%), Cimicifugae rhizoma (4.2%) and Zingiberis rhizoma (2.0%)	NR	20–40	NR	24	ORR
Lin et al. (21)	China	32/16	AD	Qingdai (indigo naturalis power) ointment/Placebo; 2/d, 6w	2.80% indigo blue and 0.15% indirubin, without clearly reported doses.	21.9/23Y	20(63)/9(56)	17.5/18.2Y	6	EASI, DLQI, AEs
Ahn et al. (8)	Korea	11/12	AD	Jaungo (Chinese name: Shiunko)/placebo; 2/d, 3w	Angelica sinensis and Lithospermi radix, without clearly reported doses.	20.82/21.67Y	3(27.3)/4(33.3)	11.70/14.67Y	NR	EASI, SCORAD
Yen and Hsieh (27)	China	15/16	AD	Tzu-Yun ointment/betamethasone valerate cream; 2/d, 8w	Arnebia euchroma 120 mg, cera flava 300 mg, A. Sinensis 60 mg, and sesame oil (quantum sufficit)	32.9/39.6Y	10(66.7)/10(62.5)	96.3/73.6D	8	EASI
Chen et al. (14)	China	55/55	AE	CMM fumigant and desonide cream/desonide cream; 30 min*2/d, 7d	Sophora flavescents 60 g, Fructus Cnidii 30 g, Fructus Scopariae, Cortex Phellodendri 15 g, Radix Angelicae Dahuricae 15 g, Rhizome Acorus Tatarinowii 10 g	5.35/5.26Y	30(54.5)/28(50.9)	2.41/2.04Y	6	ORR, EASI, Recurrence rate
Han et al. (16)	China	23/22	AD	Chinese medicine bath and Trarolimus/Trarolimus; 1/d, 4w	Cortex Phellodendri 30 g, Angelica sinensis 15 g, S. Miltiorrhiza 30 g, Poria cocos 30 g, Atractylodes macrocephala 30 g, Portulaca oleracea 30 g, Caulis spatholobi 30 g, Dictamni Cortex 15 g	9.61/10Y	13(56.5)/12(54.5)	NR	3	ORR, SCORAD, Recurrence rate
He (17)	China	84/87	Eczema	Chinese medicine Wuhuang liquid/free; 15 min*3/d, 10d	Radix Scutellariae 15 g, Radix Astragali 15 g, Rhizoma Coptidis 30 g, Cortex Phellodendri 30 g,and Rheum Officinale 15 g	16D–9M/17D–8M	47(56.0)/49(56.3	9.0/8.0D	NR	ORR
Juan and Zhi-Xiong (19)	China	40/40	Eczema	Chinese medicine and vitamin E allantoin cream/ desonide cream; 10 min*2/d, 7d	Angelica Sinensis 20 g, Fructus Kochiae 20 g, Cortex Dictamni 20 g, Fructus Cnidii 20 g, Rodix Sophorae Flavescentls 20 g, Herba Andrographitis 20 g and Feverfew 20 g	8.01/7.65M	25(63.0)/22(55)	3.15/3.01M	NR	ORR, EASI, AEs, recurrence rate
Li et al. (20)	China	35/35	AD	Chinese medicine bath and tacrolimus/tacrolimus; 10–20 min*1/d, 4w	Cortex Phellodendri 20 g, Angelica sinensis 15 g, S. Miltiorrhiza 15 g, Poria cocos 15 g, Atractylodes macrocephala 20 g, Portulaca oleracea 20 g, Caulis spatholobi 20 g, Dictamni Cortex 20 g	6.4/6.6Y	20(50)/22(55)	1.4/1.6Y	NR	ORR, SCORAD, AEs
Mai (23)	China	39/39	Eczema	Chinese medicine washing/homemade Chinese medicine ointment; 1/d, 7d	Fructus Cnidii, Rodix Sophorae Flavescentls, Fructus Kochiae, Calcined Alum and Cortex Dictamni Radicis	9.0/8.5M	23(59.0)/22(56.4)	NR	NR	ORR, AEs
Tao (24)	China	43/42	Eczema	Chinese medicine and hydrocortisone butyrate cream/hydrocortisone butyrate cream; 20 min*3–4/d, 7d	Herba Schizonepetae 20 g, Radix Saposhnikoviae 20 g, Radix Angelicae Dahuricae 20 g, Forsythia suspensa 20 g, Lonicera japonica 20 g, Radix Sophorae Flavescentis 20 g, Fructus Kochiae 20 g and Fructus Cnidii 20 g	7D–12M	15(34.9)/12(28.6)	NR	NR	ORR, recurrence rate
Dongsheng et al. (25)	China	118/85	AD	Qingdai (Indigo) powder and hydrocortis, erythromy/hydrocortis, erythromy; 3/d, 1–2w	2.80% indigo blue and 0.15% indirubin, without clearly reported doses.	2–6M, 81.3%	65(55.1)/48(56.5)	1W–2M	24	ORR
Wu (26)	China	45/45	AD	Chinese medicine and Calamine polish/Calamine polish; 15 min*2/d, 7d	Angelica Sinensis 20 g, Fructus Kochiae 20 g, Cortex Dictamni 20 g, Fructus Cnidii 20 g, Rodix Sophorae Flavescentls 20 g, Herba Andrographitis 20 g and Feverfew 20 g	5.8/5.7Y	23(51.1)/24(53.3)	3.8/3.6Y	2	ORR, AEs, recurrence rate
Zhu and Chen (28)	China	140/140	AD	Chinese medicine and hydrocortisone butyrate cream/hydrocortisone butyrate cream; 20 min*1/d, 2w	Radix Saposhnikoviae 10 g, Phellodendron amurense 20 g, Lonicera japonica 20 g, Purslane 30 g, Radix Sophorae Flavescentis 30 g and Fructus Kochiae 30 g	5.44/5.59Y	96(68.6)/94(67.1)	11.41/11.87M	2	ORR, SCORAD
Lee et al. (9)	Korean	30/30	AD	Soshiho-tang (Xiao-chai-hu-tang)	Bupleurum falcatum L. 2.33 g, Pinellia ternate 1.67 g, Zingiber officinale Roscoe 1.33 g, Scutellaria baicalensis Georgi 1.00 g, Ziziphus jujuba var. inermis Rehder 1.00 g, Panax ginseng C.A.Mey. 1.00 g, Glycyrrhiza uralensis Fisch 0.67 g, lactose hydrate 1.31 g, and corn starch 0.315 g	12.17/12.47Y	15(50)/14(46.7)	NR	8	SCORAD
Gu et al. (15)	China	15/13	AE	CHM /placebo; 2/d, 12w	Atractylodes macrocephala, Pseudostellaria heterophylla, Dioscorea opposita, Coix lacryma-jobi, Imperata cylindrica, Forsythia suspensa, Glycyrrhiza glabra, Dictamnus dasycarpus and Pteria martensii, without clearly reported doses.	6–16Y	9(30)	NR	4	EASI, DLQI
Liu et al. (22)	China	72/73	AD	Combination of traditional Chinese medicine therapy	Radix Pseudostellariae 10 g, Forsythia suspensa 10 g, Ramulus Uncariae cum Uncis 10 g, Medulla Junci 3 bundles, Herba Lophatheri 10 g, Semen Coicis 10 g, Rhizoma Dioscoreae 10 g, Concha Ostreae 10 g, Radix Glycyrrhizae 3 g	13.9/13.44Y	31(43.1)/30(41.1)	9.44/8.38Y	36	SCORAD, AEs

Note: AD: atopic dermatitis; AE: atopic eczema; I/C: intervention/comparison; NR: no report; CHM: Chinese herbal medicine; CMM: Chinese materia medica; ORR: overall recovery rate; EASI: Eczema Area and Severity Index; SCORAD: Scoring Atopic Dermatitis Index; DLQI: Dermatology Life Quality Index; AEs: adverse events; DAC: Deutsche Arzneimittel-Codex; D: day; W: week; M: month; Y: year.

Table 2. Detailed results of risk of bias assessment.

Study	Random sequence generation (selection bias)	Allocation concealment (selection bias)	Blinding of participants and personnel (performance bias)	Blinding of outcome assessment (detection bias)	Incomplete outcome data (attrition bias)	Selective reporting (reporting bias)	Other bias sources	Overall risk
Kobayashi et al. (18)	+	+	+	+	+	+	+	Low
Lin et al. (21)	+	+	+	+	+	+	+	Low
Ahn et al. (8)	+	+	+	+	+	+	+	Low
Yen and Hsieh (27)	+	?	?	?	+	+	+	Moderate
Chen et al. (14)	+	?	?	?	+	+	+	Moderate
Han et al. (16)	+	?	?	+	+	+	+	Moderate
He (17)	−	−	?	?	+	+	+	High
Juan and Zhi-Xiong (19)	+	?	?	?	+	+	+	Moderate
Li et al. (20)	+	?	?	?	+	+	+	Moderate
Mai (23)	+	?	?	?	+	+	+	Moderate
Tao (24)	?	?	?	?	+	+	+	Moderate
Dongsheng et al. (25)	+	?	?	?	+	+	+	Moderate
Wu (26)	−	?	?	?	+	+	+	High
Zhu and Chen (28)	+	−	?	?	+	+	+	Moderate
Lee et al. (9)	+	+	+	+	+	+	+	Low
Gu et al. (15)	+	+	+	+	+	+	+	Low
Liu et al. (22)	+	+	−	+	+	+	+	High

Figure 2. Meta-analysis of overall recovery rate. CI: confidence interval.

Figure 3. Meta-analysis of disease/symptoms severity based on (A) SCORAD and (B) EASI. MD: mean difference; SCORAD: scoring atopic dermatitis index; EASI: Eczema Area and Severity Index.

Figure 4. Meta-analysis of recurrence rate. CI: confidence interval.

Figure 5. Meta-analysis of the incidence of AEs. CI: confidence interval; AEs: adverse events.

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Data availability statement

All data generated or analyzed during this study are included in this published article.