Chinese Herbal Medicine Paratherapy for Parkinson's Disease: A Meta-Analysis of 19 Randomized Controlled Trials

Table 1

Characteristics of the included studies.

			Interventions (𝑛)		Samples and Characteristics		Hoehn and Yahr
Included; trials	Eligibility; criteria1	Study Designs	Drug/dosage		Male/female (𝑛); age (years); duration (years)		Staging scale (stage) : case (𝑛)		Course of; treatment	Outcomes	Intergroup; differences
			Trial	Control	Trial	Control	Trial	Control
Cui et al. [17]; CN, ADJ; monocenter	CNDS for PD; in 1984	Randomized (stratified; randomized) and; controlled nonblind; parallel study	BuShenPing; ChanFang; 1 dose/d^#	Madopar 62.5–500 mg/per; time (pt), bid-qid	M31/F21; Mean age: 67.9 ± 16.5; Disease duration: 2–12	M25/F10; Mean age: 65.5 ± 16.5; Duration: 1–10	1.5–3 : 22; 4 : 13	1.5~3 : 25; 4 : 10	3 mon	(1) UPDRS; (2) Clinical symptom; (3) Adverse effect*	(1) 𝑃<0.05; (2) 𝑃<0.05 or; 𝑃<0.01
Wang et al. [18]; CN, ADJ; monocenter	CNDS for PD; in 1984	Randomized (simple; randomized) and; controlled parallel; study	ZiYinXiFeng; HuoXueTang; 1 dose/d^#	Madopar 125 mg/pt; for 1 week; then 250 mg/; pt bid	M11/F9; Age range: 45–74; Disease duration: 7 mo–6 y	M10/F10; Age range: 42–75; Disease duration: 6 mo–5 y	nr	nr	3 mon	(1) UPDRS; (2) Tremble function	(1) 𝑃<0.01; (2) 𝑃<0.01
Wang et al. [19]; CN, ADJ; monocenter	CNDS for PD; in 1984	Randomized (method; unreported) and; controlled nonblind; parallel study	CHM according; to syndrome; differentiation^#	Madopar <3 piece/d; If stiff, add amantadine; 0.1-0.2/d	M33/F20; Mean age: 63.91 ± 9.3; Disease duration: nr	M30/F20; Mean age: 62.62 ± 9.54; Disease duration: nr	nr	nr	90 d	(1) UPDRS II, III; (2) Clinical symptom	(1) 𝑃<0.05; (2) 𝑃<0.05
Shen and Yuan [20]; CN, ADJ; monocenter	CNDS for PD; in 1984	Randomized (method; unreported) and; controlled parallel study	ZiBuGanShen; 1 dose/d^#	Madopar, Sinemet, Artane; no detailed information; concern on the dosage	M26/F14; Mean age: 71.30 ± 6.92; Disease duration: 4.30 ± 2.31	M20/F10; Age range: 67.91 ± 7.64; Disease duration: 3.91 ± 2.01	2 : 8; 2.5 : 18; 3 : 10; 4 : 4	2 : 6; 2.5 : 15; 3 : 6; 4 : 5	3 mon	(1) UPDRS II, III; (2) Webster scale	(1) 𝑃<0.05; (2) 𝑃<0.05
Luo et al. [21]; CN, ADJ; monocenter	CNDS for PD; in 1984	Randomized (simple; randomized) and; controlled nonblind; parallel study	PaBing I Hao; 1 dose/d^#	Madopar; no detailed information; concern on the dosage	M18/F4; Mean age: 64.54 ± 10.61; Disease duration: 5.19 ± 5.22	M12/F7; Mean age: 66.80 ± 9.15; Disease duration: 5.57 ± 3.56	1 : 6; 2 : 10; 3 : 3; 4 : 3	1 : 4; 2 : 10; 3 : 3; 4 : 2	3 mon	(1) UPDRS	(1) 𝑃<0.05
Zheng and Luo [22]; CN, ADJ; monocenter	CNDS for PD; in 1984	Randomized (simple; randomized) and; controlled nonblind; parallel study	PaBing III Hao; 1 dose/d^#	Madopar 125 mg/pt,; bid; for 1 w; then; 250 mg/pt,; bid	M15/F15; Mean age: 63.43 ± 10.09 y; Disease duration: 6 mo–15 y	M19/F11; Mean age: 62.30 ± 6.82 y; Disease duration: 9 mo–13 y	1 : 12; 2 : 11; 3 : 7	1 : 6; 2 : 15; 3 : 9	3 mon	(1) UPDRS; (2) Hoehn-yahr class	(1) 𝑃<0.05; (2) 𝑃>0.05
Xie et al. [23]; CN, ADJ; monocenter	CNDS for PD; in 1984	Randomized (method; unreported) and; controlled nonblind; parallel study	JunFuKangJiao; Nang 1.5 g/per; time (pt), tid #	Madopar 125 mg/pt, tid	M: 8/F: 6; Mean age: 59.00 ± 9.64 y; Disease duration: nr	M: 7/F: 7; Mean age: 58.6 ± 12.0 y; Disease duration: nr	nr	nr	6 mon	(1) UPDRS; (2) Adverse effect; (3) Clinical symptom	(1) 𝑃<0.01; (2) nr; (3) 𝑃<0.05
Cheng et al. [24]; CN, ADJ; monocenter	CNDS for PD; in 1984	Randomized (method; unreported) and; controlled nonblind; parallel study	XiFengDingChan; Wan 6 g/pt, tid #	Madopar for 12 w; convention dosage; add the dosage when; effect decline dosage; subtract 62.5 mg/d; over the 2 weeks	M12/F8; Mean age: 63 ± 6.07; Disease duration: nr	M11/F9; Mean age: 60.35 ± 6.73; Disease duration: nr	nr	nr	12 w	(1) UPDRS; (2) Madopar dosage	(1) 𝑃<0.01; (2) 𝑃<0.01
Zhu et al. [25]; CN, ADJ; monocenter	CNDS for PD; in 1984	Randomized (method; unreported) and; controlled nonblind; parallel study	DingZhenTang; 1 dose/d^#	Antiparkinsonian drug,; no detailed information	M23/F11; Mean age: 72.2 ± 6.7; Disease duration: 3.3 ± 2.4	M21/F10; Mean age: 70.0 ± 7.6; Disease duration: 3.5 ± 2.5	1 : 4; 1.5 : 4; 2 : 7; 2.5 : 10; 3 : 8	1 : 4; 1.5 : 3; 2 : 6; 2.5 : 9; 3 : 9	6 mo	(1) UPDRS; (2) Autonomic nerve; function	(1) 𝑃=0.0018; (2) 𝑃>0.05; (constipation; 𝑃<0.01)
Zhao et al. [26]; CN, ADJ; Multicenter	CNDS for PD; in 1984	Randomized (case; randomized) and; controlled blind; parallel study	GuiLingPaAnJiao; Nang 3 pill/pt tid^#	Placebo 3 pill/pt tid; Madopar, Sinemet plus; Placebo 3 pill/pt tid	M46/F29; Mean age: 64.86 ± 9.85; Disease duration: 4.27 ± 3.44	M47/F32; Mean age: 65.63 ± 8.51; Disease duration: 4.59 ± 3.82	nr	nr	12 w	(1) UPDRS II, III,; total; (2) Levodopa dosage; (3) Clinical effect	(1) 𝑃<0.05; or 𝑃<0.01; (2) 𝑃<0.05; (3) 𝑃>0.05
Kum et al. [27]; HK, ADJ; monocenter	UK Brain Bank; standard	Randomized (computer-; generated randomized); and controlled double-blind; parallel study	JiaWeiLiuJunZi; Tang; no detailed information concern on the dosage^#	Placebo with each dose of; their levodopa; treatment	M14/F8; Mean age: 64.82 ± 8.88 y; Disease duration: 5.44 ± 5.26	M17/F8; Mean age: 60.88 ± 9.41; Disease duration: 5.36 ± 5.27	nr	nr	24 w	(1) PDQ-39; (2) UPDRS; (3) GDS; (4) SF-36; (5) DSQS	(1) 𝑃<0.05; (2) 𝑃<0.05; (3) 𝑃>0.05; (4) 𝑃>0.05; (5) 𝑃>0.05
Yang et al. [28]; CN, ADJ; Multicenter	UK Brain Bank; standard	Randomized (central random; System randomized) and; controlled blind; parallel study	BuShenHuoXue; Particle 1 dose/d^#	Madopar 375–1000 mg/pt; tid-qid; placebo; 1 dose/d	M29/F26; Mean age: 66.4 ± 9.1; Disease duration: 5.3 ± 3.1	M35/F16; Mean age: 67.5 ± 9.5; Disease duration: 5.0 ± 3.9	nr	nr	3 mon	(1) UPDRS III; (2) Movement; experiment; (3) 10 m reentry run; (4) Muscular tension	(1) 𝑃<0.05; (2) 𝑃>0.05; (3) 𝑃<0.05; (4) 𝑃<0.05
Yuan et al. [29]; CN, ADJ; Multicenter	CNDS for PD; in 1984	Randomized (block; randomization) and; controlled blind; parallel study	ShuDiPingChan; Tang 2 bag/ptbid; XieWuJiaoNang; 8 pill/pt, bid^#	Antiparkinsonian drug; no definite information	M18/F12; Mean age: 69.5 ± 7.81; Disease duration: 7.43 ± 1.64	M16/F14; Mean age: 68.6 ± 7.32; Disease duration: 7.35 ± 1.82	2 : 10; 2.5 : 28; 3 : 12; 4 : 10	2 : 12; 2.5 : 30; 3 : 8; 4 : 10	3 mon	(1) UPDRS; (2) Clinical symptom; (3) H-Y Stage; (4) On-off phenomenon; (5) Levodopa dosage	(1) 𝑃<0.01; (2) 𝑃<0.01; (3) 𝑃<0.05; (4) 𝑃<0.01; (5) 𝑃>0.05
Hong [30]; CN, ADJ; monocenter	CNDS for PD; in 2006	Randomized (method; unreported) and; controlled nonblind; parallel study	CHM,; No detailed; information^#	Madopar; 62.5–125 mg/pt, bid-tid; Adjust the dosage; according to the effect	M23/F15; Mean age: 72.2 ± 6.6; Disease duration: 19.6 ± 5.4	M21/, F17; Mean age: 73.1 ± 6.9; Disease duration: 20.5 ± 5.8	nr	nr	6 mon	(1) UPDRS III; (2) UPDRS IV	(1) 𝑃<0.05; (2) 𝑃<0.05
Fan et al. 2010 [31]; CN, ADJ; monocenter	CNDS for PD; in 2006	Randomized simple; randomized) and; controlled nonblind; parallel study	PaBing II Hao; 1dose/d continue; 3 w; interval 1 w; for 3 mon^#	Madopar; 125 mg/pt, bid for 1 w; Then 250,125,125 mg/pt; (morning, middle, night,; resp.) for 3 mon	30 PD; Mean age: nr; Disease duration: nr	30 PD; Mean age: nr; Disease duration: nr	nr	nr	3 mon	(1) UPDRS; (2) Clinical symptom	(1) 𝑃<0.05; (2) 𝑃<0.05
Dou and Diao [32]; CN, ADJ; monocenter	CNDS for PD; in 1984	Randomized (method; unreported) and; controlled nonblind; parallel study	BuShenHuoXue; Tang 600 mL/d^#	Madopar; 125 mg/pt, tid	M22/F13; Mean age: 54.7 ± 11.5; Disease duration: 3.7 ± 1.9	M21/F14; Mean age: 53.5 ± 11.9; Disease duration: 3.4 ± 1.8	nr	nr	3 mon	(1) UPDRS; (2) Clinical symptom	(1) 𝑃<0.05; (2) 𝑃<0.05
Li et al. [33]; CN, ADJ; monocenter	UK Brain Bank; standard	Randomized (method; unreported) and; controlled nonblind; parallel study	BuShenHuoXueYin; 1 dose/d divide; twice 150 mL/pt^#	Madopar; 125 mg–1500 mg/d; Sinemet 125 mg–500 mg/d; Benzhexol 2–6 mg/d; Amantadine100–300 mg/d; Trastal 50–150 mg/d;	M30/F17; Mean age: 65.2 ± 7.8 y; Disease duration: 5.61 ± 4.18	M25/F19; Mean age: 65.3 ± 8.8 y; Disease duration: 5.97 ± 4.24	1.5 : 4; 2 : 16; 2.5 : 14; 3 : 10; 4 : 3	1.5 : 3; 2 : 16; 2.5 : 15; 3 : 8; 4 : 2	3 mon	(1) UPDRS total; (2) UPDRS II; (3) UPDRS III; (4) Clinical effect; (5) H-Y stage; (6) Motor; complications	(1) 𝑃<0.05; (2) 𝑃<0.05; (3) 𝑃>0.05; (4) 𝑃<0.05; (5)𝑃>0.05; (6) Reduced
Wu et al. [34]; CN, ADJ; monocenter	CNDS for PD; in 2006	Randomized (random-; number table) and; controlled nonblind; parallel study	ZhichanpingPaTang; 1 dose/d, divide; twice 600 mL/d^#	Madopar 125 mg/pt, bid; for 1 w; then 250, 125,; 125 mg/pt (morning,; middle, night,; resp.)	M20/F20; Mean age: 69.28 ± 10.21; Disease duration: 3.94 ± 3.02	M22/F18; Mean age: 68.8 ± 7.59; Disease duration: 4.44 ± 3.17	1–2.5 : 29; 3 : 11; 4-5 : 0	1–2.5 : 28; 3 : 12; 4-5 : 0	3 mon	(1) UPDRS I; (2) UPDRS II; (3) UPDRS III; (4) UPDRS IV; (5) LSIB scale; (6) PDQ	(1) 𝑃<0.05; (2) 𝑃<0.05; (3) 𝑃<0.05; (4) 𝑃<0.05; (5) 𝑃<0.05; (6) 𝑃<0.05
Pan et al. [35]; CN, ADJ; monocenter	UK Brain Bank; Standard	Randomized (random numbers) and; controlled blind; parallel study	Zengxiao Anshen; Zhichan 8 g/d^#	Placebo granule; antiparkinsonian drug	M34/F22; Mean age: 62.82 ± 10.31; Disease duration: 5.73 ± 4.81	M21/F14; Mean age: 63.1 ± 10.2; Disease duration: 5.81 ± 3.24	nr	nr	13 w	(1) AMI counts; (2) UPDRS II, III, IV; (3) Power-law; Exponent α; (4) Secondary; symptom score	(1) 𝑃<0.05; (2) 𝑃<0.05; (3) 𝑃<0.01; (4) 𝑃<0.05 or 𝑃<0.01

CN: China, ADJ: adjunctive; CNDS: Chinese National Diagnosis Standard; PD: Parkinson's disease; RCT: randomized controlled trial; nr:  no report; w:  weeks; mon:  months; UPDRS:  Unified Parkinson's Disease Rating Scale; M:  male; F:  female; PDQ-39: Parkinson's Disease Questionnaire-39; GDS: Geriatric Depression Scale; SF-36: Short-Form-36 Health Survey; DSQS: Deficiency of Splenic Qi Scale; TCM:  traditional Chinese medicine; CHM:  Chinese herbal medicine; H-Y stage: Hoehn and Yahr stage; AMI: Ambulatory Monitoring Inc. ^#: mean same as the control group treatment; *: adverse effect showed in Table 4.