Review Article

Effectiveness and Safety of Manufactured Chinese Herbal Formula for Knee Osteoarthritis: Insights from a Systematic Review

Table 1

Characteristics of included studies on manufactured Chinese herbal formulae for KOA.

Study ID Sample size
(EG/CG)
Age (yrs)
(mean)
Sex
(male/female)
Diagnostic criteriaIntervention Adverse events (cases) Outcomes
Experimental groupControl group

Zuo et al. (2015) [29]46/47EG: 56.22 ± 9.92 
CG: 58.58 ± 8.84
EG: 7/34 
CG: 6/32
ACRFufang Xiatianwu pill (0.6 g, tid, 12 w)Diclofenac sodium (25 mg, tid, 12 w)EG: GS (10) 
CG: GS (18)
VAS-2; SF-36; WOMAC;

Huang and Quan (2015) [30]34/34EG: 53–76 (68) 
CG: 53–76 (65)
EG: 19/15 
CG: 18/16
ACRHuo xue zhi tong capsule (2 pills, tid, 4 w) + CGSodium hyaluronate 
(IA, 2 mL, qw, 4 w)
EG: GS (1) 
CG: GS (2)
VAS-1

Cao et al. (2015) [31]EG1/EG2/CG: 30/30/30EG1: 61.57 ± 6.68 EG2: 61.03 ± 5.89 
CG: 61.41 ± 7.15
EG1: 8/22
EG2: 9/21 
CG: 6/24
CMA 
(2007)
EG1: Jin tian ge capsule (3 pills, tid, 1 m);  
EG2: EG1 + CG
Aceclofenac 
(0.1 g, bid, 1 m);
EG1: None 
EG2: GS (1) 
CG: GS (1)
Lequesne

Zhang et al. (2013) [32]63/61EG: 38–70 (56.3) 
CG: 39–73 (57.6)
EG: 13/50 
CG: 12/49
ACR 
(1995)
Pan long qi pill (0.9 g, tid, 4 w) + CGDiacerein (50 mg, bid, 4 w) + Aceclofenac (0.1 g, bid, 4 w)EG: GS (1); 
CG: ALF (1)
WOMAC

Yi and Ji (2013) [33]30/30EG: 40–70 (54.5) 
CG: 39–72 (55.3)
EG: 9/21 
CG: 8/24
ACRPan long qi pill (3 pills, tid, 6 w)Glucosamine 
(250 mg, tid, 6 w)
EG: GS (1) 
CG: GS (1)
VAS-1; VAS-2

Niu et al. (2013) [34]27/33NRNRCMA 
(2003)
Jin gu tong xiao pill (6 g, bid, 1 m) + CGGlucosamine 
(2 pills, tid, 1 m)
NoneLequesne; SF-36

Liao (2013) [35]230/230EG: 57.67 ± 7.62 
CG: 57.43 ± 7.81
EG: 105/125 
CG: 101/129
NRJiangu granule (12 g, tid, 1 m)Sodium hyaluronate 
(IA, 20 mg, qw, 1 m)
EG: DM (3); GS (2) 
CG: DM (1); GS (1)
VAS-1

Li et al. (2013) [36]105/105EG: 38–54 (45.0) 
CG: 40–52 (46.3)
EG: 70/35 
CG: 72/33
ACR 
(1995)
Hua mo yan granule (12 g, tid, 4 w)Ketoprofen (50 mg, tid, 4 w)NRVAS-1

Li et al. (2013) [37]93/93EG: 56.2 ± 6.7 
CG: 54.8 ± 7.2
EG: 40/53 
CG: 38/55
CMA 
(2007)
Hua mo yan granule (12 g, tid, 4 w) + CGInfrared therapy 
(15 min, bid)
NoneVAS-1

Li et al. (2013) [38]EG1/EG2/CG1/CG2: 50/50/50/50EG1: 64.23 ± 1.69 
EG2: 64.56 ± 1.75 
CG1: 64.35 ± 1.78 
CG2: 63.85 ± 1.72
EG1: 22/28 
EG2: 23/27 
CG1: 23/27 
CG2: 24/26
ACREG1: Fu gui gu tong granule (5 g, tid, 1 m) 
EG2: EG1 + CG2
CG1: Diclofenac sodium (25 mg, tid, 1 m) 
CG2: Ozone (IA, 10 mL, qw, 1 m)
GSVAS-1; WOMAC

Chen et al. (2013) [39]EG1/EG2/CG: 48/48/48EG1: 58 ± 17.7 
EG2: 61 ± 18.6 
CG: 61 ± 16.0
EG1: 17/25 
EG2: 15/25 
CG: 14/28
CMA 
(2003)
EG1: Xian ling gu bao capsule (1.5 g, bid, 4 w) 
EG2: EG1 + CG
Ozone (IA, 15 mL, qw, 4 w)EG1: None 
EG2: LS (7) 
CG: LS (7)
VAS-1; Lysholm

Luo et al. (2012) [40]EG1/EG2/CG: 33/34/36EG1: 41–74 (51.93) 
EG2: 42–67 (50.15) 
CG: 39–65 (50.35)
EG1: 15/18 
EG2: 17/17 
CG: 17/19
ACR 
(1995)
EG1: Xian ling gu bao capsule (1.5 g, bid) 
EG2: EG1 + CG
Sodium hyaluronate 
(IA, qw, 5 w)
EG1: GS (1) 
EG2: GS (1) 
CG: None
VAS-1; VAS-2; WOMAC

Lu et al. (2012) [41]120/120EG: 52.93 ± 14.22 
CG: 54.01 ± 15.35
EG: 55/65 
CG: 50/70
CMA 
(2007)
Teng huang jian gu pill (1.5–3.0 g, bid, 4 w)Celecoxib (200 mg, qd, 4 w)EG: None 
CG: GS (5)
WOMAC

Li et al. (2012) [42]58/31EG: 59.4 ± 10.3 
CG: 63.2 ± 14.8
EG: 22/36 
CG: 11/20
ACR 
(1995)
Fufang xiao huo luo pill (2 pills, bid, 2 m)Glucosamine 
(250 mg, bid, 2 m)
NoneVAS-1; VAS-2; Lysholm

Li et al. (2012) [43]75/77EG: 46–73 (55.2) 
CG: 43–72 (54.1)
EG: 22/53 
CG: 23/54
CMA 
(2007)
Hua mo yan granule (12 g, tid, 4 w) + CGInfrared therapy 
(15 min, bid, 4 w)
NRVAS-1

Jiang et al. (2012) [44]55/55EG: 61.92 ± 9.89 
CG: 62.78 ± 10.25
EG: 33/22 
CG: 31/24
ACR 
(1986)
Bai shao zong gan capsule (0.3 g, tid, 4 w) + CGCelecoxib (200 mg, qd, 4 w)EG: GS (4); ERU (1) 
CG: GS (2); ERU (1)
VAS-1

Wang et al. (2011) [45]49/4956.9 ± 13.048/50ACR 
(1995)
Jin tian ge capsule (3 pills, tid, 3 m) + CGAlfacalcidol (0.5 μg, qd) + Naproxen (0.25, bid)NoneLequesne

Kang et al. (2011) [46]EG1/EG2/CG: 72/46/42EG1: 54.34 ± 6.93 
EG2: 52.63 ± 7.29 
CG: 54.24 ± 6.80
EG1: 14/58 
EG2: 10/32 
CG: 12/34
ACR 
(1995)
EG1: Wang bi pill (2.0 g, tid, 8 w) 
EG2: EG1 + CG
Diclofenac sodium (25 mg, qd/bid, 8 w)EG1: GS (2) 
EG2: GS (4) 
CG: GS (6)
VAS-1

Yan (2010) [47]30/30EG: 57.90 ± 7.10 
CG: 59.87 ± 7.24
EG: 6/23 
CG: 6/24
CMA 
(2007)
Kang gu zeng sheng capsule (5 pills, tid, 4 w)Glucosamine 
(2 pills, tid, 4 w)
EG: None 
CG: GS (1)
WOMAC

Xiao et al. (2009) [48]77/77EG: 56.20 ± 10.64 
CG: 57.49 ± 12.82
EG: 21/53 
CG: 18/52
NRPan long qi pill (3 pills, tid, 6 w)Diclofenac sodium (25 mg, tid, 6 w)EG: GS (3); DIZ (2) 
CG: GS (3)
VAS-2

Qi and Xu (2009) [49]60/60EG: 45–69 
CG: 46–70
EG: 13/47 
CG: 11/49
GCRNDTCMXin huang pill (1.28 g, tid, 15 d)Ibuprofen (0.6 g, bid, 15 d) + 
Indometacin (25 mg, tid, 15 d)
EG: GS (2) 
CG: GS (12)
Lysholm

Li (2009) [50]50/50EG: 45–68 (51.8) 
CG: 46–67 (52.6)
EG: 22/28 
CG: 23/27
ACRBi qi capsule (1.2 g, tid, 6 w)Glucosamine 
(250 mg, tid, 6 w)
NRHSS

H. B. Liu and J. Liu (2007) [51]66/64EG: 59.5 ± 9.4 
CG: 58 ± 8.5
EG: 23/43 
CG: 26/38
ACRJin gu tong xiao pill (6 g, bid, 2 m) + CGSodium hyaluronate (IA, 5 mL, q4w, 4 w)NoneLysholm

Chen et al. (2007) [52]37/3447–7624/47ACR 
(1986)
Gu jin pill (0.9 g, tid, 8 w)Diclofenac sodium (75 mg, qd, 8 w)NoneLysholm

Yang et al. (2006) [53]60/60EG: 45–68 (51.2) 
CG: 46–65 (53.1)
EG: 28/32 
CG: 26/34
ACRPan long qi pill (3 pills, tid, 6 w)Glucosamine 
(250 mg, tid, 6 w)
NRVAS-1; VAS-2

Xu et al. (2004) [54]30/3050–7925/35ACRBai shao zong gan capsule (0.6 g, bid, 6 w)Nabumetone (1.0 g, qd, 6 w)EG: None 
CG: GS (8)
VAS-1

Note: EG: experimental group; CG: control group; NR: not reported; IA: intra-articular injection; ACR: American College of Rheumatology; CMA: Chinese Medical Association; GCRNDTCM: Guidelines for Clinical Research of New Drugs of Traditional Chinese Medicine; VAS-1: Visual Analog Score-1 (global pain); VAS-2: Visual Analog Score-2 (pain on walking); GS: gastrointestinal symptoms; ALF: abnormal liver function; DM: dry mouth; LS: local swelling; DIZ: dizziness; ERU: eruption.