Review Article

Chinese Herbal Medicine as an Adjunctive Therapy for Breast Cancer: A Systematic Review and Meta-Analysis

Table 1

Characteristics of the included studies.

StudyNumber of participants (TG/CG)/number of drop-outs (TG/CG)Duration (week)Treatment group interventionControl group interventionCHM formula and ingredients Assessment of outcomes

Liang  et al. 2015 [17]98 (48 + 50)/024CHM + chemotherapyChemotherapy: TAC: TAX/ADM/CTX, or TA: TAX/ADM, or GT: GCB/TAX, or EC: EPI/CTXHuaier Granule (did not mention specific ingredient)Survival rate, CD4,
CD4/CD8, IL-2, chemotoxicity

Du et al. 2015 [18]60 (30 + 30)/016CHM + FACFAC: 5-FU/ADM/CTXModified Xiaoyao powder (Radix Bupleuri, Angelica sinensis, Radix Paeoniae Alba, Roasted Rhizoma Atractylodis Macrocephalae, Poria cocos, Ginger, Mint, Radix Liquiritiae)KPS, chemotoxicity, survival rate, recurrence rate, clinical symptoms

Li 2015 [24] 85 (44 + 41)/09CHM + CEFCEF: CTX/EPI/5-FUFuzheng Xiaoliu compound (Radix Astragalus, Codonopsis pilosula, Fructus Lycii, Scutellaria barbata, Agrimonia pilosa, Pleione bulbocodioides, Curcuma Zedoary, Rhizoma Sparganii, Coix Seed, Rhizoma, Pericarpium Citri Reticulatae, Licorice Roots Northwest Origin)Tumor response, chemotoxicity, serum tumor marker

Li and Han 2015 [52]60 (30 + 30)/012CHM + TACTAC: TAX/ADM/CTXYiqihuoxue compound (Radix Astragalus, Coix Seed, Radix Pseudostellariae, Peach Kernel, Flos Carthami, Rhizoma Atractylodis Macrocephalae, Angelica sinensis, Red Peony Root, Cowherb Seed, Pericarpium Citri Reticulatae, Radix Liquiritiae)RECIST, KPS

Chen  et al. 2015 [25]60 (28 + 29)/36CHM + GPGP: GCB/PDDSugan Jianpi Sanjie compound (Radix Astragalus, Radix Bupleuri, Pericarpium Citri Reticulatae, Radix Curcumae, Pleione bulbocodioides, Rhizoma Atractylodis Macrocephalae, Coix Seed, Oldenlandia diffusa, Scutellaria barbata, Semen Raphani, Polygonatum Kingianum, Radix Liquiritiae)Chemotoxicity, KPS, CD3, CD4,
CD4/CD8, serum tumor marker

Wang 2015 [26]60 (30 + 30)/04CHM + FDFD: 5-FU/DDPXiaozheng compound (Radix Astragalus, Codonopsis pilosula, Oldenlandia diffusa, Scutellaria barbata, Pericarpium Citri Reticulatae Viride, Akebia Fruit, Fructus Aurantii Immaturus, Cortex Magnoliae Officinalis, Tangerine Seed)Tumor response, chemotoxicity, survival rate

Fang and Jia 2015 [27]30 (16 + 14)/012CHM + CECE: CTX + EPIChinese herbal compound (Radix Astragalus, Codonopsis pilosula, Roasted Rhizoma atractylodis macrocephalae, Poria cocos, Peach Kernel, Flos Carthami, Red Peony Root, Radix Paeoniae Alba, Radix Isatidis, Nidus Vespae, Dried Radix Rehmanniae, Angelica sinensis, Caulis Spatholobi)Tumor response, chemotoxicity, KPS

Bai  and Wu 2014 [28]64 (32 + 32)/012CHM + TECTEC: TAX/EPI/CTXJinlong capsule (did not mention specific ingredient)Tumor response, chemotoxicity, KPS

Guo 2014 [29]76 (38 + 38)/08CHM + CAFCAF: CTX/ADM/5-FUFuzheng Quji decoction (Radix Astragalus, Caulis Spatholobi, Rhizoma Sparganii, Concha Ostreae, Curcuma Zedoary, Turtle Shell, Sargassum, Roasted Rhizoma Atractylodis Macrocephalae, Polygonatum Kingianum, Codonopsis pilosula, Endothelium Corneum Gigeriae Galli, Amomum villosum, Dried Lacquer, Angelica sinensis, Fructus Lycii)Tumor response, chemotoxicity,

Xie 2014 [30]90 (45 + 45)/018CHM + CAFCAF: CTX/ADM/5-FUShenqifuzheng injection (Radix Astragalus, Codonopsis pilosula)Tumor response, chemotoxicity, peripheral blood lymphocytes

Yang  et al. 2014 [31]86 (43 + 43)/02CHM + TATAX/ADMThe beginning of chemotherapy: Xiangsha Liujunzi decoction (Rhizoma Atractylodis Macrocephalae, Codonopsis pilosula, Rhizoma, Pericarpium Citri Reticulatae, Poria cocos, Chinese Yam, Semen Raphani, Coke Hawthorn Coke Malt, Coke Medicated Leaven, Caulis Bambusae in Taeniam, Purple Perilla, Amomum villosum, Costustoot); the middle-late stages of chemotherapy: Liuweidihuang decoction (Poria cocos, Chinese Yam, Rhizoma Atractylodis Macrocephalae, Cornus officinalis, Shorthorned Epimedium, Semen Cuscutae, Mulberry, Radix Rehmanniae Preparata, Rhizoma Alismatis, Caulis Spatholobi, Radix Astragalus, Polygonatum Kingianum)Tumor response, chemotoxicity

Cheng  et al. 2013 [32]40 (20 + 20)/03CHM + CAPCAP: CTX/ADM/PDDModified Lizhong decoction (Red Ginseng, Dried Ginger, Rhizoma Atractylodis Macrocephalae, Radix Liquiritiae, Cornus officinalis, Fructus Schizandrae, Poria cocos, Radix Paeoniae Alba)Chemotoxicity, KPS

Wang 2013 [33]76 (38 + 38)/02CHM + CAFCAF: CTX/ADM/5-FUShenqifuzheng injection (Radix Astragalus, Codonopsis pilosula)Tumor response, chemotoxicity, KPS

Xiong 2012 [34]48 (24 + 24)/06CHM + CNCN: CAP + NDPFuzheng Xiaoji compound (Radix Astragalus, Polygonatum Kingianum, Codonopsis pilosula, Rhizoma Atractylodis Macrocephalae, Angelica sinensis, Fructus Lycii, Tortoiseshell, Endothelium Corneum Gigeriae Galli, Caulis Spatholobi, Sargassum, Concha Ostreae)RECIST, KPS, serum tumor marker

Zhang  and Dang 2012 [35]60 (30 + 30)/04CHM + NPNP: NDP/PDDFuzheng Guben compound (Codonopsis pilosula, Curcuma Zedoary, Coix Seed, Coke Hawthorn, Coke Medicated Leaven, Endothelium Corneum Gigeriae Galli, Roasted Rhizoma Atractylodis Macrocephalae, Radix Astragalus, Rhizoma, Pericarpium Citri Reticulatae, Radix Paeoniae Alba, Radix Liquiritiae)RECIST, KPS, chemotoxicity

Pan 2011 [36]160 (80 + 80)/04CHM + CAFCAF: CTX/ADM/5-FUCinobufaginKPS, chemotoxicity

Liu et al. 2011 [53]66 (31 + 35)/024CHM + CAFCAF: CTX/ADM/5-FUTianzhicao capsule (did not mention specific ingredient)KPS, chemotoxicity

Liu et al. 2011 [54]50 (25 + 25)/06CHM + TETE: TAX/EPIRenshen Yangrong decoction (Codonopsis pilosula, Radix Astragalus, Radix Rehmanniae Preparata, Radix Paeoniae Alba, Poria cocos, Pericarpium Citri Reticulatae, Rhizoma Atractylodis Macrocephalae, Angelica sinensis Fructus Schizandrae, Polygala tenuifolia, Radix Liquiritiae, Cinnamon, Ginger, Jujube)KPS, CD3, CD4,
CD4/CD8, CD8, clinical symptoms

Yang 2011 [37]64 (32 + 32)/012CHM + TATA: TAX/ADMShenxiao Gualousan (Radix Bupleuri, Corydalis Tuber, Snakegourd Fruit, Fritillary Bulb, Angelica sinensis, Scrophulariae, Phillyrin, Sargassum, Laminaria, Olibanum, Commiphora myrrha)Tumor response, chemotoxicity

Cheng 2011 [38]50 (26 + 24)/08CHM + TPTP: TAX/ PDDFuzheng Kanai compound (Radix Astragalus, Angelica sinensis, Radix Pseudostellariae, Roasted Rhizoma Atractylodis Macrocephalae, Poria cocos, Coix Seed, Shorthorned Epimedium, Cornus officinalis, Radix Bupleuri, Rhizoma Cyperi, Oldenlandia diffusa, Curcuma Zedoary, Radix Liquiritiae)Tumor response, KPS, CD3, CD4,
CD8, clinical symptoms

Zhang  et al. 2011 [39] 45 (23 + 22)/06CHM + CTFCTF: CTX/TAX/5-FU Xiaoyan decoction (Codonopsis pilosula, Radix Astragalus, Ligustrum lucidum Ait., Radix Curcuma, Radix Curcumae, Sophora flavescens, Oldenlandia diffusa)KPS, CD3, CD4,
CD8, CD4/CD8, serum tumor marker, chemotoxicity

Feng et al. 2010 [40]60 (32 + 28)/03CHM + NFLNFL: MTX/CF/5-FUWu Mei Wan (Concha Ostreae, Fructus Mume, processed Radix Aconiti Lateralis, Dried Ginger, Cassia Twig, Capsicum annuum, Radix Liquiritiae, Amomum villosum)Tumor response, KPS

Zhang 2009 [41]50 (26 + 24)/04CHM + NPNP: NDP/PDDChinese herbal compound (Radix Astragalus, Oldenlandia diffusa, Nidus Vespae, Angelica sinensis, Radix Pseudostellariae, Roasted Rhizoma Atractylodis Macrocephalae, Poria cocos, Coix Seed, Cornus officinalis, Achyranthes bidentata, Radix Bupleuri, Radix Paeoniae Alba, Curcuma, Pericarpium Citri Reticulatae, Rhizoma, Fructus Aurantii)Tumor response, clinical symptoms, KPS, chemotoxicity

Yang et al. 2008 [42]59 (28 + 27)/412CHM + NPNP: NDP/PDDGuben Yiliu II (Codonopsis pilosula, Poria cocos, Rhizoma Atractylodis Macrocephalae, Radix Astragalus, Ligustrum lucidum Ait., Fructus Lycii, Shorthorned Epimedium, Rhizoma Chuanxiong, Caulis Spatholobi, Curcuma Zedoary, Fritillary Bulb, Sophora flavescens)Tumor response, KPS, serum tumor marker, clinical symptoms, chemotoxicity

Hu  et al. 2008 [43]52 (28 + 24)/020 dCHM + CAFCAF: CTX/ADM/5-FUYiqihuoxue decoction (Codonopsis pilosula, Radix Astragalus, Angelica sinensis, Colla Corii Asini, Pseudoginseng, Peach Kernel, Flos Carthami, Rhizoma Atractylodis Macrocephalae, Coix Seed, Fructus Lycii, Eucommia ulmoides, Fritillary Bulb, Selfheal)Tumor response, chemotoxicity

Chen et al. 2008 [16]60 (30 + 30)/024CHM + CEFCEF: CTX/EPI/5-FUDangguibuxue decoction (Radix Astragalus, Angelica sinensis)Quality of life, chemotoxicity, CD3, CD4,
CD8, CD4/CD8

Tang et al. 2007 [44]60 (30 + 30)/012CHM + CEFCEF: CTX/EPI/5-FUYiqijiedu decoction (Radix Astragalus, Angelica sinensis, Caulis Spatholobi, Ligustrum lucidum Ait., Selfheal, Radix Bupleuri, Coke Hawthorn, Coke Malt, Coke Medicated Leaven)Clinical symptoms, CD4,
CD8, CD4/CD8, KPS

Huang et al. 2007 [45]60 (30 + 30)/06CHM + CTFCTF: CTX/TAX/5-FUJianpi Xiaoji decoction (Radix Pseudostellariae, Radix Astragalus, Coix Seed, Rhizoma Atractylodis Macrocephalae, Poria cocos, Oldenlandia diffusa, Fructus Aurantii, Pericarpium Citri Reticulatae, Radix Liquiritiae)Tumor response, KPS, chemotoxicity, CD3, CD4,
CD8, CD4/CD8

Yang et al. 2007 [46]38 (20 + 18)/09CHM + CEFCEF: CTX/EPI/5-FUTaohongsiwu decoction (Radix Paeoniae Alba, Rhizoma Chuanxiong, Angelica sinensis, Flos Carthami, Radix Rehmanniae Preparata, Peach Kernel)Tumor response, clinical symptoms, chemotoxicity

Dai  et al. 2004 [47]46 (25 + 21)/06CHM + NPNP: NDP/PDDTiaoganyangxue compound (Radix Bupleuri, Dried Radix Rehmanniae, Rhizoma Cyperi, Pericarpium Citri Reticulatae Viride, Pericarpium Citri Reticulatae, Rhizoma Chuanxiong, Angelica sinensis, Radix Paeoniae Alba, Poria cocos, Rhizoma Atractylodis Macrocephalae, Radix Astragalus, Radix Pseudostellariae, Snakegourd Fruit, Fritillary Bulb, Concha Ostreae, Uniflower Swisscentaury Root, Cowherb Seed, Stir-baked Squama Manitis, Dandelion)Tumor response, chemotoxicity, KPS

Li  et al. 2004 [48]75 (40 + 35)/012CHM + NENE: NDP/ EPIShenqifuzheng injection (Codonopsis pilosula, Radix Astragalus)Tumor response, chemotoxicity

Yang and Sun 2004 [49]51 (27 + 24)/09CHM + CMFCMF: CTX/MTX/5-FUModified Liujunzi decoction (Codonopsis pilosula, Poria cocos, Rhizoma Atractylodis Macrocephalae, Pericarpium Citri Reticulatae, Rhizoma, Radix Liquiritiae, Radix Astragalus, Angelica sinensis, Radix Rehmanniae Preparata, Ligustrum lucidum Ait., Morinda officinalis, Fructus Psoraleae)Cellular immune function, tumor response, chemotoxicity

Huang et al. 2003 [50]66 (37 + 29)/06CHM + CMFCMF: CTX/MTX/5-FUModified Bazhen decoction (Radix Rehmanniae Preparata, Angelica sinensis, Rhizoma Atractylodis Macrocephalae, Poria cocos, Rhizoma Chuanxiong, Radix Paeoniae Alba, Codonopsis pilosula, Radix Astragalus, Radix Liquiritiae, Ligustrum lucidum Ait., Pericarpium Citri Reticulatae)Tumor response, KPS, chemotoxicity, clinical symptoms

TG = treatment group; CG = control group; CHM = Chinese herbal medicine; KPS = Karnofsky performance scale; RECIST = Response Evaluation Criteria In Solid Tumors; TAC = paclitaxel + adriamycin + cyclophosphamide; TA = paclitaxel + adriamycin; GT = gemcitabine + paclitaxel; EC = epirubicin + cyclophosphamide; NE = nedaplatin + epirubicin; FAC = fluorouracil + adriamycin + cyclophosphamide; CEF = cyclophosphamide + epirubicin + fluorouracil; GP = gemcitabine + cisplatinum; FD = fluorouracil + cisplatin; CE = cyclophosphamide + epirubicin; TEC = paclitaxel + epirubicin + cyclophosphamide; CAF = cyclophosphamide + adriamycin + fluorouracil; CAP = cyclophosphamide + adriamycin + cis-platinum; CN = cyclophosphamide + nedaplatin; NP = nedaplatin + cis-platinum; TE = paclitaxel + epirubicin; TP = paclitaxel + cis-platinum; CTF = cyclophosphamide + paclitaxel + fluorouracil; NFL = methotrexate + cyclophosphamide + fluorouracil; CMF = cyclophosphamide + methotrexate + fluorouracil.