Meta-analysis showed that HM is effective in treating AD, and its curative effect is superior to antihistamine. The conclusion of this study is credible, suggesting that HM treatment of AD has positive prospects.
(1) TER
11 RCTs, n = 1479; OR 5.64, 95% CI 4.07 to 7.81, I2 = 0%
(2) Recurrence rate+
11 RCTs, n = 1436; OR 0.38, 95% CI 0.29 to 0.49, I2 = 0%
We could not find conclusive evidence that oral or external HM could reduce the severity of eczema in children or adults. We assessed most of the studies as high risk of bias, particularly in blinding of participants and personnel, and there was substantial inconsistency between studies, so any positive effect of HM must be interpreted with caution.
(1) TER
2 RCTs, n = 85; RR 2.09, 95% CI 1.32 to 3.32, I2 = 0%
(2) Itching VAS+
2 RCTs, n = 94; SMD −1.53, 95% CI −2.64 to −0.41, I2 = 74%
(3) Overall severity+
4 RCTs, n = 239; SMD −0.88, 95% CI −1.67 to −0.09, I2 = 87%
(4) CDLQI score+
1 RCT, n = 85; MD −2.50, 95% CI −4.77 to −0.23
(II) Oral or external HM vs. CM
(1) TER
21 RCTs, n = 1868; RR 1.43, 95% CI 1.27 to 1.61, I2 = 65%
(2) Itching VAS+
7 RCTs, n = 465; SMD −0.83, 95% CI −1.43 to −0.22, I2 = 89%
(3) Overall severity+
15 RCTs, n = 1062; SMD −0.97, 95% CI −1.23 to −0.71, I2 = 74%
HM significantly improved symptom severity of AD and it was reported as well-tolerated. The overall risk of bias assessment found that the quality of studies was poor; therefore, the results from the meta-analysis have to be interpreted with caution.
(1) Erythema score+
3 RCTs, n = 245; SMD −0.76, 95% CI −1.05 to −0.47, the value of I2 was not presented.
(2) Surface damage score+
3 RCTs, n = 245; SMD −1.08, 95% CI −1.59 to −0.56, the value of I2 was not presented.
The current clinical evidence showed that HM treatment for AD has better clinical effect. Due to poor methodological quality of existing trials, the future need more high quality, large-sample RCTs to get more reliable clinical conclusions.
(1) TER
13 RCTs, n = 1232; OR 4.86, 95% CI 3.44 to 6.87, I2 = 0%
(2) SCORAD score+
4 RCTs, n = 390; MD −15.51, 95% CI −20.15 to −10.87, I2 = 73%
(3) Serum IgE+
2 RCTs, n = 181; MD −67.10, 95% CI −179.63 to 45.43, I2 = 87%
(4) Recurrence rate+
4 RCTs, n = 326; OR 0.21, 95% CI 0.07 to 0.60, I2 = 58%
The present study suggests that combination of HM and CM has curative effect with lower incidence of adverse reactions in the treatment of AD. The search results are limited to domestic literature, the clinical evidence level is low, and there is a lack of high-quality, standardized RCT. Further RCTs are required to confirm it.
(1) Cure rate
11 RCTs, n = 757; OR 2.94, 95% CI 2.08 to 4.16, I2 = 0%
(2) TER
12 RCTs, n = 733; OR 4.86, 95% CI 3.13 to 7.56, I2 = 0%
(3) Recurrence rate+
3 RCTs, n = 251; OR 0.74, 95% CI 0.36 to 1.53, I2 = 0%
(I) Oral HM, acupuncture, moxibustion, etc. vs. placebo or CM
We need to make conclusion cautiously for the efficacy and safety of HM and related treatment on AD. Articles having good quality based on the Cochrane Collaboration’s risk of bias tool were included ensuring the results trustworthy.
(1) TER
8 RCTs, n = 667; RR 1.10, 95% CI 0.99 to 1.21, I2 = 65%
(2) SCORAD score+
4 RCTs, n = 173; SMD 0.89, 95% CI −0.24 to 2.02, I2 = 86%
(3) decrease of EASI score
2 RCTs, n = 50; MD 3.22, 95% CI 0.41 to 6.03, I2 = 0%
(4) decrease of SSRI score
2 RCTs, n = 105; SMD −0.36, 95% CI −1.16 to 0.45, I2 = 76%
Studies have shown that HM Jianpi therapy had significantly higher clinical efficacy than CM in the treatment of AD. Due to the publication bias and low quality of included RCTs in this study, more multicenter, high quality, large-sample, randomized double-blind controlled trials are needed to further demonstrate the conclusion.
(1) TER
30 RCTs, n = 2333; OR 4.05, 95% CI 3.27 to 5.03, I2 = 0%
(2) SCORAD score+
15 RCTs, n = 1282; MD −9.82, 95% CI −13.31 to −6.33, I2 = 90%
(3) EASI score+
3 RCTs, n = 232; MD −2.80, 95% CI −3.54 to −2.07, I2 = 0%
(4) Itching VAS+
7 RCTs, n = 448; MD −0.79, 95% CI −1.10 to −0.47, I2 = 24%
(5) Serum IgE+
6 RCTs, n = 534; MD −34.92, 95% CI −86.07 to 16.22, I2 = 97%
(6) Serum IFN-γ
4 RCTs, n = 346; MD 1.75, 95% CI 1.14 to 2.35, I2 = 0%
(7) Serum IL-4+
4 RCTs, n = 346; MD −3.15, 95% CI −4.16 to −2.15, I2 = 75%
(8) Serum EOS+
5 RCTs, n = 410; MD −0.11, 95% CI −0.20 to −0.02, I2 = 0%
(9) Recurrence rate+
4 RCTs, n = 283; OR 0.36, 95% CI 0.21 to 0.60, I2 = 0%
(II) Oral Jinpi HM vs. CM
(1) TER
21 RCTs, n = 1355; OR 4.81, 95% CI 3.63 to 6.36, I2 = 0%
(III) Oral Jinpi HM + CM vs. CM
(1) TER
9 RCTs, n = 832; OR 2.94, 95% CI 2.11 to 4.11, I2 = 0%
(I) Tripterygium agents (or Tripterygium agents + CM) vs. CM
Tripterygium agents appear to be effective when treating patients with atopic eczema, but with apparent side effects. It cannot be concluded that Tripterygium agents can be generally used for eczema in the clinic because of the small sample size. Further multi-center studies with large samples, and high-quality should be conducted to clarify the efficacy and safety of Tripterygium agents for treating eczema.
(1) TER
13 RCTs, n = 1361; RR 1.59, 95% CI 1.26 to 2.00, I2 = 93%
(2) Serum IL-2
2 RCTs, n = 178; SMD 11.09, 95% CI −13.41 to 35.58, I2 = 99%
(3) Serum IL-4+
1 RCT, n = 160; SMD −0.64, 95% CI −0.96 to −0.33
(4) Serum IFN-γ
1 RCT, n = 160; SMD 0.69, 95% CI 0.37 to 1.01
(5) Serum CRP+
1 RCT, n = 118; SMD −20.01, 95% CI −22.64 to −17.39
(6) Serum IgE+
1 RCT, n = 220; SMD −0.57, 95% CI −1.11 to −0.03
(7) Recurrence rate+
2 RCTs, n = 149; RR 0.44, 95% CI 0.06 to 3.00, I2 = 89%
(II) Tripterygium agents vs. CM
(1) TER
4 RCTs, n = 367; RR 1.19, 95% CI 0.96 to 1.48, I2 = 85%
(III) Tripterygium agents + CM vs. CM
(1) TER
9 RCTs, n = 994; RR 1.78, 95% CI 1.40 to 2.25, I2 = 84%
