The Efficacy and Safety of Chinese Herbal Medicine in the Treatment of Knee Osteoarthritis: An Updated Systematic Review and Meta-Analysis of 56 Randomized Controlled Trials

Table 1

The characteristics of the included studies.

Study	Study design	Diagnostic criteria	Sample size	Sample and characteristics (male/female; mean age, year)		Interventions		Disease duration	Course of treatment	Outcome index
				TG	CG	TG	CG
Chen 2017 [28]	RCT	CRA criteria (2003)	92	46 (16/30);	46 (20/26);	Sanbi Xiao granule (0.3 g, tid, 4 w)	Glucosamine sulfate (628 mg, tid, 4 w)	TG: CG:	4 w	(1) VAS; (2) WOMAC; (3) ADR
Chen 2018 [29]	RCT	COA criteria (2007)	128	64 (26/38); 56.1	64 (24/40); 57.3	(1) Danqi granule (12 g, bid, 24 w); (2) Glucosamine sulfate (500 mg, tid, 24 w)	Glucosamine sulfate (500 mg, tid, 24 w)	TG: 0.6 to 9 y; CG: 0.7 to 8 y	24 w	(1) WOMAC; (2) ER; (3) VAS; (4) Lequesne
Cui 2017 [31]	RCT	ACR criteria (1986)	106	66 (30/36);	40 (17/23);	Chaihu Jiangu decoction (1 package, qod, 12 w)	Glucosamine hydrochloride (750 mg, bid, 12 w)	TG: 10.6 y; CG: 9.9 y	12 w	(1) VAS; (2) ER; (3) Lequesne
Cui 2018 [30]	RCT	COA criteria (2007)	122	61 (30/31);	61 (32/29);	(1) Bushen Huoxue decoction (1 package, bid, 12 w); (2) Diclofenac sodium (75 mg, qd, 12 w)	Diclofenac sodium (75 mg, qd, 12 w)	TG: CG:	12 w	(1) ER; (2) ADR
Dou 2015 [32]	RCT	COA criteria (2007)	60	30 (14/16); 64	30 (17/13); 63	Danzi Kangxi electuary (6 g, tid, 4 w)	Glucosamine sulfate (500 mg, tid, 4 w)	TG: 2 to 6 y; CG: 3 to 5 y	4 w	(1) VAS; (2) ER
Fu 2018 [33]	RCT	ACR criteria (1995)	76	38 (13/25);	38 (14/24);	(1) Duhuo Jisheng decoction (1 package, bid, 4 w); (2) Celecoxib (200 mg, qd, 4 w)	Celecoxib (200 mg, qd, 4 w)	TG: CG:	4 w	(1) ER; (2) ADR
Guo 2019 [34]	RCT	COA criteria (2007)	102	51 (31/20);	51 (29/22);	(1) Duhuo Jisheng decoction (1 package, bid, 4 w); (2) Celecoxib (200 mg, bid, 4 w)	Celecoxib (200 mg, bid, 4 w)	TG: CG:	4 w	(1) VAS; (2) WOMAC; (3) ER
He 2019 [35]	RCT	ACR criteria (1995)	70	35 (11/24);	35 (12/23);	(1) Shuanggu Sanzi capsule (0.9 g, tid, 4 w); (2) Celecoxib (200 mg, bid, 4 w)	Celecoxib (200 mg, bid, 4 w)	TG: CG:	4 w	(1) ADR
Hong 2013 [36]	RCT	ACR criteria (1995)	115	63 (25/38);	52 (20/32);	(1) Qufeng Jiangu decoction (1 package, qd, 12 w); (2) Glucosamine hydrochloride (480 mg, tid, 12 w)	Glucosamine hydrochloride (480 mg, tid, 12 w)	TG: CG:	12 w	(1) WOMAC; (2) ER
Hu 2012 [37]	RCT	ACR criteria (1995)	90	45 (13/32);	45 (16/29);	(1) Bushen Zhuangu decoction (1 package, qd, 6 w); (2) Glucosamine hydrochloride (750 mg, bid, 6 w)	Glucosamine hydrochloride (750 mg, bid, 6 w)	NR	6 w	(1) Lequesne; (2) VAS; (3) ADR
Huang 2015 [38]	RCT	ACR criteria (1986)	80	40(NR);	40(NR);	(1) Bushen Guangjie Huoluo Pulvis (1 package, bid, 4 w); (2) Celecoxib (200 mg, bid, 4 w)	Celecoxib (200 mg, bid, 4 w)	TG: CG:	4 w	(1) Lequesne; (2) ER; (3) ADR
Jiang 2009 [39]	RCT	ACR criteria (1995)	60	30 (11/19);	30 (9/22);	Bushen Huoxue decoction (1 package, qd, 24 w)	Glucosamine sulfate (628 mg, tid, 24 w)	TG: CG:	24 w	(1) VAS; (2) WOMAC; (3) Lequesne; (4) ER
Li 2018 [40]	RCT	COA criteria (2007)	100	50 (19/31);	50 (23/27);	(1) Duhuo Jisheng decoction (1 package, bid, 8 w); (2) Celecoxib (200 mg, qd, 8 w)	Celecoxib (200 mg, qd, 8 w)	TG: CG:	4 w	(1) WOMAC; (2) ER; (3) Lysholm
Liu 2011 [43]	RCT	ACR criteria (1995)	80	40 (19/21);	40 (22/18);	(1) Zhengqing Fengtongning tablet (60 mg, tid, 12 w); (2) Glucosamine hydrochloride (480 mg, tid, 12 w)	Glucosamine hydrochloride (480 mg, tid, 12 w)	TG: CG:	12 w	(1) WOMAC; (2) ER; (3) ADR
Liu 2016 [41]	RCT	COA criteria (2007)	90	45 (25/20);	45 (21/24);	(1) Jingu Tongning capsule (0.5 g, tid, 12 w); (2) Glucosamine sulfate (628 mg, tid, 12 w)	Glucosamine sulfate (628 mg, tid, 12 w)	TG: CG:	12 w	(1) VAS; (2) ER; (3) Lysholm
Liu 2017 [42]	RCT	CRA criteria (2010)	114	57 (35/22);	57 (36/21);	(1) Shujin decoction (1 package, qd, 4 w); (2) Celecoxib (200 mg, qd, 4 w)	Celecoxib (200 mg, qd, 4 w)	TG: CG:	4 w	(1) VAS; (2) WOMAC; (3) Lysholm; (4) ER
Lu 2016 [44]	RCT	CRA criteria (2010)	100	50 (33/17);	50 (35/15);	(1) Lujiao Zhuanggu capsule (1.5 g, tid, 8 w); (2) Glucosamine hydrochloride (480 mg, tid, 8 w)	Glucosamine hydrochloride (480 mg, tid, 8 w)	TG: CG:	8 w	(1) VAS; (2) ER; (3) ADR
Luo 2019 [45]	RCT	COA criteria (2007)	98	49 (13/36);	49 (14/35);	(1) Zhengqing Fengtongning tablet (60 mg, bid, 12 w); (2) Glucosamine hydrochloride (750 mg, tid, 12 w)	Glucosamine hydrochloride (750 mg, tid, 12 w)	TG: CG:	12 w	(1) WOMAC; (2) ER; (3) ADR
Ma 2009 [48]	RCT	CRA criteria (2003)	118	59 (5/54);	59 (7/52);	Huoxue Tongluo decoction (1 package, qd, 12 w)	Celecoxib (200 mg, qd, 12 w)	TG: CG:	12 w	(1) VAS; (2) ER
Ma 2018 [46]	RCT	COA criteria (2007)	60	32 (22/10);	28 (19/9);	Duhuo Jisheng decoction (1 package, qd, 12 w)	Celecoxib (200 mg, bid, 12 w)	TG: CG:	12 w	(1) VAS; (2) ER; (3) ADR
Ma 2019 [47]	RCT	COA criteria (2007)	164	82 (38/44);	82 (40/42);	Bushen Yiqi Huayu Jiedu decoction (1 package, qd, 8 w)	Glucosamine hydrochloride (480 mg, tid, 8 w)	TG: CG:	8 w	(1) VAS; (2) Lysholm; (3) ER
Mo 2018 [49]	RCT	COA criteria (2007)	120	60 (26/34);	60 (25/35);	(1) Kangguzhi Zengsheng capsule (17.5 g, tid, 12 w); (2) Celecoxib (200 mg, bid, 12 w)	Celecoxib (200 mg, bid, 12 w)	TG: CG:	12 w	(1) VAS; (2) ER; (3) ADR; (4) Lysholm
Pan 2017 [22]	RCT	CRA criteria (2010)	80	40 (6/34);	40 (5/35);	Longbie capsule (1.2 g, tid, 4 w)	Celecoxib (200 mg, qd, 4 w)	TG: CG:	4 w	(1) VAS; (2) Lequesne; (3) ER; (4) ADR
Qian 2019 [51]	RCT	COA criteria (2007)	78	39 (17/22);	39 (19/20);	(1) Yishen Quyu decoction (1 package, bid, 2 w); (2) Celecoxib (200 mg, qd, 2 w)	Celecoxib (200 mg, qd, 2 w)	TG: CG:	2 w	(1) VAS; (2) Lequesne; (3) ER; (4) ADR
Ren 2016 [53]	RCT	CRA criteria (2005)	95	48 (34/14);	47 (30/17);	(1) Yishen Quyu decoction (1 package, bid, 4 w); (2) Celecoxib (200 mg, bid, 4 w)	Celecoxib (200 mg, bid, 4 w)	TG: CG:	4 w	(1) Lysholm; (2) ER
Ren 2018 [52]	RCT	COA criteria (2007)	80	40 (18/22);	40 (20/20);	Duhuo Jisheng decoction (1 package, qd, 5 w)	Celecoxib (200 mg, qd, 5 w)	TG: CG:	5 w	(1) VAS; (2) Lysholm; (3) ER; (4) ADR
Rong 2017 [54]	RCT	CRA criteria (2010)	73	42 (19/23);	31 (14/17);	Duhuo Jisheng decoction (1 package, qd, 4 w)	Glucosamine sulfate (500 mg, tid, 4 w)	NR	4 w	(1) VAS; (2) WOMAC; (3) ADR
Shi 2019 [55]	RCT	CRA criteria (2010)	78	39 (22/17);	39 (24/15);	(1) Duhuo Jisheng decoction (1 package, qd, 4 w); (2) Glucosamine sulfate (500 mg, tid, 4 w)	Glucosamine sulfate (500 mg, tid, 4 w)	TG: CG:	4 w	(1) WOMAC; (2) ER; (3) ADR
Song 2017 [56]	RCT	COA criteria (2007)	95	50 (28/22);	45 (27/18);	(1) Duhuo Jisheng decoction (1 package, qd, 4 w); (2) Celecoxib (200 mg, qd, 4 w)	Celecoxib (200 mg, qd, 4 w)	TG: CG:	4 w	(1) VAS; (2) Lequesne; (3) ER
Sun 2018 [57]	RCT	COA criteria (2007)	50	25 (12/13);	25 (11/14);	Qinbi decoction (1 package, qd, 4 w)	Celecoxib (200 mg, qd, 4 w)	TG: CG:	4 w	(1) VAS; (2) WOMAC; (3) ER
Tan 2014 [58]	RCT	ACR criteria (1995)	60	30 (8/22); 55.6	30 (12/18); 57.4	Huangqi Biejia pill (15 g, tid, 6 w)	Glucosamine hydrochloride (480 mg, tid, 6 w)	TG: 2.51 y; CG: 2.42 y	6 w	(1) Lequesne; (2) ER; (3) ADR
Tang 2012 [59]	RCT	ACR criteria (1995)	114	56 (20/36);	58 (22/36);	Jiedu Yishen pill (15 g, bid, 8 w)	Glucosamine sulfate (500 mg, tid, 8 w)	TG: CG:	8 w	(1) WOMAC; (2) ER
Wang 2013 [60]	RCT	ACR criteria (1986)	120	60 (35/25);	60 (28/32);	(1) Fufang Xiatian Wu pill (0.6 g, tid, 24 w); (2) Glucosamine hydrochloride (480 mg, bid, 24 w)	Glucosamine hydrochloride (480 mg, bid, 24 w)	TG: CG:	24 w	(1) Lequesne; (2) ADR
Wang 2019 [61]	RCT	COA criteria (2007)	96	48 (10/38); 56.9	48 (13/35); 58.4	(1) Taoren Xikang pill (6 g, bid, 12 w); (2) Celecoxib (200 mg, bid, 4 w)	Celecoxib (200 mg, bid, 4 w)	NR	12 w	(1) VAS; (2) WOMAC; (3) ER; (4) ADR
Wen 2016 [62]	RCT	ACR criteria (1995)	142	72 (29/43);	70 (26/44);	Duhuo Jisheng decoction (1 package, qd, 4 w)	Glucosamine hydrochloride (480 mg, tid, 4 w)	TG: CG:	4 w	(1) VAS; (2) ER; (3) ADR
Wu 2012 [65]	RCT	ACR criteria (1995)	120	60 (22/38);	60 (19/41);	Zhuanggu Tongbi pill (6 g, bid, 12 w)	Glucosamine sulfate (628 mg, tid, 12 w)	NR	12 w	(1) Lequesne; (2) ER; (3) ADR
Wu 2018 [63]	RCT	CRA criteria (2003)	93	47 (20/27);	46 (18/28);	(1) Bushen Huoxue decoction (1 package, bid, 12 w); (2) Celecoxib (200 mg, qd, 12 w)	Celecoxib (200 mg, qd, 12 w)	TG: CG:	12 w	(1) WOMAC; (2) ER
Wu 2018 [64]	RCT	COA criteria (2007)	64	32 (12/20);	32 (11/21);	(1) Sanqi Xuejie capsule (4 capsules, tid, 4 w); (2) Celecoxib (200 mg, bid, 4 w)	Celecoxib (200 mg, bid, 4 w)	TG: CG:	4 w	(1) Lequesne; (2) ER; (3) ADR
Xia 2017 [66]	RCT	COA criteria (2007)	92	46 (20/26);	46 (21/25);	(1) Jingu Tongning capsule (1.5 g, tid, 4 w); (2) Glucosamine hydrochloride (480 mg, tid, 4 w)	Glucosamine hydrochloride (480 mg, tid, 4 w)	TG: CG:	4 w	(1) WOMAC; (2) ER
Yang 2016 [67]	RCT	COA criteria (2007)	96	48 (15/33);	48 (13/35);	Jiawei Simiao Pulvis (1 package, bid, 4 w)	Celecoxib (200 mg, bid, 4 w)	TG: CG:	4 w	(1) VAS; (2) ER; (3) ADR
Yang 2019 [68]	RCT	COA criteria (2007)	120	60 (32/28);	60 (27/33);	(1) Duhuo Jisheng decoction (1 package, bid, 4 w); (2) Glucosamine sulfate (628 mg, tid, 4 w)	Glucosamine sulfate (628 mg, tid, 4 w)	TG: CG:	4 w	(1) WOMAC; (2) ER; (3) ADR; (4) VAS
Yao 2013 [69]	RCT	COA criteria (2007)	81	41 (NR); NR	40 (NR); NR	Duhuo Jisheng decoction (1 package, qd, 6 w)	Celecoxib (200 mg, qd, 6 w)	NR	6 w	(1) VAS; (2) WOMAC; (3) ER
Yi 2017 [70]	RCT	ACR criteria (1986)	120	60 (21/39); 58	60 (23/37); 56	(1) Bushen Huoxue decoction (1 package, qd, 4 w); (2) Celecoxib (200 mg, qd, 4 w)	Celecoxib (200 mg, qd, 4 w)	NR	4 w	(1) VAS; (2) WOMAC; (3) ER
Yi 2017 [71]	RCT	COA criteria (2007)	136	68 (38/30);	68 (37/31);	(1) Qiangjin Zhuanggu decoction I (1 package, qd, 4 w); (2) Celecoxib (200 mg, qd, 4 w)	Celecoxib (200 mg, qd, 4 w)	TG: CG:	4 w	(1) VAS; (2) WOMAC; (3) Lysholm; (4) ER
Yu 2010 [72]	RCT	ACR criteria (1995)	113	56 (21/35);	57 (18/38);	Duhuo Jisheng decoction (1 package, qd, 4 w)	Glucosamine sulfate (500 mg, tid, 4 w)	TG: CG:	4 w	(1) Lequesne; (2) ER; (3) ADR
Yuan 2017 [73]	RCT	COA criteria (2007)	70	35 (18/17);	35 (15/20);	Bushen Huoxue decoction (1 package, qd, 112 w)	Celecoxib (200 mg, qd, 12 w)	TG: CG:	12 w	(1) VAS; (2) Lysholm; (3) ER
Zhang 2016 [74]	RCT	COA criteria (2007)	156	80 (30/50); 53.1	76 (24/52); 51.4	(1) Jinwu Gutong capsule (0.3 g, tid, 12 w); (2) Glucosamine hydrochloride (750 mg, bid, 12 w)	Glucosamine hydrochloride (750 mg, bid, 12 w)	NR	12 w	(1) ER; (2) Lequesne
Zhang 2017 [77]	RCT	COA criteria (2007)	63	32 (19/13);	31 (20/11);	(1) Fugui Gutong capsule (1.32 g, tid, 4 w); (2) Celecoxib (200 mg, qd, 4 w)	Celecoxib (200 mg, qd, 4 w)	TG: CG:	4 w	(1) VAS; (2) Lequesne; (3) ER; (4) ADR
Zhang 2018 [76]	RCT	COA criteria (2007)	110	55 (21/34); 55.2	55 (20/35); 54.5	(1) Qianggu capsule (0.25 g, tid, 12 w); (2) Glucosamine sulfate (500 mg, tid, 12 w)	Glucosamine sulfate (500 mg, tid, 12 w)	TG: CG:	12 w	(1) VAS; (2) ER; (3) ADR; (4) Lequesne
Zhang 2019 [75]	RCT	ACR criteria (1995)	86	43 (17/26);	43 (15/28);	(1) Duhuo Jisheng decoction (1 package, tid, 8 w); (2) Meloxicam (7.5 mg, bid, 8 w)	Meloxicam(7.5 mg, bid, 8 w)	TG: CG:	8 w	(1) WOMAC; (2) ER
Zheng 2014 [78]	RCT	ACR criteria (1986)	80	40 (11/29);	40 (9/31);	(1) Zhengqing Fengtongning tablet (60 mg, tid, 4 w)	Glucosamine sulfate (628 mg, tid, 4 w)	TG: CG:	4 w	(1) Lequesne; (2) ER; (3) ADR
Zheng 2019 [79]	RCT	COA criteria (2007)	100	50 (27/23);	50 (24/26);	Bushen Huoxue decoction (1 package, bid, 4 w)	Celecoxib (200 mg, bid, 4 w)	TG: CG:	4 w	(1) VAS; (2) WOMAC; (3) ER; (4) ADR
Zhong 2017 [80]	RCT	ACR criteria (1995)	116	58 (26/32);	58 (28/30);	Shentong Zhuyu decoction (1 package, qd, 4 w)	Glucosamine hydrochloride (750 mg, tid, 4 w)	TG: CG:	4 w	(1) VAS; (2) ER
Zhou 2012 [81]	RCT	ACR criteria (1986)	78	43 (17/26);	35 (14/21);	Shufu Jiangu decoction (1 package, qd, 8 w)	Celecoxib (200 mg, qd, 8 w)	TG: CG:	8 w	(1) VAS; (2) Lysholm; (3) ER
Zhu 2013 [82]	RCT	ACR criteria (1995)	86	43 (8/22);	43 (12/18);	Zhengqing Fengtongning tablet (60 mg, bid, 12 w)	Glucosamine hydrochloride (480 mg, tid, 12 w)	TG: CG:	12 w	(1) WOMAC; (2) ER; (3) ADR
Zhuo 2019 [83]	RCT	COA criteria (2007)	64	32 (13/19);	32 (14/18);	(1) Rendong Bixie decoction (1 package, bid, 4 w); (2) Celecoxib (200 mg, qd, 4 w)	Celecoxib (200 mg, qd, 4 w)	TG: CG:	4 w	(1) WOMAC; (2) ER; (3) ADR

RCT: randomized controlled trial; TG: trial group; CG: control group; COA: Chinese Orthopedic Association; CRA: Chinese Rheumatology Association; ACR: American College of Rheumatology; VAS: visual analog score; WOMAC: Western Ontario and McMaster Universities Osteoarthritis Index; ER: effective rate; ADR: adverse drug reaction; NR: not reported.