Six Gentlemen Decoction adding Aucklandia and Amomum (Xiangsha Liujunzi Tang) for the treatment of ulcerative colitis: A systematic review and meta-analysis of randomized clinical trials

Ulcerative colitis is an inflammatory bowel disease that causes inflammation and ulceration in the large intestines and exacerbates gut microbiome dysbiosis which leads to the development of various diseases. Six Gentlemen Decoction is a traditional Chinese medicine for treating gastrointestinal disorders and when Aucklandia and Amomum (SGDAA; Xiangsha Liujunzi Tang) are added, this further improves colitis, by relieving pain. The efficacy and safety of SGDAA intake in the treatment of ulcerative colitis was systematically evaluated and a meta-analysis conducted. Randomized controlled trials (RCTs) on the use of SGDAA and colitis were retrieved from medical and scientific databases in English, Korean, and Chinese from January 1960 to October 2019. RevMan 5.3 software was used for the meta-analysis. According to study homogeneity, odds ratios(ORs) and confidence intervals of pooled RCTs were assessed by fixed or random model meta-analysis. The risk of bias was evaluated for all included studies. Seven studies (614 colitis patients) were included in this meta-analysis: 308 patients had SGDAA (SGDAA group) and 306 patients received conventional Western medicine or another Chinese medicine (control group). Meta-analysis of the 7 pooled RCTs showed that SGDAA was more effective for ulcerative colitis treatment (OR = 0.22, 95% CI: 0.13 ∼ 0.37; P < 0.00001) and curative response (OR = 0.52, 95% CI: 0.34 ∼ 0.80, P = 0.003) than the control. SGDAA treatment for 4 and 12 weeks significantly improved effective response (OR = 0.26, 95% CI: 0.13∼0.52, P = 0.0001 and OR = 0.18, 95% CI: 0.08∼0.39, P < 0.0001, respectively). Oral SGDAA treatment for ulcerative colitis more than 4 weeks was superior to conventional Western medicine for the treatment of ulcerative colitis.