Efficacy of Chinese herbal medicine for lumbar disc herniation： a systematic review of randomized controlled trials

OBJECTIVE： This is a review of the effects of Chi- nese herbal medicine （CHM） used alone to treat lumbar disc herniation （LDH）. METHORDS： A literature search of the following electronic databases from their inception to Febru- ary 2013 was conducted： Chinese Biomedical data- bases, Chinese National Knowledge Infrastructure, Wanfang Database, China Science and Technology Journal Database, Cochrane Library, Web of Sci- ence, MEDLINE, and EMBASE. Randomized con- trolled trials where CHM had been used to treat LDH were selected. Data extraction, quality assess- ment, and data analysis were carried out by two in- dependent reviewers. RESULTS： Of the 2415 studies identified, eight with complete data on 1146 patients were selected. The methodological quality was poor in all trials. Five studies reported that CHM was better than WesternMedicine [OR=2.81, 95% CI （1.27, 6.18）; OR=3.34, 95% CI （1.92, 5.79）; 0R=2.22, 95% CI （1.08, 4.57）; OR= 6.67, 95% CI （1.34, 33.28）; and OR=1.94, 95% CI （1.23, 3.06）]. Two studies reported that the clinical outcome was better in CHM groups than in physio- therapy and placebo groups, [OR=3.02, 9.5% CI （1.08, 8.46）; and OR=2.67, 95% CI （1.26, 5.64）, re- spectively], whereas one study reported no differ- ence between CHM and physiotherapy groups. One study reported that CHM resulted in higher Japanese Orthopedic Association scores [MD=7.78, 95% CI （6.67, 8.89）] than in a control group and an- other that participants treated with CHM had lower Visual Analogue Scale scores [MD=- 0.72, 95% CI （ - 0.86, 0.58）] than those in a control group. Three studies reported that the adverse effects of CHM and Western Medicine did not differ signifi- cantly [OR=0.10, 95% CI （0.01, 1.85）; OR=0.19, 95% CI （0.01,4.07）; and OR=O.07, 95% CI （0.00, 1.32）]. CONCLUSION： CHM may be more effective than other interventions for LDH; however, methodologi- cal weaknesses in the studies assessed in this re- view prevent a definitive conclusion. More high-quality large-scale studies are required to clar- ify this matter.