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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Herbal Medicines for Treating Metabolic Syndrome: A Systematic Review of Randomized Controlled Trials</title><author><name sortKey="Jang, Soobin" sort="Jang, Soobin" uniqKey="Jang S" first="Soobin" last="Jang">Soobin Jang</name><affiliation><nlm:aff id="I1">Department of Korean Preventive Medicine, Graduate School, Kyung Hee University, Seoul 02447, Republic of Korea</nlm:aff></affiliation></author><author><name sortKey="Jang, Bo Hyoung" sort="Jang, Bo Hyoung" uniqKey="Jang B" first="Bo-Hyoung" last="Jang">Bo-Hyoung Jang</name><affiliation><nlm:aff id="I2">Department of Preventive Medicine, College of Korean Medicine, Kyung Hee University, Seoul 02447, Republic of Korea</nlm:aff></affiliation></author><author><name sortKey="Ko, Youme" sort="Ko, Youme" uniqKey="Ko Y" first="Youme" last="Ko">Youme Ko</name><affiliation><nlm:aff id="I1">Department of Korean Preventive Medicine, Graduate School, Kyung Hee University, Seoul 02447, Republic of Korea</nlm:aff></affiliation></author><author><name sortKey="Sasaki, Yui" sort="Sasaki, Yui" uniqKey="Sasaki Y" first="Yui" last="Sasaki">Yui Sasaki</name><affiliation><nlm:aff id="I1">Department of Korean Preventive Medicine, Graduate School, Kyung Hee University, Seoul 02447, Republic of Korea</nlm:aff></affiliation></author><author><name sortKey="Park, Jeong Su" sort="Park, Jeong Su" uniqKey="Park J" first="Jeong-Su" last="Park">Jeong-Su Park</name><affiliation><nlm:aff id="I3">Department of Healthcare Safety Research, National Evidence-Based Healthcare Collaborating Agency, Seoul 04554, Republic of Korea</nlm:aff></affiliation></author><author><name sortKey="Hwang, Eui Hyoung" sort="Hwang, Eui Hyoung" uniqKey="Hwang E" first="Eui-Hyoung" last="Hwang">Eui-Hyoung Hwang</name><affiliation><nlm:aff id="I4">Third Division of Clinical Medicine, School of Korean Medicine, Pusan National University, Yangsan 50612, Republic of Korea</nlm:aff></affiliation></author><author><name sortKey="Song, Yun Kyung" sort="Song, Yun Kyung" uniqKey="Song Y" first="Yun-Kyung" last="Song">Yun-Kyung Song</name><affiliation><nlm:aff id="I5">Department of Korean Medicine Rehabilitation, College of Korean Medicine, Gachon University, Incheon 21565, Republic of Korea</nlm:aff></affiliation></author><author><name sortKey="Shin, Yong Cheol" sort="Shin, Yong Cheol" uniqKey="Shin Y" first="Yong-Cheol" last="Shin">Yong-Cheol Shin</name><affiliation><nlm:aff id="I2">Department of Preventive Medicine, College of Korean Medicine, Kyung Hee University, Seoul 02447, Republic of Korea</nlm:aff></affiliation></author><author><name sortKey="Ko, Seong Gyu" sort="Ko, Seong Gyu" uniqKey="Ko S" first="Seong-Gyu" last="Ko">Seong-Gyu Ko</name><affiliation><nlm:aff id="I2">Department of Preventive Medicine, College of Korean Medicine, Kyung Hee University, Seoul 02447, Republic of Korea</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">27413388</idno><idno type="pmc">4930818</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4930818</idno><idno type="RBID">PMC:4930818</idno><idno type="doi">10.1155/2016/5936402</idno><date when="2016">2016</date><idno type="wicri:Area/Pmc/Corpus">000416</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Herbal Medicines for Treating Metabolic Syndrome: A Systematic Review of Randomized Controlled Trials</title><author><name sortKey="Jang, Soobin" sort="Jang, Soobin" uniqKey="Jang S" first="Soobin" last="Jang">Soobin Jang</name><affiliation><nlm:aff id="I1">Department of Korean Preventive Medicine, Graduate School, Kyung Hee University, Seoul 02447, Republic of Korea</nlm:aff></affiliation></author><author><name sortKey="Jang, Bo Hyoung" sort="Jang, Bo Hyoung" uniqKey="Jang B" first="Bo-Hyoung" last="Jang">Bo-Hyoung Jang</name><affiliation><nlm:aff id="I2">Department of Preventive Medicine, College of Korean Medicine, Kyung Hee University, Seoul 02447, Republic of Korea</nlm:aff></affiliation></author><author><name sortKey="Ko, Youme" sort="Ko, Youme" uniqKey="Ko Y" first="Youme" last="Ko">Youme Ko</name><affiliation><nlm:aff id="I1">Department of Korean Preventive Medicine, Graduate School, Kyung Hee University, Seoul 02447, Republic of Korea</nlm:aff></affiliation></author><author><name sortKey="Sasaki, Yui" sort="Sasaki, Yui" uniqKey="Sasaki Y" first="Yui" last="Sasaki">Yui Sasaki</name><affiliation><nlm:aff id="I1">Department of Korean Preventive Medicine, Graduate School, Kyung Hee University, Seoul 02447, Republic of Korea</nlm:aff></affiliation></author><author><name sortKey="Park, Jeong Su" sort="Park, Jeong Su" uniqKey="Park J" first="Jeong-Su" last="Park">Jeong-Su Park</name><affiliation><nlm:aff id="I3">Department of Healthcare Safety Research, National Evidence-Based Healthcare Collaborating Agency, Seoul 04554, Republic of Korea</nlm:aff></affiliation></author><author><name sortKey="Hwang, Eui Hyoung" sort="Hwang, Eui Hyoung" uniqKey="Hwang E" first="Eui-Hyoung" last="Hwang">Eui-Hyoung Hwang</name><affiliation><nlm:aff id="I4">Third Division of Clinical Medicine, School of Korean Medicine, Pusan National University, Yangsan 50612, Republic of Korea</nlm:aff></affiliation></author><author><name sortKey="Song, Yun Kyung" sort="Song, Yun Kyung" uniqKey="Song Y" first="Yun-Kyung" last="Song">Yun-Kyung Song</name><affiliation><nlm:aff id="I5">Department of Korean Medicine Rehabilitation, College of Korean Medicine, Gachon University, Incheon 21565, Republic of Korea</nlm:aff></affiliation></author><author><name sortKey="Shin, Yong Cheol" sort="Shin, Yong Cheol" uniqKey="Shin Y" first="Yong-Cheol" last="Shin">Yong-Cheol Shin</name><affiliation><nlm:aff id="I2">Department of Preventive Medicine, College of Korean Medicine, Kyung Hee University, Seoul 02447, Republic of Korea</nlm:aff></affiliation></author><author><name sortKey="Ko, Seong Gyu" sort="Ko, Seong Gyu" uniqKey="Ko S" first="Seong-Gyu" last="Ko">Seong-Gyu Ko</name><affiliation><nlm:aff id="I2">Department of Preventive Medicine, College of Korean Medicine, Kyung Hee University, Seoul 02447, Republic of Korea</nlm:aff></affiliation></author></analytic><series><title level="j">Evidence-based Complementary and Alternative Medicine : eCAM</title><idno type="ISSN">1741-427X</idno><idno type="eISSN">1741-4288</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><italic>Objective</italic>. The aim of this systematic review is to evaluate the efficacy and safety of herbal medicines in the management of metabolic syndrome.<italic> Materials and Methods</italic>. On December 9, 2015, we searched PubMed, EMBASE, Cochrane Library, SCOPUS, AMED, CNKI, KoreaMed, KMBASE, OASIS, and J-STAGE with no restriction on language or published year. We selected randomized controlled trials that involved patients with metabolic syndrome being treated with herbal medicines as intervention. The main keywords were “Chinese herbal medicines”, “metabolic syndrome”, and “randomized controlled trials”. Herbal substances which were not based on East Asian medical theory, combination therapy with western medicines, and concurrent diseases other than metabolic syndrome were excluded. The risk of bias was assessed by Cochrane's “Risk of Bias” tool. The protocol or review was registered in PROSPERO (an international prospective register of systematic reviews) (<ext-link ext-link-type="uri" xlink:href="http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42014006842">CRD42014006842</ext-link>).<italic> Results</italic>. From 1,098 articles, 12 RCTs were included in this review: five trials studied herbal medicines versus a placebo or no treatment, and seven trials studied herbal medicines versus western medicines. Herbal medicines were effective on decreasing waist circumference, blood glucose, blood lipids, and blood pressure.<italic> Conclusion</italic>. This study suggests the possibility that herbal medicines can be complementary and alternative medicines for metabolic syndrome.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Eckel, R H" uniqKey="Eckel R">R. H. Eckel</name></author><author><name sortKey="Grundy, S M" uniqKey="Grundy S">S. M. 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Evid Based Complement Alternat Med</journal-id><journal-id journal-id-type="iso-abbrev">Evid Based Complement Alternat Med</journal-id><journal-id journal-id-type="publisher-id">ECAM</journal-id><journal-title-group><journal-title>Evidence-based Complementary and Alternative Medicine : eCAM</journal-title></journal-title-group><issn pub-type="ppub">1741-427X</issn><issn pub-type="epub">1741-4288</issn><publisher><publisher-name>Hindawi Publishing Corporation</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">27413388</article-id><article-id pub-id-type="pmc">4930818</article-id><article-id pub-id-type="doi">10.1155/2016/5936402</article-id><article-categories><subj-group subj-group-type="heading"><subject>Review Article</subject></subj-group></article-categories><title-group><article-title>Herbal Medicines for Treating Metabolic Syndrome: A Systematic Review of Randomized Controlled Trials</article-title></title-group><contrib-group><contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="false">http://orcid.org/0000-0003-0943-9290</contrib-id><name><surname>Jang</surname><given-names>Soobin</given-names></name><xref ref-type="aff" rid="I1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="false">http://orcid.org/0000-0002-2141-3483</contrib-id><name><surname>Jang</surname><given-names>Bo-Hyoung</given-names></name><xref ref-type="aff" rid="I2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Ko</surname><given-names>Youme</given-names></name><xref ref-type="aff" rid="I1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Sasaki</surname><given-names>Yui</given-names></name><xref ref-type="aff" rid="I1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="false">http://orcid.org/0000-0003-1834-0823</contrib-id><name><surname>Park</surname><given-names>Jeong-Su</given-names></name><xref ref-type="aff" rid="I3"><sup>3</sup></xref></contrib><contrib contrib-type="author"><name><surname>Hwang</surname><given-names>Eui-Hyoung</given-names></name><xref ref-type="aff" rid="I4"><sup>4</sup></xref></contrib><contrib contrib-type="author"><name><surname>Song</surname><given-names>Yun-Kyung</given-names></name><xref ref-type="aff" rid="I5"><sup>5</sup></xref><xref ref-type="corresp" rid="cor1"><sup>*</sup></xref></contrib><contrib contrib-type="author"><name><surname>Shin</surname><given-names>Yong-Cheol</given-names></name><xref ref-type="aff" rid="I2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="false">http://orcid.org/0000-0002-2345-430X</contrib-id><name><surname>Ko</surname><given-names>Seong-Gyu</given-names></name><xref ref-type="aff" rid="I2"><sup>2</sup></xref><xref ref-type="corresp" rid="cor2"><sup>*</sup></xref></contrib></contrib-group><aff id="I1"><sup>1</sup>Department of Korean Preventive Medicine, Graduate School, Kyung Hee University, Seoul 02447, Republic of Korea</aff><aff id="I2"><sup>2</sup>Department of Preventive Medicine, College of Korean Medicine, Kyung Hee University, Seoul 02447, Republic of Korea</aff><aff id="I3"><sup>3</sup>Department of Healthcare Safety Research, National Evidence-Based Healthcare Collaborating Agency, Seoul 04554, Republic of Korea</aff><aff id="I4"><sup>4</sup>Third Division of Clinical Medicine, School of Korean Medicine, Pusan National University, Yangsan 50612, Republic of Korea</aff><aff id="I5"><sup>5</sup>Department of Korean Medicine Rehabilitation, College of Korean Medicine, Gachon University, Incheon 21565, Republic of Korea</aff><author-notes><corresp id="cor1">*Yun-Kyung Song: <email>oxyzen@korea.com</email> and </corresp><corresp id="cor2">*Seong-Gyu Ko: <email>epiko@khu.ac.kr</email></corresp><fn fn-type="other"><p>Academic Editor: Chris Zaslawski</p></fn></author-notes><pub-date pub-type="ppub"><year>2016</year></pub-date><pub-date pub-type="epub"><day>19</day><month>6</month><year>2016</year></pub-date><pub-date pub-type="pmc-release"><day>19</day><month>6</month><year>2016</year></pub-date><pmc-comment> PMC Release delay is 0 months and 0 days and was based on the
<volume>2016</volume><elocation-id>5936402</elocation-id><history><date date-type="received"><day>19</day><month>1</month><year>2016</year></date><date date-type="accepted"><day>11</day><month>5</month><year>2016</year></date></history><permissions><copyright-statement>Copyright © 2016 Soobin Jang et al.</copyright-statement><copyright-year>2016</copyright-year><license license-type="open-access"><license-p>This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><abstract><p><italic>Objective</italic>. The aim of this systematic review is to evaluate the efficacy and safety of herbal medicines in the management of metabolic syndrome.<italic> Materials and Methods</italic>. On December 9, 2015, we searched PubMed, EMBASE, Cochrane Library, SCOPUS, AMED, CNKI, KoreaMed, KMBASE, OASIS, and J-STAGE with no restriction on language or published year. We selected randomized controlled trials that involved patients with metabolic syndrome being treated with herbal medicines as intervention. The main keywords were “Chinese herbal medicines”, “metabolic syndrome”, and “randomized controlled trials”. Herbal substances which were not based on East Asian medical theory, combination therapy with western medicines, and concurrent diseases other than metabolic syndrome were excluded. The risk of bias was assessed by Cochrane's “Risk of Bias” tool. The protocol or review was registered in PROSPERO (an international prospective register of systematic reviews) (<ext-link ext-link-type="uri" xlink:href="http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42014006842">CRD42014006842</ext-link>).<italic> Results</italic>. From 1,098 articles, 12 RCTs were included in this review: five trials studied herbal medicines versus a placebo or no treatment, and seven trials studied herbal medicines versus western medicines. Herbal medicines were effective on decreasing waist circumference, blood glucose, blood lipids, and blood pressure.<italic> Conclusion</italic>. This study suggests the possibility that herbal medicines can be complementary and alternative medicines for metabolic syndrome.</p></abstract></article-meta></front><body><sec id="sec1"><title>1. Background</title><p>Metabolic syndrome is a complex disorder consisting of central obesity, hyperglycemia, hypertension, and hyperlipidemia [<xref rid="B1" ref-type="bibr">1</xref>]. There have been different diagnosis criteria for metabolic syndrome after it was first being defined by the World Health Organization (WHO) in 1998 [<xref rid="B2" ref-type="bibr">2</xref>]. The most commonly accepted definition uses the criteria suggested by the American Heart Association/National Heart Lung and Blood Institute (AHA/NHLBI).</p><p>According to the AHA/NHLBI, metabolic syndrome is technically diagnosed when three or more of the following five conditions are met: (1) waist circumference (WC) ≥102 cm in men and ≥88 cm in women, (2) triglycerides (TG) ≥150 mg/dL (1.7 mmol/L) or being on drug treatment for elevated triglycerides, (3) high density lipoprotein cholesterol (HDL-C) <40 mg/dL (1.03 mmol/L) in men and <50 mg/dL (1.3 mmol/L) in women or being on drug treatment for reduced HDL-C, (4) blood pressure (BP) ≥130 mmHg systolic blood pressure (SBP) or ≥85 mmHg diastolic blood pressure (DBP) or being on antihypertensive drug treatment, for a patient with a history of hypertension, and (5) fasting plasma glucose (FPG) ≥100 mg/dL or being on drug treatment for elevated glucose [<xref rid="B3" ref-type="bibr">3</xref>]. However, the criterion for waist circumference is slightly different for each country and race.</p><p>Each metabolic risk factor is associated with one another, and together the risk factors promote atherosclerotic cardiovascular disease [<xref rid="B5" ref-type="bibr">4</xref>]. The main underlying risk factors for metabolic syndrome are abdominal obesity and insulin resistance [<xref rid="B6" ref-type="bibr">5</xref>, <xref rid="B7" ref-type="bibr">6</xref>]. Therefore, preventing atherosclerotic cardiovascular disease by controlling waist circumference and insulin resistance is the key to managing metabolic syndrome. Clinically, each treatment of hyperglycemia, hypertension, and hyperlipidemia is prescribed according to each patient's state.</p><p>However, ACE inhibitor that is a drug used for hypertension, including enalapril and captopril, may cause adverse events such as cough, increased serum creatinine, headache, and skin rash [<xref rid="B8" ref-type="bibr">7</xref>, <xref rid="B9" ref-type="bibr">8</xref>]. It has also been shown that metformin, a drug used to treat type 2 diabetes mellitus, can induce gastrointestinal symptoms and lactic acidosis [<xref rid="B7" ref-type="bibr">6</xref>]. Therefore, herbal medicines showing evidence of safety and efficacy can be alternative treatments for metabolic diseases.</p><p>Although there are several reviews of herbal medicines for obesity [<xref rid="B10" ref-type="bibr">9</xref>, <xref rid="B11" ref-type="bibr">10</xref>], hypertension [<xref rid="B12" ref-type="bibr">11</xref>], and type 2 diabetes mellitus [<xref rid="B13" ref-type="bibr">12</xref>], systematic review for metabolic syndrome has not been conducted yet. This study, however, reviews not only a single disease but also metabolic syndrome as a whole. The aim of this study is to evaluate the efficacy and safety of herbal medicines to help manage metabolic syndrome.</p></sec><sec id="sec2"><title>2. Materials and Methods</title><sec id="sec2.1"><title>2.1. Data Source and Search Strategy</title><sec id="sec2.1.1"><title>2.1.1. Data Source</title><p>This study included the following databases: PubMed, EMBASE, Cochrane Library, SCOPUS, AMED, China National Knowledge Infrastructure (CNKI), KoreaMed, KMBASE, OASIS, Electronic (J-STAGE), and Japan Science and Technology Information Aggregator.</p></sec><sec id="sec2.1.2"><title>2.1.2. Search Strategy</title><p>The study used herbal medicine, metabolic syndrome, and randomized controlled trials for the basic search terms. A search strategy in PubMed is shown in <xref ref-type="table" rid="tab1">Table 1</xref>. Language and publication date were not restricted. The date for the search was December 9, 2015. This review's protocol was registered in PROSPERO (an international prospective register of systematic reviews) (registration number: <ext-link ext-link-type="uri" xlink:href="http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42014006842">CRD42014006842</ext-link>).</p></sec></sec><sec id="sec2.2"><title>2.2. Inclusion Criteria</title><sec id="sec2.2.1"><title>2.2.1. Study Design</title><p>Randomized controlled trials (RCTs) were included regardless of blinding. Other designs such as<italic> in vivo</italic>,<italic> in vitro</italic>, case report, and retrospective study and thesis were excluded.</p></sec><sec id="sec2.2.2"><title>2.2.2. Participants</title><p>Participants were patients with metabolic syndrome and there was no restriction to sex or age. Diagnosis criteria of metabolic syndrome were restricted to international or national standard criteria such as AHA/NHLBI, National Cholesterol Education Program-Adults Treatment Panel (NCEP-ATP), and International Diabetes Federation (IDF) and should be clearly described in <xref ref-type="sec" rid="sec2">Section 2</xref>. Chinese pattern identification was optional. Concurrent diseases with metabolic syndrome were excluded.</p></sec><sec id="sec2.2.3"><title>2.2.3. Interventions</title><p>Single or mixed herbal medicines with East Asian medical theory were included. Traditional Chinese Medicine, Traditional Korean Medicine, and Japanese Kampo Medicine are regarded as East Asian medicine. Ayurvedic medicine, crude plant, food, and dietary supplement were excluded. Combination therapy with western medicines, acupuncture, and moxibustion was also excluded. Exercise, diet-control, and health education were not restricted if they were applied to both intervention and control groups.</p></sec><sec id="sec2.2.4"><title>2.2.4. Comparisons</title><p>There was no special restriction on comparisons. Placebo, no treatment, active-control, exercise, diet-control, health education, and usual care were allowed as control groups. Active-control means western medicines for metabolic syndrome, or herbal medicines other than intervention.</p></sec><sec id="sec2.2.5"><title>2.2.5. Outcome Measures</title><p>The primary outcome measures were WC, FPG, TG, HDL-C, SBP, and DBP which are clinical parameters of metabolic syndrome. Secondary outcome measures included body mass index (BMI), body weight, hemoglobin A1c, 2-hour postprandial glucose (2 hPG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), and clinical effective rate. Trials that assessed one or more outcome measures were included. However, trials which measured level of hormone or enzyme, such as leptin and adiponectin, were excluded in this review.</p></sec></sec><sec id="sec2.3"><title>2.3. Study Selection and Data Extraction</title><sec id="sec2.3.1"><title>2.3.1. Selection of Literature Articles</title><p>After excluding any duplication of literature reviews from 10 databases, two authors (S. Jang and J.-S. Park) reviewed titles and abstracts for the first exclusion. Then, full texts of the selected literature articles were subject to another review before the final selection of literature articles was made to make sure each article qualified using the inclusion criteria for this study. For excluded literature articles, the reason for exclusion was recorded. When two authors showed a difference of opinion, a third author (B.-H. Jang) intervened to help come to an agreement. The entire process was displayed by generating a flow diagram in PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) (<xref ref-type="fig" rid="fig1">Figure 1</xref>).</p></sec><sec id="sec2.3.2"><title>2.3.2. Data Extraction</title><p>One author (S. Jang) conducted data extraction, and a different author (Y. Ko) reviewed the data. Items extracted from each trial include the following: (1) general characteristics of the study: author, published year, language, and country; (2) participants: sample size, sex, and age, Chinese pattern identification; (3) interventions: intervention, compositions of intervention, formulation of intervention, control, dosage, and medication period; and (4) outcomes: outcomes, main conclusion, and adverse events.</p></sec></sec><sec id="sec2.4"><title>2.4. Assessment with Risk of Bias</title><p>Two authors (S. Jang and Y. Ko) assessed methodological quality using the Risk of Bias (RoB) tool, which was developed by Cochrane [<xref rid="B8" ref-type="bibr">7</xref>]. RoB was divided into 6 selection biases, including 2 selection biases (random sequence generation and allocation concealment), performance bias, detection bias, attrition bias, and reporting bias. Each item of all the included RCTs was determined as “high risk,” “unclear,” or “low risk.” A RoB graph was drawn using RevMan 5.3 program.</p></sec><sec id="sec2.5"><title>2.5. Data Analysis</title><p>We used mean difference (MD) with 95% confidential interval (CI) to measure primary outcomes between trials. Analyses were divided into 4 subgroups depending on type of controls: no treatment, placebo, metformin, other western medicines. Heterogeneity was analyzed by the Cochrane <italic>Q</italic> and <italic>I</italic><sup>2</sup> test. <italic>I</italic><sup>2</sup> values of 25%, 50%, and 75% mean low, medium, and high levels of statistical heterogeneity. RevMan 5.3 program was used for analysis. We also made summary of findings (SoF) table to present results of review by Gradepro software.</p></sec></sec><sec id="sec3"><title>3. Results</title><sec id="sec3.1"><title>3.1. Description of Included Trials</title><p>From ten databases, 1,098 literature articles were identified. Among them, 826 records remained after eliminating duplications, and 733 records were excluded after screening titles and abstracts. By reviewing full texts of 93 records, 12 RCTs were included in this systematic review. The process of the study selection is shown in <xref ref-type="fig" rid="fig1">Figure 1</xref>.</p><sec id="sec3.1.1"><title>3.1.1. Characteristics of Study</title><p>Among the 12 included RCTs [<xref rid="B14" ref-type="bibr">13</xref>–<xref rid="B25" ref-type="bibr">24</xref>], 11 studies [<xref rid="B15" ref-type="bibr">14</xref>–<xref rid="B25" ref-type="bibr">24</xref>] were written in Chinese and conducted in China, and 1 study [<xref rid="B14" ref-type="bibr">13</xref>] was written in English and conducted in India. Four trials [<xref rid="B16" ref-type="bibr">15</xref>, <xref rid="B17" ref-type="bibr">16</xref>, <xref rid="B20" ref-type="bibr">19</xref>, <xref rid="B25" ref-type="bibr">24</xref>] selected the IDF guideline for diagnosis of metabolic syndrome, 2 trials [<xref rid="B14" ref-type="bibr">13</xref>, <xref rid="B23" ref-type="bibr">22</xref>] used the NCEP-ATP guideline, 3 trials [<xref rid="B18" ref-type="bibr">17</xref>, <xref rid="B21" ref-type="bibr">20</xref>, <xref rid="B24" ref-type="bibr">23</xref>] used the Chinese Diabetes Society criteria, and 3 trials used the American Diabetes Association guideline [<xref rid="B19" ref-type="bibr">18</xref>], the AACE clinical criteria [<xref rid="B22" ref-type="bibr">21</xref>], and the China Dyslipidemia Prevention guideline [<xref rid="B15" ref-type="bibr">14</xref>], respectively. Six trials [<xref rid="B16" ref-type="bibr">15</xref>, <xref rid="B18" ref-type="bibr">17</xref>–<xref rid="B21" ref-type="bibr">20</xref>, <xref rid="B25" ref-type="bibr">24</xref>] additionally applied Chinese pattern identification as the inclusion criterion. There were 4 trials [<xref rid="B16" ref-type="bibr">15</xref>, <xref rid="B18" ref-type="bibr">17</xref>, <xref rid="B20" ref-type="bibr">19</xref>, <xref rid="B21" ref-type="bibr">20</xref>] that had a medication period of less than 8 weeks, 3 trials [<xref rid="B19" ref-type="bibr">18</xref>, <xref rid="B22" ref-type="bibr">21</xref>, <xref rid="B24" ref-type="bibr">23</xref>] with a medication period of more than 8 weeks but less than 12 weeks, and 5 trials [<xref rid="B14" ref-type="bibr">13</xref>, <xref rid="B15" ref-type="bibr">14</xref>, <xref rid="B17" ref-type="bibr">16</xref>, <xref rid="B23" ref-type="bibr">22</xref>, <xref rid="B25" ref-type="bibr">24</xref>] with a medication period of more than 12 weeks. Details are described in <xref ref-type="table" rid="tab2">Table 2</xref>.</p></sec><sec id="sec3.1.2"><title>3.1.2. Participants</title><p>The number of participants for the trials varied from 43 [<xref rid="B15" ref-type="bibr">14</xref>] to 183 [<xref rid="B14" ref-type="bibr">13</xref>]. No trial was restricted to participants based on sex, but one trial [<xref rid="B18" ref-type="bibr">17</xref>] did not report sex distribution. Six trials included Chinese pattern identification as inclusion criteria: 2 trials [<xref rid="B16" ref-type="bibr">15</xref>, <xref rid="B20" ref-type="bibr">19</xref>] of Exuberance of Phlegm-Dampness Type, 1 trial [<xref rid="B25" ref-type="bibr">24</xref>] of Spleen Deficiency and Stagnation of Dampness Type, 1 trial [<xref rid="B19" ref-type="bibr">18</xref>] of Heart-Liver Stagnated Heat Type, 1 trial [<xref rid="B21" ref-type="bibr">20</xref>] of Flaming-Up of Fire of the Liver Type, and 1 trial [<xref rid="B18" ref-type="bibr">17</xref>] of Blood-Stasis Type. Two trials [<xref rid="B15" ref-type="bibr">14</xref>, <xref rid="B21" ref-type="bibr">20</xref>] were conducted on patients with hypertension and metabolic syndrome.</p></sec><sec id="sec3.1.3"><title>3.1.3. Comparisons</title><p>Comparisons were divided into two types. One type was a placebo or no treatment, and 2 trials [<xref rid="B14" ref-type="bibr">13</xref>, <xref rid="B15" ref-type="bibr">14</xref>] were compared with a placebo, while 3 trials [<xref rid="B16" ref-type="bibr">15</xref>–<xref rid="B18" ref-type="bibr">17</xref>] were conducted under no treatment. Diet-control and exercise or health education was used for the no treatment group. The other type was western medicine, and 7 trials [<xref rid="B19" ref-type="bibr">18</xref>–<xref rid="B25" ref-type="bibr">24</xref>] followed this comparison type. Metformin was used as a comparison in 3 trials [<xref rid="B19" ref-type="bibr">18</xref>, <xref rid="B20" ref-type="bibr">19</xref>, <xref rid="B22" ref-type="bibr">21</xref>], and nifedipine was used in 1 trial [<xref rid="B21" ref-type="bibr">20</xref>]. Two trials [<xref rid="B23" ref-type="bibr">22</xref>–<xref rid="B25" ref-type="bibr">24</xref>] provided different conventional medicines according to the symptoms of the patients.</p></sec></sec><sec id="sec3.2"><title>3.2. Effects of Interventions</title><p>Overall efficacy of FPG, TG, SBP, DBP, WC, and HDL-C was presented in summary of findings (<xref ref-type="table" rid="tab3">Table 3</xref>). Meta-analyses of FPG, TG, SBP, and DBP were shown in Figures <xref ref-type="fig" rid="fig2">2</xref><xref ref-type="fig" rid="fig3"></xref><xref ref-type="fig" rid="fig4"></xref>–<xref ref-type="fig" rid="fig5">5</xref>. All 12 trials had different herbal medicine interventions; therefore, we also compared effects of each intervention. <xref ref-type="table" rid="tab4"> Table 4</xref> shows the mean differences (MD) for each outcome measure. The unit mmol/L was converted into mg/dL.</p><sec id="sec3.2.1"><title>3.2.1. Waist Circumference and Body Mass Index</title><p>There were seven trials [<xref rid="B14" ref-type="bibr">13</xref>–<xref rid="B17" ref-type="bibr">16</xref>, <xref rid="B20" ref-type="bibr">19</xref>, <xref rid="B21" ref-type="bibr">20</xref>, <xref rid="B25" ref-type="bibr">24</xref>] reporting WC. Five trials [<xref rid="B15" ref-type="bibr">14</xref>–<xref rid="B17" ref-type="bibr">16</xref>, <xref rid="B21" ref-type="bibr">20</xref>, <xref rid="B25" ref-type="bibr">24</xref>] showed significant reductions of WC compared with the control groups: Yiqi Huaju Recipe (MD: −4.68, <italic>n</italic> = 43), Daotan decoction (MD: −2.98, <italic>n</italic> = 108), Gegen Shanzha decoction (MD: −5.31, <italic>n</italic> = 152), Pinggan Jianya pill (MD: −7.81, <italic>n</italic> = 100), and Shenling Jianpihuashi decoction (MD: −7.2, <italic>n</italic> = 80). Modified Banxia Baizhu Tianma decoction [<xref rid="B20" ref-type="bibr">19</xref>] showed less effect on decreasing WC than metformin. There was a slight increase in one trial [<xref rid="B14" ref-type="bibr">13</xref>]; however, it was not statistically significant.</p><p>There were nine trials [<xref rid="B14" ref-type="bibr">13</xref>–<xref rid="B17" ref-type="bibr">16</xref>, <xref rid="B20" ref-type="bibr">19</xref>–<xref rid="B22" ref-type="bibr">21</xref>, <xref rid="B24" ref-type="bibr">23</xref>, <xref rid="B25" ref-type="bibr">24</xref>] reporting BMI. Six trials [<xref rid="B14" ref-type="bibr">13</xref>–<xref rid="B17" ref-type="bibr">16</xref>, <xref rid="B21" ref-type="bibr">20</xref>, <xref rid="B24" ref-type="bibr">23</xref>] showed significant reductions of BMI compared with the control groups: Dia-No decoction (MD: −0.18, <italic>n</italic> = 183), Yiqi Huaju Recipe (MD: −1.51, <italic>n</italic> = 43), Daotan decoction (MD: −0.49, <italic>n</italic> = 108), Gegen Shanzha decoction (MD: −2.69, <italic>n</italic> = 152), Pinggan Jiangya pill (MD: −0.74, <italic>n</italic> = 100), and Shengjiangtongmai powder (MD: −2.52, <italic>n</italic> = 120). There were significant reductions after treatment in the remaining 3 trials [<xref rid="B20" ref-type="bibr">19</xref>, <xref rid="B22" ref-type="bibr">21</xref>, <xref rid="B25" ref-type="bibr">24</xref>]; however, it was not significant when compared with the control groups. These trials included the Modified Banxia Baizhu Tianma decoction (MD: −0.74, <italic>n</italic> = 60), Huanglian Wendan decoction (MD: −1.95, <italic>n</italic> = 68), and Shenling Jianpihuashi decoction (MD: −2.7, <italic>n</italic> = 80).</p></sec><sec id="sec3.2.2"><title>3.2.2. Blood Glucose</title><p>There were 10 trials [<xref rid="B14" ref-type="bibr">13</xref>–<xref rid="B17" ref-type="bibr">16</xref>, <xref rid="B19" ref-type="bibr">18</xref>, <xref rid="B20" ref-type="bibr">19</xref>, <xref rid="B22" ref-type="bibr">21</xref>–<xref rid="B25" ref-type="bibr">24</xref>] reporting FPG and 4 trials [<xref rid="B15" ref-type="bibr">14</xref>, <xref rid="B19" ref-type="bibr">18</xref>, <xref rid="B20" ref-type="bibr">19</xref>, <xref rid="B25" ref-type="bibr">24</xref>] reporting 2 hPG. Three trials [<xref rid="B14" ref-type="bibr">13</xref>, <xref rid="B17" ref-type="bibr">16</xref>, <xref rid="B24" ref-type="bibr">23</xref>] showed significant reductions of FPG compared with the control groups: Dia-No decoction (MD: −41.15, <italic>n</italic> = 183), Gegen Shanzha decoction (MD: −21.42, <italic>n</italic> = 152), and Shengjiangtongmai powder (MD: −82.08, <italic>n</italic> = 120). Five trials had an effect on lowering FPG; however, effects of herbal medicines were not more than the controls: Yiqi Huaju Recipe (MD: −7.02, <italic>n</italic> = 43), Qinggan Jiangtang tablet (MD: −28.8, <italic>n</italic> = 60), Modified Banxia Baizhu Tianma decoction (MD: −7.02, <italic>n</italic> = 60), Huanglian Wendan decoction (MD: −27.54, <italic>n</italic> = 68), and Shenling Jianpihuashi decoction (MD: −16.2, <italic>n</italic> = 80). Daotan decoction [<xref rid="B16" ref-type="bibr">15</xref>] and Xueguan Ruanhua decoction [<xref rid="B23" ref-type="bibr">22</xref>] were not effective in decreasing FPG. As shown in <xref ref-type="fig" rid="fig2">Figure 2</xref>, mean FPG in the intervention groups was 1.37 lower than control groups within 10 trials (−3.13 to 0.39).</p><p>For 2 hPG, four trials [<xref rid="B15" ref-type="bibr">14</xref>, <xref rid="B19" ref-type="bibr">18</xref>, <xref rid="B20" ref-type="bibr">19</xref>, <xref rid="B25" ref-type="bibr">24</xref>] showed significant reductions after treatment, and 1 trial [<xref rid="B15" ref-type="bibr">14</xref>] demonstrated an effect when compared with the control group: Yiqi Huaju Recipe (MD: −29.34, <italic>n</italic> = 43).</p></sec><sec id="sec3.2.3"><title>3.2.3. Blood Lipids</title><p>There were 10 trials [<xref rid="B14" ref-type="bibr">13</xref>–<xref rid="B17" ref-type="bibr">16</xref>, <xref rid="B19" ref-type="bibr">18</xref>, <xref rid="B20" ref-type="bibr">19</xref>, <xref rid="B22" ref-type="bibr">21</xref>–<xref rid="B25" ref-type="bibr">24</xref>] reporting TG and 9 trials [<xref rid="B14" ref-type="bibr">13</xref>–<xref rid="B17" ref-type="bibr">16</xref>, <xref rid="B19" ref-type="bibr">18</xref>, <xref rid="B20" ref-type="bibr">19</xref>, <xref rid="B22" ref-type="bibr">21</xref>, <xref rid="B23" ref-type="bibr">22</xref>, <xref rid="B25" ref-type="bibr">24</xref>] reporting HDL-C. Nine trials [<xref rid="B14" ref-type="bibr">13</xref>, <xref rid="B16" ref-type="bibr">15</xref>, <xref rid="B17" ref-type="bibr">16</xref>, <xref rid="B19" ref-type="bibr">18</xref>, <xref rid="B20" ref-type="bibr">19</xref>, <xref rid="B22" ref-type="bibr">21</xref>–<xref rid="B25" ref-type="bibr">24</xref>] showed significant reductions of TG compared with the control groups: Dia-No decoction (MD: −10.59, <italic>n</italic> = 183), Daotan decoction (MD: −28.48, <italic>n</italic> = 108), Gegen Shanzha decoction (MD: −99.68, <italic>n</italic> = 152), Qinggan Jiangtang tablet (MD: −12.46, <italic>n</italic> = 60), Modified Banxia Baizhu Tianma decoction (MD: −23.14, <italic>n</italic> = 60), Huanglian Wendan decoction (MD: −62.3, <italic>n</italic> = 68), Xueguan Ruanhua decoction (MD: −30.26, <italic>n</italic> = 106), Shengjiangtongmai powder (MD: −71.2, <italic>n</italic> = 120), and Shenling Jianpihuashi decoction (MD: −89.89, <italic>n</italic> = 80). As shown in <xref ref-type="fig" rid="fig3">Figure 3</xref>, mean TG in the intervention groups was 22.54 lower than control groups within 10 trials (−27.81 to −17.27).</p><p>Five trials [<xref rid="B16" ref-type="bibr">15</xref>, <xref rid="B17" ref-type="bibr">16</xref>, <xref rid="B20" ref-type="bibr">19</xref>, <xref rid="B22" ref-type="bibr">21</xref>, <xref rid="B23" ref-type="bibr">22</xref>] demonstrated significant increases of HDL-C: Daotan decoction (MD: +2.32, <italic>n</italic> = 108), Gegen Shanzha decoction (MD: +18.91, <italic>n</italic> = 152), Modified Banxia Baizhu Tianma decoction (MD: +7.72, <italic>n</italic> = 60), Huanglian Wendan decoction (MD: +11.19, <italic>n</italic> = 68), and Xueguan Ruanhua decoction (MD: +15.83, <italic>n</italic> = 106). Yiqi Huaju Recipe [<xref rid="B15" ref-type="bibr">14</xref>] was not effective in improving either TG or HDL-C.</p></sec><sec id="sec3.2.4"><title>3.2.4. Blood Pressure</title><p>There were 11 trials [<xref rid="B14" ref-type="bibr">13</xref>–<xref rid="B17" ref-type="bibr">16</xref>, <xref rid="B19" ref-type="bibr">18</xref>–<xref rid="B25" ref-type="bibr">24</xref>] reporting systolic and diastolic blood pressure. All 11 trials showed significant decreases in blood pressure: Dia-No decoction (MD: −2.29/−1.23, <italic>n</italic> = 183), Yiqi Huaju Recipe (MD: −11.32/−6.5, <italic>n</italic> = 43), Daotan decoction (MD: −7.43/−2.28, <italic>n</italic> = 108), Gegen Shanzha decoction (MD: −19.66/−10.5, <italic>n</italic> = 152), Qinggan Jiangtang tablet (MD: −7.5/−2.9, <italic>n</italic> = 60), Modified Banxia Baizhu Tianma decoction (MD: −4.38/−3.23, <italic>n</italic> = 60), Pinggan Jiangya pill (MD: −28.00/−14.33, <italic>n</italic> = 100), Huanglian Wendan decoction (MD: −10.73/−8.24, <italic>n</italic> = 68), Xueguan Ruanhua decoction (MD: −8.75/−9.33, <italic>n</italic> = 106), Shengjiangtongmai powder (MD: −30/−15, <italic>n</italic> = 120), and Shenling Jianpihuashi decoction (MD: −11.6/−9.3, <italic>n</italic> = 80). Ten herbal medicines (except Shenling Jianpihuashi decoction [<xref rid="B25" ref-type="bibr">24</xref>]) had more effect than the controls, and Shenling Jianpihuashi decoction was not inferior to nifedipine.</p><p>The mean SBP was 6.76 lower in the intervention groups compared to control groups within 11 trials (−7.72 to −5.81) (<xref ref-type="fig" rid="fig4">Figure 4</xref>). The mean DBP was 5.23 lower in the intervention groups than control groups within 11 trials (−5.77 to −4.86) (<xref ref-type="fig" rid="fig5">Figure 5</xref>).</p></sec></sec><sec id="sec3.3"><title>3.3. Adverse Events and Safety</title><p>Six RCTs [<xref rid="B14" ref-type="bibr">13</xref>, <xref rid="B15" ref-type="bibr">14</xref>, <xref rid="B21" ref-type="bibr">20</xref>–<xref rid="B23" ref-type="bibr">22</xref>, <xref rid="B25" ref-type="bibr">24</xref>] reported 26 adverse events. Nine cases occurred in the herbal medicine group, and the remaining 17 cases occurred in the western medicine group. There was no adverse event in the placebo or no treatment control group. The Dia-No group [<xref rid="B14" ref-type="bibr">13</xref>] had 6 upper digestive disorders, the Huanglian Wendan decoction group [<xref rid="B22" ref-type="bibr">21</xref>] had 1 gastrointestinal disorder, and the Yiqi Huaju Recipe group [<xref rid="B15" ref-type="bibr">14</xref>] had 2 skin hypersensitivities. There was no observed adverse event in the Pinggan Jiangya pill group [<xref rid="B21" ref-type="bibr">20</xref>], the Xueguan Ruanhua decoction group [<xref rid="B23" ref-type="bibr">22</xref>], and the Shenling Jianpihuashi decoction group [<xref rid="B25" ref-type="bibr">24</xref>]. The most commonly reported symptoms were digestive disorders such as nausea, vomiting, and burning of the epigastrium (<xref ref-type="table" rid="tab5">Table 5</xref>).</p></sec><sec id="sec3.4"><title>3.4. Assessment with Risk of Bias</title><p>RoB of the 12 RCTs was assessed into 6 areas. Six RCTs [<xref rid="B14" ref-type="bibr">13</xref>–<xref rid="B19" ref-type="bibr">18</xref>] used a random number table to generate the random sequence. There were high risks of performance bias (blinding of participants and personnel) in 10 trials [<xref rid="B16" ref-type="bibr">15</xref>–<xref rid="B25" ref-type="bibr">24</xref>] due to the difference of drug formulation. Except in 2 RCTs [<xref rid="B18" ref-type="bibr">17</xref>, <xref rid="B21" ref-type="bibr">20</xref>] where the primary outcomes were blood pressure and blood-stasis symptom, the remaining 10 trials were assessed as “low risk” for detection bias (blinding of outcome assessment). There were low risks of attrition bias (incomplete outcome data) and reporting bias (selective reporting) in all 12 trials. Only 1 RCT [<xref rid="B14" ref-type="bibr">13</xref>] was assessed as “low risk” for all six items. Details of RoB are presented in <xref ref-type="fig" rid="fig6">Figure 6</xref>.</p></sec></sec><sec id="sec4"><title>4. Discussion</title><p>As a result of searching 10 databases, 12 randomized controlled trials were included in the systematic review. Because the review's purpose was to determine the efficacy and safety of herbal medicines for metabolic syndrome, clinical trials that included herbal medicines combined with conventional western medicines were excluded. Five trials [<xref rid="B14" ref-type="bibr">13</xref>–<xref rid="B18" ref-type="bibr">17</xref>] studied herbal medicines versus a placebo or no treatment, and seven trials [<xref rid="B19" ref-type="bibr">18</xref>–<xref rid="B25" ref-type="bibr">24</xref>] studied herbal medicines versus western medicines. All 12 trials included controls for diet-control, exercise, or health education with medications.</p><p>According to <xref ref-type="table" rid="tab4">Table 4</xref>, all the trials showed positive effects with the administration of herbal medicines, and most of them proved significant. Gegen Shanzha decoction [<xref rid="B17" ref-type="bibr">16</xref>] improved 5 metabolic indexes, including WC, FPG, TG, HDL-C, and BP. Yiqi Huaju Recipe [<xref rid="B15" ref-type="bibr">14</xref>] had an effect on lowering body weight, blood sugar, and blood pressure (except blood lipids). Because the outcome measured the blood-stasis symptom only in the trial for Xuefu Zhuyu decoction [<xref rid="B18" ref-type="bibr">17</xref>], the efficacy of Xuefu Zhuyu decoction on metabolic diseases could not be determined. The Pinggan Jiangya pill [<xref rid="B21" ref-type="bibr">20</xref>] was effective for the metabolic syndrome of Flaming-Up of Fire of the Liver Type. Flaming-Up of Fire of the Liver Type is the largest type of hypertension [<xref rid="B26" ref-type="bibr">25</xref>]; therefore, the Pinggan Jiangya pill would be suitable to treat obesity and hypertension. The Qinggan Jiangtang tablet [<xref rid="B19" ref-type="bibr">18</xref>], Modified Banxia Baizhu Tianma decoction [<xref rid="B20" ref-type="bibr">19</xref>], Huanglian Wendan decoction [<xref rid="B22" ref-type="bibr">21</xref>], Xueguan Ruanhua decoction [<xref rid="B23" ref-type="bibr">22</xref>], the Shengjiangtongmai powder [<xref rid="B24" ref-type="bibr">23</xref>], and Shenling Jianpihuashi decoction [<xref rid="B25" ref-type="bibr">24</xref>] were superior (or not inferior) to western medicines used to treat metabolic syndrome.</p><p>As for summary of findings (<xref ref-type="table" rid="tab3">Table 3</xref>), mean differences of metabolic parameters were compared. Metabolic syndrome is not determined by single indicator, and comparing value of each parameter is not appropriate, strictly speaking. Relative risk (RR) of metabolic syndrome should be calculated. However, there was no study presenting difference of prevalence before and after treatment. Meanwhile, WC and HDL-C could not be calculated because they were not separated by men and women within included trials.</p><p>Forest plots of FPG, TG, SBP, and DBP indicate high heterogeneity although subgroup analysis was done (Figures <xref ref-type="fig" rid="fig2">2</xref><xref ref-type="fig" rid="fig3"></xref><xref ref-type="fig" rid="fig4"></xref>–<xref ref-type="fig" rid="fig5">5</xref>). It is assumed that heterogeneity did not result from controls. Instead, difference of each intervention would have been affected. It is also limitation of meta-analysis in this review.</p><p>Regarding safety, adverse events were reported less in herbal medicines than in western medicines (<xref ref-type="table" rid="tab5">Table 5</xref>). In Zhang et al.'s trial [<xref rid="B21" ref-type="bibr">20</xref>], the nifedipine group had 4 facial flushes, while the Pinggan Jiangya group had no adverse events. Additionally, there was 1 gastrointestinal disorder with Huanglian Wendan decoction, but there were 5 adverse events when metformin was used in Guan et al.'s trial [<xref rid="B22" ref-type="bibr">21</xref>]. Therefore, herbal medicines would be an effective and safe treatment for metabolic syndrome compared with western medicines.</p><p>In 6 trials [<xref rid="B16" ref-type="bibr">15</xref>, <xref rid="B18" ref-type="bibr">17</xref>–<xref rid="B21" ref-type="bibr">20</xref>, <xref rid="B25" ref-type="bibr">24</xref>], oriental pattern identification along with metabolic factors was set for inclusion criteria. A selection of treatments with pattern identifications would help reduce metabolic risk factors, improve general conditions, and decrease chances of adverse events. With the collection of such trial data, this would provide a ground for herbal medicines to be used as treatment for obesity or metabolic syndrome by pattern identifications.</p><p>There are more studies on herbal medicines for metabolic syndrome although they were not included in this review. Keishibukuryogan [<xref rid="B27" ref-type="bibr">26</xref>], Yiqi Huaju Qingli Formula [<xref rid="B28" ref-type="bibr">27</xref>], Ba-Wei-Wan [<xref rid="B29" ref-type="bibr">28</xref>], Heqi San [<xref rid="B30" ref-type="bibr">29</xref>], Baoling decoction [<xref rid="B31" ref-type="bibr">30</xref>], and Combination of Four Gentlemen Decoction and Sini Powder [<xref rid="B32" ref-type="bibr">31</xref>] showed effects on metabolic syndrome; however, trials on these were excluded because treatment group was also treated with conventional western medicines. Herbal supplements, for example, Ginseng [<xref rid="B33" ref-type="bibr">32</xref>], berberine, bitter melon [<xref rid="B34" ref-type="bibr">33</xref>], nigella sativa [<xref rid="B35" ref-type="bibr">34</xref>], and<italic> Gymnema sylvestre</italic> [<xref rid="B36" ref-type="bibr">35</xref>], are also used for management of metabolic diseases. In particular it is well known that ginsenosides which are compounds of ginseng have clear effect of regulating blood glucose and blood pressure [<xref rid="B34" ref-type="bibr">33</xref>].</p><p>This review has some limitations. First, metabolic syndrome is not a single disorder but rather a complex disease. The herbal medicines used as interventions and their efficacy need to be matched for the following indicators: waist circumference, body weight, blood glucose, blood lipids, and blood pressure. Second, the trials included in the study showed a relatively low level of quality because most of them failed to conduct a double-blinded technique, and only 1 trial [<xref rid="B14" ref-type="bibr">13</xref>] met the qualification for advanced protocol. Because of these limitations, there may be the possibility that therapeutic effects have been overestimated. Publication bias also needs to be taken into consideration. Third, there could be trials missing even though we tried to cover all of the RCTs from English, Korean, Chinese, and Japanese databases. However, the study is significant because it has reviewed RCTs on the administration of herbal medicines for treating metabolic diseases. Further studies are needed to develop new herbal medicines for metabolic syndrome and to build evidence on their effectiveness and safety.</p></sec><sec id="sec5"><title>5. Conclusion</title><p>Herbal medicines showed therapeutic effects on regulating waist circumference, blood glucose, blood lipids, and blood pressure in this systematic review. This means herbal medicines have the potential to be complementary and alternative medicines for metabolic syndrome. 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(b) Risk of bias summary: assessments about each risk of bias item for each included study. “+”: low risk, “?”: unclear risk, and “−”: high risk.</p></caption><graphic xlink:href="ECAM2016-5936402.006"></graphic></fig><table-wrap id="tab1" orientation="portrait" position="float"><label>Table 1</label><caption><p>Search strategy (PubMed).</p></caption><table frame="hsides" rules="groups"><thead><tr><th colspan="2" align="center" rowspan="1">Chinese herbal medicine</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">#1</td><td align="center" rowspan="1" colspan="1">Chinese medic<sup><italic>∗</italic></sup></td></tr><tr><td align="left" rowspan="1" colspan="1">#2</td><td align="center" rowspan="1" colspan="1">TCMs or TCM</td></tr><tr><td align="left" rowspan="1" colspan="1">#3</td><td align="center" rowspan="1" colspan="1">Chinese herb<sup><italic>∗</italic></sup></td></tr><tr><td align="left" rowspan="1" colspan="1">#4</td><td align="center" rowspan="1" colspan="1">Chinese drug<sup><italic>∗</italic></sup></td></tr><tr><td align="left" rowspan="1" colspan="1">#5</td><td align="center" rowspan="1" colspan="1">Chinese formul<sup><italic>∗</italic></sup></td></tr><tr><td align="left" rowspan="1" colspan="1">#6</td><td align="center" rowspan="1" colspan="1">Chinese plant<sup><italic>∗</italic></sup></td></tr><tr><td align="left" rowspan="1" colspan="1">#7</td><td align="center" rowspan="1" colspan="1">Chinese prescri<sup><italic>∗</italic></sup></td></tr><tr><td align="left" rowspan="1" colspan="1">#8</td><td align="center" rowspan="1" colspan="1">Chinese remed<sup><italic>∗</italic></sup></td></tr><tr><td align="left" rowspan="1" colspan="1">#9</td><td align="center" rowspan="1" colspan="1">Chinese materia<sup><italic>∗</italic></sup> medica<sup><italic>∗</italic></sup></td></tr><tr><td align="left" rowspan="1" colspan="1">#10</td><td align="center" rowspan="1" colspan="1">kampo</td></tr><tr><td align="left" rowspan="1" colspan="1">#11</td><td align="center" rowspan="1" colspan="1">herb<sup><italic>∗</italic></sup> medic<sup><italic>∗</italic></sup></td></tr><tr><td align="left" rowspan="1" colspan="1">#12</td><td align="center" rowspan="1" colspan="1">“Medicine, Chinese traditional” (MeSH Terms)</td></tr><tr><td align="left" rowspan="1" colspan="1">#13</td><td align="center" rowspan="1" colspan="1">“Medicine, East Asian Traditional” (MeSH Terms)</td></tr><tr><td align="left" rowspan="1" colspan="1">#14</td><td align="center" rowspan="1" colspan="1">“Medicine, kampo” (MeSH Terms)</td></tr><tr><td align="left" rowspan="1" colspan="1">#15</td><td align="center" rowspan="1" colspan="1">“Herbal Medicine” (MeSH Terms)</td></tr><tr><td align="left" rowspan="1" colspan="1">#16</td><td align="center" rowspan="1" colspan="1">“drugs, Chinese herbal” (MeSH Terms)</td></tr><tr><td align="left" rowspan="1" colspan="1">#17</td><td align="center" rowspan="1" colspan="1">#1 or #2 or #3 or #4 or #5 or #6 or #7 or #8 or #9 or #10 or #11 or #12 or #13 or #14 or #15 or #16</td></tr><tr><td align="center" colspan="2" rowspan="1"><hr></hr></td></tr><tr><td colspan="2" align="center" rowspan="1">Metabolic syndrome</td></tr><tr><td align="center" colspan="2" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">#18</td><td align="center" rowspan="1" colspan="1">“Metabolic Syndrome X” (MeSH Terms)</td></tr><tr><td align="left" rowspan="1" colspan="1">#19</td><td align="center" rowspan="1" colspan="1">metabolic syndrome</td></tr><tr><td align="left" rowspan="1" colspan="1">#20</td><td align="center" rowspan="1" colspan="1">cardiometabolic syndrome</td></tr><tr><td align="left" rowspan="1" colspan="1">#21</td><td align="center" rowspan="1" colspan="1">insulin resistance syndrome</td></tr><tr><td align="left" rowspan="1" colspan="1">#22</td><td align="center" rowspan="1" colspan="1">“syndrome X”</td></tr><tr><td align="left" rowspan="1" colspan="1">#23</td><td align="center" rowspan="1" colspan="1">“Reaven's syndrome”</td></tr><tr><td align="left" rowspan="1" colspan="1">#24</td><td align="center" rowspan="1" colspan="1">CHAOS AND Australia</td></tr><tr><td align="left" rowspan="1" colspan="1">#25</td><td align="center" rowspan="1" colspan="1">#18 or #19 or #20 or #21 or #22 or #23 or #24</td></tr><tr><td align="center" colspan="2" rowspan="1"><hr></hr></td></tr><tr><td colspan="2" align="center" rowspan="1">Randomized controlled trials</td></tr><tr><td align="center" colspan="2" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">#26</td><td align="center" rowspan="1" colspan="1">((clinical (Title/Abstract) AND trial (Title/Abstract)) OR clinical trials (MeSH Terms) OR clinical trial (Publication Type) OR random<sup><italic>∗</italic></sup> (Title/Abstract) OR random allocation (MeSH Terms) OR therapeutic use (MeSH Subheadings))</td></tr><tr><td align="left" rowspan="1" colspan="1">#27</td><td align="center" rowspan="1" colspan="1">#17 AND #25 AND #26</td></tr></tbody></table></table-wrap><table-wrap id="tab2" orientation="portrait" position="float"><label>Table 2</label><caption><p>Characteristics of RCTs using herbal medicine in the treatment of metabolic syndrome.</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1">Author, year, country</th><th align="center" rowspan="1" colspan="1">Sample size (I/C)</th><th align="center" rowspan="1" colspan="1">Age</th><th align="center" rowspan="1" colspan="1">Sex (M/F)</th><th align="center" rowspan="1" colspan="1">Inclusion criteria of MetS</th><th align="center" rowspan="1" colspan="1">Chinese pattern identification</th><th align="center" rowspan="1" colspan="1">Intervention</th><th align="center" rowspan="1" colspan="1">Control</th><th align="center" rowspan="1" colspan="1">Period</th><th align="center" rowspan="1" colspan="1">Outcomes</th><th align="center" rowspan="1" colspan="1">Main conclusion</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1"> Agrawal et al., 2008, India [<xref rid="B14" ref-type="bibr">13</xref>]</td><td align="center" rowspan="1" colspan="1">94/89</td><td align="center" rowspan="1" colspan="1">I: 51.85 ± 11.8 C: 52.81 ± 10.3</td><td align="center" rowspan="1" colspan="1">103/80</td><td align="center" rowspan="1" colspan="1">NCEP-ATP guideline (2002)</td><td align="center" rowspan="1" colspan="1">ND</td><td align="center" rowspan="1" colspan="1">Dia-No,<break></break>1 tab, bid</td><td align="center" rowspan="1" colspan="1">Placebo,<break></break>1 tab, bid</td><td align="center" rowspan="1" colspan="1">3 m</td><td align="center" rowspan="1" colspan="1">WC, FPG, HbA1c, TC, TG, HDL-C, VLDL, LDL-C, SBP, DBP, urea, creatinine, bilirubin, GOT, GPT</td><td align="center" rowspan="1" colspan="1">Dia-No is safe and effective drug in the management of MetS.</td></tr><tr><td align="center" colspan="11" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1"> Chen et al., 2014, China [<xref rid="B15" ref-type="bibr">14</xref>]</td><td align="center" rowspan="1" colspan="1">22/21</td><td align="center" rowspan="1" colspan="1">I: 48.73 ± 9.4<break></break>C: 48.90 ± 8.9</td><td align="center" rowspan="1" colspan="1">28/15</td><td align="center" rowspan="1" colspan="1">China Dyslipidemia Prevention guideline (2007)</td><td align="center" rowspan="1" colspan="1">ND</td><td align="center" rowspan="1" colspan="1">Yiqi Huaju Formula</td><td align="center" rowspan="1" colspan="1">Placebo, bid</td><td align="center" rowspan="1" colspan="1">12 w</td><td align="center" rowspan="1" colspan="1">BMI, body weight, WC, HC, WHR, FPG, HbA1c, FPI, 2 hPG, HOMA-IR, TC, TG, HDL-C, LDL-C, 24 hBP, dBP, nBP, 24 hBPv, dBPv, nBPv, 24 hBPp, dBPp, nBPp</td><td align="center" rowspan="1" colspan="1">Yiqi Huaju Formula combining with diet-control and exercise has effect on reducing blood pressure.</td></tr><tr><td align="center" colspan="11" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1"> Zhang et al., 2014, China [<xref rid="B16" ref-type="bibr">15</xref>]</td><td align="center" rowspan="1" colspan="1">56/52</td><td align="center" rowspan="1" colspan="1">61.5 (37~80)</td><td align="center" rowspan="1" colspan="1">59/49</td><td align="center" rowspan="1" colspan="1">IDF<break></break>guideline (2005)</td><td align="center" rowspan="1" colspan="1">Phlegm-Dampness Type</td><td align="center" rowspan="1" colspan="1">Daotan decoction</td><td align="center" rowspan="1" colspan="1">No treatment</td><td align="center" rowspan="1" colspan="1">4 w</td><td align="center" rowspan="1" colspan="1">BMI, WC, TG, HDL-C, FPG, SBP, DBP</td><td align="center" rowspan="1" colspan="1">Daotan decoction can ameliorate the blood lipid and blood pressure of MetS of phlegm-dampness constitution.</td></tr><tr><td align="center" colspan="11" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1"> Xu et al., 2014, China [<xref rid="B17" ref-type="bibr">16</xref>]</td><td align="center" rowspan="1" colspan="1">83/69</td><td align="center" rowspan="1" colspan="1">I: 51.75 ± 10.1<break></break>C: 52.30 ± 14.3</td><td align="center" rowspan="1" colspan="1">70/82</td><td align="center" rowspan="1" colspan="1">IDF<break></break>guideline (2005)</td><td align="center" rowspan="1" colspan="1">ND</td><td align="center" rowspan="1" colspan="1">Gegen shanzha decoction</td><td align="center" rowspan="1" colspan="1">No treatment</td><td align="center" rowspan="1" colspan="1">6 m</td><td align="center" rowspan="1" colspan="1">BMI, body weight, WC, AC, HC, WHR, SFA, VFA, FPG, FINS, HOMA-IR, TC, TG, HDL-C, LDL-C, SBP, DBP, SF-36</td><td align="center" rowspan="1" colspan="1">Gegen Shanzha decoction combining with TCM physique recuperation is effective for MetS.</td></tr><tr><td align="center" colspan="11" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">Li, 2014, China [<xref rid="B18" ref-type="bibr">17</xref>]</td><td align="center" rowspan="1" colspan="1">32/30</td><td align="center" rowspan="1" colspan="1">NR</td><td align="center" rowspan="1" colspan="1">NR</td><td align="center" rowspan="1" colspan="1">Chinese Diabetes Society criteria (2004)</td><td align="center" rowspan="1" colspan="1">Blood-Stasis Type</td><td align="center" rowspan="1" colspan="1">Xuefu zhuyu decoction, bid</td><td align="center" rowspan="1" colspan="1">No treatment</td><td align="center" rowspan="1" colspan="1">4 w</td><td align="center" rowspan="1" colspan="1">Blood stasis symptoms</td><td align="center" rowspan="1" colspan="1">Xuefu Zhuyu decoction has clinical efficacy for MetS of Blood-Stasis Type.</td></tr><tr><td align="center" colspan="11" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1"> Wang et al., 2005, China [<xref rid="B19" ref-type="bibr">18</xref>]</td><td align="center" rowspan="1" colspan="1">30/30</td><td align="center" rowspan="1" colspan="1">I: 49.6 ± 7.9<break></break>C: 50.6 ± 7.6</td><td align="center" rowspan="1" colspan="1">27/33</td><td align="center" rowspan="1" colspan="1">American Diabetes Association guideline (1997)</td><td align="center" rowspan="1" colspan="1">Heart-Liver Stagnated Heat Type</td><td align="center" rowspan="1" colspan="1">Qinggan Jiangtang,<break></break>3 tabs, bid</td><td align="center" rowspan="1" colspan="1">Glucophage<break></break>(metformin),<break></break>3 tabs, bid</td><td align="center" rowspan="1" colspan="1">2 m</td><td align="center" rowspan="1" colspan="1">FPG, 2 hPG, HbA1c, TC, TG, HDL-C, LDL-C, SBP, DBP, FINS, PINS, F-CP, P-CP, HOMA-IR, HOMA-<italic>β</italic>, FFA,</td><td align="center" rowspan="1" colspan="1">Qinggan Jiangtang tablet has effects on reducing blood glucose, blood lipids, blood pressure, and insulin resistance.</td></tr><tr><td align="center" colspan="11" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1"> Liu et al., 2008, China [<xref rid="B20" ref-type="bibr">19</xref>]</td><td align="center" rowspan="1" colspan="1">30/30</td><td align="center" rowspan="1" colspan="1">30–60</td><td align="center" rowspan="1" colspan="1">NR</td><td align="center" rowspan="1" colspan="1">IDF<break></break>guideline (2005)</td><td align="center" rowspan="1" colspan="1">Exuberance of Phlegm-Dampness Type</td><td align="center" rowspan="1" colspan="1">Modified Banxia Baizhu Tianma decoction,<break></break>120 mL, bid</td><td align="center" rowspan="1" colspan="1">Metformin,<break></break>0.25 mg, tid</td><td align="center" rowspan="1" colspan="1">6 w</td><td align="center" rowspan="1" colspan="1">WC, BMI, FPG, 2 hPG, FINS, ISI, TC, TG, HDL-C, LDL-C, ApoA1, ApoB, SBP, DBP, effective rate, Chinese symptoms</td><td align="center" rowspan="1" colspan="1">Modified Banxia Baizhu Tianma Decoction has effects on treating MetS of Exuberance of Phlegm-Dampness Type.</td></tr><tr><td align="center" colspan="11" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1"> Zhang et al., 2010, China [<xref rid="B21" ref-type="bibr">20</xref>]</td><td align="center" rowspan="1" colspan="1">50/50</td><td align="center" rowspan="1" colspan="1">I: 52.61 ± 5.4<break></break>C: 51.10 ± 12.2</td><td align="center" rowspan="1" colspan="1">80/20</td><td align="center" rowspan="1" colspan="1">Chinese Diabetes Society criteria (2004)</td><td align="center" rowspan="1" colspan="1">Flaming-Up of Fire of the Liver Type</td><td align="center" rowspan="1" colspan="1">Pinggan Jiangya pill, 6 g, tid</td><td align="center" rowspan="1" colspan="1">Nifedipine,<break></break>10 mg, tid</td><td align="center" rowspan="1" colspan="1">1 m</td><td align="center" rowspan="1" colspan="1">BMI, body weight, WC, SBP, DBP</td><td align="center" rowspan="1" colspan="1">Pinggan Jiangya pill has effects on decreasing blood pressure and weight of MetS of Flaming-Up of Fire of the Liver Type.</td></tr><tr><td align="center" colspan="11" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1"> Guan et al., 2012, China [<xref rid="B22" ref-type="bibr">21</xref>]</td><td align="center" rowspan="1" colspan="1">36/32</td><td align="center" rowspan="1" colspan="1">47.2 ± 15.4</td><td align="center" rowspan="1" colspan="1">39/29</td><td align="center" rowspan="1" colspan="1">AACE clinical criteria (2003)</td><td align="center" rowspan="1" colspan="1">ND</td><td align="center" rowspan="1" colspan="1">Huanglian Wendan decoction</td><td align="center" rowspan="1" colspan="1">Metformin,<break></break>0.25 mg, bid</td><td align="center" rowspan="1" colspan="1">8 w</td><td align="center" rowspan="1" colspan="1">BMI, FPG, TC, TG, HDL-C, LDL-C, SBP, DBP</td><td align="center" rowspan="1" colspan="1">Huanglian Wendan decoction is the same as metformin in reducing weight and blood sugar but better in decreasing blood lipids and blood pressure.</td></tr><tr><td align="center" colspan="11" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">Dong, 2012, China [<xref rid="B23" ref-type="bibr">22</xref>]</td><td align="center" rowspan="1" colspan="1">58/48</td><td align="center" rowspan="1" colspan="1">I: 24~78<break></break>C: 21~73</td><td align="center" rowspan="1" colspan="1">44/62</td><td align="center" rowspan="1" colspan="1">NCEP ATP guideline (2002)</td><td align="center" rowspan="1" colspan="1">ND</td><td align="center" rowspan="1" colspan="1">Xueguan Ruanhua decoction (1 m) → Xueguan Ruanhua pill (2 m)</td><td align="center" rowspan="1" colspan="1">① DM: metformin or rosiglitazone<break></break>② HL: simvastatin or fenofibric acid<break></break>③ HTN: captopril or nifedipine</td><td align="center" rowspan="1" colspan="1">3 m</td><td align="center" rowspan="1" colspan="1">FPG, TG, HDL-C, SBP, DBP, effective rate</td><td align="center" rowspan="1" colspan="1">Xueguan Ruanhua decoction has effects on the treatment of MetS.</td></tr><tr><td align="center" colspan="11" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1"> Cui and Wie, 2014, China [<xref rid="B24" ref-type="bibr">23</xref>]</td><td align="center" rowspan="1" colspan="1">60/60</td><td align="center" rowspan="1" colspan="1">I: 51.3 ± 6.0<break></break>C: 52.3 ± 5.4</td><td align="center" rowspan="1" colspan="1">69/51</td><td align="center" rowspan="1" colspan="1">Chinese Diabetes Society criteria (2004)</td><td align="center" rowspan="1" colspan="1">ND</td><td align="center" rowspan="1" colspan="1">Shengjiangtongmai powder,<break></break>300 mL, bid</td><td align="center" rowspan="1" colspan="1">① Metformin, 0.25 mg, bid<break></break>② Simvastatin, 10 mg, qd<break></break>③ Enalapril,<break></break>10 mg, qd</td><td align="center" rowspan="1" colspan="1">2 m</td><td align="center" rowspan="1" colspan="1">BMI, SBP, DBP, TC, TG, FPG, effective rate</td><td align="center" rowspan="1" colspan="1">Shengjiangtongmai powder can effectively improve blood glucose, blood lipid, blood pressure, and obesity.</td></tr><tr><td align="center" colspan="11" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">Danyang Zhao and Danun Zhao, 2015, China [<xref rid="B25" ref-type="bibr">24</xref>]</td><td align="center" rowspan="1" colspan="1">40/40</td><td align="center" rowspan="1" colspan="1">I: 48.7 ± 12.5<break></break>C: 47.6 ± 12.6</td><td align="center" rowspan="1" colspan="1">NR</td><td align="center" rowspan="1" colspan="1">IDF guideline (2005)</td><td align="center" rowspan="1" colspan="1">Spleen Deficiency and Stagnation of Dampness Type</td><td align="center" rowspan="1" colspan="1">Shenling Jianpihuashi decoction, bid</td><td align="center" rowspan="1" colspan="1">① DM: metformin, 500 mg, tid<break></break>② HTN: losartan, 50 mg, qd</td><td align="center" rowspan="1" colspan="1">12 w</td><td align="center" rowspan="1" colspan="1">WC, BMI, FPG, 2 hPG, HbA1c, TC, TG, HDL-C, LDL-C, SBP, DBP, HOMA-IR, effective rate</td><td align="center" rowspan="1" colspan="1">Shenling Jianpihuashi decoction can effectively improve MetS of Spleen Deficiency and Stagnation of Dampness type.</td></tr></tbody></table><table-wrap-foot><fn><p> I: intervention group; C: control group; M: male; F: female; NR: not reported; MetS: metabolic syndrome; DM: diabetes mellitus; HTN: hypertension; HL: hyperlipidemia; WC: waist circumference; FPG: fasting plasma glucose; TC: total cholesterol; HDL-C: high density lipoprotein cholesterol; VLDL: very low density lipoprotein; LDL-C: low density lipoprotein cholesterol; SBP: systolic blood pressure; DBP: diastolic blood pressure; GOT: glutamic oxaloacetic transaminase; GPT: glutamic-pyruvic transaminase; BMI: body mass index; HC: hip circumference; WHR: waist hip ratio; FPI: fasting plasma insulin; 2hPG: 2-hour postprandial glucose; TG: triglycerides; AC: arm circumference; SFA: subcutaneous fat area; VFA: visceral fat area; FINS: fasting serum insulin; PINS: postprandial serum insulin; F-CP: fasting serum C-peptide; P-CP: postprandial serum C-peptide; FFA: free fatty acids; ISI: insulin sensitivity index.</p></fn></table-wrap-foot></table-wrap><table-wrap id="tab3" orientation="portrait" position="float"><label>Table 3</label><caption><p>Summary of findings in this systematic review.</p></caption><table frame="hsides" rules="groups"><thead><tr><th colspan="7" align="left" rowspan="1"> Herbal medicines compared to controls for metabolic syndrome</th></tr></thead><tbody><tr><td colspan="7" align="left" rowspan="1"><italic>Patient or population</italic>: metabolic syndrome </td></tr><tr><td colspan="7" align="left" rowspan="1"><italic>Setting</italic>: outpatient and inpatient </td></tr><tr><td colspan="7" align="left" rowspan="1"><italic>Intervention</italic>: herbal medicines </td></tr><tr><td colspan="7" align="left" rowspan="1"><italic>Comparison</italic>: no treatment, placebo, and western medicines</td></tr><tr><td align="center" colspan="7" rowspan="1"><hr></hr></td></tr><tr><td rowspan="2" align="left" colspan="1">Outcomes</td><td colspan="2" align="center" rowspan="1"> Anticipated absolute effects<sup><italic>∗</italic></sup> (95% CI)</td><td rowspan="2" align="center" colspan="1"> Relative effect (95% CI) </td><td rowspan="2" align="center" colspan="1">Number of participants (studies) </td><td rowspan="2" align="center" colspan="1">Quality of the evidence (grade) </td><td rowspan="2" align="center" colspan="1"> Comments</td></tr><tr><td align="center" rowspan="1" colspan="1">Risk with control</td><td align="center" rowspan="1" colspan="1">Risk with intervention</td></tr><tr><td align="center" colspan="7" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">Fasting plasma glucose (FPG) </td><td align="center" rowspan="1" colspan="1">The mean FPG ranged across control groups from 87 to 260 mg/dL</td><td align="center" rowspan="1" colspan="1">The mean FPG in the intervention groups was 1.37 mg/dL lower (3.12 lower to 0.39 higher)</td><td align="center" rowspan="1" colspan="1">—</td><td align="center" rowspan="1" colspan="1">980 (10 RCTs)</td><td align="center" rowspan="1" colspan="1">⨁⨁◯◯ <break></break>Low<sup>1</sup></td><td align="center" rowspan="1" colspan="1">Lower score indicates less risk of diabetes mellitus.</td></tr><tr><td align="left" rowspan="1" colspan="1">Triglycerides (TG) </td><td align="center" rowspan="1" colspan="1">The mean TG ranged across control groups from 135 to 291 mg/dL</td><td align="center" rowspan="1" colspan="1">The mean TG in the intervention groups was 22.54 mg/dL lower (27.81 lower to 17.27 lower)</td><td align="center" rowspan="1" colspan="1">—</td><td align="left" rowspan="1" colspan="1">980 (10 RCTs)</td><td align="center" rowspan="1" colspan="1">⨁⨁⨁◯ <break></break>Moderate<sup>2</sup></td><td align="center" rowspan="1" colspan="1">Lower score indicates less risk of dyslipidemia.</td></tr><tr><td align="left" rowspan="1" colspan="1">Systolic blood pressure (SBP) </td><td align="center" rowspan="1" colspan="1">The mean SBP ranged across control groups from 122 to 150 mmHg</td><td align="center" rowspan="1" colspan="1">The mean SBP in the intervention groups was 6.76 mmHg lower (7.72 lower to 5.81 lower)</td><td align="center" rowspan="1" colspan="1">—</td><td align="center" rowspan="1" colspan="1">1080 (11 RCTs)</td><td align="center" rowspan="1" colspan="1">⨁⨁⨁◯ <break></break>Moderate<sup>3</sup></td><td align="center" rowspan="1" colspan="1">Lower score indicates less risk of hypertension.</td></tr><tr><td align="left" rowspan="1" colspan="1">Diastolic blood pressure (DBP) </td><td align="center" rowspan="1" colspan="1">The mean DBP ranged across control groups from 72 to 95 mmHg</td><td align="center" rowspan="1" colspan="1">The mean DBP in the intervention groups was 5.23 mmHg lower (4.77 lower to 4.68 lower)</td><td align="center" rowspan="1" colspan="1">—</td><td align="center" rowspan="1" colspan="1">1080 (11 RCTs)</td><td align="center" rowspan="1" colspan="1">⨁⨁⨁◯ <break></break>Moderate<sup>3</sup></td><td align="center" rowspan="1" colspan="1">Lower score indicates less risk of hypertension.</td></tr><tr><td align="left" rowspan="1" colspan="1">Waist circumference (WC) </td><td colspan="2" align="center" rowspan="1">See comment</td><td align="center" rowspan="1" colspan="1">—</td><td align="center" rowspan="1" colspan="1">726 (7 RCTs)</td><td align="center" rowspan="1" colspan="1">⨁⨁◯◯ <break></break>Low</td><td align="center" rowspan="1" colspan="1">Only 2 studies showed WC separated by sex, so risk could not be calculated.</td></tr><tr><td align="left" rowspan="1" colspan="1">High density lipoprotein cholesterol (HDL-C) </td><td colspan="2" align="center" rowspan="1">See comment</td><td align="center" rowspan="1" colspan="1">—</td><td align="center" rowspan="1" colspan="1">860 (9 RCTs)</td><td align="center" rowspan="1" colspan="1">⨁⨁◯◯ <break></break>Low</td><td align="center" rowspan="1" colspan="1">No study showed HDL-C separated by sex, so risk could not be calculated.</td></tr></tbody></table><table-wrap-foot><fn><p><sup><italic>∗</italic></sup>The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).</p></fn><fn><p>CI: confidence interval; MD: mean difference.</p></fn><fn><p><sup>1</sup>Heterogeneity and possible publication bias downgraded quality of the evidence.</p></fn><fn><p><sup>2</sup>Sparse data downgraded quality of the evidence.</p></fn><fn><p><sup>3</sup>Heterogeneity downgraded quality of the evidence.</p></fn></table-wrap-foot></table-wrap><table-wrap id="tab4" orientation="portrait" position="float"><label>Table 4</label><caption><p>Estimate effects of herbal medicines for metabolic syndrome: differences of values before and after treatment.</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1">Intervention </th><th align="center" rowspan="1" colspan="1">Study ID</th><th align="center" rowspan="1" colspan="1">WC</th><th align="center" rowspan="1" colspan="1">BMI</th><th align="center" rowspan="1" colspan="1">FPG</th><th align="center" rowspan="1" colspan="1">2 hPG</th><th align="center" rowspan="1" colspan="1">TG</th><th align="center" rowspan="1" colspan="1">HDL-C</th><th align="center" rowspan="1" colspan="1">SBP</th><th align="center" rowspan="1" colspan="1">DBP</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">Dia-No</td><td align="center" rowspan="1" colspan="1">Agrawal et al., 2008 [<xref rid="B14" ref-type="bibr">13</xref>]</td><td align="center" rowspan="1" colspan="1">+0.02</td><td align="center" rowspan="1" colspan="1">−0.18<sup><italic>∗</italic></sup></td><td align="center" rowspan="1" colspan="1">−41.15<sup><italic>∗</italic></sup></td><td align="center" rowspan="1" colspan="1">NR</td><td align="center" rowspan="1" colspan="1">−10.59<sup><italic>∗</italic></sup></td><td align="center" rowspan="1" colspan="1">+1.12</td><td align="center" rowspan="1" colspan="1">−2.29<sup><italic>∗</italic></sup></td><td align="center" rowspan="1" colspan="1">−1.23<sup><italic>∗</italic></sup></td></tr><tr><td align="left" rowspan="1" colspan="1">Yiqi Huaju Recipe</td><td align="center" rowspan="1" colspan="1">Chen et al., 2014 [<xref rid="B15" ref-type="bibr">14</xref>]</td><td align="center" rowspan="1" colspan="1">−4.68<sup><italic>∗</italic></sup></td><td align="center" rowspan="1" colspan="1">−1.51<sup><italic>∗</italic></sup></td><td align="center" rowspan="1" colspan="1">−7.02<sup>#</sup></td><td align="center" rowspan="1" colspan="1">−29.34<sup><italic>∗</italic></sup></td><td align="center" rowspan="1" colspan="1">−7.12</td><td align="center" rowspan="1" colspan="1">+1.93</td><td align="center" rowspan="1" colspan="1">−11.32<sup><italic>∗</italic></sup></td><td align="center" rowspan="1" colspan="1">−6.5<sup><italic>∗</italic></sup></td></tr><tr><td align="left" rowspan="1" colspan="1">Daotan decoction</td><td align="center" rowspan="1" colspan="1">Zhang et al., 2014 [<xref rid="B16" ref-type="bibr">15</xref>]</td><td align="center" rowspan="1" colspan="1">−2.98<sup><italic>∗</italic></sup></td><td align="center" rowspan="1" colspan="1">−0.49<sup><italic>∗</italic></sup></td><td align="center" rowspan="1" colspan="1">−2.52</td><td align="center" rowspan="1" colspan="1">NR</td><td align="center" rowspan="1" colspan="1">−28.48<sup><italic>∗</italic></sup></td><td align="center" rowspan="1" colspan="1">+2.32<sup><italic>∗</italic></sup></td><td align="center" rowspan="1" colspan="1">−7.43<sup><italic>∗</italic></sup></td><td align="center" rowspan="1" colspan="1">−2.28<sup><italic>∗</italic></sup></td></tr><tr><td align="left" rowspan="1" colspan="1">Gegen Shanzha decoction</td><td align="center" rowspan="1" colspan="1">Xu et al., 2014 [<xref rid="B17" ref-type="bibr">16</xref>]</td><td align="center" rowspan="1" colspan="1">−5.31<sup><italic>∗</italic></sup></td><td align="center" rowspan="1" colspan="1">−2.69<sup><italic>∗</italic></sup></td><td align="center" rowspan="1" colspan="1">−21.42<sup><italic>∗</italic></sup></td><td align="center" rowspan="1" colspan="1">NR</td><td align="center" rowspan="1" colspan="1">−99.68<sup><italic>∗</italic></sup></td><td align="center" rowspan="1" colspan="1">+18.91<sup><italic>∗</italic></sup></td><td align="center" rowspan="1" colspan="1">−19.66<sup><italic>∗</italic></sup></td><td align="center" rowspan="1" colspan="1">−10.5<sup><italic>∗</italic></sup></td></tr><tr><td align="left" rowspan="1" colspan="1">Xuefu Zhuyu decoction</td><td align="center" rowspan="1" colspan="1">Li, 2014 [<xref rid="B18" ref-type="bibr">17</xref>]</td><td align="center" rowspan="1" colspan="1">NR</td><td align="center" rowspan="1" colspan="1">NR</td><td align="center" rowspan="1" colspan="1">NR</td><td align="center" rowspan="1" colspan="1">NR</td><td align="center" rowspan="1" colspan="1">NR</td><td align="center" rowspan="1" colspan="1">NR</td><td align="center" rowspan="1" colspan="1">NR</td><td align="center" rowspan="1" colspan="1">NR</td></tr><tr><td align="left" rowspan="1" colspan="1">Qinggan Jiangtang tablet</td><td align="center" rowspan="1" colspan="1">Wang et al., 2005 [<xref rid="B19" ref-type="bibr">18</xref>]</td><td align="center" rowspan="1" colspan="1">NR</td><td align="center" rowspan="1" colspan="1">NR</td><td align="center" rowspan="1" colspan="1">−28.8<sup>#</sup></td><td align="center" rowspan="1" colspan="1">−52.2<sup>#</sup></td><td align="center" rowspan="1" colspan="1">−12.46<sup><italic>∗</italic></sup></td><td align="center" rowspan="1" colspan="1">+2.70</td><td align="center" rowspan="1" colspan="1">−7.5<sup><italic>∗</italic></sup></td><td align="center" rowspan="1" colspan="1">−2.9<sup><italic>∗</italic></sup></td></tr><tr><td align="left" rowspan="1" colspan="1">Modified Banxia Baizhu Tianma decoction</td><td align="center" rowspan="1" colspan="1">Liu et al., 2008 [<xref rid="B20" ref-type="bibr">19</xref>]</td><td align="center" rowspan="1" colspan="1">−0.91</td><td align="center" rowspan="1" colspan="1">−0.74<sup>#</sup></td><td align="center" rowspan="1" colspan="1">−7.02<sup><sup>#</sup></sup></td><td align="center" rowspan="1" colspan="1">−19.08<sup>#</sup></td><td align="center" rowspan="1" colspan="1">−23.14<sup><italic>∗</italic></sup></td><td align="center" rowspan="1" colspan="1">+7.72<sup><italic>∗</italic></sup></td><td align="center" rowspan="1" colspan="1">−4.38<sup><italic>∗</italic></sup></td><td align="center" rowspan="1" colspan="1">−3.23<sup><italic>∗</italic></sup></td></tr><tr><td align="left" rowspan="1" colspan="1">Pinggan Jiangya pill</td><td align="center" rowspan="1" colspan="1">Zhang et al., 2010 [<xref rid="B21" ref-type="bibr">20</xref>]</td><td align="center" rowspan="1" colspan="1">−7.81<sup><italic>∗</italic></sup></td><td align="center" rowspan="1" colspan="1">−2.95<sup><italic>∗</italic></sup></td><td align="center" rowspan="1" colspan="1">NR</td><td align="center" rowspan="1" colspan="1">NR</td><td align="center" rowspan="1" colspan="1">NR</td><td align="center" rowspan="1" colspan="1">NR</td><td align="center" rowspan="1" colspan="1">−28.00<sup><italic>∗</italic></sup></td><td align="center" rowspan="1" colspan="1">−14.33<sup><italic>∗</italic></sup></td></tr><tr><td align="left" rowspan="1" colspan="1">Huanglian Wendan decoction</td><td align="center" rowspan="1" colspan="1">Guan et al., 2012 [<xref rid="B22" ref-type="bibr">21</xref>]</td><td align="center" rowspan="1" colspan="1">NR</td><td align="center" rowspan="1" colspan="1">−1.95<sup>#</sup></td><td align="center" rowspan="1" colspan="1">−27.54<sup>#</sup></td><td align="center" rowspan="1" colspan="1">NR</td><td align="center" rowspan="1" colspan="1">−62.3<sup><italic>∗</italic></sup></td><td align="center" rowspan="1" colspan="1">+11.19<sup><italic>∗</italic></sup></td><td align="center" rowspan="1" colspan="1">−10.73<sup><italic>∗</italic></sup></td><td align="center" rowspan="1" colspan="1">−8.24<sup><italic>∗</italic></sup></td></tr><tr><td align="left" rowspan="1" colspan="1">Xueguan Ruanhua decoction</td><td align="center" rowspan="1" colspan="1">Dong, 2012 [<xref rid="B23" ref-type="bibr">22</xref>]</td><td align="center" rowspan="1" colspan="1">NR</td><td align="center" rowspan="1" colspan="1">NR</td><td align="center" rowspan="1" colspan="1">−6.12</td><td align="center" rowspan="1" colspan="1">NR</td><td align="center" rowspan="1" colspan="1">−30.26<sup><italic>∗</italic></sup></td><td align="center" rowspan="1" colspan="1">+15.83<sup><italic>∗</italic></sup></td><td align="center" rowspan="1" colspan="1">−8.75<sup><italic>∗</italic></sup></td><td align="center" rowspan="1" colspan="1">−9.33<sup><italic>∗</italic></sup></td></tr><tr><td align="left" rowspan="1" colspan="1">Shengjiangtongmai powder</td><td align="center" rowspan="1" colspan="1">Cui and Wie, 2014 [<xref rid="B24" ref-type="bibr">23</xref>]</td><td align="center" rowspan="1" colspan="1">NR</td><td align="center" rowspan="1" colspan="1">−2.52</td><td align="center" rowspan="1" colspan="1">−82.08<sup><italic>∗</italic></sup></td><td align="center" rowspan="1" colspan="1">NR</td><td align="center" rowspan="1" colspan="1">−89.89<sup><italic>∗</italic></sup></td><td align="center" rowspan="1" colspan="1">NR</td><td align="center" rowspan="1" colspan="1">30<sup><italic>∗</italic></sup></td><td align="center" rowspan="1" colspan="1">15<sup><italic>∗</italic></sup></td></tr><tr><td align="left" rowspan="1" colspan="1">Shenling Jianpihuashi decoction</td><td align="center" rowspan="1" colspan="1">Danyang Zhao and Danun Zhao, 2015 [<xref rid="B25" ref-type="bibr">24</xref>]</td><td align="center" rowspan="1" colspan="1">−7.2<sup><italic>∗</italic></sup></td><td align="center" rowspan="1" colspan="1">−2.7<sup>#</sup></td><td align="center" rowspan="1" colspan="1">−16.2<sup>#</sup></td><td align="center" rowspan="1" colspan="1">−34.2<sup>#</sup></td><td align="center" rowspan="1" colspan="1">−71.2<sup><italic>∗</italic></sup></td><td align="center" rowspan="1" colspan="1">+3.86</td><td align="center" rowspan="1" colspan="1">−11.6<sup>#</sup></td><td align="center" rowspan="1" colspan="1">−9.3<sup>#</sup></td></tr></tbody></table><table-wrap-foot><fn><p><sup><italic>∗</italic></sup>Significant difference between intervention and control group (<italic>P</italic> < 0.05).</p></fn><fn><p><sup>#</sup>Significant difference before and after treatment (<italic>P</italic> < 0.05).</p></fn><fn><p>WC: waist circumference; BMI: body mass index; FPG: fasting plasma glucose; 2 hPG: 2-hour postprandial glucose; TG: triglycerides; HDL-C: high density lipoprotein cholesterol; SBP: systolic blood pressure; DBP: diastolic blood pressure.</p></fn></table-wrap-foot></table-wrap><table-wrap id="tab5" orientation="portrait" position="float"><label>Table 5</label><caption><p>Compositions of herbal medicines and adverse events in the included RCTs.</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1">Intervention </th><th align="center" rowspan="1" colspan="1">Study ID</th><th align="center" rowspan="1" colspan="1">Compositions</th><th align="center" rowspan="1" colspan="1">Formulation</th><th align="center" rowspan="1" colspan="1">Adverse events</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">Dia-No</td><td align="center" rowspan="1" colspan="1">Agrawal et al., 2008 [<xref rid="B14" ref-type="bibr">13</xref>]</td><td align="center" rowspan="1" colspan="1"><italic>Syzygium cumini </italic>20%,<italic> Gymnema sylvestre </italic>20%,<break></break><italic>Trigonella foenumgraecum 14%, Emblica officinalis 10%, Azadirachta indica 7%, Cassia auriculata 7%, Tribulus terrestris 7%, Andrographis paniculata 5%, Pterocarpus marsupium 5%</italic>, and<italic> Momordica charantia </italic>5%</td><td align="center" rowspan="1" colspan="1">Tablet</td><td align="center" rowspan="1" colspan="1">Nausea 2, vomiting 1, loss of appetite 2, and burning epigastrium 1 in intervention group</td></tr><tr><td align="center" colspan="5" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">Yiqi Huaju Recipe</td><td align="center" rowspan="1" colspan="1">Chen et al., 2014 [<xref rid="B15" ref-type="bibr">14</xref>]</td><td align="center" rowspan="1" colspan="1"><italic>Astragalus membranaceus, Coptis chinensis, Typha orientalis, Alisma canaliculatum, Artemisia capillaris, </italic>and so forth</td><td align="center" rowspan="1" colspan="1">Decoction</td><td align="center" rowspan="1" colspan="1">Skin hypersensitivity 2 in intervention group</td></tr><tr><td align="center" colspan="5" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">Daotan decoction</td><td align="center" rowspan="1" colspan="1">Zhang et al., 2014 [<xref rid="B16" ref-type="bibr">15</xref>]</td><td align="center" rowspan="1" colspan="1"><italic>Pinellia ternata </italic>10 g<italic>, Arisaema erubescens </italic>Schott 5 g<italic>, Citrus reticulata </italic>10 g<italic>, Citrus sinensis </italic>10 g<italic>, Poria cocos</italic> 15 g,<break></break><italic>Zingiber officinale </italic>5 g, and<italic> Glycyrrhiza uralensis</italic> 5 g</td><td align="center" rowspan="1" colspan="1">Decoction</td><td align="center" rowspan="1" colspan="1">Not reported</td></tr><tr><td align="center" colspan="5" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">Gegen Shanzha decoction</td><td align="center" rowspan="1" colspan="1">Xu et al., 2014 [<xref rid="B17" ref-type="bibr">16</xref>]</td><td align="center" rowspan="1" colspan="1"><italic>Pueraria montana</italic> and <italic>Crataegus pinnatifida </italic>Bunge each 10~20 g (1 : 1)</td><td align="center" rowspan="1" colspan="1">Decoction</td><td align="center" rowspan="1" colspan="1">Not reported</td></tr><tr><td align="center" colspan="5" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">Xuefu Zhuyu decoction</td><td align="center" rowspan="1" colspan="1">Li, 2014 [<xref rid="B18" ref-type="bibr">17</xref>]</td><td align="center" rowspan="1" colspan="1"><italic>Prunus persica </italic>(L.) Batsch 9 g<italic> Carthamus tinctorius</italic> 9 g,<italic> Rehmannia glutinosa</italic> 9 g, <italic>Ligusticum officinale</italic> Kitag. 5 g, <italic>Angelica sinensis </italic>9 g,<break></break><italic>Paeonia lactiflora </italic>Pallas 6 g, <italic>Achyranthes japonica</italic> Nakai 9 g, <italic>Platycodon grandiflorum </italic>5 g, <italic>Bupleurum falcatum</italic> 3 g,<break></break><italic>Citrus aurantium</italic> L. 6 g, and <italic>Glycyrrhiza uralensis</italic> 3 g</td><td align="center" rowspan="1" colspan="1">Decoction</td><td align="center" rowspan="1" colspan="1">Not reported</td></tr><tr><td align="center" colspan="5" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">Qinggan Jiangtang tablet</td><td align="center" rowspan="1" colspan="1">Wang et al., 2005 [<xref rid="B19" ref-type="bibr">18</xref>]</td><td align="center" rowspan="1" colspan="1"><italic>Bupleurum falcatum</italic> 8 g, <italic>Gardenia jasminoides</italic> 10 g, <italic>Coptis chinensis</italic> 4 g, <italic>Scutellaria baicalensis</italic> 8 g, <italic>Rehmannia glutinosa</italic> 15 g,<break></break><italic>Lilium longiflorum</italic> 20 g, <italic>Anemarrhena asphodeloides</italic> Bunge 10 g,<break></break>pollen 20 g, <italic>Gastrodia elata</italic> Blume 10 g, and <italic>Cassia occidentalis</italic> L. 20 g</td><td align="center" rowspan="1" colspan="1">Tablet</td><td align="center" rowspan="1" colspan="1">Not reported</td></tr><tr><td align="center" colspan="5" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">Modified Banxia Baizhu Tianma decoction</td><td align="center" rowspan="1" colspan="1">Liu et al., 2008 [<xref rid="B20" ref-type="bibr">19</xref>]</td><td align="center" rowspan="1" colspan="1"><italic>Pinellia ternata</italic> 9 g, <italic>Gastrodia elata</italic> Blume 6 g, <italic>Pueraria montana</italic> 20 g,<break></break><italic>Atractylodes macrocephala</italic> Koidzumi 15 g, <italic>Alisma canaliculatum</italic> 30 g,<break></break><italic>Pleuropterus multlforus</italic> 15 g, <italic>Crataegus pinnatifida</italic> Bunge 15 g,<break></break><italic>Salviae miltiorrhizae</italic> Radix 25 g, <italic>Astragalus membranaceus</italic> 30 g,<break></break><italic>Poria cocos</italic> 15 g, <italic>Cassia obtusifolia </italic>L. 15 g, and <italic>Citrus reticulata</italic> 10 g,</td><td align="center" rowspan="1" colspan="1">Decoction</td><td align="center" rowspan="1" colspan="1">Not reported </td></tr><tr><td align="center" colspan="5" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">Pinggan Jiangya pill</td><td align="center" rowspan="1" colspan="1">Zhang et al., 2010 [<xref rid="B21" ref-type="bibr">20</xref>]</td><td align="center" rowspan="1" colspan="1"><italic>Prunella vulgaris</italic> 24 g<italic>, Uncaria rhynchophylla </italic>20 g<italic>, Saiga tataria </italic>L. 2 g, <italic>Folium ilicis</italic> (Kuding tea) 10 g,<break></break><italic>Sophora japonica</italic> L. 10 g, <italic>Pteria martensii </italic>30 g,<break></break><italic>Tribulus terrestris </italic>L. 20 g, magnetitum 20 g, <italic>Scutellaria baicalensis</italic> 15 g, <italic>Cassia obtusifolia</italic> L. 20 g, <italic>Achyranthes japonica </italic>Nakai 15 g</td><td align="center" rowspan="1" colspan="1">Pill</td><td align="center" rowspan="1" colspan="1">Facial flush 4 in control group</td></tr><tr><td align="center" colspan="5" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">Huanglian Wendan decoction</td><td align="center" rowspan="1" colspan="1">Guan et al., 2012 [<xref rid="B22" ref-type="bibr">21</xref>]</td><td align="center" rowspan="1" colspan="1"><italic>Coptis chinensis</italic>, <italic>Pinellia ternata</italic>, <italic>Citrus reticulata, Poria cocos, Pueraria montana, Cassia obtusifolia</italic> L., <italic>Astragalus membranaceus, Phyllostachys bambusoides </italic>Sieb. et Zucc.,<italic> Salviae miltiorrhizae </italic>Radix, and<italic> Glycyrrhiza uralensis</italic></td><td align="center" rowspan="1" colspan="1">Decoction</td><td align="center" rowspan="1" colspan="1">Gastrointestinal disorder 1 in intervention group, abdominal pain and vomiting 4, and weakness 1 in control group</td></tr><tr><td align="center" colspan="5" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">Xueguan Ruanhua decoction</td><td align="center" rowspan="1" colspan="1">Dong, 2012 [<xref rid="B23" ref-type="bibr">22</xref>]</td><td align="center" rowspan="1" colspan="1"><italic>Taxillus chinensis, Apocynum cannabinum, Angelica sinensis, Paeonia lactiflora</italic> Pallas, <italic>Ligusticum officinale</italic> Kitag.,<break></break><italic>Gastrodia elata </italic>Blume, <italic>Eucommia ulmoides </italic>Oliver,<break></break><italic>Salviae miltiorrhizae </italic>Radix, <italic>Vitex rotundifolia</italic> L.,<break></break><italic>Chrysanthemum morifolium, Hirudo nipponica </italic>Whitman, mulberry leaf, <italic>Coptis chinensis</italic>, <italic>Pueraria montana, Fritillaria cirrhosa</italic> D. Don, and so forth</td><td align="center" rowspan="1" colspan="1">Decoction</td><td align="center" rowspan="1" colspan="1">Nausea and vomiting 2, hypoglycemia 1, and hypotension 3 in control group</td></tr><tr><td align="center" colspan="5" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">Shengjiangtongmai powder</td><td align="center" rowspan="1" colspan="1">Cui and Wie, 2014 [<xref rid="B24" ref-type="bibr">23</xref>]</td><td align="center" rowspan="1" colspan="1"><italic>Bombyx mori </italic>10 g<italic>, Cryptotympana coreana </italic>10 g<italic>, Curcuma longa </italic>9 g, <italic>Rheum palmatum </italic>12 g,<italic> Coptis chinensis </italic>6 g,<break></break><italic>Panax quinquefolius </italic>25 g<italic>, Atractylodes japonica </italic>15 g,<break></break><italic>Pinellia ternata </italic>12 g,<italic> Trichosanthes kirilowii </italic>Maxim.15 g</td><td align="center" rowspan="1" colspan="1">Decoction</td><td align="center" rowspan="1" colspan="1">Not reported</td></tr><tr><td align="center" colspan="5" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">Shenling Jianpihuashi decoction</td><td align="center" rowspan="1" colspan="1">Danyang Zhao and Danun Zhao, 2015 [<xref rid="B25" ref-type="bibr">24</xref>]</td><td align="center" rowspan="1" colspan="1"><italic>Codonopsis tangshen</italic> Oliver 15 g, <italic>Astragalus membranaceus</italic> 15 g,<break></break><italic>Poria cocos</italic> 15 g, <italic>Atractylodes macrocephala </italic>Koidzumi 15 g, <italic>Dioscorea opposita</italic> 15 g, <italic>Coixlachrymajobi </italic>var. mayuen 15 g, <italic>Amomum xanthioides</italic> 6 g, <italic>Nelumbo nucifera </italic>10 g, <italic>Alisma canaliculatum</italic> 15 g, and <italic>Panax notoginseng</italic> 3 g</td><td align="center" rowspan="1" colspan="1">Decoction</td><td align="center" rowspan="1" colspan="1">Gastrointestinal disorder 2 in control group</td></tr></tbody></table></table-wrap></floats-group></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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