REVIEW

Chinese herbal medicine for atopic dermatitis:

A systematic review
Hsiewe Ying Tan, BAppSci,a Anthony Lin Zhang, PhD,a DaCan Chen, PhD,b Charlie Changli Xue, PhD,a,b
and George Binh Lenon, PhDa
Bundoora, Australia, and Guangzhou, China

Background: Atopic dermatitis (AD) is a chronic, itching skin disease, and conventional therapies offer
inadequate symptom management. Patients with AD are increasingly turning to Chinese medicine.

Objective: We systematically evaluated the clinical evidence of the efficacy and safety of oral Chinese
herbal medicine for AD.

Methods: Searches were conducted on major electronic databases using the following key words:
randomized controlled trials, atopic dermatitis, traditional Chinese medicine, traditional East Asian
medicine, herbal medicine, Chinese herbal drugs, medicinal plants, phytotherapy, Kampo
medicine, and Korean traditional medicine. The results were screened to include English/Chinese
randomized controlled trials. A metaanalysis was conducted on suitable outcome measures.

Results: Seven randomized controlled trials were included (1 comparing Chinese herbal medicine and
Western medicine with Western medicine alone; 6 comparing Chinese herbal medicine with placebo).
Combined Chinese herbal medicine with Western medicine was superior to Western medicine alone. Three
placebo controlled trials showed significant treatment efficacy and 2 showed significantly reduced
concurrent therapy with Chinese herbal medicine. No abnormalities in safety profile or severe adverse
events were reported.

Limitations: A metaanalysis of all included studies could not be conducted because of study
heterogeneity.

Conclusions: Chinese herbal medicine significantly improved symptom severity of AD and was reported
as well tolerated. However, the poor quality of studies did not allow for valid conclusions to support its
tolerability and routine use. Additional studies addressing the methodologic issues are warranted
to determine the therapeutic benefit of Chinese herbal medicine for AD. ( J Am Acad Dermatol
2013;69:295-304.)

Key words: allergy; alternative and complementary medicine; atopic dermatitis; Chinese herbal medicine;
eczema; systematic review.

A topic dermatitis (AD) is a chronic, inflamma- redness and dryness, weeping, scarring, and lichen-
tory skin disease that affects approximately ification.2,3 AD impacts activities of daily living and
15% to 30% of children and 2% to 10% of increases financial burden of patients and their
adults.1 It is characterized by severe itching, skin carers.4 In the United Kingdom, the annual

From the Traditional and Complementary Medicine Research Reprint requests: George Binh Lenon, PhD, Traditional and
Program,a Health Innovations Research Institute, School of Complementary Medicine Research Program, Health
Health Sciences, Royal Melbourne Institute of Technology Innovations Research Institute, School of Health Sciences,
University, Bundoora Campus, Victoria, Australia, and the RMIT University, Bundoora, VIC 3083, Australia. E-mail: george.
Guangdong Provincial Hospital of Chinese Medicine,b lenon@rmit.edu.au.
Guangzhou, China. Published online June 6, 2013.
Supported by the Guangdong Provincial Academy of Chinese 0190-9622/$36.00
Medical Sciences, Guangdong Provincial Hospital of Chinese 2013 by the American Academy of Dermatology, Inc.
Medicine, China. http://dx.doi.org/10.1016/j.jaad.2013.01.019
Conflicts of interest: None declared.

295
296 Tan et al J AM ACAD DERMATOL
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expenditure on AD was approximately 465 million5; Study selection criteria

in the United States, the national direct costs ranged RCTs with the following criteria were included:
from $364 million to $3.8 billion USD.6 In Australia, published English or Chinese RCTs; diagnosis of AD
the annual personal financial costs ranged from $330 (or atopic eczema) using clinical diagnosis or vali-
to $1255 AUD, and is said to be greater than the dated diagnostic criteria; diagnosis of eczema was
management costs of asthma.7 only accepted when referring to children/infants;
The exact pathophysiology of AD has not placebo, no treatment or non-Chinese medicine
been fully elucidated, and treatments as control inter-
there is currently no cure. ventions; non-Chinese medi-
Symptomatic management CAPSULE SUMMARY
cine cointerventions were
has been the focus of man- accepted only if it was ap-
d Previous reviews on Chinese medicine
agement,8 involving the plied to all groups; and $ 1
for atopic dermatitis were inconclusive.
long-term use of topical cor- of the following outcome
Clinical trials examining the safety and
ticosteroids and calcineurin measures: (1) disease/symp-
efficacy of Chinese medicine for atopic
inhibitors. However, these tom severity scoring and (2)
dermatitis have since been conducted
treatments have been associ- quality of life. Concurrent
but have yet to be systematically
ated with adverse events9,10 therapies, adverse events,
reviewed.
and the development of drug and safety profiles were re-
tolerance.11 d
A metaanalysis revealed significant corded as secondary out-
Consequently, patients improvement in symptom severity and come measures. Studies
frequently seek other thera- quality of life, but the quality of studies involving other forms of
peutic options, such as was poor. TCM therapy (eg, acupunc-
Chinese herbal medicine d
Patients can potentially reduce steroid ture and topical CHM) or
(CHM).12 CHM is part of tra- therapy use with the help of Chinese dermatitis (eg, neuroderma-
ditional Chinese medicine medicine and subsequently reduce the titis and contact dermatitis)
(TCM) therapy, whereby in- occurrence of related side effects. were excluded.
quiry of the condition and
observation of the patient Data extraction and risk
leads to the TCM diagnosis and treatment. Two of bias assessment
previously published systematic reviews on CHM Two independent reviewers extracted the data of
for AD were inconclusive,8,13 and the current state of included studies onto the Cochrane Skin Group data
evidence of CHM treatment of AD remains un- extraction form and conducted a risk of bias assess-
known.4,13,14 The different pathways of medication ment using the Cochrane Collaborations tool for
administration affect treatment actions and indica- assessing risk of bias16 (Fig 1). The metaanalysis was
tions; oral and topical CHM are therefore considered conducted in RevMan5. For CHM and Western med-
different interventions.15 This systematic review aims icine (WM) compared with WM only, the metaanal-
to evaluate the published randomized controlled ysis was performed on overall clinical scores. For
trials (RCTs) on the safety and efficacy of treatment of CHM compared with placebo, the metaanalysis
AD with orally administered CHM compared with was conducted on disease or symptom severity
placebo, pharmacotherapy, or no treatment. scores, quality of life, and reduction in concurrent
treatments.
METHODS
Protocol RESULTS
This systematic review was not registered with the Description of studies
Cochrane Collaboration but was conducted with The searches yield a total of 1014 articles. After
reference to the Cochrane Handbook.16 Electronic screening titles and abstracts, duplicates, non-
searches were carried out on the following databases: English or Chinese articles, animal or immunologic
CINAHL, Cochrane Library, Embase, ProQuest, studies, studies not involving AD or CHM, and non-
PubMed, ScienceDirect, Scopus, Web of Science, VIP RCTs were excluded. Two hundred eighty-one full
Database for Chinese Technical Periodicals (CQVIP), articles were retrieved for further evaluation. Seven
and China National Knowledge Infrastructure studies were included for qualitative analysis (Fig 2).
(CNKI). All databases were searched from their incep- One study was excluded from the metaanalysis
tion to 2011. The search terms were a combination of because of insufficient data. The 6 studies in the
Medical Subject Heading terms and their synonyms metaanalysis included a total of 432 participants
(Table I). with AD.
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Table I. Example for search strategy (in PubMed) Pentaherb with an identical-looking placebo con-
No. Search term Hits*
taining corn starch and caramel22; 1 study compared
Xiao Feng San with a placebo made of caramel,
1 Randomized controlled trial (publication 315,419
lactose, and starch18; and the fifth study compared
type)
2 Randomized controlled trials as topic 75,706 Hochu-ekki-to with placebo, with no details of
(MeSH) placebo content.10 The authors of the Pentaherb
3 Dermatitis, atopic (MeSH) 12,635 trial22 provided raw data for analysis. The Hochu-
4 Medicine, Chinese traditional (MeSH) 9495 ekki-to trial presented results in graphs only10; con-
5 Medicine, East Asian traditional (MeSH) 11,336 sequently, estimate figures from the graphs were
6 Herbal medicine (MeSH) 1,116 used in analysis.
7 Drugs, Chinese herbal (MeSH) 22,232 Primary outcome measures. Disease/symp-
8 Plants, medicinal (MeSH) 48,114 tom severity scoring. Three studies reported overall
9 Phytotherapy (MeSH) 23,989 clinical scores1 used the validated Scoring Atopic
10 Medicine, Kampo (MeSH) 353
Dermatitis (SCORAD) instrument,22 another used the
11 Medicine, Korean traditional (MeSH) 115
scoring system by the Atopic Dermatitis Severity
12 Terms 1 or 2 385,792
13 Terms 4 or 5 or 6 or 7 or 8 or 9 or 10 or 11 93,361 Evaluation Committee of Japanese Dermatological
14 Terms 3 and 12 and 13 28 Association,10 and the third study used a standard-
ized scoring system calculating the extent and sever-
MeSH, Medical Subject Heading. ity of dermatitis.18 The former 2 studies presented
*As of December 19, 2011. results as means and standard deviations, and the
latter study presented the scores as least-square
Table II summarizes the studies characteristics. means. Only 1 trial showed significant improvement
Table III summarizes the diagnoses, interventions, in overall clinical score by CHM compared to pla-
and outcome measures. One study was a single cebo.18 Because of the heterogeneity of instruments,
blinded RCT comparing WM with CHM (Jian Pi Shen metaanalysis of overall clinical scores could not be
Shi granules) with WM alone17; 6 studies were conducted.
placebo controlled, double blinded RCTs (1 used Three studies18,20,21 used a standardized scoring
Xiao Feng San,18 3 used the formula from the study system to calculate the extent and severity of ery-
by Sheehan et al,19-21 1 applied a Pentaherb for- thema and surface damage. Erythema and surface
mula,22 and 1 used Hochu-ekki-to10). The ingredi- damage scores were presented as least-squares
ents of each formula are listed in Table IV. Only 2 means, percentage of median change, and geometric
RCTs included TCM diagnosis,10,17 and 1 measured mean, respectively. The metaanalysis of erythema
quality of life.22 scores (standard mean difference, 0.76; 95% con-
fidence interval [CI], 1.05 to 0.47; P \.00001) and
surface damage scores (standard mean difference,
CHM and WM combination compared to WM 1.08; 95% CI, 1.59 to 0.56; P\.0001) favor CHM
alone compared to placebo (Fig 3).
Only one study compared a combination of CHM One trial reported pruritus score.18 A significant
and WM treatment to WM alone.17 difference was seen in CHM treatment compared to
Primary outcome measure. Disease/symp- placebo (mean difference [MD], 1.10; 95% CI,
tom severity scoring. The overall clinical score was 1.59 to 0.61; P \ .0001). In a crossover trial by
calculated by summing the severity score (0-3) of Sheehan et al,21 out of 31 participants, 14 reported
each symptom (ie, itch, erythema, papules, exuda- improvement in itching during CHM treatment and
tion, erosion, infiltration, lichenification, dryness). A 1 during the placebo phase.
significant difference was shown in the end score Cheng reported that CHM significantly improved
(mean difference [MD], 2.56; 95% confidence in- sleep scores when compared with placebo (MD,
terval [CI], 3.46 to 1.66; P \.00001), favoring the 0.80; 95% CI, 1.12 to 0.48; P \ .00001).18 Two
combination treatment. other studies reported sleep improvement.20,21 In the
former study, out of 37 participants, 19 had improved
CHM compared to Placebo sleep during CHM treatment and 3 during placebo
Five studies compared CHM with placebo. Two treatment; in the latter study, out of 31 participants,
studies compared the formula used by Sheehan 15 experienced improved sleep with CHM and 6 with
et al21 with a placebo of inert plant materials of placebo.
similar appearance, taste, and smell, but without Quality of life. One study measured quality of
known benefits to AD20,21; another study compared life.22 The metaanalysis found that CHM significantly
298 Tan et al J AM ACAD DERMATOL
AUGUST 2013

One study reported 2 cases of mild transient gas-

trointestinal upset during CHM treatment.18 Three
studies10,21,22 reported the occurrence of mild or
moderate side effects, such as gastrointestinal upset,
various dermatoses (including new rash, hives, acne
pustulosa, and facial herpes), and dizziness in both
the treatment and control groups. One study in
children required participants parents to complete a
questionnaire relating to adverse effects but did not
report the occurrence of any adverse events.20

DISCUSSION
Results from the metaanalysis revealed significant
improvement in disease severity scores by the com-
bination treatment of CHM and WM compared with
WM alone (P \ .00001). When compared with
placebo, CHM revealed significant improvement in
erythema (P \.00001), surface damage (P \.0001),
pruritus (P \ .0001), sleep scores (P \ .00001), and
quality of life (P \ .05). CHM also significantly
reduced the need for concurrent pharmacotherapy
(P \.00001).
The overall risk of bias assessment found that the
quality of studies was poor; therefore, the results
from the metaanalysis have to be translated with
caution. Only 1 study was judged with low risk in
all domains for bias assessment,18 while the other
studies had unclear or high risk judgments
in $ 1 domains.10,17,19-22 In the study comparing
CHM and WM with WM alone, despite being labeled
Fig 1. Summary of risk of bias assessment. as a single blind trial, there were no details on
blinding. Aside from selective reporting and a lack of
details regarding random sequence generation and
improved Childrens Dermatology Life Quality Index allocation concealment, the main flaw was the lack
(CDLQI) compared to placebo (MD, 2.50; 95% of intention to treat (ITT) analysis, leading to incom-
CI, 4.77 to 0.23; P \.05). plete outcome data. ITT analysis stresses that any
Secondary outcome measures. Concurrent exclusions from analysis would affect the compara-
treatment. Kobayashi et al10 measured the effects of bility generated through randomization between
CHM on the amount of concurrent topical treatments groups.23 In addition, dropouts may reflect a flaw
used by participants during the trial. At the end of the of the intervention.24 The 4 studies with high risk in
study, the total equivalent amount of topical agents this domain had exclusions likely related to the
used was significantly lower in the CHM group intervention, such as side effects, noncompliance,
compared to the placebo group (MD, 24.50; 95% and the use of prescribed drugs.10,17,20,21 One study
CI, 27.92 to 21.08; P \ .00001). In the study by that excluded 2 participants at baseline because of
Hon et al,22 the amount of topical mometasone family objections18 was considered low risk because
furoate used at the end of the trial was significantly the withdrawals were not related to the intervention.
lower in the CHM group (P = .024) compared to the Two previous systematic reviews evaluating CHM
placebo group.22 for AD focused on the clinical evidence of the
Safety profile and adverse events. Out of the formula used by Sheehan et al.21 The conflicting
included studies, 1 study did not evaluate safety profile evidence with regard to the efficacy of the formula
and occurrence of adverse events.17 In the other used by Sheehan et al21 was said to be related to the
studies, no significant differences in safety profiles variance in dosage, dropout rates, or racial variability
were reported. However, there was 1 case of transient in drug responsiveness.8 In addition, the investiga-
elevation in aspartate aminotransferase that was tors did not provide details on the chemical proper-
reversed within 8 weeks of treatment cessation.18 ties of the herbal placebo; its similar smell and taste
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VOLUME 69, NUMBER 2

Fig 2. Study selection process. CHM, Chinese herbal medicine; TCM, traditional Chinese
medicine.

to the active treatment indicates a possibility of In contrast, 2 trials found no significant difference
containing similar chemical properties and, subse- in clinical scores. The lack of efficacy in the study by
quently, similar or other pharmacologic actions. Hon et al22 may be related to an inadequate dose of
From the metaanalysis of the placebo controlled CHM.27 Although the capsule dose calculation was
trials, 3 studies favored CHM compared to placebo, 2 not stated, the Pentaherb formulation consisted of
of which were studies by Sheehan and Atherton20 9 g of raw herbs for patients 5 to 21 years of age.22
and Sheehan et al.21 The third trial used a CHM Despite the lack of efficacy, the Pentaherb group saw
formula commonly used for atopic dermatitis, Xiao significant improvement in CDLQI, decrease in days
Feng San. However, participants were given CHM of corticosteroid use and amount of mometasone
granules with daily doses that were significantly furoate. However, it was unclear if the days of
higher than the recommended dose.25 Also, the corticosteroid use comprised of corticosteroids
placebo of caramel, lactose, and starch may pose a other than mometasone furoate, including those of
risk to lactose intolerant individuals. In addition, higher potencies. Kobayashi et als study10 only
according to TCM theory, sweet foods such as included patients with Kikyo (Qi deficiency) consti-
caramel could aggravate skin conditions.26 tution, which did not address the condition as per
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Table II. Characteristics of the included studies

Run-in/treatment/
follow-up/washout
Author (year) Age group Study design No. of participants Dropout period
Cheng et al (2010) Not specified Double blind TCM, 47; placebo, 24 2 (dropped out Run-in, not
RCTcomputer at baseline, not mentioned;
generated included in ITT) treatment, 8 wks;
randomization follow-up, 4 wks
list by an
independent
statistician
Fung et al (1999) 7-50 years of age Double blind, TCM, 40; placebo, 40 3 (ITT analysis not Run-in, not
crossover RCT mentioned) mentioned;
treatment, 8 wks;
follow-up, not
mentioned;
washout, 4 wks
Hon et al (2007) 5-21 years of age Double blind TCM, 42; placebo, 43 ITT analysis to Run-in, 2 wks;
RCTcomputer include all treatment, 12
generated participants wks; follow-up,
randomization 4 wks
code
Huang et al (2004) 3-11 years of age Single blind TCM plus WM, 49; 6 (ITT analysis Run-in, not
RCTsimple WM, 49 used to analyze mentioned;
randomization overall treatment treatment, 4 wks;
method (ratio 1:1) effect) follow-up, 3
months
Kobayashi et al 20-40 years of age Double blind TCM, 43; placebo, 48 7 (excluded from Run-in, not
(2010) RCTblock analysis) mentioned;
randomization treatment, 24
wks; follow-up,
not mentioned
Sheehan and Children (age Double blind, TCM, 47; placebo, 47 10 (excluded from Run-in, 4 wks;
Atherton (1992) group not crossover RCT analysis) treatment, 8 wks;
specified) follow-up, not
mentioned;
washout, 4 wks
Sheehan et al 16-65 years of age Double blind, TCM, 40; placebo, 40 9 (excluded from Run-in, not
(1992) crossover RCT analysis) mentioned;
treatment, 8 wks;
follow-up, not
mentioned;
washout, 4 wks

ITT, Intention to treat; RCT, randomized controlled trial; TCM, traditional Chinese medicine; WM, Western medicine.

TCM theory and may have reduced the treatment both groups.10,20,21 However, the Pentaherb group in
efficacy. Nevertheless, there was a significant de- the study by Hon et al22 had significantly more
crease in the total equivalent amount of topical general practitioner visits without further explana-
agents in the CHM group when compared to the tion, making it difficult to determine whether these
placebo group.10 These 2 studies indicate that CHM visits were related to Pentaherb. There was 1 case of
may function as an adjunct treatment for AD. transient elevation of aspartate amino transferase that
The CHM in 4 of the studies underwent quality was reversed within 8 weeks of treatment cessa-
check for potential contaminants (including ste- tion.18 Elevated aspartate amino transferase levels
roids),18,20-22 while the Hochu-ekki-to was manufac- can have multiple causes, including alcohol abuse,
tured by a Good Manufacturing Practiceecertified medications, such as antihistamines or nonsteroidal
company.10 Three of the 5 studies that had adverse antiinflammatory drugs, and certain herbs.28
events reported nonsignificant differences between However, the herbal ingredients of the respective
Table III. Diagnosis, interventions, and outcome measures of included studies

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J AM ACAD DERMATOL
Author (year) WM/TCM diagnosis Severity Treatment interventions Control interventions Outcome measures
Cheng et al (2010) AD: Hanifin and Rajka Extensive AD ([20% Xiao Feng San granules (3-7 years Placebo Total clinical lesion; erythema
diagnostic criteria BSA involved) of age, 3 g tid; 8-12 years of age, score; surface damage score;
6 g tid; [13 years of age, 9 g tid pruritus score; sleep score
Fung et al (1999) AD: Hanifin and Rajka Moderate to severe AD Sheehans formula (decoction): Placebo Clinical scores for erythema,
diagnostic criteria 7-13 years of age, 2 large plus 2 surface damage, lichenification,
small sachets of herbs per day; and scaling
[14 years of age, 3 large plus 3
small sachets
Hon et al (2007) AD: Hanifin and Rajka Moderate to severe AD Pentaherb capsule 3 capsules bid Placebo SCORAD; CDLQI; allergic rhinitis
diagnostic criteria (objective SCORAD symptoms; concurrent
[15) treatment
Huang et al (2004) AD: UK diagnostic criteria/ Moderate AD Jian Pi Shen Shi granules (3-5 years Cyproheptadine tablets Rajka and Langeland scoring;
SP deficiency of age, 5 g tid; 6-11 years of age, 0.25 mg/kg/day tid; overall treatment effect; total
10 g tid plus cyproheptadine triamcinolone urea immunoglobulin E; rate of
tablets 0.25 mg/kg/day tid; cream recurrence 3 months posttrial
triamcinolone urea cream
Kobayashi et al AD: diagnostic criteria Hochu-ekki-to granules 3.25 g bid Placebo Skin severity score; dose of topical
(2010) according to the Japanese steroids/tacrolimus used;
Dermatological prominent efficacy rate;
Association for AD/Kikyo aggravated rate
condition (Qi deficiency)
Sheehan and AD: diagnostic criteria not Extensive nonexudative Sheehans formula (decoction): 1-7 Placebo Erythema score; surface damage
Atherton (1992) stated AD, not confined to years of age, 2 large plus 2 small score; preference in treatment;
flexural sites sachets of herbs per day; 8-13 improvement in ability to sleep
years of age, 3 large plus 3 small
sachets; [14 years of age, 4
large plus 4 small sachets (100
mL decoction/day)
Sheehan et al AD: Hanifin and Rajka Extensive AD ([20% Sheehans formula (decoction): 4 Placebo Erythema score; surface damage
(1992) diagnostic criteria BSA involved) large plus 4 small sachets (200 score; improvement in itching,
mL decoction/day) sleep and asthma; preference of
treatment

AD, Atopic dermatitis; bid, twice daily; BSA, body surface area; CDLQI, Childrens Dermatology Life Quality Index; SCORAD, Scoring Atopic Dermatitis; SD, spleen deficiency; tid, three times daily.

Tan et al 301
302 Tan et al J AM ACAD DERMATOL
AUGUST 2013

Table IV. Herbal ingredients used in Chinese herbal medicine formulas of included studies
Sheehans formula Jian Pi Shen Shi granules Pentaherb Hochu-ekki-to Xiao Feng San
Glycyrrhiza uralensis Wolfiporia extensa Herba menthae Glycyrrhizae radix Glycyrrhiza uralensis
(Gan Cao) (Fu Ling) (Bo He) (Gan Cao) (Gan Cao)
Ledebouriella seseloides Codonopsis pilosula Flos lonicerae Ginseng radix Saposhnikovia divaricate
(Fang Feng) (Dang Shen) (Jin Yin Hua) (Ren Shen) (Fang Feng)
Schizonepeta tenuifolia Atractylodes rhizoma Cortex phellodendri Atractylodes rhizoma Schizonepeta tenuifolia
(Jing Jie) (Bai Zhu) (Huang Bai) (Bai Zhu) (Jing Jie)
Lophatherum gracile Aurantii nobilis Rhizoma atractylodis Aurantii nobilis Atractylodes lancea
(Dan Zhu Ye) pericarpium (Chen Pi) (Cang Zhu) pericarpium (Cang Zhu)
(Chen Pi)
Paeonia lactiflora Semen coicis (Yi Yi Ren) Cortex moutan Angelicae radix Angelica sinensis (Dang Gui)
(Bai Shao) (Mu Dan Pi) (Dang Gui)
Rehmannia glutinosa Bupleuri radix Rehmannia glutinosa
(Sheng Di Huang) (Chai Hu) (Sheng Di Huang)
Anebia clematidis Zizyphi fructus Clematis armandii (Chuan
(Chuan Mu Tong) (Da Zao) Mu Tong)
Dictamnus dasycarpus Astragali radix Cryptotympana pustulata
(Bai Xian Pi) (Huang Qi) (Chan Tui)
Tribulus terrestris (Ji Li) Zingiberis rhizome Linum usitatissimum
(Gan Jiang) (Hu Ma Ren)
Potentilla chinensis Cimicifugae rhizome Anemarrhena asphodeloides
(Wei Ling Cai) (Sheng Ma) (Zhi Mu)
Gypsum fibrosum (Shi Gao)
Sophora flavescens
(Ku Shen)
Articum lappa
(Niu Bang Zi)

Fig 3. Metaanalysis of Chinese herbal medicine compared to placebo studies. CHM, Chinese
herbal medicine; CI, confidence interval.

study were not for such effects. No additional details granules,10,17,18 and 3 used decoctions.19-21
were provided to evaluate the possible relation Decoctions are the most common form of CHM,
between the elevation and the trial intervention. while granules and capsules are modern forms
This review showed no significant safety concerns aimed to be more convenient and palatable.29 It
regarding CHM treatment for AD. However, in these remains unclear if the different methods of CHM
studies, CHM was only administered for 4 to 24 delivery influence their treatment effects.29,30
weeks under controlled conditions. However, studies with significantly better outcomes
The included studies applied different methods of used higher treatment doses, regardless of the
medication delivery: 1 study used capsules,22 3 used method of delivery.
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