Herbal medicines for viral myocarditis

 

Abstract

Background

Herbal medicines are being used for treating viral diseases including viral myocarditis, and many controlled trials have been done to investigate their efficacy.

Objectives

To assess the effects of herbal medicines on clinical and indirect outcomes in patients with viral myocarditis.

Search strategy

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochrane Library 2003, Issue 3, MEDLINE (January 1966 to October 2003), EMBASE (January 1998 to October 2003), Chinese Biomedical Database (1979-2003), AMED (1985-2003), LILACS accessed in October 2003 and the trials register of the Cochrane Complementary Medicine Field. We handsearched Chinese journals and conference proceedings. No language or publication restrictions were used.

Selection criteria

Randomised controlled trials of herbal medicines (with a minimum of seven days treatment duration) compared with placebo, no intervention, or conventional interventions were included. Trials of herbal medicine plus conventional drug versus drug alone were also included.

Data collection and analysis

Two reviewers independently extracted data and evaluated trial quality. Study authors were contacted for additional information. Adverse effects information was collected from the trials.

Main results

Forty randomised trials, involving 3448 people were included. All trials were conducted and published in China, and the methodological quality was assessed as generally low. No trial had diagnosis of viral myocarditis confirmed histologically, and few trials attempted to establish viral aetiology for the myocarditis. Twenty-five different herbal medicines were tested in the included trials, which compared herbs with supportive therapy (17 trials), other controls (three trials), or treatment of herbs plus supportive therapy with supportive therapy alone (20 trials). The trials reported electrocardiogram, myocardial enzymes, cardiac function, symptoms, and adverse effects.

Astragalus membranaceus (either as single herb or compound of herbs) showed significantly effects on improving arrhythmia, CPK levels, and cardiac function. Salviae miltiorrhizae injection showed significant effects on decreasing the arrhythmia and reducing LDH levels. Shenmai and Shengmai injection (Ginseng preparation) showed significantly effects on reducing myocardial enzymes and improving cardiac function. No serious adverse effect was reported.

Authors' conclusions

Some herbal medicines may have anti-arrhythmia effect in suspected viral myocarditis. However, interpretation of these findings should be careful due to the low methodological quality, small sample size, and limited number of trials on individual herbs. In the light of the findings, some herbal medicines deserve further examination in rigorous trials.

 

Plain language summary

There is no firm evidence to support the use of Chinese herbal medicines for treatment of viral myocarditis

Viral myocarditis is a heart disease when the muscles in the walls of heart become infected with a virus. This systematic review evaluates the effect of various herbal formulations (including single herbs, ingredients, and mixtures of different herbs) for treating acute and chronic viral myocarditis patients. All identified clinical trials were performed and published in China. The review of trials found that some of the herbal medicines may have positive effect on improving cardiac function, lowering blood enzymes, and relieving symptoms in viral myocarditis patients. However, the methodological quality of the clinical trials evaluating these herbs was generally poor.