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Herbal medicines for viral myocarditis

  1. Zhao Lan Liu1,
  2. Zhi Jun Liu1,
  3. Jian Ping Liu1,*,
  4. Joey SW Kwong2

Editorial Group: Cochrane Heart Group

Published Online: 28 AUG 2013

Assessed as up-to-date: 1 FEB 2013

DOI: 10.1002/14651858.CD003711.pub5


How to Cite

Liu ZL, Liu ZJ, Liu JP, Kwong JSW. Herbal medicines for viral myocarditis. Cochrane Database of Systematic Reviews 2013, Issue 8. Art. No.: CD003711. DOI: 10.1002/14651858.CD003711.pub5.

Author Information

  1. 1

    Beijing University of Chinese Medicine, Centre for Evidence-Based Chinese Medicine, Beijing, China

  2. 2

    The Chinese University of Hong Kong, Institute of Vascular Medicine, Li Ka Shing Institute of Health Sciences, Heart Education And Research Training (HEART) Centre, and Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, New Territories, Hong Kong

*Jian Ping Liu, Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, 11 Bei San Huan Dong Lu, Chaoyang District, Beijing, 100029, China. jianping_l@hotmail.com.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 28 AUG 2013

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Summary of findings    [Explanations]

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Differences between protocol and review
  18. Index terms

 
Summary of findings for the main comparison. Herbal medicines versus supportive therapy for viral myocarditis

Herbal medicines versus supportive therapy for viral myocarditis

Patient or population: patients with viral myocarditis
Settings: outpatients and inpatients
Intervention: Herbal medicines versus supportive therapy

OutcomesIllustrative comparative risks* (95% CI)Relative effect
(95% CI)
No of Participants
(studies)
Quality of the evidence
(GRADE)
Comments

Assumed riskCorresponding risk

ControlHerbal medicines versus supportive therapy

Number of patients died of cardiac failure: Astragaloside injection versus supportive therapy49 per 100060 per 1000
(17 to 216)
RR 1.22
(0.34 to 4.38)
164
(1 study, Yang YX 2008)
⊕⊝⊝⊝
very low1,2,3

Number of patients with premature beat: Xinshu capsule versus supportive therapy950 per 1000798 per 1000
(532 to 941)
RR 0.84
(0.56 to 0.99)
120
(1 study, Chen PY 2006)
⊕⊝⊝⊝
very low1,2,4

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (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).
CI: Confidence interval; RR: Risk ratio; OR: Odds ratio;

GRADE Working Group grades of evidence
High quality: further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: we are very uncertain about the estimate.

 1 No information about allocation concealment, lack of blinding
2 The confidence interval is wide
3 Outcomes were selectively reported
4 All the included patients were suffered from frequent ventricular extrasystoles

 Summary of findings 2 Herbal medicines plus supportive therapy for viral myocarditis

 Summary of findings 3 Herbal medicines plus supportive therapy for viral myocarditis

 

Background

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Differences between protocol and review
  18. Index terms
 

Description of the condition

Viral myocarditis (inflammation of the heart muscle) results from a viral infection that leads to myocardial necrosis (death of heart tissue) (Suddaby 1996; Feldman 2000; Kearney 2001; Cooper 2009). Many pathogenic mechanisms may contribute to myocardial cell loss including cytokine production, which influences myocardium inflammation; viral persistence, which may produce an autoimmune response to cardiac myosin; and viral invasion of vascular endothelium, which causes vascular spasm with reperfusion injury (Feldman 2000; Rose 2009). Viral myocarditis is one of the causes of dilated cardiomyopathy (when the heart is weakened and inefficient) (Dec 1994; Kawai 1999; Cooper 2009). Severe outcomes of viral myocarditis include arrhythmias (irregular heartbeat), cardiogenic shock (potential precursor of cardiac arrest), development of dilated cardiomyopathy, and death (necrosis) of heart tissue, although the majority of cases are subclinical (without symptoms) and self-limited (Feldman 2000; Eckart 2004).

Myocarditis is an insidious disease that is usually asymptomatic (symptomless) in its early stages, and it appears to be far more common in children than in adults (Feldman 2000). The true prevalence of viral myocarditis in the general population is unknown due to the invasive technique (myocardial biopsy) required for diagnosis (Haas 2001; Cooper 2009). Myocarditis is a major cause of sudden, unexpected death in adults under the age of 40 in Western countries (accounting for approximately 20% of cases) (Drory 1991; Feldman 2000; Baughman 2006). Routine postmortem examinations have identified myocardial inflammation in 1% to 9% of sudden, unexpected adult deaths, taking into consideration three early studies in Western countries (Feldman 2000). Viral infection is thought to be the most common cause of myocarditis. Viral myocarditis can be caused by more than 27 viruses, such as coxsackie virus, parvovirus B19, enterovirus, adenovirus, rubella virus, polio virus, human immunodeficiency virus 1 (HIV-1), cytomegalovirus, and hepatitis A and C viruses (Dec 1985; Kuhl 2005).

The clinical features of myocarditis are varied. The spectrum includes asymptomatic individuals and others who may have chest pain, fever, palpitations, electrocardiographic abnormalities, signs and symptoms of clinical heart failure and ventricular dilation, fulminant (sudden) heart failure and severe left ventricular dysfunction with or without cardiac dilations (Dec 1985; Feldman 2000). Although endomyocardial biopsy remains the gold standard for the diagnosis of viral myocarditis, comprehensive criteria have been developed for diagnosis through evaluation of cardiac function, symptoms and signs, history of a flu-like syndrome, laboratory findings, identification of the viruses, as well as elimination of other causes of global cardiac dysfunction (see 'Types of participants') (Dec 1992; Feldman 2000; Andreoletti 2009; Schultz 2009). Dilated cardiomyopathy with chronic heart failure is the major long-term consequence of myocarditis (Cooper 2009). Treatment measures mainly involve alleviating heart failure (salt restriction, water pills, angiotensin converting enzyme (ACE) inhibitors, beta blockers, etc.) and treating, as well as monitoring, heart rhythm abnormalities.

Supportive care is the first line of therapy for left ventricular dysfunction in patients with viral myocarditis. Cardiac function support is provided by pharmacological agents such as digitalis and diuretics, extracorporeal membrane oxygenation, and implantation of a ventricular-assisting device (Topkara 2006). Current trials of treatment in chronic heart failure secondary to dilated cardiomyopathy support the use of ACE inhibitors, angiotensin-receptor blockers, beta-adrenoceptor blockers, and diuretics (Kearney 2001; Cooper 2009). Other treatments for viral myocarditis include immunosuppressive agents (Parrillo 2001; Wojnicz 2001), immunoadsorption (removal of antibodies) (Staudt 2001), and interferon (interferes with viral reproduction) (Miric 1995).

 

Description of the intervention

Increasingly, complementary therapies are being used in mainstream medicine (Eisenberg 1998; Vickers 2000; Koithan 2009; O'Regan 2009), and the number of randomised trials of complementary treatments has increased significantly in recent years (Tang JL 1999). By 2010, The Cochrane Database of Systematic Reviews had over 100 systematic reviews of complementary medicine interventions. Many people turn to this type of therapy when conventional medicine fails them, or they believe strongly in the effectiveness of complementary medicine (John 2005).

Herbal medicine forms the main part of traditional Chinese medicine, which is a 3000 year-old holistic system of medicine, combining medicinal herbs, acupuncture, food therapy, massage, and therapeutic exercise for both treatment and prevention of disease (Fulder 1996). Herbal medicines are defined in this review as products derived from plants or parts of plants (for example the leaves, stems, buds, flowers, roots, or tubers; raw or refined) used for treatment of diseases. Synonyms for 'herbal medicine' include 'herbal remedies', 'herbal medications', 'herbal products', 'herbal preparations', 'medicinal herbs', and 'phyto-pharmaceuticals'. There are four kinds of herbal therapies we will consider in this review: single herbs, Chinese proprietary medicines, a mixture of different herbs, and any one of the three types plus western medicines. The most commonly tested single herbs include Astragalus membranaceus, Salviae miltiorrhizae, Ginseng, and Sophorae flavescentis; though Chinese proprietary medicines such as Shenmai and Shuanghuanglian have also been used in clinical trials. Chinese proprietary medicines are usually based on well-established and longstanding recipes and they are formulated as tablets or capsules for commerce, convenience, or palatability (Yang XZ 2006). A mixture of herbs is prescribed by Chinese herbalists according to their differentiation of symptoms through the Chinese diagnostic patterns (that is inspection, listening, smelling, inquiry, and palpation) (MOH 2007). General adverse effects of herbal medicines that have been reported include itching, increased leucocyte (white blood cell) count, flatulence, diarrhoea, tiredness, dry mouth, bloating, gastrointestinal symptoms, and nausea (Zheng RF 2005; Dong 2011; Liu 2011).

 

How the intervention might work

The active ingredients of these herbal medicines are largely unknown, and herbs are often combined to regulate body functions (Jiang TL 1999). Several trials have shown that Astragalus membranaceus and Shenmai might have potential for treating viral myocarditis, alleviating its symptoms and signs and decreasing cardiac enzymes, and few trials have reported adverse effects (Yang YZ 1990; Ren W 1991; Li L1992; Huang ZQ 1995; Liu GJ 1996; Yang HB 1997; Yin YS 1997; Li ZY 1998; Chen H 1999). The possible modes of action include enhancing natural killer cell activity, inducing production of alpha- and gamma-interferon, improving cardiac microcirculation, and activity against free radicals and lipid peroxidation (Yang YZ 1990; Li L1992; Huang ZQ 1995; Zhao MH 1996). There are an increasing number of reports in the medical literature about liver toxicity, renal damage, and even cancer from some Chinese herbal products (Ishizaki 1996; Melchart 1999; Gottieb 2000), therefore, this area needs further research and systematic evaluation. Chinese herbal medicine may be important in treating viral myocarditis.

 

Why it is important to do this review

Since more and more herbal medicines are being used to treat viral myocarditis, a systematic review that critically appraises the available evidence on the potential benefits and harms of herbal medicines for viral myocarditis is needed in order to update the body of evidence, identify areas in need of further research, and to help people make practical decisions.

 

Objectives

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Differences between protocol and review
  18. Index terms

To assess the benefits and harms of herbal medicines on clinical (e.g. mortality, incidence of complications) and indirect outcomes (e.g. cardiac function, biochemical response) in patients with viral myocarditis, irrespective of the patients' age, gender or type (including acute and chronic viral myocarditis).

 

Methods

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Differences between protocol and review
  18. Index terms
 

Criteria for considering studies for this review

 

Types of studies

Randomised controlled trials (RCTs) with an adequate method of allocation sequence generation were included irrespective of blinding, publication status, and language of publication. Adequate methods of sequence generation included computer-generated random numbers, tables of random numbers, or drawing lots. Randomised cross-over trials would also be included if the data were available. Quasi-randomised trials, non-randomised studies and studies that described themselves as randomised controlled studies but did not elaborate on the method of sequence generation used were excluded.

The following comparisons were tabulated, where data were available:

  1. herbal medicines versus placebo;
  2. herbal medicines versus supportive intervention;
  3. herbal medicines plus supportive therapy versus supportive intervention;
  4. herbal medicines versus antiviral therapy; and
  5. herbal medicines plus antiviral therapy versus antiviral therapy.

 

Types of participants

Male or female patients of any age or ethnic origin who had viral myocarditis (including acute and chronic viral myocarditis).

Viral myocarditis was diagnosed on the basis of: history of an antecedent flu-like syndrome accompanied by symptoms such as fever, arthralgias (joint pain), and malaise; followed by signs and symptoms of clinical heart failure and ventricular dilation; laboratory findings of leukocytosis (high white blood cell count), an elevated sedimentation rate (for red blood cells), eosinophilia (elevated levels of a particular type of white blood cell), or an elevation in the cardiac fraction of creatine phosphokinase (CPK-MB); an electrocardiogram showing ventricular arrhythmias or heart block; and exclusion of other causes of global cardiac dysfunction, for example acute myocardial infarction (heart attack) or pericarditis (inflammation of the sac around the heart) (Vignola 1984; Dec 1992; Feldman 2000; Baughman 2006; Schultz 2009). The gold standard diagnosis from the findings of an endomyocardial biopsy was not imperative. Acute viral myocarditis was considered to be present in patients who presented with recent (less than two weeks) onset of cardiac failure or arrhythmia. Trials that included patients presenting with recent onset of cardiac failure or arrhythmia and laboratory tests corresponding with myocarditis, but without electrocardiogram confirmation, were included.

 

Types of interventions

We defined herbal medicines as products derived from plants or parts of plants (for example the leaves, stems, buds, flowers, roots, or tubers; raw or refined) used for treatment of diseases. Synonyms for 'herbal medicine' included: 'herbal remedies', 'herbal medications', 'herbal products', 'herbal preparations', 'medicinal herbs', and 'phyto-pharmaceuticals'.

The herbal medicines intervention included a single herb (including an extract from a single herb), a Chinese proprietary medicine, or a compound of several herbs irrespective of preparation (for example decoction, oral liquid, tablet, capsule, pill, powder, granule, injection, or plaster (external use of dressings impregnated with herbal extracts)), route of administration (for example oral, topical, intramuscular or intravenous injection), dosage, and regimen.

We also included trials of herbal medicines plus a conventional intervention versus the conventional intervention alone. Control interventions included placebo; a non-specific treatment such as vitamins or nutritional supplement; or supportive therapy such as diuretics, beta-blockers, or antiviral therapy. Any co-intervention additional to the experimental and control interventions was allowed as long as all randomised arms of the trial received the same co-intervention.

We included trials if the treatment was given for a minimum of seven days, although definitive information about duration of treatment was lacking in the literature.

 

Types of outcome measures

 

Primary outcomes

  1. Mortality (all-cause and myocarditis related).
  2. Incidence of complications (heart failure, arrhythmias and premature beat).

 

Secondary outcomes

  1. Cardiac function (electrocardiogram, ST-T (heartbeat) changes, left ventricular ejection time (LVET) levels, sinus bradycardia (low rate of heartbeat)).
  2. Biochemical response, defined as decrease or normalisation of serum enzyme levels.
  3. Number and type of adverse events.
  4. Quality of life (assessed by validated scale).
  5. Health economics (such as cost of interventions, length of hospital stay).

In this review, we considered complications of myocarditis to be those secondary conditions or other disorders that were caused by the myocarditis, such as heart failure and arrhythmias, and adverse events to be unexpected events related to the interventions. Two types of adverse events were analysed: serious and minor. Serious adverse events were defined as those that led to death; were life-threatening; required - or prolonged - hospitalisation; resulted in persistent, or significant, disability or incapacity; or were events that could jeopardise the patient, or required another intervention to prevent or treat the relevant adverse event (ICH-GCP 1997). All other adverse events were considered to be minor.

 

Search methods for identification of studies

 

Electronic searches

We updated the searches of the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (2013, Issue 1), the Cochrane Complementary Medicine Field Trials Register, MEDLINE (Ovid, 1946 to January Week 4 2013), EMBASE (Ovid, 1980 to 2013 Week 04) and LILACS (Bireme) (1 February 2013).

The following databases were last searched in June 2011: Chinese Biomedical Database (1979 to June 2011), China National Knowledge Infrastructure (1979 to June 2011), Chinese VIP Information (1989 to 2011), Chinese Academic Conference Papers Database and Chinese Dissertation Database (1980 to 2011), AMED (1985 to 2011) and the Cochrane Complementary Medicine Field Trials Register (June 2011). We handsearched Chinese journals and conference proceedings.

The search strategies that were used to search the databases in the most recent update can be found in Appendix 1. The Cochrane highly sensitive search strategy for identifying RCTs was also used (Lefebvre 2011).

The strategies that were used for previous versions of this review can be found in Appendix 2, Appendix 3 and Appendix 4.

No language restrictions were applied.

 

Searching other resources

We handsearched the following journals published in Chinese for the first version of the review: Journal of Clinical Cardiology (1985 to 2003), Chinese Journal of Hypertension (1993 to 2003), Chinese Journal of Cardiac Arrhythmia (1997 to 2003), Chinese Circulation Journal (1986 to 2003), Journal of Traditional Chinese Medicine (1980 to 2003), Chinese Journal of Integrated Traditional and Western Medicine (1982 to 2003).

No handsearching was performed for the updates of the review because all the post-2003 publications in above journals were embodied in electronic databases.

We checked the reference lists of identified randomised clinical trials and review articles in order to find randomised trials not identified by the electronic searches or handsearches. We searched for ongoing trials through the National Research Register (https://portal.nihr.ac.uk/Pages/NRRArchive.aspx) and Current Controlled Trials (www.controlled-trials.com), and grey literature through the database OpenGrey.

 

Data collection and analysis

 

Selection of studies

Two authors (ZLL and ZJL) independently selected the trials using a pre-specified selection criteria form. Any disagreement was resolved by discussion.

 

Data extraction and management

Two authors (ZLL and ZJL) extracted data independently using a self-developed data extraction form. Data extraction was validated by a third author (JPL). Papers not in Chinese, English, Japanese, or German were translated with the help of the Cochrane Heart Group. The following characteristics and data were extracted from each included trial: primary author; funding source; quality assessment; mean age; proportion of males; ethnicity of patients; number of randomised participants; reasons for, and numbers of drop-outs or participants lost during follow-up; inclusion and exclusion criteria; acute or chronic viral myocarditis; methods of diagnosis; type of herb or herbs; method of administration; dosage and duration of intervention; details of the comparison regime; outcome measures; and number and type of adverse events.

Data on the number of participants with each outcome, by allocated treatment group irrespective of compliance or follow-up, were sought to allow an intention-to-treat analysis. If the above data were not available in the trial reports, we contacted the principal investigator.

 

Assessment of risk of bias in included studies

We only included trials with a clear description of the method used to generate allocation sequences. The risk of bias of included studies was assessed by two authors (ZLL, ZJL) independently. Any disagreements were resolved by consensus or with consultation with a third author (JPL). The Cochrane Collaboration risk of bias tool was used (Higgins 2011), as follows.

  • Was the allocation sequence adequately generated?
  • Was the allocation adequately concealed?
  • Was knowledge of the allocated intervention adequately prevented during the study?
  • Were incomplete outcome data adequately addressed?
  • Were reports of the study free of suggestion of selective outcome reporting?
  • Was the study apparently free of other problems that could put it at a high risk of bias?

Judgements of low risk of bias, high risk of bias and unclear or uncertain risk of bias were given for each question for each trial.

Furthermore, we aimed to investigate whether intention-to-treat analysis and pre-sample estimations were applied in the included studies.

 

Assessment of heterogeneity

Heterogeneity was assessed using the I2 statistic. Thresholds for the interpretation of I2 can be misleading since the importance of inconsistency depends on several factors. A rough guide to interpretation is as follows:

  • 0% to 40%, low level of heterogeneity;
  • 30% to 60%, moderate heterogeneity;
  • 50% to 90%, substantial heterogeneity;
  • 75% to 100%, high level of heterogeneity.

If I2 was greater than 50%, we explored the reasons for the heterogeneity. If there was no clinical heterogeneity, we used the random-effects model for analysis.

Data from randomised studies for assessment of safety were tabulated and analysed in  Table 1.

 

Assessment of reporting biases

Potential biases were investigated using a funnel plot (Vickers 1998), or other corrective analytical methods according to Egger 1997.

 

Data synthesis

Every type of herbal medicine was individually compared with a control (for example placebo) regardless of route of administration, dose, or preparation. In Chinese prescriptions a difference of even one herb could make a  different formula and have different effects. We decided not to do meta-analysis if the interventions were different. Meta-analyses were performed for trials that compared the same herb against the same control. Dichotomous data were expressed as relative risk (RR) and continuous outcomes as weighted mean difference (WMD), both with 95% confidence intervals (CI). Intention-to-treat analyses were performed where possible. For dichotomous outcomes, patients with incomplete or missing data were included in a sensitivity analysis by counting them as treatment failures in order to explore the possible effect of losses to follow-up.

 

Subgroup analysis and investigation of heterogeneity

If a sufficient number of randomised trials were identified, we performed subgroup analyses according to clinical course (acute or chronic viral myocarditis), electrocardiogram diagnosis (yes or no), formulation of herbs (extract, single herb, or mixture of herbs), and treatment duration (short- and long-term).

 

Sensitivity analysis

Had we identified a sufficient number of randomised trials, we planned to perform sensitivity analyses to explore the influence of trial quality on effect estimates. The quality components of the methodology included adequacy of concealment of allocation, double blinding, and the use of intention-to-treat analysis (yes or no).

 

Results

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Differences between protocol and review
  18. Index terms
 

Description of studies

 

Results of the search

Our searches identified 3043 references (620 in 2003, 1787 in 2009, 590 in 2011 and 46 in 2013). After reading titles and abstracts, we excluded 2894 of these articles because they were duplicates, non-clinical studies, or had different study objectives to this review. A total of 149 references published in Chinese or English were retrieved for further assessment. Of these, 127 references (of 120 trials) were excluded because they did not meet our inclusion criteria. A total of 20 trials (22 references) were included (Figure 1; Figure 2). The reasons for exclusion are listed under Characteristics of excluded studies. No new trials were identified for inclusion by the update search in 2013 (Figure 3).

 FigureFigure 1. QUOROM flow chart showing origins of material for 2009 update of this review
 FigureFigure 2. PRISMA diagram showing origins of material for 2011 update of this review
 FigureFigure 3. PRISMA diagram showing origins of material for 2013 update of this review

 

Included studies

Twenty RCTs are included in this review update. Further details are given in the Characteristics of included studies. All the included trials were conducted and published in China.

 

Participants

A total of 2177 participants with viral myocarditis were included in the 20 trials. The proportion of male participants was 40.65% (885/2177). The average age of the participants was 24.23 years ± 11.40 years, ranging from one year old to 68. Ten trials included inpatients (Tan YB 2003; Zheng R 2003; Wang Y 2005; Yao 2005; Li L 2006; Li M 2006; Yang YX 2008; Wu JW 2009; Wu JW2 2009; Tan HQ 2010), seven trials included both inpatients and outpatients (Peng 2005; Zheng RF 2005; Chen PY 2006; Zhang ZZ 2006; Zhou Y 2006; Hu XF 2009; Wang ZT 2010), and three trials did not specify the study setting (Zhou YW 2008; Pan 2010; Dong 2011). The average size of the trials was 109 participants (ranging from 40 to 224 participants per trial).

 

Diagnosis

Eight trials enrolled participants with acute viral myocarditis (Zheng R 2003; Zheng RF 2005; Li L 2006; Yang YX 2008;Pan 2010; Wang ZT 2010; Tan HQ 2010; Dong 2011); four enrolled participants with a mixture of acute and chronic viral myocarditis (Wang Y 2005; Yao 2005; Chen PY 2006; Zhou YW 2008); two enrolled patients with chronic viral myocarditis (Peng 2005; Li M 2006); and the remaining six trials enrolled patients with an undefined phase of viral myocarditis. The diagnostic criteria were based on the national conference consensus in China (NCSSMC 1995; Li JY 1996; Guo LN 1999; Zhu WF 1999; Wu TJ 2000; WHO and ISFC 2001; Chen JZ 2005; Huang Y 2006), and included antecedent history, clinical manifestations, abnormal electrocardiogram and laboratory tests (biochemical parameters or aetiology); and excluded other diseases with similar presentations. No trials attempted to establish a viral aetiology for the myocarditis.

 

Interventions

There were large variations in the formulation, dosage, administration, duration of treatment, and control intervention in the included trials for the herbal medicines tested ( Table 1). In total, 13 different herbal medicines were tested. The single herb Astragalus membranaceus was tested in nine trials (Tan YB 2003; Zheng R 2003; Zhang ZZ 2006; Zhou Y 2006; Yang YX 2008; Hu XF 2009; Wu JW 2009; Pan 2010; Dong 2011); eight of these trials tested injections of Astragalus membranaceus ( Astragloside injection), while the ninth trial tested Astragalus membranaceus granules (Wu JW 2009). Xinshu in capsules was tested in one trial (Chen PY 2006). Five herbal decoctions, including Qingxin Kangyan Yin decoction, Shengyang Yixin decoction, Qi Lu decoction, Qingxin Huoming decoction and Xinjikang decoction, were tested separately in five different trials, respectively (Yao 2005; Li L 2006; Li M 2006; Zhou YW 2008; Wang ZT 2010). Two formulations (oral liquids and injection) of Shengmai were tested in three trials (Peng 2005; Zheng RF 2005; Wu JW2 2009); two trials used Shengmai injections in 107 patients with viral myocarditis (Peng 2005; Wu JW2 2009), and the other used Shengmai decoction in 40 patients (Zheng RF 2005). One trial compared herbal extract from Shortscape Fleabane injection plus supportive therapy against supportive therapy alone in 83 patients with acute viral myocarditis (Wang Y 2005). One trial tested the Compound Qiangqi pill (herb mixture) (Zheng RF 2005), another tested Danhong injection (herb extract) (Tan HQ 2010), and another tested Garlicin injection (Pan 2010). The formulations of herbal medicines were different, ranging from capsules, pills, oral liquid or decoction to injection. The composition of the herbal medicines also varied ( Table 1). The duration of treatment varied from 14 days to 30 days (mostly from 14 to 21 days). No trial reported quality standards of the herbal preparations.

Radix Astragali could be prepared to the single herb Astragalus membranaceus, Astragalactoside injection (Radix Astragali injection), granules or other forms.

 

Outcomes

No trial reported on the incidence of complications or on health economic costs. One trial reported quality of life (Zheng RF 2005). The outcomes that were reported included mortality, conversion to persistent myocarditis, clinical symptoms and signs, electrocardiogram, cardiac function, myocardial enzymes, and adverse effects. One trial reported mortality (Yang YX 2008). Six trials reported adverse effects as an outcome (Tan YB 2003; Zheng RF 2005; Hu XF 2009; Wu JW2 2009; Tan HQ 2010; Dong 2011). Three trials observed no adverse events (Tan YB 2003, Wu JW2 2009; Tan HQ 2010). Reported adverse events were: a high leucocyte count, seen in 15/132 (11%) patients in Zheng RF 2005; fever in 3/50 (6%) patients in Hu XF 2009; and itching in 2/60 (3.3%) patients in Dong 2011. The outcomes reported in 18 trials were measured at the end of treatment. Two trials reported a follow-up period of six months.

Given that a large majority of the outcomes included a small number of trials (on many occasions one trial only), it would be premature to confirm or exclude heterogeneity between trials.

 

Risk of bias in included studies

None of the trials reported sample size calculations or stated that they performed an intention-to-treat analysis to evaluate their data. No multicentre, large scale RCTs were identified in our searches. Three trials reported drop-outs (Zheng R 2003; Zheng RF 2005; Yang YX 2008), with a 20% drop-out rate observed in Yang YX 2008. Regrettably, no information was available on how the drop-out rate was dealt with in the analysis. Seventeen trials made baseline comparisons (Tan YB 2003; Zheng R 2003; Peng 2005; Yao 2005; Zheng RF 2005; Wang Y 2005; Zhou Y 2006; Li L 2006; Li M 2006; Zhang ZZ 2006; Wu JW 2009; Hu XF 2009; Wu JW2 2009; Tan HQ 2010; Wang ZT 2010; Pan 2010; Dong 2011). Eight trials had clear inclusion criteria (Zheng RF 2005; Chen PY 2006; Hu XF 2009; Wu JW2 2009; Pan 2010; Tan HQ 2010; Wang ZT 2010; Dong 2011), and six had specified exclusion criteria (Zheng RF 2005; Chen PY 2006; Hu XF 2009; Pan 2010; Wang ZT 2010; Dong 2011). Outcome assessment was made after treatment, but there was no stated indication for further interventions.

Assessment of risk of bias is described for each included study in the Characteristics of included studies tables as well as in Figure 4 and Figure 5. The trials provided limited information on allocation concealment and blinding. All of the trials were assessed as being at high risk of bias.

 FigureFigure 4. Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies
 FigureFigure 5. Methodological quality summary: review authors' judgements about each methodological quality item for each included study

 

Allocation

All 20 trials had adequate sequence generation, but only four provided information on how the allocation sequence was concealed (Zheng R 2003; Zheng RF 2005; Zhang ZZ 2006; Zhou Y 2006). In each case sealed opaque envelopes were used.

 

Blinding

Only one of the 20 included trials was double-blinded (Zheng RF 2005). The remaining 19 trials did not provide information about blinding.

 

Incomplete outcome data

One trial did not provide sufficient information for us to make a judgement on incomplete outcome data assessment (Zheng R 2003). The remaining 19 trials reported that the same number of participants were randomised as analysed, or addressed the incomplete outcome data or the reasons for missing outcome data.

 

Selective reporting

Eight of the 20 trials were judged to be at high risk of bias for selective reporting due to the lack of information on pre-specified primary outcomes (Peng 2005; Yao 2005; Li L 2006; Li M 2006; Zhang ZZ 2006; Zhou Y 2006; Yang YX 2008; Pan 2010).

 

Other potential sources of bias

All included trials contained insufficient information for us to make a judgement on other potential sources of bias and thus were all judged to be unclear for the item 'free of other bias'.

 

Effects of interventions

See:  Summary of findings for the main comparison Herbal medicines versus supportive therapy for viral myocarditis;  Summary of findings 2 Herbal medicines plus supportive therapy for viral myocarditis;  Summary of findings 3 Herbal medicines plus supportive therapy for viral myocarditis

 

Primary outcomes

 

1. Mortality (all-cause and myocarditis related)

One trial reported the outcome of mortality (Yang YX 2008). Compared with supportive therapy, Astragalus membranaceus injection did not show a significant reduction in the number of patients that died of cardiac failure (Yang YX 2008) ( Table 2;  Analysis 1.1).

 

2. Incidence of complications (heart failure, arrhythmias and premature beats)

A significant difference was found between Xinshu capsules and supportive therapy regarding the number of patients with premature beats (RR 0.84, 95% CI 0.73 to 0.97;  Table 2;  Analysis 1.4) (Chen PY 2006).

There was no significant difference between Shengmai decoction plus supportive therapy and supportive therapy alone regarding the number of patients with premature beats (Zheng RF 2005) ( Table 2;  Analysis 2.3).

There was no significant difference between Fleabane injection plus supportive therapy and supportive therapy alone regarding the number of patients with premature beats (Wang Y 2005) ( Table 2;  Analysis 2.3).

No significant difference was found between Qi Lu decoction plus supportive therapy and supportive therapy alone regarding the number of patients with premature beats (Yao 2005) ( Table 2;  Analysis 2.3).

There was no significant difference between Danhong decoction plus supportive therapy and supportive therapy alone in number of participants with arrhythmias (Tan HQ 2010) ( Table 2;  Analysis 2.3).

There was no significant difference between Astragalus membranaceus injection (Astragloside injection) and supportive therapy alone in reducing the number of patients with premature beat (Tan YB 2003) ( Table 2;  Analysis 2.3), or in reducing the number of patients with arrhythmias (Pan 2010) (Table 2;  Analysis 2.7).

The combination of Garlicin injection plus supportive therapy versus supportive therapy alone showed a significant effect on the number of participants with arrhythmias (RR 0.22, 95% CI 0.05 to 0.91;  Table 2;  Analysis 2.7) (Pan 2010).

Compared with acyclovir plus supportive therapy, Astragaloside injection plus supportive therapy showed a significant effect on premature beats in one trial (RR 0.31, 95% CI 0.11 to 0.85;  Table 2;  Analysis 3.1) (Hu XF 2009).

 

Secondary outcomes

 

1. Cardiac function

There was no significant difference between Shengmai injection and supportive therapy regarding abnormal ST-T changes (RR 1.18, 95% CI 0.58 to 2.40;  Table 2;  Analysis 1.2) (Peng 2005).

One trial showed a significant difference between Astragalus membranaceus granules plus supportive therapy and supportive therapy alone regarding LVET (MD 12.00, 95% CI 5.06 to 18.94;  Table 2). A combination of Astragalus membranaceus granules and supportive therapy did not significantly reduce the number of participants with an abnormal electrocardiogram (Wu JW 2009) ( Table 2;  Analysis 2.1).

There was no significant difference between Shengmai decoction plus supportive therapy and supportive therapy alone regarding an abnormal electrocardiogram (Zheng RF 2005) ( Table 2;  Analysis 2.1).

The combination of Shengyangyixin decoction and supportive therapy significantly reduced the number of participants with an abnormal electrocardiogram (RR 0.56, 95% CI 0.35 to 0.90;  Table 2;  Analysis 2.1) compared with supportive therapy alone (Li M 2006).

The combination of Qingxin Huoming decoction and supportive therapy significantly reduced the number of participants with an abnormal electrocardiogram (RR 0.32, 95% CI 0.13 to 0.79;  Table 2) compared with supportive therapy alone ( Analysis 2.1) (Zhou YW 2008).

The combination of Xinjikang decoction and supportive therapy did not show any significant reduction in the number of participants with an abnormal electrocardiogram compared with supportive therapy alone (Wang ZT 2010) ( Table 2;  Analysis 2.1).

A meta-analysis of two trials showed significant effects ofAstragalus membranaceus injection plus supportive therapy on the number of participants with an abnormal electrocardiogram (RR 0.28, 95% CI 0.13 to 0.61;  Table 2;  Analysis 2.1) (Tan YB 2003; Dong 2011), and on ST-T changes (RR 0.72, 95% CI 0.54 to 0.95;  Table 2;  Analysis 2.2) (Zheng R 2003; Pan 2010).

The combination of Garlicin injection and supportive therapy significantly reduced the number of participants with abnormal ST-T changes (RR 0.09, 95% CI 0.01 to 0.65;  Table 2;  Analysis 2.2) (Pan 2010).

There was no significant difference between Astragalus membranaceus injection and supportive therapy alone in ST-T changes (Zheng R 2003) ( Table 2;  Analysis 2.2), or for reducing the number of participants with abnormal LVEF (Zheng R 2003) ( Table 2;  Analysis 2.10).

One trial showed a significant difference between Astragalus membranaceus injection plus supportive therapy and supportive therapy alone regarding left ventricular ejection time (LVET) with a MD of 4.67 (95% CI 1.94 to 7.40;  Table 2;  Analysis 2.10) (Zheng R 2003).

When compared with acyclovir plus support therapy in one trial, Astragaloside injection plus support therapy had no significant effect on the number of participants with sinus bradycardia (Hu XF 2009) ( Table 2;  Analysis 3.2).

 

2. Biochemical response, defined as decrease or normalisation of serum enzymes levels

Shengmai injections plus supportive therapy showed a significant effect on the number of abnormal electrocardiograms (RR 0.11, 95% CI 0.01 to 0.86;  Table 2;  Analysis 2.1),

The combination of Garlicin injection and supportive therapy showed a significant reduction in the number of participants with abnormal ST-T changes (RR 0.09, 95% CI 0.01 to 0.65;  Table 2;  Analysis 2.2),

There was no significant difference between the combination of Astragalus membranaceus injections and supportive therapy alone on abnormal myocardial enzyme levels (Tan YB 2003) ( Table 2;  Analysis 2.4),

A combination of Astragalus membranaceus granules and supportive therapy did not show a significant effect in patients with abnormal myocardial enzyme levels (Wu JW 2009) ( Table 2;  Analysis 2.4).

The combination of Danhong decoction and supportive therapy showed significant effect on CPK levels (MD -22.02, 95% CI -37.50 to -6.54;  Table 2;  Analysis 2.8),

A meta-analysis of two trials showed a significant effect of Astragalus membranaceus injection on creatine phosphate kinase (CPK) levels (MD -21.54, 95% CI -33.80 to -9.28;  Analysis 2.8), and lactate dehydrogenase (LDH) levels (MD -30.33, 95% CI -46.78 to -13.88;  Analysis 2.9) (Zhang ZZ 2006; Zhou Y 2006).

Shengmai injections plus supportive therapy showed a significant effect on CPK levels (MD -103.90, 95% CI -114.97 to -92.83;  Table 2;  Analysis 2.8), LDH levels (MD -34.60, 95% CI -51.25 to -17.95;  Table 2;  Analysis 2.9), and on myocardial CK-MB levels (MD -10.87, 95% CI -14.50 to -7.24;  Table 2;  Analysis 2.11) (Wu JW2 2009).

The combination of Shortscape Fleabane injections and supportive therapy appeared to be better than supportive therapy alone in reducing CPK levels (MD -41.73, 95% CI -67.00 to -16.46;  Table 2;  Analysis 2.8), LDH levels (MD -29.28, 95% CI -57.82 to -0.74;  Table 2;  Analysis 2.9), and CK-MB levels (MD -5.81, 95% CI -11.34 to -0.28;  Table 2;  Analysis 2.11) (Wang Y 2005).

A significant difference was found between the combined Shengyangyixin decoction and supportive therapy regarding LDH levels (MD -186.63, 95% CI -215.02 to -158.24;  Table 2;  Analysis 2.9), and CK-MB levels (MD -3.30, 95% CI -3.74 to -2.86;  Table 2;  Analysis 2.11) compared with supportive therapy alone.

There was no significant difference between the combination of Astragalus membranaceus injections and supportive therapy alone on myocardial creatine kinase MB (CK-MB) levels (Pan 2010) ( Table 2;  Analysis 2.11).

One trial showed a significant difference between Astragalus membranaceus granules plus supportive therapy and supportive therapy alone for CK-MB levels (MD 16.30, 95% CI -19.66 to -12.94;  Table 2;  Analysis 2.11) (Wu JW 2009).

The combination of Danhong decoction and supportive therapy showed significant effect on CPK levels (MD -22.02, 95% CI -37.50 to -6.54;  Table 2; Analysis 2.8), CK-MB levels (MD -2.66, 95% CI -5.07 to -0.25;  Table 2;  Analysis 2.11).

The combination of Garlincin injection and supportive therapy showed a significant reduction in the number of participants with abnormal ST-T changes (RR 0.09, 95% CI 0.01 to 0.65;  Table 2; Analysis 2.2), myocardial CK-MB levels (MD -16.30 U/L, 95% CI -20.32 to -12.28;  Table 2;  Analysis 2.11), cTnT levels (MD -0.35 U/L, 95% CI -0.52 to -0.18;  Table 2;  Analysis 2.13) (Pan 2010).

One trial showed a significant difference between Astragalus membranaceus injection plus supportive therapy and supportive therapy alone regarding cardiac troponin T (cTnT) levels (MD -0.27, 95% CI -0.47 to -0.07;  Table 2;  Analysis 2.13) (Pan 2010).

The combination of Danhong decoction and supportive therapy showed significant effect on CPK levels (MD -22.02, 95% CI -37.50 to -6.54;  Table 2; Analysimyocardial AST levels (MD -6.28, 95% CI -11.35 to -1.21;  Table 2;  Analysis 2.14) compared with supportive therapy alone (Tan HQ 2010). There was no significant difference between Danhong decoction plus supportive therapy and supportive therapy alone on myocardial LDH levels (Tan HQ 2010) ( Table 2).

Shengmai injections plus supportive therapy did not show any significant effect on myocardial hydroxybutyrate dehydrogenase (HBDH) levels (Wu JW2 2009) ( Table 2;  Analysis 2.15).

No significant effects were found on myocardial aspartate aminotransferase (AST) levels (Hu XF 2009) ( Analysis 3.3). In one trial, when compared with acyclovir plus support therapy, Astragaloside injections plus support therapy showed significant effects on myocardial CK-MB levels (MD -9.25 U/L, 95% CI -12.17 to -6.33;  Table 2;  Analysis 3.4) and myocardial LDH levels (MD -14.35 U/L, 95% CI -25.05 to -3.65;  Table 2;  Analysis 3.5) (Hu XF 2009).

 

3. Number and type of adverse events

Six trials reported on adverse effects (Tan YB 2003; Zheng RF 2005; Hu XF 2009; Wu JW2 2009; Tan HQ 2010; Dong 2011). Three trials observed no adverse events (Tan YB 2003; Wu JW2 2009; Tan HQ 2010). Adverse events of: high leucocyte counts were seen in 15/132 (11%) patients (including herbal and control group) in Zheng RF 2005, fever in 3/50 (6%) patients in Hu XF 2009, and itching in 2/60 (3.3%) patients in Dong 2011. There was no significant difference between Astragaloside injection plus support therapy and support therapy (Hu XF 2009) ( Table 2). Detailed information is shown in  Table 1 ( Analysis 3.6).

 

4. Quality of life (assessed by validated scale)

One trial reported on quality of life (Zheng RF 2005).

Shengmai decoction plus supportive therapy showed a significant improvement in quality of life measured by the SF-36 (MD 40.20, 95% CI 18.13 to 62.27;  Table 2;  Analysis 2.12) compared to supportive therapy alone (Zheng RF 2005).

The combination of Compound Qiangqi pills and supportive therapy showed significant improvements in quality of life measured by the SF-36 (MD 88.35, 95% CI 68.01 to 108.69;  Table 2;  Analysis 2.12) compared to supportive therapy alone (Zheng RF 2005).

 

5. Health economics (such as cost of interventions, length of hospital stay)

None of the trials reported on health economics.

 

Discussion

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Differences between protocol and review
  18. Index terms
 

Summary of results

The present systematic review suggests that some herbal medicines have positive effects in patients with suspected viral myocarditis. No significant effects were found on mortality or the incidence of complications.

Astragalus membranaceus plus supportive therapy was effective on an abnormal electrocardiogram. Shengmai injection was effective on cardiac function. Shortscape Fleabane, Xinshu capsule, Compound Qiangqi pill, Qi Lu decoction, Shengyangyixin decoction, and Qingxinhuoming decoction appear to be effective if we use the electrocardiogram as an outcome measure. Danhong decoction and Garlicin injection showed beneficial effects on cardiac function.

Astragalus membranaceus plus supportive therapy was effective in improving myocardial enzymes. Shengmai injection, Shortscape Fleabane, Xinshu capsule, Compound Qiangqi pill, Qi Lu Decoction, Shengyangyixin decoction, and Qingxinhuoming decoction also appeared to be effective on myocardial enzymes. Danhong decoction and Garlicin injection showed beneficial effects on myocardial enzyme levels.

We could not find other reviews on this topic. At present there is no strong evidence to recommend the use of any of these herbal medicines for the treatment of viral myocarditis due to the weak methodological quality of the trials, lack of a confirmed diagnosis, variations in the populations studied, the regimens and duration of the herbal medicines tested, and the outcomes reported. More specifically, the positive findings should be interpreted conservatively.

 

Risk of bias

All the randomised trials included in this review were at risk of bias in terms of design, reporting and methodology. They provided only limited descriptions of study design, randomisation and baseline data. Some of the trials reported a skewed distribution of data, which cannot be explained by the randomisation principle. Methodologically speaking, poorly-designed trials show larger differences between experimental and control groups than those conducted rigorously (Schulz 1995; Moher 1998; Kjaergard 2001). An insufficient number of trials prohibited us from performing meaningful sensitivity analyses to determine how robust the results of the review are to exclusion of trials with inadequate methodology. The included trials were heterogeneous in the populations studied (adults, children, or a mixture with acute or undefined viral myocarditis), interventions (few herbal medicines tested more than twice), and the reported outcomes. No multicentre, large scale RCTs were identified.

 

Publication bias

Although we conducted comprehensive searches, we only identified and included trials that were conducted and published in Chinese. Most of the trials were small with positive findings. We tried to avoid language bias and location bias, but we cannot exclude potential publication bias. Vickers and colleagues found that some countries, including China, publish unusually high proportions of positive results within the complementary medicine field (Vickers 1998). Publication bias may be a possible explanation. We have undertaken extensive searches for unpublished material, and few of the identified trials qualified for inclusion, but at the same time we cannot disregard the fact that trials with negative findings remain unpublished.

 

Diagnostic criteria

Most of the trials did not specify whether the diagnosis of viral myocarditis was confirmed with histopathological tests. In most trials diagnoses were made on the basis of the national conference consensus on the diagnosis of viral myocarditis, which essentially conforms with the international recommended criteria. No trial reported aetiological confirmation. Therefore, the participants in the included trials are considered to have 'suspected' viral myocarditis. Due to the lack of information about diagnosis of acute and chronic types of viral myocarditis, with subgroup outcomes reported as well as the electrocardiogram diagnosis, we could not perform the pre-specified subgroup analyses based on diagnosis we had hoped to.

 

Interventions

There are wide variations among the tested herbal medicines and control interventions. No trial used a placebo control. The herbal medicines were compared with supportive therapy or added to supportive therapy and then compared with supportive therapy alone. Even for the same herbal intervention, there were differences in treatment regimens including dosage, co-interventions, and duration of treatment. Therefore, it is difficult to undertake subgroup analyses to explore factors that may affect the findings. There is still a lack of information on a quality standard for the development of herbal preparations or for the manufacture of herbal products. Future trials should provide information about standardisation, including composition, quality control, a detailed regimen, and fixed duration of treatment.

 

Surrogate outcomes

The primary goal of treatment for viral myocarditis is to prevent death or progression to complications. Only one trial reported deaths in participants with viral myocarditis (Yang YX 2008). Other outcomes from the included trials included myocardial enzyme levels and cardiac function, which are surrogate outcomes. Only one trial reported quality of life. There is a lack of data from most trials on clinically relevant outcomes such as mortality, incidence of complications, and quality of life. We excluded 109 randomised trials on herbal medicines for viral myocarditis from this review. The main reasons for exclusion were inadequate reporting of the outcomes and methods of sequence generation. Most of the excluded studies reported a global improvement of outcomes, combined symptoms and signs, electrocardiogram, and myocardial enzyme levels. Data from individual outcomes were not available.

Nevertheless, herbal medicines are widely used for treating viral myocarditis in China. We have identified more than 1000 clinical controlled studies on this topic. However, most of the studies are not eligible for this review due to inadequate design, methodology, and reporting. Chinese researchers must be aware of the need to use appropriate statistical power in future randomised controlled trials of herbal medicines and to measure clinical outcomes rather than physiological (surrogate) outcomes.

 

Adverse outcomes

There was inadequate reporting on adverse events in the included trials, so no conclusions can be drawn about the safety of herbal medicines for viral myocarditis. In China, there is a general perception that it is safe to use herbal medicines for various conditions, and some studies support this perception (Haines 2008; May 2009; Ramesh 2009; Wang L 2009). The low level of reporting on adverse events may reflect this. However, there are some reports of liver toxicity and other adverse events associated with using Chinese herbal medicines (Ishizaki 1996; Melchart 1999; Gottieb 2000; Pinn 2001; Liu J 2006). For this reason, the safety of herbal medicines needs to be monitored and reported in clinical trials.

 

Authors' conclusions

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Differences between protocol and review
  18. Index terms

 

Implications for practice

Since no new trials were included in the update search in 2013, the conclusions remain the same as in the 2012 version. Based on this systematic review, the effectiveness and safety of herbal medicines in suspected viral myocarditis is uncertain. The evidence is inconclusive due to poorly designed, low-quality trials and uncertain diagnosis of viral myocarditis. Further randomised trials with a robust methodology are warranted.

 
Implications for research

Future research needs to emphasise not only good clinical trial methods but also a more rigorous description of the pharmacology of the interventions and histological diagnosis of myocarditis. Trials on Chinese herbal medicines for viral myocarditis should be designed to record meaningful clinical outcomes.

From the results of the present review, it would be interesting to evaluate preparations of Astragalus membranaceus and Shengmai compared with supportive therapy in patients with established viral myocarditis. Information about the species, geographical origin of the herbs, season for collecting, and the quality of the preparations should be provided. Standardised monitoring and reporting should be used for assessment of adverse events.

Future research should also pay attention to the quality of trials. To improve the quality of future trials, we suggest that all researchers should receive necessary training on clinical trial methodology before designing a trial and should register trials with authorised registering organizations. The following methodological issues should be addressed: (i) the methods used to generate random sequence; (ii) methods used to allocation concealment; and (iii) double-blinding with the use of an adequate placebo. At the data analysis stage, clear descriptions of withdrawals and drop-outs during the trial and the use of an intention-to-treat analysis are preferred. We suggest that the authors report trials according to the CONSORT 2010 Statement (Schulz 2010).

 

Acknowledgements

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Differences between protocol and review
  18. Index terms

We thank Margaret Burke of the Cochrane Heart Group for her help in the development of the search strategy. We are grateful to Theresa Moore for her previous constructive suggestions in the development of the protocol. We also wish to acknowledge Xinmiao Du for her help in the trials search, study selection, quality assessment of trials and data extraction with the initial review and previous review update.

We would also like to thank Nicole Martin for her updated searches for English databases.
We would also like to thank Yan Ming, who was an author of the original review, for her work.

Jianping Liu was partially funded by grant number R24 AT001293-10 from the National Center for Complementary and Alternative Medicine (NCCAM) of the US National Institutes of Health (www.nccam.nih.gov).

 

Data and analyses

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Differences between protocol and review
  18. Index terms
Download statistical data

 
Comparison 1. Herbal medicines versus supportive therapy

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Number of patients that died of cardiac failure1Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

    1.1 Astragaloside injection versus supportive therapy
1Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

 2 Abnormal ST-T changes1Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

    2.1 Shenmai injection versus supportive therapy
1Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

 3 Number of patients converting to persistant myocarditis1Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

    3.1 Astragaloside injection versus supportive therapy
1Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

 4 Number of patients with premature beat1Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

    4.1 Xinshu capsule versus supportive therapy
1Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

 
Comparison 2. Herbal medicines plus supportive therapy versus supportive therapy

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Abnormal electrocardiogram8Risk Ratio (M-H, Fixed, 95% CI)Subtotals only

    1.1 Astragalus membranaceus plus supportive therapy versus supportive therapy
148Risk Ratio (M-H, Fixed, 95% CI)0.64 [0.29, 1.41]

    1.2 Qingxinhuoming decoction plus supportive therapy versus supportive therapy
178Risk Ratio (M-H, Fixed, 95% CI)0.32 [0.13, 0.79]

    1.3 Compound Qiangqi pill plus supportive therapy versus supportive therapy
132Risk Ratio (M-H, Fixed, 95% CI)0.81 [0.53, 1.23]

    1.4 Shenmai injection plus supportive therapy versus supportive therapy
180Risk Ratio (M-H, Fixed, 95% CI)0.11 [0.01, 0.86]

    1.5 Shengmai decoction plus supportive therapy versus supportive therapy
131Risk Ratio (M-H, Fixed, 95% CI)0.95 [0.67, 1.36]

    1.6 Shengyangyixin decoction plus supportive therapy versus supportive therapy
176Risk Ratio (M-H, Fixed, 95% CI)0.56 [0.35, 0.90]

    1.7 Astragaloside injection plus supportive therapy versus supportive therapy
2170Risk Ratio (M-H, Fixed, 95% CI)0.28 [0.13, 0.61]

    1.8 Xinjikang decoction plus supportive therapy versus supportive therapy
1224Risk Ratio (M-H, Fixed, 95% CI)0.71 [0.48, 1.05]

 2 Abnormal ST-T changes2Risk Ratio (M-H, Fixed, 95% CI)Subtotals only

    2.1 Astragaloside injection plus supportive therapy versus supportive therapy
2149Risk Ratio (M-H, Fixed, 95% CI)0.72 [0.54, 0.95]

    2.2 Garlicin injection plus supportive therapy versus supportive therapy
152Risk Ratio (M-H, Fixed, 95% CI)0.09 [0.01, 0.65]

 3 Number of patients with premature beat5Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

    3.1 Qi Lu decoction plus supportive therapy versus supportive therapy
1Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

    3.2 Shortscape Fleabane injection plus supportive therapy versus supportive therapy
1Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

    3.3 Astragaloside injection plus supportive therapy versus supportive therapy
1Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

    3.4 Compound Qiangqi pill plus supportive therapy versus supportive therapy
1Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

    3.5 Shengmai decoction plus supportive therapy versus supportive therapy
1Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

    3.6 Danhong injection plus supportive therapy versus supportive therapy
1Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

 4 Number of patients with abnormal myocardial enzyme levels2Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

    4.1 Astragalus membranaceus plus supportive therapy versus supportive therapy
1Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

    4.2 Astragaloside injection plus supportive therapy versus supportive therapy
1Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

 5 Abnormal LVEF1Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

    5.1 Astragaloside injection plus supportive therapy versus supportive therapy
1Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

 6 Number of patients converting to persistant myocarditis1Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

    6.1 Astragaloside injection plus supportive therapy versus supportive therapy
1Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

 7 Number of patients with arrhythmia2Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

    7.1 Astragaloside injection plus supportive therapy versus supportive therapy
1Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

    7.2 Garlicin injection plus supportive therapy versus supportive therapy
1Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

    7.3 Danhong injection plus supportive therapy versus supportive therapy
1Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

 8 Myocardial enzyme CPK levels (U/L)5Mean Difference (IV, Random, 95% CI)Subtotals only

    8.1 Astragaloside injection plus supportive therapy versus supportive therapy
2120Mean Difference (IV, Random, 95% CI)-21.54 [-33.80, -9.28]

    8.2 Shortscape Fleabane injection plus supportive therapy versus supportive therapy
183Mean Difference (IV, Random, 95% CI)-41.73 [-65.00, -16.46]

    8.3 Danhong injection plus supportive therapy versus supportive therapy
1104Mean Difference (IV, Random, 95% CI)-22.02 [-37.50, -6.54]

    8.4 Shenmai injection plus supportive therapy versus supportive therapy
180Mean Difference (IV, Random, 95% CI)-103.90 [-114.97, -92.83]

 9 Myocardial enzyme LDH levels (U/L)6Mean Difference (IV, Random, 95% CI)Subtotals only

    9.1 Shengyangyixin decoction plus supportive therapy versus supportive therapy
176Mean Difference (IV, Random, 95% CI)-186.63 [-215.02, -158.24]

    9.2 Astragaloside injection plus supportive therapy versus supportive therapy
2120Mean Difference (IV, Random, 95% CI)-30.33 [-46.78, -13.88]

    9.3 Shortscape Fleabane injection plus supportive therapy versus supportive therapy
183Mean Difference (IV, Random, 95% CI)-29.28 [-57.82, -0.74]

    9.4 Danhong injection plus supportive therapy versus supportive therapy
1104Mean Difference (IV, Random, 95% CI)-18.36 [-37.23, 0.51]

    9.5 Shenmai injection plus supportive therapy versus supportive therapy
180Mean Difference (IV, Random, 95% CI)-34.60 [-51.25, -17.95]

 10 Cardiac function LVET (%)2Mean Difference (IV, Fixed, 95% CI)Totals not selected

    10.1 Astragaloside injection plus supportive therapy versus supportive therapy
1Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

    10.2 Astragalus membranaceus plus supportive therapy versus supportive therapy
1Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

 11 Myocardial enzyme CK-MB levels (U/L)6Mean Difference (IV, Fixed, 95% CI)Totals not selected

    11.1 Astragalus membranaceus plus supportive therapy versus supportive therapy
1Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

    11.2 Shengyangyixin decoction plus supportive therapy versus supportive therapy
1Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

    11.3 Shortscape Fleabane injection plus supportive therapy versus supportive therapy
1Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

    11.4 Astragalus injection plus supportive therapy versus supportive therapy
1Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

    11.5 Garlicin injection plus supportive therapy versus supportive therapy
1Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

    11.6 Danhong injection plus supportive therapy versus supportive therapy
1Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

    11.7 Shenmai injection plus supportive therapy versus supportive therapy
1Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

 12 Scores of quality of life measured by SF-361Mean Difference (IV, Fixed, 95% CI)Totals not selected

    12.1 Compound Qiangqi pill plus supportive therapy versus supportive therapy
1Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

    12.2 Shengmai decoction plus supportive therapy versus supportive therapy
1Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

 13 Cardiac troponin cTnT levels (U/L)1Mean Difference (IV, Fixed, 95% CI)Totals not selected

    13.1 Astragaloside injection plus support therapy versus support therapy
1Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

    13.2 Garlicin injection plus supportive therapy versus supportive therapy
1Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

 14 Myocardial enzyme AST levels (U/L)1Mean Difference (IV, Fixed, 95% CI)Totals not selected

    14.1 Danhong injection plus supportive therapy versus supportive therapy
1Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

 15 Myocardial enzyme HBDH levels (U/L)1Mean Difference (IV, Fixed, 95% CI)Totals not selected

    15.1 Shenmai injection plus supportive therapy versus supportive therapy
1Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

 
Comparison 3. Herbal medicines plus supportive therapy versus Western medicines plus supportive therapy

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Number of patients with premature beat1Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

    1.1 Astragaloside injection plus supportive therapy versus Acyclovir plus supportive therapy
1Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

 2 Number of patients with sinus bradycardia1Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

    2.1 Astragaloside injection plus supportive therapy versus Acyclovir plus supportive therapy
1Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

 3 Myocardial enzyme AST levels (U/L)1Mean Difference (IV, Fixed, 95% CI)Totals not selected

    3.1 Astragaloside injection plus supportive therapy versus Acyclovir plus supportive therapy
1Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

 4 Myocardial enzyme CK-MB levels (U/L)1Mean Difference (IV, Fixed, 95% CI)Totals not selected

    4.1 Astragaloside injection plus supportive therapy versus Acyclovir plus supportive therapy
1Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

 5 Myocardial enzyme LDH levels (U/L)1Mean Difference (IV, Fixed, 95% CI)Totals not selected

    5.1 Astragaloside injection plus supportive therapy versus Acyclovir plus supportive therapy
1Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

 6 Adverse effects1Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

    6.1 Astragaloside injection plus supportive therapy versus Acyclovir plus supportive therapy
1Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

 

Appendices

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Differences between protocol and review
  18. Index terms
 

Appendix 1. Search strategies 2013

 

CENTRAL

#1 MeSH descriptor: [Myocarditis] this term only
#2 MYOCARDITIS
#3 MYOCARD* near/6 INFLAMM*
#4 HEART near/6 INFLAMM*
#5 #1 or #2 or #3 or #4
#6 MeSH descriptor: [Medicine, Traditional] explode all trees
#7 MeSH descriptor: [Plant Extracts] explode all trees
#8 MeSH descriptor: [Plants, Medicinal] this term only
#9 HERB or HERBAL or HERBS
#10 ALTERNATIVE next MEDICIN*
#11 COMPLEMENTARY next MEDICINE*
#12 TRADITIONAL near/6 MEDICINE*
#13 PLANT* near/6 MEDICIN*
#14 CHINESE near/6 MEDICIN*
#15 PHYTODRUG*
#16 PHYTOPHARMACEUTIC*
#17 AYURVEDIC
#18 ORIENTAL near/6 MEDICINE*
#19 MeSH descriptor: [Phytotherapy] this term only
#20 MeSH descriptor: [Nonprescription Drugs] explode all trees
#21 plant or plants
#22 #6 or #7 or #8 or #9 or #10 or #11 or #12 or #13 or #14 or #15 or #16 or #17 or #18 or #19 or #20 or #21
#23 #5 and #22

 

MEDLINE OVID

1. exp Myocarditis/
2. myocarditis.tw.
3. or/1-2
4. exp Medicine, Traditional/
5. Complementary Therapies/
6. exp Plant Extracts/
7. exp Plants, Medicinal/
8. Nonprescription Drugs/
9. exp Phytotherapy/
10. (herb or herbs or herbal).tw.
11. alternative medicine$.tw.
12. complementary medicine$.tw.
13. traditional medicine$.tw.
14. (plant or plants).tw.
15. ((chinese or oriental) adj3 medicine$).tw.
16. ayurvedic.tw.
17. (phytodrug$ or phyto-drug$ or phytopharmaceutical$).tw.
18. or/4-17
19. 3 and 18
20. exp animals/ not humans/
21. 19 not 20
22. (201106* or 201107* or 201108* or 201109* or 201110* or 201111* or 20112* or 2012* or 2013*).ed.
23. 21 and 22
24. (myocard* adj2 inflam*).tw.
25. (heart adj2 inflam*).tw.
26. 3 or 24 or 25
27. 18 and 26
28. 27 not 20
29. 28 not 21
30. 23 or 29

 

EMBASE OVID

1. exp myocarditis/
2. myocarditis.tw.
3. or/1-2
4. exp traditional medicine/
5. alternative medicine/
6. exp plant extract/
7. exp medicinal plant/
8. phytotherapy/
9. (herb or herbs or herbal).tw.
10. alternative medicine$.tw.
11. complementary medicine$.tw.
12. traditional medicine$.tw.
13. (plant or plants).tw.
14. ((chinese or oriental) adj3 medicine$).tw.
15. ayurvedic.tw.
16. (phytodrug$ or phyto-drug$ or phytopharmaceutical$).tw.
17. or/4-16
18. 3 and 17
19. (exp animals/ or nonhuman/) not human/
20. 18 not 19
21. ("201123" or "201124" or "201125" or "201126" or "201127" or "201128" or "201129" or 20113* or 20114* or 20115* or 2012* or 2013*).em.
22. 20 and 21

 

LILACS

(myocarditis or Miocarditis or miocardite) and not (animals and not humans) [Words] and (random$ or trial$ or RCT or placebo$ or comparative or prospective or groups) [Words] and 2011 or 2012 or 2013 [Country, year publication]

 

Appendix 2. Search strategies 2011

 

CENTRAL on The Cochrane Library

#1 MeSH descriptor Myocarditis, this term only
#2 MYOCARDITIS
#3 MYOCARD* near/6 INFLAMM*
#4 HEART near/6 INFLAMM*
#5 (#1 OR #2 OR #3 OR #4)
#6 MeSH descriptor Medicine, Traditional explode all trees
#7 MeSH descriptor Plant Extracts explode all trees
#8 MeSH descriptor Plants, Medicinal, this term only
#9 HERB or HERBAL or HERBS
#10 ALTERNATIVE next MEDICIN*
#11 COMPLEMENTARY next MEDICINE*
#12 TRADITIONAL near/6 MEDICINE*
#13 PLANT* near/6 MEDICIN*
#14 CHINESE near/6 MEDICIN*
#15 PHYTODRUG*
#16 PHYTOPHARMACEUTIC*
#17 AYURVEDIC
#18 ORIENTAL near/6 MEDICINE*
#19 MeSH descriptor Phytotherapy, this term only
#20 (#6 OR #7 OR #8 OR #9 OR #10 OR #11 OR #12 OR #13 OR #14 OR #15 OR #16 OR #17 OR #18 OR #19)
#21 (#5 AND #20)

 

MEDLINE (on Ovid)

1. exp Myocarditis/
2. myocarditis.tw.
3. or/1-2
4. exp Medicine, Traditional/
5. Complementary Therapies/
6. exp Plant Extracts/
7. exp Plants, Medicinal/
8. Nonprescription Drugs/
9. exp Phytotherapy/
10. (herb or herbs or herbal).tw.
11. alternative medicine$.tw.
12. complementary medicine$.tw.
13. traditional medicine$.tw.
14. (plant or plants).tw.
15. ((chinese or oriental) adj3 medicine$).tw.
16. ayurvedic.tw.
17. (phytodrug$ or phyto-drug$ or phytopharmaceutical$).tw.
18. or/4-17
19. 3 and 18
20. exp animals/ not humans/
21. 19 not 20
22. (200908* or 200909* or 200910* or 200911* or 200912* or 2010* or 2011*).ed.
23. 21 and 22

 

EMBASE (on Ovid)

1. exp myocarditis/
2. myocarditis.tw.
3. or/1-2
4. exp traditional medicine/
5. alternative medicine/
6. exp plant extract/
7. exp medicinal plant/
8. phytotherapy/
9. (herb or herbs or herbal).tw.
10. alternative medicine$.tw.
11. complementary medicine$.tw.
12. traditional medicine$.tw.
13. (plant or plants).tw.
14. ((chinese or oriental) adj3 medicine$).tw.
15. ayurvedic.tw.
16. (phytodrug$ or phyto-drug$ or phytopharmaceutical$).tw.
17. or/4-16
18. 3 and 17
19. (exp animals/ or nonhuman/) not human/
20. 18 not 19
21. (200908* or 200909* or 200910* or 200911* or 200912* or 2010* or 2011*).dd.
22. 20 and 21

 

AMED (Allied and Complementary Medicine) (on Ovid)

1 myocarditis.tw.
2 limit 1 to yr="2009 - 2011"

 

LILACs (on BIREME)

(myocarditis or Miocarditis or miocardite) and not (animals and not humans) [Words] and (random$ or trial$ or RCT or placebo$ or comparative or prospective or groups) [Words] and 2009 or 2010 or 2011 [Country, year publication]

 

Chinese Biomedical Database (CBM)

1 MeSH ==" Myocarditis /all subtitles/all trees"
2 Myocarditis
3 1 and 2
4 MeSH=="medicine, eastern tradition/all subtitles/all trees"
5 MeSH=="complementary medicine/"
6 MeSH=="plant extracts/all subtitles/all trees"
7 MeSH=="Plant, Therapeutic Use /All subtitles"
8 MeSH=="drugs, over the counter"
9 MeSH=="Phytotherapy/All subtitles/all trees"
10 Herbs or herbal or herb
11 Alternative medicine*
12 Complementary medicine*
13 Traditional medicine*
14 plant or plants
15 (China or The East) with medicine*
16 Plant medicinal product * or medicinal materials or herbal medicine
17 MeSH="Chinese herbal drugs/all subtitles"
18 #17or #16 or #15 or #14 or #13 or #12 or #11 or #10 or #9 or #8 or #7 or #6 or #5 or #4
19 Title: rats or rabbits
20 (not #19) and #18 and 3
21 limit 20 to yr="2009 - 2011"

 

China National Knowledge Infrastructure (CNKI)

1 Myocarditis
2 herbal medicine or Chinese medicine or Chinese and western or plants or herbs
3 1 and 2

 

Chinese VIP Information (VIP)

1 Myocarditis

2 herbal medicine or Chinese medicine or Chinese and western or plants or herbs
3 1 and 2

 

Chinese Academic Conference Papers Database and Chinese Dissertation Database

1 Myocarditis

2 Herbal medicine or Chinese medicine or Chinese and western or plants or herbs
3 1 and 2

 

Appendix 3. Search strategies 2009

 

CENTRAL on The Cochrane Library

#1 MeSH descriptor myocarditis this term only
#2 MYOCARDITIS in All Text
#3 (MYOCARD* in All Text near/6 INFLAMM* in All Text)
#4 (HEART in All Text near/6 INFLAMM* in All Text)
#5 (#1 or #2 or #3 or #4)
#6 MeSH descriptor Medicine, Traditional explode all trees
#7 MeSH descriptor Plant Extracts explode all trees
#8 MeSH descriptor Plants, Medicinal explode all trees
#9 ( (HERB in All Text or HERBAL in All Text) or HERBS in All Text)
#10 ALTERNATIVE next MEDICIN* in All Text
#11 COMPLEMENTARY next MEDICINE* in All Text
#12 (TRADITIONAL in All Text near/6 MEDICINE* in All Text)
#13 (PLANT* in All Text near/6 MEDICIN* in All Text)
#14 (CHINESE in All Text near/6 MEDICIN* in All Text)
#15 PHYTODRUG* in All Text
#16 PHYTOPHARMACEUTIC* in All Text
#17 AYURVEDIC in All Text
#18 (ORIENTAL in All Text near/6 MEDICINE* in All Text)
#19 MeSH descriptor phytotherapy this term only
#20 (#6 or #7 or #8 or #9 or #10 or #11 or #12 or #13 or #14 or #15 or #16 or #17 or #18 or #19)
#21 (#5 and #20)

 

MEDLINE (on Ovid)

1 exp Myocarditis/
2 myocarditis.tw.
3 or/1-2
4 exp Medicine, Traditional/
5 Alternative Medicine/
6 exp Plant Extracts/
7 exp Plants, Medicinal/
8 Drugs, Non-Prescription/
9 exp Phytotherapy/
10 (herb or herbs or herbal).tw.
11 alternative medicine$.tw.
12 complementary medicine$.tw.
13 traditional medicine$.tw.
14 (plant or plants).tw.
15 ((chinese or oriental) adj3 medicine$).tw.
16 ayurvedic.tw.
17 (phytodrug$ or phyto-drug$ or phytopharmaceutical$).tw.
18 or/4-17
19 3 and 18
20 limit 19 to yr="2003 - 2009"
21 exp animals/ not humans/
23 20 not 21

 

EMBASE (on Ovid)

1 exp Myocarditis/
2 myocarditis.tw.
3 or/1-2
4 exp traditional medicine/
5 Alternative Medicine/
6 exp Plant Extracts/
7 exp Medicinal Plant/
8 Phytotherapy/
9 (herb or herbs or herbal).tw.
10 alternative medicine$.tw.
11 complementary medicine$.tw.
12 traditional medicine$.tw.
13 (plant or plants).tw.
14 ((chinese or oriental) adj3 medicine$).tw.
15 ayurvedic.tw.
16 (phytodrug$ or phyto-drug$ or phytopharmaceutical$).tw.
17 or/4-16
18 3 and 17
19 limit 18 to yr="2003 - 2009"
20 (exp animals/ or nonhuman/) not human/
21 19 not 20

 

AMED (Allied and Complementary Medicine) (on Ovid)

1 myocarditis.tw.
2 limit 1 to yr="2003 - 2009"

 

LILACs (on BIREME)

(myocarditis or Miocarditis or miocardite) and not (animals and not humans) [Words] and (random$ or trial$ or RCT or placebo$ or comparative or prospective or groups) [Words] and 2009 or 2010 or 2011 [Country, year publication]

 

Appendix 4. Search strategy 2003

 

MEDLINE

1 exp Myocarditis/
2 myocarditis.tw.
3 or/1-2
4 exp Medicine, Traditional/
5 Alternative Medicine/
6 exp Plant Extracts/
7 exp Plants, Medicinal/
8 Drugs, Non-Prescription/
9 Herbs/
10 (herb or herbs or herbal).tw.
11 alternative medicine$.tw.
12 complementary medicine$.tw.
13 traditional medicine$.tw.
14 (plant or plants).tw.
15 ((Chinese or oriental) adj3 medicine$).tw.
16 (phytodrug$ or phyto-drug$ or phytopharmaceutical$).tw.
17 or/4-16
18 3 and 17
19 a RCT filter (Dickersin 1994)
20 18 and 19.
[/ indicates MeSH term, exp = exploded, tw = textword, $ = truncation]

 

What's new

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Differences between protocol and review
  18. Index terms

Last assessed as up-to-date: 1 February 2013.


DateEventDescription

28 August 2013New citation required but conclusions have not changedNo new trials were located.



 

History

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Differences between protocol and review
  18. Index terms

Protocol first published: Issue 3, 2002
Review first published: Issue 3, 2004


DateEventDescription

28 August 2013New search has been performedNo new trials were located.

12 February 2013New search has been performedSearch has been re-run to February 2013 for English language databases and no new trials were included. Conclusion unchanged.

15 November 2011New search has been performedSearch has been re-run to June 2011. A total of 6 new studies have been included. The conclusions remain unchanged.

15 November 2011New citation required but conclusions have not changedChanges to the author team.

13 May 2010New citation required but conclusions have not changedChange of authors.

13 May 2010New search has been performedThe inclusion criteria were revised to include only trials that included an adequate description of the generation of allocation sequence. This resulted in 40 trials (of 43 references) that were included in the previous review being excluded in this update. Searches were updated and 14 new trials were identified. The conclusions were not changed.

8 September 2008AmendedConverted to new review format.

29 March 2004New citation required and conclusions have changedSubstantive amendment



 

Contributions of authors

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Differences between protocol and review
  18. Index terms

Zhao Lan Liu: searched for trials, selected studies, assessed quality of trials, extracted data, analysed data, and drafted the updated review.
Zhi Jun Liu: searched for trials, selected studies, assessed quality of trials, and extracted data.

Joey SW Kwong: interpreted data and the analyses; provided methodological perspective and general advice on this review update.

Jian Ping Liu: defined the review question, developed the protocol and search strategy, selected studies, assessed quality, extracted data, analysed data, developed the final review.

 

Declarations of interest

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Differences between protocol and review
  18. Index terms

Zhao Lan Liu: nothing to declare.
Zhi Jun Liu: nothing to declare.

Joey SW Kwong: nothing to declare.

Jian Ping Liu: nothing to declare.

Inrenal sources:
•Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, China
•Beijing University of Chinese Medicine (2011-CXTD-09), Beijing, China
•National Research Centre in Complementary and Alternative Medicine (NAFKAM), University of Tromso, Norway
And the external sources as follows:
•Beijing Nova Programme(Number: xx2013031), China
•Grant number CSO-51 from Global fund for HIV, China, China
•Grant number 2011ZX09302-006 from the Ministry of Science and Technology, China
•The Project for Standard Operation Procedure of Clinical Appraisal in the Program for Significant New Drugs Development (2011ZX09302-006-01-03(5), China
•Grant number JYBZZ-JS006 from Beijing University of Chinese Medicine, China
•Basic Operational Funding for Scientific Research from Beijing University of Chinese Medicine, China
•Grant number 2009DFA31460 from the International Cooperation Project of the Ministry of Science and Technology, China
•National Basic Research Program ('973' Program) Grant Number 2006CB504602 from the Ministry of Science and Technology, China

 

Sources of support

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Differences between protocol and review
  18. Index terms
 

Internal sources

  • Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, China.
  • National Research Centre in Complementary and Alternative Medicine (NAFKAM), Norway.

 

External sources

  • Grant number JYBZZ-JS006 from Beijing University of Chinese Medicine, China.
  • The program for Innovative Research Team of Beijing University of Chinese Medicine (No. 2011-CXTD-09), China.
  • Grant number 2009DFA31460 from the Internaitonal Cooperation Project of the Ministry of Science and Technology, China.

 

Differences between protocol and review

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Differences between protocol and review
  18. Index terms

During the updating of the published review in 2009, we applied stricter inclusion criteria regarding study design. We restricted all randomised trials to those with an adequate description of generation of the allocation sequence. Therefore, some RCTs included in the original review were excluded due to being unclear about methods used for generation of the allocation sequence. This resulted the exclusion of 40 trials (43 references) from this update that had been included in the previous version of the review. Searches were updated and 14 new trials were identified.

* Indicates the major publication for the study

References

References to studies included in this review

  1. Top of page
  2. Abstract
  3. Summary of findings
  4. Background
  5. Objectives
  6. Methods
  7. Results
  8. Discussion
  9. Authors' conclusions
  10. Acknowledgements
  11. Data and analyses
  12. Appendices
  13. What's new
  14. History
  15. Contributions of authors
  16. Declarations of interest
  17. Sources of support
  18. Differences between protocol and review
  19. Characteristics of studies
  20. References to studies included in this review
  21. References to studies excluded from this review
  22. Additional references
  23. References to other published versions of this review
Chen PY 2006 {published data only}
  • Chen PY, Zhou F, Ceng Y, Li G, Luo LY. Clinical observation on the effect of Xinshu Capsule (XC) in treating frequent ventricular extrasystoles due to viral myocarditis and the influence on ET, MDA AND CRP [in Chinese]. Shanxi Journal of Traditional Chinese Medicine 2006;22(3):13-5.
  • Chen PY, Zhou F, Chen WL, Ceng Y, Luo LY. Clinical observation on the effect of Xinshu Capsule (XC) in treating frequent ventricular extrasystoles due to viral myocarditis and the influence on NO, NOS AND SOD [in Chinese]. Chinese Journal of Current Traditional and Western Medicine 2005;3(10):893-5.
Dong 2011 {published data only}
  • Dong XP. Study on the effects of combined treatment with Astragalactoside injection for infantile viral myocarditis. Chinese Journal of Hospital Pharmacy 2011;31(1):64-5,73.
Hu XF 2009 {published data only}
  • Hu XF. Huanqi the treatment of viral myocarditis caused by the clinical research of arrhythmia. Full paper database of Chinese excellent dissertations by doctors and masters 2009.
Li L 2006 {published data only}
  • Li L, Zhang SL, Zhong XL, Xu LL, Duan AY. Observation on therapeutic effect of Qingxinkangyan Yin Decoction in treating patients with CVB myocarditis and nursing strategy. Journal of Nursing (China) 2006;13(3):59-60.
Li M 2006 {published data only}
  • Li M. 38 cases of viral myocarditis treated by Sheng Yang Yi Xin decoction. Shanxi Journal of Traditional Chinese Medicine 2006;27(7):791-3.
Pan 2010 {published data only}
  • Pan XS. Analysis on the effect of garlicin for treating viral myocarditis. Youjiang Medical Journal 2010;38(2):120-2.
Peng 2005 {published data only}
  • Ma XB. Observation of Shengmai injection in treating 127 patients with viral myocarditis [in Chinese]. Chinese Community Doctors 2008;23(10):132.
  • Peng Q, Liu JQ. Observation of Shengmai injection in treating 127 patients with viral myocarditis [in Chinese]. Maternal and Child Health Care of China 2005;20(23):3096.
Tan HQ 2010 {published data only}
  • Tan HQ, Gong XF, Yang JG. Clinical research of Dan Hong injection combined taurine in treatment of viral myocarditis. Chong Qing Medicine 2010;39(1):91-3.
Tan YB 2003 {published data only}
  • Tan YB. Clinical observation on the effect of Astragalactoside injection in the treatment of infantile viral myocarditis [in Chinese]. Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care 2003;10(1):60-1.
Wang Y 2005 {published data only}
  • Wang Y, Chen YR, Ye L, Wu YZ, Chen BW. Clinical observation of shortscape fleabane injection in treating patients with viral myocarditis [in Chinese]. Journal of Emergency in Traditional Chinese Medicine 2005;14(9):813-4.
Wang ZT 2010 {published data only}
  • Wang ZT, Han LH, Suo HL. Clinical investigation on treatment of self recipe of Xinjikang for 112 children with acute viral myocarditis. Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care 2010;17(3):166-8.
Wu JW 2009 {published data only}
  • Wu JW, Tao N, Jiang RF, Feng HD. Clinical observation on infantile viral myocarditis treated with radix astragali granules [in Chinese]. Journal of Pediatric Pharmacy 2009;15(1):23-5.
Wu JW2 2009 {published data only}
  • Wu JW, Zhu JB, Sun DL. Clinical observation on paediatric viral myocarditis by Shenmai injection (attached 80 cases). Guide of China Medicine 2009;7(1):232-3.
Yang YX 2008 {published data only}
  • Yang YX. Clinical research on treatment of acute viral myocarditis by Astragalactoside injection [in Chinese]. World Health Digest Medical Periodical 2008;5(9):35.
Yao 2005 {published data only}
  • Yao BJ. Qi Lu decoction in the treatment of viral myocarditis with arrhythmia. Journal of Henan University of Chinese Medicine 2005;20(3):39-40.
Zhang ZZ 2006 {published data only}
  • Zhang ZZ, Yu XH, Zhang P, Yang YH. Observation on 20 cases of viral myocarditis treated with Astragalactoside injection [in Chinese]. Journal of Nanhua University (Medical Edition) 2006;34(1):143-4.
Zheng R 2003 {published data only}
  • Zheng Rong. 120 cases of viral myocarditis treated with integrated Chinese and western medicine [in Chinese]. The Journal of Medical Theory and Practice 2003;16(8):907-8.
Zheng RF 2005 {published data only}
  • Zheng Ruifeng. The double-blinding study on the effects of compound recipe Qiang Qi pill in treating patients with VMC. Full paper database of Chinese excellent dissertations by doctors and masters 2005:1-72.
Zhou Y 2006 {published data only}
  • Zhou Y, Yu XH, Yang YH. Observation of astragaloside on treating viral myocarditis in 40 cases [in Chinese]. Chinese Journal of the Practical with Modern Medicine 2006;19(8):880-1.
Zhou YW 2008 {published data only}
  • Zhou YW, Zhang ZJ. Observation of Huo Ming decoction in treatment of viral myocarditis. Chinese Journal of Misdiagnosis 2008;8(23):5584-5.

References to studies excluded from this review

  1. Top of page
  2. Abstract
  3. Summary of findings
  4. Background
  5. Objectives
  6. Methods
  7. Results
  8. Discussion
  9. Authors' conclusions
  10. Acknowledgements
  11. Data and analyses
  12. Appendices
  13. What's new
  14. History
  15. Contributions of authors
  16. Declarations of interest
  17. Sources of support
  18. Differences between protocol and review
  19. Characteristics of studies
  20. References to studies included in this review
  21. References to studies excluded from this review
  22. Additional references
  23. References to other published versions of this review
An 1997 {published data only}
  • An XF. 50 cases of viral myocarditis complicated with arrhythmia treated with Radix Salviae miltiorrhizae [in Chinese]. Tianjin Medical Journal 1997;25(8):502-3.
Cao 1996 {published data only}
  • Cao GM, Zhang SF, Hu YH, Lu JZ, Wang JC, Li LS, et al. Clinical observation on acute viral myocarditis treated with Xinyikang oral liquid [in Chinese]. Chinese Journal of Traditional Chinese Medical Science and Technology 1996;3(6):35-7.
Chen BY 1993 {published data only}
  • Chen BY, Zhang XL, Ying XZ, Dong YQ, Liu H, Qiao WP, et al. Clinical research on treatment of children viral myocarditis by the principle of nourishing Qi and Yin and promoting blood circulation by removing blood stasis [in Chinese]. Chinese Journal of Traditional Chinese Medicine and Pharmacy 1993;8(5):20-2.
Chen BY 1994 {published data only}
  • Chen BY, Yin XZ, Hu SY, Liu H, Qiao WP, He AY. Controlled observation on 65 infantile acute viral myocarditis treated with traditional and western medicine [in Chinese]. Chinese Journal of Integrated Traditional and Western Medicine 1994;14(4):216-9.
Chen H 1999 {published data only}
  • Chen H. 104 cases of acute viral myocarditis treated with Astragalactoside injection [in Chinese]. Chinese Journal of Information on Traditional Chinese Medicine 1999;6(4):49.
Chen LJ 1997 {published data only}
  • Chen LJ. Observation on 48 cases of viral myocarditis by treatment with Chinese herbs Yixinyin [in Chinese]. Journal of Practical Traditional Chinese Medicine 1997;12(1):8-9.
Chen SX 1992 {published data only}
  • Chen SX, Chang PL, Bao SH, Zheng XJ, Mei SW, Zhang LQ. A study of integrated traditional Chinese and western medicines for treatment of severe viral myocarditis [in Chinese]. Chinese Journal of Integrated Traditional and Western Medicine 1992;12(7):398-401.
Chen ZJ 2009 {published data only}
  • Chen ZJ. Observation of Astragalactoside injection combined meglumine cyclic adenosine injection in treatment of viral myocarditis. Guangxi Medical Journal 2009;31(8):1126-7.
Fang 2010 {published data only}
  • Fang Q. Effects of Shenmai injection on serum migration inhibitory factor and tumour necrosis factor- α levels in patients with acute viral myocarditis and its significance. Chinese Journal of Ethnomedicine and Ethnopharmacy 2010;5(2):31-2.
Feng 1996 {published data only}
  • Feng DX, Chen KJ. Observation on the effect of Xinluning in the treatment of frequent ventricular premature beat [in Chinese]. Integrated Traditional Chinese and Western Medicicine in Practical Clinical Emergency 1996;3(10):444-5.
Geng 1996 {published data only}
  • Geng J. Yiqi Yangyin Huoxue recipe for treatment of 44 cases of acute viral myocarditis [in Chinese]. Chinese Journal of School Doctor 1996;10(6):453-4.
Gong 2001 {published data only}
  • Gong LH, Wu JW. Astragalactoside injection for treatment of 36 cases of viral myocarditis [in Chinese]. Study Journal of Traditional Chinese Medicine 2001;19(2):167.
Gu 1996 {published data only}
  • Gu W, Yang YZ, He MX. A study on combination therapy of western and traditional Chinese medicine of acute viral myocarditis [in Chinese]. Chinese Journal of Integrated Traditional and Western Medicine 1996;16(12):713-6.
Guo FQ 2008 {published data only}
  • Guo FQ, Yang YH, Deng H. 30 cases of infantile viral myocarditis treated by radix astragali, Caculus Bovis and coenzyme Q10 [in Chinese]. Journal of Nanhua University (Medical Edition) 2008;36(2):208-9.
Guo WX 2000 {published data only}
  • Guo WX, Liu WM, Lin HJ, Wang CP, Zhang H. Clinical observation on oral liquid of Xinyikang used in the treatment of viral myocarditis [in Chinese]. Chinese Journal of Information on Traditional Chinese Medicine 2000;7(7):38-41.
Han DS 1997 {published data only}
  • Han DS, Li CL, Lou AG. 42 cases of viral myocarditis treated with Yixin decoction [in Chinese]. Journal of Traditional Chinese Medicine and Chinese Materia Medica of Jilin 1997;17(5):11.
Han Y 2000 {published data only}
  • Han Y, Zhang XJ, Li JY. 30 cases of infantile viral myocarditis treated by integrated Chinese and western drugs [in Chinese]. Journal of Practical Traditional Chinese Medicine 2000;16(4):21.
He AY 1999 {published data only}
  • He AY, Hu SY, Chen BY. Shuanghuanglian injection and Tongmaiye for treatment of children with viral myocarditis [in Chinese]. Liaoning Journal of Traditional Chinese Medicine 1999;26(10):450-1.
He P 1995 {published data only}
  • He P, Yang SZ. Clinical observation on the effect of Radix Astragali in the treatment of viral myocarditis complicated with ventricular premature beat and in the regulation of immunologic function [in Chinese]. Journal of Traditional Chinese Medicine and Chinese Materia Medica of Jilin 1995;15(2):7-8.
Huang W 1999 {published data only}
  • Huang W. Clinical observation on viral myocarditis treated with decoction Invigoration Yang for recuperation [in Chinese]. Journal of Practical Traditional Chinese Medicine 1999;15(8):6-7.
Huang ZQ 1995 {published data only}
  • Huang ZQ, Qin NP, Ye W, Guo P, Wang HR. Effect of Astragalus membranaceus on T-lymphocyte subsets in patients with viral myocarditis [in Chinese]. Chinese Journal of Integrated Traditional and Western Medicine 1995;15(6):328-30.
Huang ZQ 1996 {published data only}
  • Huang ZQ, Qin NP, Zhou Y. Effect of herbal extract Yixinling on NK cell activity and T-lymphocyte subsets in patients with viral myocarditis [in Chinese]. Traditional Chinese Drug Research & Clinical Pharmacology 1996;7(3):7-9.
Hu SY 1995 {published data only}
  • Hu SY, He AY, Liu H, Hu SP, Chen Y, Chen BY. Effect of Tongmaiye on left cardiac function in children with acute viral myocarditis [in Chinese]. Chinese Journal of Integrated Traditional and Western Medicine 1995;15(7):432-3.
Hu SY 1999 {published data only}
  • Hu SY, He AY, Liu H, Qiao WP, Xiang Y, Liu YZ, et al. Clinical study on infantile coxsackie viral myocarditis with heart invaded by toxic pathogen treated with Qingxin solution [in Chinese]. Journal of Traditional Chinese Medicine 1999;40(5):297-9.
Hu SY 2010 {published data only}
  • Hu SY, Ma R, Liu H, He AY, Hu SP, Zhong CL. Activating blood and resolving stasis for treatment of paediatric viral myocarditis: a randomised clinical trial. conference. 2010:181-6.
Ji 1995 {published data only}
  • Ji XL, Guo H. Clinical observation on 54 cases of viral myocarditis treated by Xinjiyin [in Chinese]. Tianjin Journal of Traditional Chinese Medicine 1995;12(1):19-20.
Jia 1998 {published data only}
  • Jia WH. 43 cases of viral myocarditis treated by the principle of nourishing Qi and Yin. Chinese Journal of Integrated Traditional and Western Medicine 1998;18(5):308.
  • Jia WH. Clinical study of patients with viral myocarditis treated with supplemented Huangqi Shengmai Powder [in Chinese]. Chinese Journal of Experimental Traditional Medical Formulae 1998;4(2):35-7.
Jiang Y 2000 {published data only}
  • Jiang Y, Hu QY, Hu XY. Clinical study on viral myocarditis treated by differential diagnosis of syndromes [in Chinese]. Journal of Traditional Chinese Medicine and Chinese Materia Medica of Jilin 2000;20(5):12.
Jin 2002 {published data only}
  • Jin W, Chen XR, Rong ZM. Treatment of viral myocarditis with vitamin C and Shenmai injection [in Chinese]. Modern Journal of Integrated Chinese Traditional and Western Medicine 2002;11(4):287-8.
Kuo 1986 {published data only}
  • Kuo C. Successful treatment of complete left bundle branch block complicating acute viral myocarditis employing Chinese herbs. American Journal of Chinese Medicine 1986;14(3-4):124-30.
Li DP 2005 {published data only}
  • Li DP, Li Y, Liu XF. 48 cases of viral myocarditis treated with integrated Chinese and western medicine [in Chinese]. Modern Medicine and Health 2005;21(19):2664-5.
Li JL 1999 {published data only}
  • Li JL, Zhao J. Clinical study of Chinese medicine for treatment of viral myocarditis [in Chinese]. Chinese Journal of Integrated Traditional and Western Medicine 1999;19(4):246-7.
Lin 1998 {published data only}
  • Lin GZ, Liu DM, Zhu L, Qiu DZ. Clinical study on Shuanghuanglian powder in treating children viral myocarditis [in Chinese]. Chinese Journal of Integrated Traditional and Western Medicine 1998;18(10):601-2.
Liu AD 2005 {published data only}
  • Liu AD. Clinical observation on viral myocarditis treated with new Chinese medicinal regimens [in Chinese]. Chinese Community Doctors 2005;7(23):58.
Liu GJ 1996 {published data only}
  • Liu GJ, Liu QP. Clinical observation on 45 cases of acute viral myocarditis treated with Shenmai injection [in Chinese]. Research of Traditional Chinese Medicine 1996;12(6):18.
Liu HQ 2000 {published data only}
  • Liu HQ, Li JX. Study on therapeutic effect of Shenqiyin for 66 cases of viral myocarditis [in Chinese]. Jiangxi Journal of Traditional Chinese Meidicine 2000;31(3):40.
Liu J 1995 {published data only}
  • Liu J, Cai HB, Yang XW. Clinical observation of Huangqi Shengmaisan for treatment of 36 cases of viral myocarditis [in Chinese]. Guang Ming Journal Traditional Chinese Medicine 1995;10(1):17-8.
Liu MD 1999 {published data only}
  • Liu MD, Zhang YX. Integrated Chinese and western medicine for treatment of 45 cases of viral myocarditis [in Chinese]. Chinese Journal of Integrated Traditional and Western Medicine 1999;19(2):123.
Liu SS 1997 {published data only}
  • Liu SS. Study of adjunct treatment of Astragali membranaceus for viral myocarditis [in Chinese]. Clinical Focus 1997;12(14):657-8.
Liu YJ 1997 {published data only}
  • Liu YJ, Huang P. Clinical observation on viral myocarditis treated with Astragalus membranaceus injection [in Chinese]. Acta Chinese Medicine and Pharmacology 1997;25(1):18.
Li Y 2000 {published data only}
  • Li Y. Report of 265 cases of acute viral myocarditis treated with Erhuang Wendan decoction [in Chinese]. Jiangxi Journal of Traditional Chinese Medicine 1999;30(5):61.
  • Li Y. Treatment of 268 cases of acute viral myocarditis by ingredient-modified "Erhuang Wendan Decoction" [in Chinese]. Shanghai Journal of Traditional Chinese Medicine 2000;34(7):22-3.
  • Li Y. Treatment of viral myocarditis with ingredient-modified "HuangLian WenDan Decoction" [in Chinese]. Shanghai Journal of Traditional Chinese Medicine 1995;29(7):43.
  • Li Y, Shen LM. Chinese traditional medicine fractionally treating acute viral myocarditis [in Chinese]. Chinese Traditional Patent Medicine 2002;24(6):436-7.
Li YR 1996 {published data only}
  • Li YR, Liu XP, Bai CL, Li RS, Jia XL, Yang YL, et al. Effect of Shenmai Injection on cardiac function and cellular immune function in children viral myocarditis [in Chinese]. Chinese Journal of Integrated Traditional and Western Medicine 1996;16(8):477-9.
Li YW 1997 {published data only}
  • Li YW, Tan XJ, Zhang WF. Chinese medicine Yangxinshi for treatment of 32 cases of viral myocarditis [in Chinese]. Shandong Journal of Traditional Chinese Medicine 1997;16(10):445-6.
Li ZY 1998 {published data only}
  • Li ZY, Liu BG, Liu YM. Observation on viral myocarditis treated with Astragalactoside injection [in Chinese]. Chinese Journal of Information on Traditional Chinese Medicine 1998;5(12):51.
Lu 1997 {published data only}
  • Lu Y, Lang YQ, Zhou WL, Wang JH. Application of Dengzhanhua injection in treatment of acute viral myocarditis [in Chinese]. Chinese Journal of Integrated Traditional and Western Medicine 1997;17(12):753.
Luo 1998 {published data only}
  • Luo L. 38 cases of viral myocarditis treated with Wushen Jiwei Shengmai Powder [in Chinese]. Hubei Journal of Traditional Chinese Medicine 1998;20(3):16.
Lv 2011 {published data only}
  • Lv YX, Wang MM, Li R, Meng QK. Observation on the effect Linggui Longmu decoction in the treatment of acute viral myocarditis [in Chinese]. Chinese Pediatrics of Integrated Traditional and Western Medicine 2011;3(1):44-6.
Ma CH 1995 {published data only}
  • Ma CH, Wu X, Cheng SS. Integrated traditional Chinese and western medicines for treatment of viral myocarditis [in Chinese]. Jiangsu Journal of Traditional Chinese Medicine 1995;16(6):19.
Ma GL 1998 {published data only}
  • Ma GL, Wang CY, Diao WX. Clinical study on viral myocarditis treated with integrated Chinese and western medicine [in Chinese]. Acta Chinese Medicine and Pharmacology 1998;26(1):9-10.
Ma HB 1997 {published data only}
  • Ma HB, Su BL, Zhang RF. Clinical study on 30 cases of children viral myocarditis treated by Chinese differentiated therapy [in Chinese]. Shanxi Traditional Chinese Medicine 1997;13(3):9-10.
Ma L 2010 {published data only}
  • Ma L, Ge JB, Zhu XF, Wang X, Wang ZM, Zhao MN, et al. Observation on the effect of Diammonni Glycyrrhizinatis in the treatment of serious type of acute virus myocarditis. Chinese Journal of Modern Applied Pharmacy 2010;27(10):958-60.
Ma YL 1984 {published data only}
  • Ma YL, Xiong YQ. Clinical observation on 40 cases of infantile viral myocarditis treated by differential diagnosis of syndromes [in Chinese]. Journal of Traditional Chinese Medicine 1984;25(6):25-7.
Pei 2009 {published data only}
  • Pei LK. Observation of Astragalactoside injection combined 1, 6-diphosphate in treatment of viral myocarditis. China Modern Doctor 2009;47(27):71-2.
Qin FH 2001 {published data only}
  • Qin FH. Ingredient-modified "Minor Bupleurum Decoction" for myocarditis in 31 cases. Shanghai Journal of Traditional Chinese Medicine 2001;35(4):22-3.
Qin HS 2006 {published data only}
  • Qin HS. Observation on the effect of radix astragali combined salviae miltiorrhizae in the treatment of acute viral myocarditis [in Chinese]. Modern Journal of Integrated Traditional Chinese and Western Medicine 2006;15(8):1033-4.
Ren GH 1996 {published data only}
  • Ren GH. Therapeutic study on Astragalus injection for children with viral myocarditis [in Chinese]. Central Plains Medical Journal 1996;23(4):17.
Ren W 1991 {published data only}
  • Ren W, Zhu HW, Zhang DY. Clinical observation on effect of Radix Astragali treating 66 patients with viral myocarditis complicated with cardiac dysfunction [in Chinese]. Chinese Journal of Critical Care Medicine 1991;11(3):38-40.
  • Ren W, Zhu HW, Zhang DY. Observation on the effect of Radix Astragali in the treatment of viral myocarditis complicated with cardiac insufficiency [in Chinese]. Chinese Journal of Internal Medicine 1992;31(10):644-5.
Rong 2001 {published data only}
  • Rong YS, Jiao SL. Treatment of 66 cases of viral myocarditis using integrated Chinese and western medicine [in Chinese]. Journal of Hebei Traditional Chinese Medicine and Pharmacology 2001;16(1):28-9.
Shi 2010 {published data only}
  • Shi WG, Sun XY, Qu L, Wang GQ. Effects of Danhong injection on cardiac inflammatory reaction and coronary artery blood flow after selective percutaneous coronary artery intervention. Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care 2010;17(5):288-91.
Song 1999 {published data only}
  • Song JM, Xu CQ, Zhang DR, Xu GC, Wang YC. Clinical study on oral liquid of Yangyin Qingxin used in the treatment of acute viral myocarditis [in Chinese]. Guang Ming Journal of Traditional Chinese Medicine 1999;14(1):41-5.
Su 1999 {published data only}
  • Su CT, Fan DM, Yu MX. Therapeutic study on Shengmai San modified for treatment of viral myocarditis [in Chinese]. Acta Chinese Medicine and Pharmacology 1999;27(5):14.
Sun DX 2000 {published data only}
  • Sun DX, Yu J. Clinical study on treatment of acute viral myocarditis with Shenmai injection [in Chinese]. Jiangxi Journal of Traditional Chinese Medicine 2000;31(5):19-20.
Sun J 1998 {published data only}
  • Sun J, Song GW, Sun F, Liu ZQ, Zhang SQ, Yu QF. Clinical observation on viral myocarditis treated with Xinankang [in Chinese]. Journal of Traditional Chinese Medicine and Chinese Materia Medica of Jilin 1998;18(6):11.
Sun KJ 1998 {published data only}
  • Sun KJ, Wang LP, Me HY, Mei CJ. Clinical observation on 12 cases of viral myocarditis complicated with arrhythmia in the convalescent period treated with Shengmai injection [in Chinese]. Acta Chinese Medicine and Pharmacology 1998;26(1):19.
Sun WM 1999 {published data only}
  • Sun WM, Liu XY, Ma LX. Clinical observation on treatment of viral myocarditis by combined method of Chinese and western medicine [in Chinese]. Journal of Traditional Chinese Medicine and Chinese Materia Medica of Jilin 1999;19(6):39.
Sun Y 1997 {published data only}
  • Sun Y, Sun SF, Sun H. Clinical observation on viral myocarditis treated with Radix Acanthopanacis senticosi and Radix Salviae miltiorrhizae [in Chinese]. Guizhou Medical Journal 1997;21(3):178-9.
Tang SY 2000 {published data only}
  • Tang SY. Observation on the effect of Qingxinkang in the treatment of viral myocarditis [in Chinese]. Journal of Traditional Chinese Medicine and Chinese Materia Medica of Jilin 2000;20(3):18.
Tan JC 1995 {published data only}
  • Tan JC, Xie HF, Zhang CY, Qi LJ. 30 cases of acute viral myocarditis treated with Shengmai injection [in Chinese]. Hebei Journal of Traditional Chinese Medicine 1995;17(4):47-8.
Tan YP 2010 {published data only}
  • Tan YP, Chen ZH. Nursing for 33 cases of vIrial myocarditis with traditional Chinese medicine regimen. Journal of Hunan Normal University 2010;7(2):60-2.
Tu 1996 {published data only}
  • Tu XH, Xu FQ, Miao Y, Wang XF, Xu MY, Huang YS, et al. Clinical trial of Qidong Yixin oral liquid for treatment of viral myocarditis [in Chinese]. Traditional Chinese Drug Research & Clinical Pharmacology 1996;7(4):6-9.
Wang AP 2011 {published data only}
  • Wang AP, Xie F. Study on clinical effects of Shenmai injection combined with Astragalactoside injection for treating child viral myocarditis in 84 cases. China Pharmaceuticals 2011;20(6):76-7.
Wang JM 2003 {published data only}
  • Wang JM, Tian ZX, Yang SW, Meng QJ, Li WC. Clinical observation of Meglumine Cyclic Adenylate combined Astragalactoside injection in treating 36 patients with viral myocarditis [in Chinese]. Chinese Journal of Integrative Medicine on Cardio/Cerebrovascular Disease 2003;1(2):93.
Wang K 2000 {published data only}
  • Wang K, Gao LZ, Yang L, Lin T. Study on 36 children with viral myocarditis treated with Huangzhihua oral liquid [in Chinese]. Journal of Beijing University of Traditional Chinese Medicine 2000;23(1):75.
Wang WR 2001 {published data only}
  • Wang WR, Zhu RH. Study on integrated traditional Chinese and western medicines for treatment of 53 cases of viral myocarditis [in Chinese]. Journal of Practical Traditional Chinese Medicine 2001;17(3):24.
Wang XF 1997 {published data only}
  • Wang XF, Yan WC, Guo ZW, Zhang J, Bai XH. The effect of Chaihu Qingxin Yin on left cardiac function and T-cell subgroup in peripheral blood in children with viral myocarditis [in Chinese]. Chinese Journal of Integrated Traditional and Western Medicine 1997;17(2):73-5.
Wang XJ 1995 {published data only}
  • Wang XJ. Evaluation of the effect of Astragali in treating 58 patients with viral myocarditis complicated with cardiac dysfunction [in Chinese]. The Practical Journal of Integrating Chinese with Modern Medicine 1995;8(5):309-10.
Wang ZH 1998 {published data only}
  • Wang ZH, Li DM, Zhou CH. Effect of Astragalus membranaceus injection on TNF and IL-1 in patients with viral myocarditis [in Chinese]. Journal of Changchun College of Traditional Chinese Medicine 1998;14(1):12.
Wang ZH 2001 {published data only}
  • Wang ZH, Liao YH. Combined treatment of viral myocarditis with traditional Chinese medicine and western medicine [in Chinese]. Journal of Clinical Cardiology (China) 2001;17(8):353.
Wang ZL 2000 {published data only}
  • Wang ZL, Sun BQ. 24 cases of viral myocarditis treated with combination of Chinese and western drugs [in Chinese]. Journal of Practical Traditional Chinese Medicine 2000;16(1):32-3.
Wang ZM 2000 {published data only}
  • Wang ZM. Chinese herbal medicine for viral myocarditis [in Chinese]. Hubei Journal of Traditional Chinese Medicine 2000;22(6):26-7.
Wang ZT 2004 {published data only}
  • Wang ZT, Zeng CY, Shi XQ, Han LH. Xinjikang for adults' chronic viral myocarditis. Journal of Henan University of Chinese Medicine 2004;19(6):48-9.
Wei QH 2004 {published data only}
  • Wei QH, Shi YY, Shen BS, Zhang JR. Clinical study on Fufang Sishen decoction in treating arrhythmia after virus myocarditis [in Chinese]. Journal of Chinese Integrative Medicine 2004;2(2):97-9.
Wei YL 1998 {published data only}
  • Wei YL, Wu XM, Li Q. Study of Wei Er Xin for treatment of 300 cases of children with viral myocarditis [in Chinese]. Chinese Journal of Information on Traditional Chinese Medicine 1998;5(8):24-5.
Wu CS 1988 {published data only}
  • Wu CS. Clinical observation of effect of Shenmai injection in treating 100 patients with viral myocarditis [in Chinese]. Zhejiang Journal of Traditional Chinese Medicine 1988;23:369-70.
Wu XN 2002 {published data only}
  • Wu XN, Zhang XL. Therapeutic study on integrated traditional and western medicines for 24 cases of acute viral myocarditis [in Chinese]. New Journal of Traditional Chinese Medicine 2002;34(5):38.
Xia 2000 {published data only}
  • Xia DC. Modified Qinggong decoction treated 32 cases of acute viral myocarditis [in Chinese]. Hunan Guiding Journal of Traditional Chinese Medicine and Pharmacology 2000;6(6):25-6.
Xing 1998 {published data only}
  • Xing YH, Meng FL. Study on the effect of Royal jelly in the treatment of viral myocarditis. Journal of Binzhou Medical College 1998;21(1):47.
Xu MM 2000 {published data only}
  • Xu MM. 54 cases of infantile viral myocarditis treated by integrated Chinese and western drugs [in Chinese]. Journal of Practical Traditional Chinese Medicine 2000;16(8):17-8.
Xu T 1996 {published data only}
  • Xu T. Composita Salviae miltiorrhizae injection for treatment of children with viral myocarditis [in Chinese]. Zhejiang Journal of Integrated Traditional Chinese and Western Medicine 1996;6(2):73-4.
Yang CJ 2005 {published data only}
  • Yang CJ. 35 cases of infantile viral myocarditis treated with integrated Chinese and western medicine [in Chinese]. Journal of Sichuan of Traditional Chinese Medicine 2005;23(10):90-1.
Yang FQ 1998 {published data only}
  • Yang FQ, Xie WH. The clinical observation of the treatment of viral myocarditis by clearing away the heat evil and toxic materials and by Shengmai injection [in Chinese]. Nei Mongol Journal of Traditional Chinese Medicine 1998;17(3):8-9.
Yang GF 2002 {published data only}
  • Yang GF. Study on integrated traditional and western medicines for treatment of 87 cases of viral myocarditis [in Chinese]. Heilongjiang Journal of Traditional Chinese Medicine 2002;37(3):13-4.
Yang HB 1997 {published data only}
  • Yang HB. Clinical observation on viral myocarditis treated with Shengmai injection [in Chinese]. Acta Chinese Medicine and Pharmacology 1997;25(3):11.
Yang SJ 1997 {published data only}
  • Yang SJ, Yin SY, Peng JH. Shenmai injection for treatment of 60 cases of acute viral myocarditis with deficiency of both Qi and Yin [in Chinese]. Liaoning Journal of Traditional Chinese Medicine 1997;24(10):452.
Yang YZ 1990 {published data only}
  • Yang YZ, Jin PY, Guo Q, Wang QD, Li ZS, Ye YC, et al. Effect of Astragalus membranaceus on natural killer cell activity and induction of alpha- and gamma-interferon in patients with coxsackie B viral myocarditis. Chinese Medical Journal 1990;103(4):304-7.
Yao ZP 1995 {published data only}
  • Yao ZP, Huang WQ. Study on 16 cases of acute viral myocarditis treated by herbal extract Qing Kai Ling [in Chinese]. Chinese Journal of Integrated Traditional and Western Medicine 1995;15(10):633-4.
Yin YS 1997 {published data only}
  • Yin YS, Lu ZF. Observation on effect of Shengmai injection in treating of viral myocarditis [in Chinese]. The Practical Journal of Integrating Chinese with Modern Medicine 1997;10(15):1477-8.
Yu 1996 {published data only}
  • Yu ZK, Chen ZH. Clinical observation on 61 cases of viral myocarditis treated with mainly Chinese herbal medicine [in Chinese]. Sichuan Journal of Traditional Chinese Medicine 1995;13(9):34-5.
  • Yu ZK, Chen ZH, Yang XG. 61 cases of viral myocarditis treated with Chinese herbs [in Chinese]. Guang Ming Journal Traditional Chinese Medicine 1996;11(4):24-5.
Zeng 1997 {published data only}
  • Zeng CF. Clinical observation on 25 cases of acute viral myocarditis treated with combined method of Chinese and western medicine [in Chinese]. Journal of Gansu College of Traditional Chinese Medicine 1997;14(3):28-30.
Zhang DF 2005 {published data only}
  • Zhang DF, Liu XQ. Combination treatment with FDP and Astragus injection for patients with viral myocarditis [in Chinese]. Chinese Modern Medicine 2005;3(3):48.
Zhang PY 1997 {published data only}
  • Zhang PY, Xu X, Wang J, Qu SQ, Sun ZH, Guo SW. Combination treatment with Qing Kai Ling and Shengmai injection in 100 patients with acute stage of viral myocarditis [in Chinese]. Journal of Emergency Syndromes in Chinese Medicine 1997;6(6):265-6.
Zhang SY 2000 {published data only}
  • Zhang SY, Wu SH, Shao XS, Wang JH. Observation on viral myocarditis in children (34 cases) treated with Red Sage injection [in Chinese]. Journal of Practical Traditional Chinese Medicine 2000;16(2):3-4.
Zhang XL 1999 {published data only}
  • Zhang XL, Yuan XD. 30 cases of children with viral myocarditis treated with oral liquid of Qidong Yixin [in Chinese]. Chinese Journal of Integrated Traditional and Western Medicine 1999;19(6):339.
Zhang XM 2000 {published data only}
  • Zhang XM, Zhao SY, Jia YZ. Integrated traditional Chinese and western medicines for treatment of 36 cases of acute viral myocarditis [in Chinese]. Journal of Practical Traditional Chinese Medicine 2000;16(10):28-9.
Zhang ZX 2000 {published data only}
  • Zhang ZX. Clinical observation on 46 cases of viral myocarditis treated with Yiqi Yangyin Decoction [in Chinese]. Chinese Journal of Information on Traditional Chinese Medicine 2000;7(6):71-2.
Zhao CS 2005 {published data only}
  • Zhao CS, Dong KD, Dong M, Lv J. The Qing Xin Tang and Yan Po Nings treat the curative effect observation of the AVMC. Chinese Journal of the Practical Chinese with Modern Medicine 2005;18(17):824-5.
  • Zhao CS, Dong KD, Dong M, Lv J. The Qing Xin Tang and Yan Po Nings treat the curative effect observation of the AVMC. Guangming Journal of Chinese Medicine 2006;21(5):47-8.
Zhao MH 1996 {published data only}
  • Zhao MH, Rong HZ, Lu BJ, Zhu XY, Huang GF, Yang JW. Effect of Shengmaisan on serum lipid peroxidation in acute viral myocarditis [in Chinese]. Chinese Journal of Integrated Traditional and Western Medicine 1996;16(3):142-5.
Zhao QC 1996 {published data only}
  • Zhao QC, Yu JY. 32 cases of viral myocarditis treated with Ginseng [in Chinese]. Clinical Nugget 1996;11(1):41-2.
Zhao XS 2008 {published data only}
  • Zhao XS, He ZJ, Huang SS. Clinical observation of 54 cases of viral myocarditis treated with integrated Chinese and western medicine [in Chinese]. Nei Mongol Journal of Traditional Chinese Medicine 2008;27(9):79-80.
Zhao YT 1994 {published data only}
  • Zhao YT, Lu M, Shang BQ, Yang ZT. Study on Yangxin Fumai Tang for treatment of 40 cases of viral myocarditis [in Chinese]. Heilongjiang Journal of Traditional Chinese Medicine 1994;29(3):12.
Zhao YZ 1998 {published data only}
  • Zhao YZ, Wang GF, Wang LQ. Clinical observation on 60 cases of acute viral myocarditis treated with the method of integration of traditional and western medicine [in Chinese]. Henan Journal of Traditional Chinese Medicine and Pharmacy 1998;13(5):36-8.
Zhou D 2004 {published data only}
  • Zhou D. Integrated Traditional Chinese and Western Medicine in Treating 30 Cases of Viral Myocarditis. Journal of Henan University of Chinese Medicine 2004;19(6):50.
Zhou FR 2001 {published data only}
  • Zhou FR, Su Y. Observation on effect of Xinjikang capsule in the treatment of infantile viral myocarditis [in Chinese]. Liaoning Journal of Traditional Chinese Medicine 2001;28(2):101-2.
Zhou L 2000 {published data only}
  • Zhou L, Wu SS, Liu GM. Integrated Chinese and western medicine for treatment of 60 cases of acute viral myocarditis [in Chinese]. Journal of Henan College of Traditional Chinese Medicine 2000;15(4):39-40.
Zhou LC 2010 {published data only}
  • Zhou LC, Yu ZK, Chen ZH. Summary of 30 cases treated with integrated Chinese and western medicine in acute viral myocarditis [in Chinese]. Hunan Journal of Traditional Chinese Medicine 2010;26(2):16-7.
Zhou MY 1996 {published data only}
  • Zhou MY, Wan YH. 30 cases of viral myocarditis treated with integrated Chinese and western medicine [in Chinese]. Journal of Nanjing University of Traditional Chinese Medicine 1996;12(5):53-4.
Zhou ZY 2000 {published data only}
  • Zhou ZY, Ni FX. Integrated Chinese and western drugs for treatment of 102 cases of viral myocarditis in acute stage [in Chinese]. Liaoning Journal of Traditional Chinese Medicine 2000;27(5):223.
Zhu Q 1997 {published data only}
  • Zhu Q, Liu SJ. Exploration on treatment and relationship between Chest Bi-Syndrome and infantile viral myocarditis [in Chinese]. Zhejiang Journal of Traditional Chinese Medicine 1997;32(10):451-2.
Zhu YD 1997 {published data only}
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Zhu YY 2009 {published data only}
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Additional references

  1. Top of page
  2. Abstract
  3. Summary of findings
  4. Background
  5. Objectives
  6. Methods
  7. Results
  8. Discussion
  9. Authors' conclusions
  10. Acknowledgements
  11. Data and analyses
  12. Appendices
  13. What's new
  14. History
  15. Contributions of authors
  16. Declarations of interest
  17. Sources of support
  18. Differences between protocol and review
  19. Characteristics of studies
  20. References to studies included in this review
  21. References to studies excluded from this review
  22. Additional references
  23. References to other published versions of this review
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References to other published versions of this review

  1. Top of page
  2. Abstract
  3. Summary of findings
  4. Background
  5. Objectives
  6. Methods
  7. Results
  8. Discussion
  9. Authors' conclusions
  10. Acknowledgements
  11. Data and analyses
  12. Appendices
  13. What's new
  14. History
  15. Contributions of authors
  16. Declarations of interest
  17. Sources of support
  18. Differences between protocol and review
  19. Characteristics of studies
  20. References to studies included in this review
  21. References to studies excluded from this review
  22. Additional references
  23. References to other published versions of this review
Liu 2004
  • Liu JP, Yang M, Du XM. Herbal medicines for viral myocarditis. The Cochrane database of systematic reviews 2004;2(3):CD003711. [PUBMED: 15266498]
Liu 2010
  • Liu ZL, Liu ZJ, Liu JP, Yang M, Kwong J. Herbal medicines for viral myocarditis. The Cochrane database of systematic reviews 2010;1(7):CD003711. [PUBMED: 20614436]
Liu 2012
  • Liu ZL, Liu ZJ, Liu JP, Kwong JS. Herbal medicines for viral myocarditis. The Cochrane database of systematic reviews 2012;11(14):CD003711. [PUBMED: 23152220]