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Herbal preparations for uterine fibroids

  1. Jian Ping Liu1,*,
  2. Hong Yang2,
  3. Yun Xia3,
  4. Francesco Cardini4

Editorial Group: Cochrane Menstrual Disorders and Subfertility Group

Published Online: 30 APR 2013

Assessed as up-to-date: 28 FEB 2013

DOI: 10.1002/14651858.CD005292.pub3


How to Cite

Liu JP, Yang H, Xia Y, Cardini F. Herbal preparations for uterine fibroids. Cochrane Database of Systematic Reviews 2013, Issue 4. Art. No.: CD005292. DOI: 10.1002/14651858.CD005292.pub3.

Author Information

  1. 1

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

  2. 2

    Beijing University of Chinese Medicine, Graduate School, Beijing, China

  3. 3

    Beijing University of Chinese Medicine Subsidiary Dongfang Hospital, Science of Education, Beijing, China

  4. 4

    Regional Healthcare and Social Agency of Emilia Romagna, Bologna, Emilia Romagna, Italy

*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. jianping@fagmed.uit.no.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 30 APR 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. Index terms

 
Summary of findings for the main comparison. Herbal preparations versus placebo

Herbal preparations versus placebo for uterine fibroids

Patient or population: Women with uterine fibroids
Intervention: Herbal preparations versus placebo

OutcomesQuality of the evidence
(GRADE)
Comments

Change in fibroid related symptomsNo evidence availableOnly one study made this comparison and did not report this outcome

Adverse eventsOne double blind, placebo-controlled, randomised trialOnly one study made this comparison and did not report clinically relevant adverse events. Results of lab tests were reported.1

1 When Guihong turtle shell was compared with placebo there was one case in the herbal group who developed abnormal serum blood urea nitrogen (BUN) and creatinine levels after three months treatment, but no case occurred in the placebo group. Liver function was monitored and no participant developed abnormal levels of serum alanine transaminase (ALT) or aspartate aminotransferase (AST) levels

 Summary of findings 2 Herbal preparations versus medication

 Summary of findings 3 Herbal preparations plus medication versus medication

 

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. Index terms
 

Description of the condition

Uterine fibroids are the most common, non-cancerous uterine growths in women of childbearing age. Alternative names are uterine leiomyomata, fibromyoma, myoma, or fibroids. The lifetime risk of fibroids in a woman over the age of 45 years has been estimated to be more than 60%, including symptomatic and non-symptomatic conditions (Okolo 2008). Around 30% of women of childbearing age have clinically symptomatic uterine fibroids (Newbold 2000; Stewart 2001). Common symptoms may include heavy or painful periods; prolonged menstrual periods; bleeding between periods; pelvic pain or low back pain; 'fullness' in the lower abdomen, with or without urinary or rectal symptoms due to compression; and reproductive problems, such as infertility, multiple miscarriages, or early onset of labour during pregnancy. Many women with uterine fibroids do not have any symptoms. A recent investigation of 21,479 women across eight countries showed that the prevalence of fibroids was from 9.4% (UK) to 17.8% (Italy) in the age population of 40 to 49 years (Zimmermann 2012). Uterine fibroids constitute the main reason for hysterectomies to be carried out, based on data between 1990 and 1997 in the United States (Farquhar 2002).

Uterine fibroids are growths of muscular and fibrous cells within, or attached to, the wall of the uterus. According to the location of the growth, they can be categorised as submucosal when they grow just underneath the uterine lining, intramural when they are in between the muscles of the uterus, and subserosal when they are on the outside of the uterus. Fibroids may grow as a single tumour or in clusters. A single fibroid can be less than one inch in size or can grow to eight inches or more. A group of fibroids can also vary in size. The cause of uterine fibroids remains unknown, however genetic, hormonal, immunological, and environmental factors may play a role in starting the growth of fibroids, or in continuing that growth (Munro 2011). Several risk factors for uterine fibroids have been identified. African-American women are at three- to five-times greater risk than white women. Women who are overweight or obese for their height (based on body mass index (BMI)) are also at slightly higher risk than women who are average in weight for their height. Women who have given birth appear to be at lower risk (Marshall 1997).

Recommended treatment for uterine fibroids depends on the severity of symptoms, the woman's age, pregnancy status, desire for future pregnancies, general health, and the characteristics of the fibroids (Stewart 2001). If a woman shows no symptoms, or the fibroids are small, she may not need any treatment. If a woman has serious symptoms or pain, medical therapy can be used to relieve symptoms. Such treatment may include gonadotropin-releasing hormone agonists (GnRHa) (Lethaby 2001); synthetic steroids with antiprogesterone activity, such as mifepristone, to slow or stop the growth of fibroids (Tristan 2012); and the use of progesterone and its derivatives for short-term treatment of bleeding and for inhibiting the fibroids' growth (Grigorieva 2003; Maruo 2004).

Surgical therapy is considered to be an effective treatment and includes myomectomy to remove only the fibroids and leave the healthy uterus, or hysterectomy to remove the entire uterus (Falcone 2002; Griffiths 2006). Another accepted treatment is uterine artery embolization (UAE), which is used to block off the blood supply to the uterus and so make the fibroids shrink (Gupta 2012; McLucas 2001; Tranquart 2002; Watson 2002). However, few women with uterine fibroids prefer surgery and women may seek less invasive options, such as pain medication, medical therapy, or other alternative therapies.

 

Description of the intervention

Among alternative therapies, herbal treatments for fibroids are used in several medical traditions and countries (Fugh-Berman 2004). For example, in China the use of traditional Chinese herbal medicines for treating uterine fibroids is a common clinical practice. In this review, herbal preparations are defined as any formulation of medicinal herbs including extracts, raw herbs, or herbal decoctions prescribed by practitioners. These could include herbal products such as Chinese proprietary medicine or self-prepared herbal decoctions. In Chinese medicine, herbal medicine has been used for many years for different diseases or conditions. For example, the herbal medicine Guizhi Fuling formula has been described in historical classics in ancient China for treatment of women's symptoms, and it is still used in China (Li J 2008). However, there are huge variations in the herbal preparations used, which will depend on the practitioners themselves and on the individualised treatment of different women.

 

How the intervention might work

According to the theory of Chinese medicine, practitioners recognise uterine fibroids as a condition of imbalance between yin and yang in the body (in allopathic terms, disturbances of the endocrine system and blood circulation). Therefore, it is important that the practitioners make a diagnosis based on the symptoms and signs from observing the tongue and taking the pulse, and this practice is called 'pattern differentiation' (Chinese medicine diagnosis). The practitioners prescribe a herbal formula according to the pattern of the syndrome (in Chinese, Zheng). Clinical studies from the Chinese literature show that Chinese herbal preparations might relieve symptoms and shrink the fibroid tumours without significant adverse effects (Huang 2003; Xiong 2002). One of the commonly used herbal medicines is Guizhi Fuling formula, and basic studies showed that Guizhi Fuling formula might work on fibroids by promoting qi flow and blood circulation, immune regulation, and softening and resolving hard lumps (Ji 2011; Li J 2008; Sang 2004). However, the exact mechanisms of the therapeutic effect are not fully understood.

 

Why it is important to do this review

Is the practice of using herbs for fibroids supported by well-designed clinical evidence? We aim to review the clinical research studies systemically and inform practice by presenting comprehensive, critically appraised evidence.

 

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. Index terms

The primary objective was to evaluate the effectiveness and safety of Chinese herbal medicine for treatment of uterine fibroids.

 

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. Index terms
 

Criteria for considering studies for this review

 

Types of studies

Published and unpublished randomised controlled trials were eligible for inclusion, regardless of blinding, publication status, or language. We planned to include cross-over randomised trials but to use only the data from the first phase. We excluded quasi-randomised trials or 'randomised' trials with false methods for random allocation of participants, or where a trial was not stated to be randomised.

 

Types of participants

Women with uterine fibroids diagnosed by clinical symptoms and physical signs,and confirmed by ultrasound scanning, computed tomography (CT), magnetic resonance imaging (MRI), or a combination of more than one of these procedures. We planned to include women with fibroid related symptoms and palpable uterine fibroids, without confirmation by imaging technology, and to compare these in subgroup analyses. We also planned to include women without any symptoms who were found to have uterine fibroids during routine gynaecological examination, which were confirmed by imaging techniques.

 

Types of interventions

Experimental interventions included Chinese patented herbal medicines, other patented herbal products pertaining to different traditional medicines, extracts of a single herb or a compound of herbs, or other individualised herbal remedies. We did not limit the administration or formulation of herbal preparations, such as capsule, tablet, granule, decoction, or injection. The control interventions included no treatment, placebo, medical therapy, or surgical procedures.

 

Types of outcome measures

 

Primary outcomes

  1. Uterine fibroid related symptoms such as heavy, irregular, or prolonged menstrual periods; bleeding between periods; pelvic or low back pain; and low abdominal pressure symptoms such as frequent or urgent urination, or constipation. Symptoms could be measured by either patient reporting or an instrument, regardless of blinding.
  2. Adverse effects of herbal preparations.

 

Secondary outcomes

3. Number of women undertaking surgery (myomectomy, hysterectomy, embolization) due to failure of medical prevention or management of the above symptoms.

4. Incidence of complications including anaemia, infertility, miscarriage, premature labour and delivery, abnormal fetal position.

5. Quality of life (measured by a validated scale or instrument).

6. Number and size of the fibroids, the volume of the uterus, or both.

 

Search methods for identification of studies

 

Electronic searches

We searched the following electronic databases for published and unpublished randomised trials of herbal medicine, without language restriction and in consultation with the Mentrual Disorders and Subfertility Group (MDSG) Trials Search Coordinator:

  1. Trials Registers of the Cochrane MDSG and the Cochrane Complementary Medicine Field;
  2. Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 9);
  3. MEDLINE (1966 to September 2012), EMBASE (1998 to September 2012), AMED, and LILACS (www.bireme.br/bvs/I/ibd.htm) from their date of inception onwards.

The following five major Chinese biomedical databases were searched:

1. Chinese Biomedical Literature database (CBM) (http://www.imicams.ac.cn/);

2. Chinese Medical Current Content (CMCC) (http://www.cmcc.org.cn);

3. China National Knowledge Infrastructure (CNKI-CAJ) (www.cnki.net);

4. VIP information/Chinese Scientific Journals Database (CSJD-VIP) (http://dx3.cqvip.com/);

5. WanFang database/Chinese Medicine Premier (hppt://www.wanfangdata.com.cn/).

We used the search terms: uterine fibroids, hysteromyoma, uterine leiomyomata, fibromyoma, myoma; and combined with traditional medicine, alternative medicine, plant extracts, medicinal plants, non-prescription drugs, herbs, complementary medicine, Chinese medicine, phytodrug or phytopharmaceutical. We had no restriction on publication type. The detailed search strategies are listed in Appendix 1 and Appendix 2.

 

Searching other resources

  1. We checked the reference lists of identified randomised controlled trials and review articles in order to find further trials not identified by the electronic searches.
  2. We searched for ongoing trials through the National Research Register and the website www.controlled-trials.com.
  3. We also checked the 'grey' literature, including unpublished conference proceedings or abstract books, and contacted pharmaceutical companies which produce herbal medicines for uterine fibroids to identify unpublished trials.

 

Data collection and analysis

 

Selection of studies

After an initial screen of titles and abstracts retrieved by the search, conducted by H Yang, the full texts of all potentially eligible studies were retrieved. Two review authors (JP Liu and H Yang) independently selected the trials to be included in the review according to the prespecified selection criteria. Any disagreements were resolved by discussion. Y Xia confirmed the randomisation through phone calls to Chinese trialists.

 

Data extraction and management

Two review authors (JP Liu and H Yang) independently extracted data from eligible studies using a data extraction form designed and pilot-tested by the authors. Any disagreements were resolved by discussion or by a third review author (Y Xia). Papers not in Chinese, English, Japanese, or Italian were translated with the help of the Cochrane Menstrual Disorders and Subfertility Group. We extracted the following characteristics and data from each included trial: primary author, study setting, methodology, age, gender, and ethnicity of participants, number of participants randomised and analysed, participant inclusion and exclusion criteria, symptoms and methods for measurement, the diagnostic criteria, type of herb or herbs, quality of the products, route of delivery, dosage and duration of intervention, details of the comparison regime, duration of follow up, reasons for and number that dropped out or were lost during follow up, outcome measures (end of treatment and at follow up), and number and type of adverse events.

We sought data on the number of participants with each outcome by allocated treatment group, irrespective of compliance or follow up, to allow an intention-to-treat analysis. For three-arm trials, the data from the control group would be split in half so that half of the participants and half of the events would be used in each comparison.

 

Assessment of risk of bias in included studies

Two review authors (JP Liu and H Yang) independently assessed the included studies for risk of bias using the Cochrane risk of bias assessment tool (www.cochrane-handbook.org) to assess: selection bias (random sequence generation and allocation concealment); performance bias (blinding of participants and personnel); detection bias (blinding of outcome assessors); attrition bias (incomplete outcome data); reporting bias (selective reporting); and other bias. Disagreements were resolved by discussion or by a third review author (F Cardini). We described all judgements fully and presented the conclusions in the 'Risk of bias' table.

 

Generation of the allocation sequence

Low risk of bias: if the allocation sequence was generated by a computer or random number table. Drawing of lots, tossing of a coin, shuffling of cards, or throwing dice may also be considered as low risk if a person who was not otherwise involved in the recruitment of participants performed the procedure.

 

Allocation concealment

Low risk of bias: if the allocation of participants involved a central independent unit, on-site locked computer, identical appearing numbered drug bottles or containers prepared by an independent pharmacist or investigator, or sealed envelopes. Envelopes should be serially numbered, sealed, and opaque. However, this information is rarely provided, indicating an increased risk of bias.

Unclear risk of bias: if the trial was described as randomised but the method used to conceal the allocation was not described, or the sealed envelopes were not described as opaque.

High risk of bias: if the allocation sequence was known to the investigators who assigned participants, or if the study was quasi-randomised.

 

Blinding (or masks)

Low risk of bias: double blinding, if the trial was described as double blind and both the participant and physician were blinded, or participant and outcome assessor.
Unclear risk of bias: single blinding, if the participants, or physicians, or outcome assessors were blinded.
High risk of bias: open-label, if blinding was not applied.

 

Incomplete data reporting

Low risk of bias: if the dropout numbers were low (e.g. less than 20%) and they were evenly distributed among different groups, or if it was specified that there were no withdrawals or losses to follow up.
Unclear risk of bias: if the report gave the impression that there had been no withdrawals or losses to follow up but this was not specifically stated.
High risk of bias: if the number of, or reasons for, withdrawals or losses to follow up were not described.

 

Selective reporting bias

Selective reporting is a type of reporting bias that affects the internal validity of an individual study. It refers to the selective reporting of some outcomes (for example positive outcomes) and the failure to report others (for example adverse events). If the trial protocols were not available, we would compare the outcome measures in the method section with the actual reported outcomes in the results for the assessment of selective reporting bias.

 

Other bias

We considered baseline comparability as an important factor for other bias. If baseline data were comparable, the study would be at low risk of other bias. Otherwise, no information or insufficient information would be considered as either high or unclear risk of bias.

 

Measures of treatment effect

We presented dichotomous data as risk ratios (RR) and continuous outcomes as mean differences (MD), both with 95% confidence intervals (CI). If similar outcomes were reported on different scales (for example change in weight) we would calculate the standardised mean difference (SMD) with 95% CI.

 

Unit of analysis issues

The primary analysis would be per woman randomised. Only first-phase data from cross-over trials would be included.

 

Dealing with missing data

We would perform analyses by intention to treat where possible and attempt to obtain missing data from the original trialists. For dichotomous outcomes, participants with incomplete or missing data were to be included in a sensitivity analysis by counting them as treatment failures to explore the possible effect of loss to follow up on the findings ('worst-case' scenario). For continuous data, we took a 'carry forward' approach, in which we used the last observed patient data, if available, as the missing data to conduct data analysis.

 

Assessment of heterogeneity

We considered whether the clinical and methodological characteristics of the included studies were sufficiently similar for meta-analysis to provide a clinically meaningful summary. We would assess statistical heterogeneity by the I2 statistic. An I2 measurement greater than 50% would be taken to indicate substantial heterogeneity (Higgins 2011).

 

Assessment of reporting biases

If there were 10 or more studies in an analysis, we would use a funnel plot to explore the possibility of small study effects (a tendency for estimates of the intervention effect to be more beneficial in smaller studies) (Egger 1997; Vickers 1998).

 

Data synthesis

If the studies were sufficiently similar, we combined the data using a fixed-effect model in the following comparisons:
1. herbal medicine versus no treatment;

2. herbal medicine versus placebo;

3. herbal medicine versus pharmacological treatment;

4. herbal medicines versus a surgical procedure; or

5. herbal medicines plus conventional therapy versus conventional therapy.

Furthermore, if a combined analysis showed significant heterogeneity (defined as P < 0.1 for the heterogeneity test), we would use a random-effects model for the analysis.

 

Subgroup analysis and investigation of heterogeneity

If a sufficient number of randomised trials was identified and data were available, we would have performed subgroup analyses according to symptoms (presence or absence of), diagnosis with or without imaging confirmation, and the location of uterine fibroids (submucosal, intramural, or subserosal fibroids). Whenever there was significant heterogeneity we used a random-effects model and investigated heterogeneity in both the clinical characteristics and methodological differences between studies. We would carry out subgroup analyses in Review Manager 5.1.7 (RevMan 2012) to see if any differences were explained by differences between the studies.

 

Sensitivity analysis

If a sufficient number of randomised trials were identified for the same interventions, we would conduct sensitivity analyses for the primary outcomes to determine whether the conclusions were robust to arbitrary decisions made regarding the eligibility of studies and analysis. These analyses would include consideration of whether the review conclusions would have differed if:

1. eligibility was restricted to studies without high risk of bias;

2. alternative imputation strategies had been implemented;

3. the summary effect measure was odds ratio rather than risk ratio.

 

Overall quality of the body of evidence: summary of findings table

Summary of findings tables were generated using GRADEPRO software. These tables evaluated the overall quality of the body of evidence for the main review outcomes using GRADE criteria (study limitations (that is risk of bias), consistency of effect, imprecision, indirectness, and publication bias). Judgements about evidence quality (high, moderate, or low) were justified, documented, and incorporated into reporting of results for each outcome.

We intend to complete an update of the review every 24 months.

 

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. Index terms
 

Description of studies

See: Characteristics of included studies; Characteristics of excluded studies.

 

Results of the search

Our initial electronic searches identified 984 citations, with a further 35 from additional handsearches. After reading titles and abstracts we excluded 733 of these because they were either duplicates, non-clinical studies, review articles, case reports, case series, or had study objectives different from this review. A total of 158 references published in Chinese or in English were retrieved for further assessment. We excluded 93 of these studies because they did not meet our inclusion criteria. We contacted the trial authors of 13 trials to confirm the randomisation methods and missing data, and this allowed us to exclude, by phone calls, 136 trials that had claimed to be 'randomised'. This was due to inadequate randomisation methods or failure to provide required data (Figure 1).

 FigureFigure 1. Study flow diagram.

In the previous version of the review, only two trials were included. Our updated searches in September 2012 identified 132 trials, and 19 randomised trials were eligible to be included taking the total number of included trials to 21.

 

Included studies

 

Study design and setting

We were able to include 21 parallel-group, randomised controlled trials (RCTs) involving 2222 participants in this review (Deng XL 2010; Dong M 2011; Fu WJ 2005; Gu HH 2011; Hazlina 2005; Lai XL 2010; Liu Y 2009; Liu LY 2010; Lu JX 2007; Lu HJ 2010; Luo SQ 2010; Ma R 2010; Mao CX 2012; Mao XG 2012; Ni XP 2012; Wang XR 2011; Wen Q 2005; Wu JH 2011; Wu YF 2011; Yan LQ 2000; Zhu FH 2006). These RCTs reported random allocation of participants with uterine fibroids to herbal medicines or placebo, mifepristone, or GnRH agonist. Twelve trials compared the herbal medicine Guizhi Fuling formula plus medication with medication alone (including eight trials of Guizhi Fuling capsule plus mifepristone versus mifepristone, one trial of Guizhi Fuling capsule plus leuprolide versus mifepristone, one trial of Gongliuqing capsule plus mifepristone versus mifepristone, one trial of Lenge Xiaozheng Tang plus mifepristone versus mifepristone, and one trial of Jiliu Tang plus mifepristone versus mifepristone). The 21 RCTs are listed in the table 'Characteristics of included studies'. Twenty trials were published in Chinese and one trial in English. No trial had a pre-trial sample size estimation (power calculation) or was presented as a multicentre trial.

 

Participants

A total of 2222 women with uterine fibroids were randomised into herbal treatment (n = 1118) or control (n = 1104). Twenty trials were conducted in China and one trial in Malaysia. The 21 trials included women of childbearing age with uterine fibroids, diagnosed through routine gynaecological examination and confirmed by B-mode ultrasound (most commonly used diagnostic method for uterine fibroids, which can show a clear two (or three) dimensional image of the size and location of uterine fibroids). As available outcome data were limited, we could not perform prespecified subgroup analyses, that is of symptom type or location of fibroids.

 

Interventions

Ten herbal preparations were tested in the 21 trials ( Table 1). The controls were placebo (one trial), pharmaceutical medicines including mifepristone and GnRH agonist (eight trials). Twelve trials tested herbal medicine plus medication versus medication (including four herbal medicines: Guizhi Fuling capsule, Qingliuqing capsule, Lenge Xiaozheng Tang, and Jiliu Tang). The average treatment duration was 3.6 months (ranging from three to six months).

 

Outcomes

No trial reported the primary outcome for effectiveness, that is uterine fibroid related symptoms measured by a validated instrument. Thirteen of 21 trials reported the outcome of adverse events in relation to herbal medicines ( Table 2). Among secondary outcomes, no trials reported the need for surgical treatment, quality of life, or incidence of complications such as infertility. The outcomes reported were volume of the fibroids or size of the uterus. The volume of fibroids or the size of the uterus was measured by B-mode ultrasound. However, the method of calculating volume was different in some of the trials. Some studies reported the average volume of the fibroids by calculating the maximum fibroid size in each woman, while others reported the average volume by calculating the totality of multiple fibroids. Three trials reported follow up after the completion of treatment, ranging from three to six months.

 

Excluded studies

The reasons for exclusion of 137 studies are listed in the table 'Characteristics of excluded studies'.

 

Risk of bias in included studies

We had made phone calls to the authors of included 'randomised' trials to confirm the randomisation methods and enquire about missing information. This led to us excluding some 'randomised' trials we planned to include. In general, the included trials had high or unclear risk of bias, and therefore, they were evaluated as low methodological quality (Figure 2; Figure 3).

 FigureFigure 2. Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
 FigureFigure 3. Methodological quality summary: review authors' judgements about each methodological quality item for each included study.

Our contact with trial authors by phone resulted in our exclusion of eight trials that we originally planned to include (see Characteristics of excluded studies). The main reasons were inadequate methods for allocation of participants, such as alternate allocation, or the data for this review were not available and the authors failed to provide them. We were not able to perform meaningful sensitivity or funnel plot analysis due to the limited number of trials.

 

Allocation

Eight out of 21 included trials reported generation of allocation sequence. However, only one trial described adequate allocation concealment (Hazlina 2005). The other trials did not report the method for allocation concealment.

 

Blinding

Two trials applied blinding (Hazlina 2005; Ma R 2010), including one trial using blinding of participants and personnel (Ma R 2010) and one trial using blinding of the outcome assessor (Hazlina 2005).

 

Incomplete outcome data

All included trials analysed all or most (> 95%) women randomised and we judged the majority of trials to be at low risk of bias. However, due to the non-availability of raw data from the missing participants for continuous data, we were not able to do an intention-to-treat analysis.

 

Selective reporting

As we were not able to get access to trial protocols for any of the 21 trials, we made our judgement by comparing the outcome measures mentioned in the method section with the reporting in results: 13/21 trials reported all outcome measures described in the methods and, therefore, were evaluated as at low risk of bias; 7/21 partially reported the outcomes in the results, and were evaluated as at high risk of bias.

 

Other potential sources of bias

All trials reported baseline comparability between the two groups, and were considered to be at low risk of bias. We found no potential sources of within-study bias in the included trials.

 

Effects of interventions

See:  Summary of findings for the main comparison Herbal preparations versus placebo;  Summary of findings 2 Herbal preparations versus medication;  Summary of findings 3 Herbal preparations plus medication versus medication

 

1. Herbal medicine versus placebo

No trial in this category reported the primary outcome, that is fibroids related symptoms, using validated methods. One trial tested the herbal medicine Guihong turtle shell pill against placebo for three-month treatment of 136 women with uterine fibroids (Ma R 2010). The participants were diagnosed as having qi stagnation and blood stasis, without an indication for surgery.

Since this trial evaluated non-relevant outcomes such as disappearance or shrinkage of uterine fibroids, we were not able to evaluate the efficacy of herbal medicine in this comparison.

In the Ma R 2010 study, there was one case in the herbal group who developed abnormal serum blood urea nitrogen (BUN) and creatinine levels after three months of treatment, which might represent potential impairment to kidney function. No case with abnormal kidney function occurred in the placebo group. Liver function was monitored and no trial participant developed abnormal levels of serum alanine transaminase (ALT) or aspartate aminotransferase (AST).

 

2. Herbal medicine versus medication

No trial in this category reported the primary outcome, that is fibroids related symptoms, using validated methods. Seven trials compared herbal medicines versus medication (Fu WJ 2005; Hazlina 2005; Lai XL 2010; Lu JX 2007; Ni XP 2012; Wen Q 2005; Yan LQ 2000). Six different herbal preparations were tested: Gongliuqing capsule, Nona Roguy herbal product, Huoxue Huayu Ruanjian Sanjie, Huoxue Sanjie decoction, Tripterygium wilfordii, and Xiaozheng decoction. Since no two trials tested the same herbal medicine except for Tripterygium wilfordii, a meta-analysis was performed for Tripterygium wilfordii compared with mifepristone on the average volume of uterine fibroids.

 

2.1 Average volume of uterine fibroids

Among four herbal medicines compared to mifepristone, there was no significant difference between herbal medicine and mifepristone in the average volume of uterine fibroids ( Analysis 1.1). The tested herbal medicines were Gongliuqing capsule (Lai XL 2010), Huoxue Huayu Ruanjian Sanjie (Yan LQ 2000), Huoxue Sanjie decoction (Lu JX 2007), and Xiaozheng decoction (Ni XP 2012). Similarly, there was no significant difference between the Nona Roguy herbal product and GnRH agonist in average volume of uterine fibroids (Hazlina 2005). However, herbal extracts of Tripterygium wilfordii showed a significantly better effect than mifepristone in the average volume of uterine fibroids (MD -23.03 cm3, 95% CI -28.39 to -17.67) from two trials (Fu WJ 2005; Wen Q 2005).

 

2.2 Average size of uterus

Six trials reported on the size of the uterus after three to six months of treatment. Extracts of Tripterygium wilfordii showed significantly better effect than mifepristone in reducing the size of the uterus (MD -51.25 cm3, 95% CI -77.7 to -24.8; 2 trials) (Fu WJ 2005; Wen Q 2005). However, three other herbal medicines were less effective than mifepristone, including Huoxue Huayu Ruanjian Sanjie, Huoxue Sanjie decoction, and Xiaozheng decoction, for the average size of the uterus ( Analysis 1.2).

There was no significant difference between the herbal preparation Nona Roguy and the GnRH agonist regarding uterus size (Hazlina 2005).

 

2.3 Adverse effects

Five trials in this category reported on adverse effects ( Table 2) and the reported adverse effects included amenorrhoea, menopausal symptoms, gastrointestinal discomfort in the herbal treatment group. However, similar adverse effects were reported in the control group. No serious adverse events such as death or disability were reported.

 

3. Herbal medicine plus medical treatment versus medical treatment

No trial in this category reported the primary outcome, that is fibroids related symptoms, using validated methods. Thirteen randomised trials tested herbal medicine plus medication against medication alone. Nine trials compared the herbal medicine Guizhi Fuling formula plus mifepristone versus mifepristone (Deng XL 2010; Gu HH 2011; Liu Y 2009; Lu HJ 2010; Mao CX 2012; Mao XG 2012; Wang XR 2011; Wu JH 2011; Wu YF 2011). One trial tested Guizhi Fuling capsule plus leuprolide acetate against mifepristone (Dong M 2011). Guizhi Fuling formula was taken in either capsule or decoction form. Three other herbal medicines were tested with mifepristone against mifepristone alone, including Gongliuqing capsule (Liu LY 2010), Lenge Xiaozheng Tang (Zhu FH 2006), and Jiliu Tang (Luo SQ 2010).

 

3.1 Average volume of maximum fibroids

Compared with mifepristone alone, Guizhi Fuling formula combined with mifepristone showed a significantly better effect in reducing the average volume of maximum fibroids (MD -1.72 cm3, 95% CI -2.42 to -1.02; 7 trials) using the random-effects model ( Analysis 2.1).

The combination therapy of Guizhi Fuling capsule and leuprolide acetate was more effective than mifepristone alone in one trial (Dong M 2011). Similarly, Gongliuqing capsule plus mifepristone was more effective than mifepristone alone in one trial (Liu LY 2010). In another trial, Lenge Xiaozheng Tang plus mifepristone showed no significant difference compared to mifepristone alone in one trial (Zhu FH 2006).

 

3.2 Average volume of total multiple fibroids

Three trials measured and reported the average volume of the total multiple fibroids (Liu Y 2009; Lu HJ 2010; Luo SQ 2010). Guizhi Fuling capsule plus mifepristone showed a better effect in reducing the average volume of total multiple fibroids (MD -16.58 cm3, 95% CI -20.30 to -12.86; 2 trials) compared to mifepristone ( Analysis 2.2). Another trial showed a better effect of Jiliu Tang plus mifepristone in reducing the average volume of total multiple fibroids than mifepristone alone (MD -16.30 cm3, -18.97 to -13.63) (Luo SQ 2010).

 

3.3 Average size of uterus

Four trials in this category reported on the average size of the uterus after treatment (Deng XL 2010; Liu Y 2009; Luo SQ 2010; Wu JH 2011). A pooled analysis of data from three trials showed a significant beneficial effect of Guizhi Fuling capsule plus mifepristone in reducing the average size of uterus compared to mifepristone alone (MD -31.63 cm3, 95% CI -54.58 to -8.68) using the random-effects model. There was significant heterogeneity for this analysis with an I2 of 90%, which might be due to the relatively large size of the uterus from one trial (Liu Y 2009). Another trial showed a better effect of Jiliu Tang plus mifepristone in reducing the average size of the uterus (MD -47.80 cm3, -55.68 to -39.92) (Luo SQ 2010).

 

3.4 Adverse effects

Eight trials in this category reported on the adverse effects in relation to the herbal treatments (Deng XL 2010; Dong M 2011; Liu Y 2009; Liu LY 2010; Mao CX 2012; Mao XG 2012; Wu JH 2011; Zhu FH 2006) ( Table 2). The adverse effects included gastrointestinal discomfort, itching, and hot flushes. Similar adverse effects were reported in the control group. No serious adverse events from herbal preparations were reported.

 

4. Other analyses

Our specified sensitivity analyses, subgroup analyses, and test for publication bias were unable to be performed due to significant heterogeneity of the herbal interventions and the limited number of trials under each comparison.

Although no trial reported on the primary outcome of symptoms, we summarised the major findings in the summary of findings tables ( Summary of findings for the main comparison;  Summary of findings 2;  Summary of findings 3).

 

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. Index terms
 

Summary of main results

This systematic review included 21 randomised trials of herbal preparations for the treatment of uterine fibroids. The majority of the herbal preparations were tested in single trials. Only the herbal medicines Guizhi Fuling formula (either capsule or decoction) and Tripterygium wilfordii were tested in two or more trials, with or without mifepristone against mifepristone alone. One trial with good quality was published in English (Hazlina 2005) and the other trials, published in Chinese, were of low quality. No trials reported menstrual symptoms related to fibroids, quality of life, incidence of complications, or the need for a surgical procedure. Most of the trials reported the volume of fibroids or size of the uterus, or both. The trials in this review showed a similar effect of herbal preparations combined with medication in terms of reduced volume of uterine fibroids. However, due to the small sample of the trials and methodological flaws in the majority of the trials, any indicated benefit is not conclusive. Further large and rigorous trials are needed.

 

Overall completeness and applicability of evidence

The included studies tested 10 different herbal medicines with conventional therapy, including mifepristone or GnRHa. In general, there was no significant difference between herbs and medical treatment for the reduced volume of fibroids. However, the lack of statistical significant difference does not mean equal effectiveness as none of the trials were designed as equivalence or non-inferiority trials and the sample size was no more than 100 in each arm in the majority of the trials.

With regard to the conventional medical treatments used in the included studies, the efficacy of mifepristone for reducing fibroid volume has not been firmly established (Tristan 2012). A Cochrane systematic review demonstrated that mifepristone reduced heavy menstrual bleeding and improved fibroid-specific quality of life (Tristan 2012). Unfortunately, none of the trials in our review reported these outcomes and we don't know whether herbal medicines can be helpful in relieving fibroid related symptoms or not.

The evidence from this review is not sufficiently convincing to support a clinical recommendation due to the following aspects of the trials.

  1. There is a lack of evidence on the clinical effect of individual herbal preparations for menstrual symptom improvement in uterine fibroids. In clinical practice, Chinese herbal medicine is used mainly for symptom improvement, but this was not confirmed from the included trials due to the lack of a validated measurement, or reporting of symptoms or quality of life. Almost all reported outcomes were surrogate outcomes and may not reflect the clinical effectiveness. Comparisons with placebo are needed, as there is no clear evidence of the efficacy of the comparators used in the trials.
  2. Although Chinese herbal extracts of Tripterygium wilfordii showed a promising effect compared with mifepristone, the findings are not confirmed as we only had two small trials that were of poor quality and uncertain evidence on safety. The Chinese herbal medicine Guizhi Fuling showed a promising benefit when combined with mifepristone versus mifepristone alone. However, the findings need to be verified in large, rigorous trials.
  3. The trials reported outcomes by the end of treatment or at short-term follow up. For those women with asymptomatic fibroids or mild symptoms, the use of herbal therapies is intended to prevent fibroid growth or to manage the mild symptoms. For this (wide) subgroup of women the main outcome is the avoidance of surgical treatment, measured through long-term follow up. Future trialists are encouraged to adopt this outcome, as women may simply reach their menopause without needing surgery. In addition, reproductive outcomes related to uterine fibroids, such as the relationship between submucosal, intramural, or subserosal fibroids and pregnancy rates, miscarriage, and malpresentation, should be addressed in future trials (Klatsky 2008).
  4. Reporting of adverse events in relation to herbal preparations was not sufficient in the included trials, and one trial suggested potential kidney function impairment after three-month herbal treatment. Therefore, the safety of herbal medicine is still undetermined.

 

Quality of the evidence

This systematic review has several methodological limitations. Firstly, there is a lack of high quality trials and we had to exclude some of the trials that claimed to be randomised because of an unexplainable skew in the distribution of participants among the compared groups or an inadequate method for sequence generation for randomisation, which means they were highly prone to selection bias (Liu J 2002).

Secondly, trials did not report use of double blinding (except for one trial), which may be related to performance and detection bias (Moher 1998; Schulz 1995).

Thirdly, the trials had a small sample size. Although some data analyses did not demonstrate a statistically significant difference between herbal medicines and conventional medicine, the results are likely to have been underpowered. Therefore, the size of the trials may mean that the analyses may not establish with confidence that the two interventions have equivalent effects.

Fourth, the trials failed to report clinically useful outcomes such as symptoms or quality of life, which may suggest evidence of selective reporting bias. We could not differentiate the participants with symptoms from those without symptoms in the included studies. It is difficult to justify the herbal medicine treatment as some women without symptoms may not need any treatment. Therefore, we suggest that future trials should measure and report clinical symptoms as one of the major outcomes.

The above limitations mean that potential bias may have been present in the selection of participants, administration of treatment, and assessment of outcomes in the primary studies. Methodologically less rigorous trials show significantly larger intervention effects than more robust trials (Egger 2003; Kjaergard 2001; Moher 1998; Schulz 1995). An empirical study has shown that Chinese trials are significantly affected by publication bias (Vickers 1998). When interpreting the present findings, publication bias should be taken into consideration accordingly.

In summary, the findings of this review should be interpreted with caution due to the small sample sizes, low methodological quality in the majority of the 21 trials, and the limited number of trials included for each individual herbal preparation.

 

Potential biases in the review process

Although we conducted comprehensive searches in both English and Chinese databases, we may have missed some studies published in the non-English or non-Chinese literature, such as in the Japanese or Korean language. Second, we endeavoured to contact trial authors to clarify the methods for randomisation and obtain missing data, but the response was not satisfactory and leaves some trials with unclear randomisation. This may cause selection bias, and may not reflect the whole picture in using herbal medicine for the treatment of uterine fibroids.

 

Agreements and disagreements with other studies or reviews

As far as we know, there is no other systematic review or meta-analysis published on the same topic. We also could not identify any large, multicentre trials for a comparison of our findings with other types of evidence.

 

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. Index terms

 

Implications for practice

Current evidence does not support the use of herbal preparations for treatment of uterine fibroids. There is no conclusive evidence of benefit due to a limited number of trials conducted for individual herbal preparations, the methodological quality of the primary studies, and their insufficient power to meet robust conclusions.

 
Implications for research

Further well-designed, randomised, double blind, placebo-controlled trials are needed to evaluate herbal preparations for uterine fibroids. To improve quality, trials needs to use appropriate allocation concealment; blinding of participants, researchers and outcome assessors; and clarify the number of participants randomised and the number analysed. Clinically relevant outcomes, such as symptoms, quality of life, infertility, and anaemia, should be addressed and measured using validated patient-reported instruments. Potentially promising herbal preparations require further trials with large samples. As in this systematic review, the quality of herbal medicines was not reported in detail and for future trials it is important to investigate herbal medicines according to a set of criteria which include a preparation consistent with the description in the pharmacopoeia, chemical standardisation, biological assays, animal models, and clinical testing (Yuan 2000). It will be necessary to improve the description of the herbal medicines being tested, for example plant species, geographical origin, harvest season, preparation procedures, and the quality of the products. Furthermore, future trials should pay more attention to the adverse effects of herbal medicines, especially for long-term use. Adverse events should be fully recorded and reported. Finally, trial reports should follow international standards, such as the CONSORT statement (http://www.consort-statement.org/), and the trial protocol should be registered and accessible.

 

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. Index terms

The authors thank the Cochrane Menstrual Disorders and Subfertility Group (MDSG) for their expertise and editorial input. We would like to specifically thank the Trials Search Coordinator of the MDSG, Marian Showell, for her help with the literature searches. We thank Dr Nik Hazlina, Nik Hussain for providing us with additional data from their study. We also thank Ms Nini Chen for helping with validating data extraction and analyses in the updating of the review.

This work was funded by the Grant Number 2011ZX09302-006-01(5) and 101207007 from the Ministry of Science and Technology of China. The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the funders.

Jianping Liu's work was supported by the Programme of Innovative Research Team Project (2011-CXTD-09) of Beijing University of Chinese Medicine, and the "111" Project (B08006).

 

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. Index terms
Download statistical data

 
Comparison 1. Herbal preparations versus medication

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

 1 Average volume of uterine fibroids (cm3)7Mean Difference (IV, Fixed, 95% CI)Subtotals only

    1.1 Gongliuqing capsule versus mifepristone
1188Mean Difference (IV, Fixed, 95% CI)-0.11 [-0.62, 0.40]

    1.2 Huoxue Huayu Ruanjian Sanjie versus mifepristone
130Mean Difference (IV, Fixed, 95% CI)7.97 [-4.24, 20.18]

    1.3 Huoxue Sanjie decoction versus mifepristone
1115Mean Difference (IV, Fixed, 95% CI)4.98 [-6.08, 16.04]

    1.4 Nona Roguy herbal product versus GnRH agonist
135Mean Difference (IV, Fixed, 95% CI)6.74 [-27.43, 40.91]

    1.5 Tripterygium wilfordii versus mifepristone
2186Mean Difference (IV, Fixed, 95% CI)-23.03 [-28.39, -17.67]

    1.6 Xiaozheng decoction versus mifepristonee
1260Mean Difference (IV, Fixed, 95% CI)1.79 [-2.13, 5.71]

 2 Average size of uterus (cm3)6Mean Difference (IV, Random, 95% CI)Subtotals only

    2.1 Huoxue Huayu Ruanjian Sanjie versus mifepristone
130Mean Difference (IV, Random, 95% CI)22.76 [10.76, 34.76]

    2.2 Huoxue Sanjie decoction versus mifepristone
1115Mean Difference (IV, Random, 95% CI)23.23 [17.85, 28.61]

    2.3 Nona Roguy herbal product versus GnRH agonist
135Mean Difference (IV, Random, 95% CI)-23.61 [-223.63, 176.41]

    2.4 xiaozheng decoction versus mifepristone
1260Mean Difference (IV, Random, 95% CI)10.22 [3.25, 17.19]

    2.5 Tripterygium wilfordii versus mifepristone
2186Mean Difference (IV, Random, 95% CI)-51.25 [-77.70, -24.80]

 
Comparison 2. Herbal preparations plus medication versus medication

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

 1 Average volume of maximum fibroids (cm3)10Mean Difference (IV, Random, 95% CI)Subtotals only

    1.1 Gongliuqing capsule plus mifepristone versus mifepristone
1100Mean Difference (IV, Random, 95% CI)-5.28 [-6.46, -4.10]

    1.2 Guizhi Fuling capsules plus mifepristone versus mifepristone
7687Mean Difference (IV, Random, 95% CI)-1.72 [-2.42, -1.02]

    1.3 Guizhi Fuling capsule plus Leuprolide acetate versus mifepristone
1100Mean Difference (IV, Random, 95% CI)-1.25 [-1.50, 1.00]

    1.4 Lenge Xiaozheng Tang plus mifepristone versus mifepristone
167Mean Difference (IV, Random, 95% CI)-1.44 [-3.24, 0.36]

 2 Average volume of total multiple fibroids (cm3)3Mean Difference (IV, Fixed, 95% CI)Subtotals only

    2.1 Guizhi Fuling capsules plus mifepristone versus mifepristone
2180Mean Difference (IV, Fixed, 95% CI)-16.58 [-20.30, -12.86]

    2.2 Jiliu Tang plus mifepristone versus mifepristone
1138Mean Difference (IV, Fixed, 95% CI)-16.30 [-18.97, -13.63]

 3 Average size of uterus (cm3)4Mean Difference (IV, Random, 95% CI)Subtotals only

    3.1 Guizhi Fuling capsules plus mifepristone versus mifepristone
3231Mean Difference (IV, Random, 95% CI)-31.63 [-54.58, -8.68]

    3.2 Jiliu Tang plus mifepristone versus mifepristone
1138Mean Difference (IV, Random, 95% CI)-47.80 [-55.68, -39.92]

 

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. Index terms
 

Appendix 1. Detailed search strategies for English literature

MDSG keywords Sept 2012

Keywords CONTAINS "fibroid" or "Leiomyoma" or "myoma" or "myomas" or "myomata" or "uterine fibroids" or "uterine leiomyomas" or "uterine myoma" or "uterine myomas" or "Uterine Neoplasms" or "fibroids" or Title CONTAINS "fibroid" or "Leiomyoma" or "myoma" or "myomas" or "myomata" or "uterine fibroids" or "uterine leiomyomas" or "uterine myoma" or "uterine myomas" or "Uterine Neoplasms" or "fibroids"

AND

Keywords CONTAINS "Chinese herbal medicine" or "chinese herbal preparations" or "Chinese herbal remedy" or "Chinese traditional medicine" or "plant extracts" or "herbal preparations" or "herbal remedy", "herbal supplement" or "herbal supplements" or Title CONTAINS "Chinese herbal medicine" or "chinese herbal preparations" or "Chinese herbal remedy" or "Chinese traditional medicine" or "plant extracts" or "herbal preparations" or "herbal remedy", "herbal supplement" or "herbal supplements"

AMED 1985 to Sept 2012

1 traditional medicine$.tw. (5881)

2 exp plant extracts/ or exp drugs, chinese herbal/ (15672)

3 chinese herb$.tw. (1492)

4 plant extract$.tw. (9931)

5 chinese medicine$.tw. (1026)

6 exp Plants, Medicinal/ (14154)

7 (Plant$ adj2 Medicin$).tw. (13318)

8 herb$.tw. (9770)

9 exp Phytotherapy/ (1049)

10 Phytotherap$.tw. (1346)

11 alternative medicine$.tw. (1201)

12 exp ethnopharmacology/ or exp remedies/ or exp traditional medicine chinese/ (4761)

13 exp herbal drugs/ (6344)

14 or/1-13 (26465)

15 exp uterine neoplasms/ (20)

16 (uterine adj5 neoplasm$).tw. (28)

17 fibroid$.tw. (23)

18 (fibroma$ or leiomyom$).tw. (48)

19 (myoma$ or hysteromyom$).tw. (15)

20 fibroid$.tw. (23)

21 or/15-20 (87)

22 14 and 21 (17)

23 from 22 keep 1-17 (17)

CENTRAL Issue 4, 2012

1 exp Fibroma/ (1)

2 fibroma$.tw. (16)

3 leiomyom$.tw. (148)

4 exp Myoma/ (7)

5 myoma$.tw. (150)

6 hysteromyom$.tw. (7)

7 fibroma$.tw. (16)

8 fibroid$.tw. (153)

9 exp Leiomyoma/ (247)

10 or/1-9 (442)

11 exp medicine, traditional/ or exp medicine, oriental traditional/ (351)

12 traditional medicine$.tw. (69)

13 exp plant extracts/ or exp drugs, chinese herbal/ (2840)

14 chinese herb$.tw. (331)

15 plant extract$.tw. (72)

16 chinese medicine$.tw. (428)

17 exp Plants, Medicinal/ (742)

18 (Plant$ adj2 Medicin$).tw. (35)

19 herb$.tw. (1117)

20 exp Phytotherapy/ (1566)

21 Phytotherap$.tw. (48)

22 alternative medicine$.tw. (69)

23 or/11-22 (4822)

24 10 and 23 (7)

25 from 24 keep 1-7 (7)

CINAHL 1982 to Sept 2012

1 exp Fibroma/ (0)

2 fibroma$.tw. (184)

3 leiomyom$.tw. (177)

4 exp Myoma/ (36)

5 myoma$.tw. (72)

6 hysteromyom$.tw. (0)

7 fibroma$.tw. (184)

8 fibroid$.tw. (297)

9 exp Leiomyoma/ (569)

10 or/1-9 (879)

11 exp medicine, traditional/ or exp medicine, oriental traditional/ (10482)

12 traditional medicine$.tw. (294)

13 exp plant extracts/ or exp drugs, chinese herbal/ (2691)

14 chinese herb$.tw. (313)

15 plant extract$.tw. (123)

16 chinese medicine$.tw. (678)

17 exp Plants, Medicinal/ (13658)

18 (Plant$ adj2 Medicin$).tw. (236)

19 herb$.tw. (4109)

20 exp Phytotherapy/ (3397)

21 Phytotherap$.tw. (93)

22 alternative medicine$.tw. (2179)

23 or/11-22 (26022)

24 10 and 23 (14)

25 exp clinical trials/ (57427)

26 Clinical trial.pt. (29998)

27 (clinic$ adj trial$1).tw. (13150)

28 ((singl$ or doubl$ or trebl$ or tripl$) adj (blind$3 or mask$3)).tw. (7801)

29 Randomi?ed control$ trial$.tw. (11197)

30 Random assignment/ (17445)

31 Random$ allocat$.tw. (1211)

32 Placebo$.tw. (10846)

33 Placebos/ (4145)

34 Quantitative studies/ (3735)

35 Allocat$ random$.tw. (73)

36 or/25-35 (79254)

37 24 and 36 (2)

38 from 37 keep 1-2 (2)

EMBASE to Sept 2012

1 exp traditional medicine/ or exp chinese medicine/ or exp herbal medicine/ or exp oriental medicine/ (21306)

2 exp Plant Extract/ (57548)

3 exp Medicinal Plant/ (40872)

4 (traditional adj2 medicin$).tw. (6936)

5 chinese herb$.tw. (2504)

6 plant extract$.tw. (2889)

7 chinese medicine.tw. (3872)

8 (herbal adj2 medicin$).tw. (3621)

9 (oriental adj2 medicine).tw. (354)

10 (Medicin$ adj2 Plant$).tw. (4699)

11 herb$.tw. (27378)

12 exp Phytotherapy/ (3672)

13 Phytotherap$.tw. (1297)

14 alternative medicine$.tw. (2950)

15 or/1-14 (109922)

16 exp benign uterus tumor/ or exp leiomyoma/ or exp uterus myoma/ (8988)

17 exp Fibroma/ (2830)

18 (Fibroma$ or leiomyom$).tw. (9914)

19 (myoma$ or hysteromyom$).tw. (2258)

20 fibroid$.tw. (2241)

21 or/16-20 (17218)

22 15 and 21 (35)

23 Clinical trial/ (495185)

24 Randomized controlled trials/ (155511)

25 Random Allocation/ (25203)

26 Single-Blind Method/ (7410)

27 Double-Blind Method/ (68576)

28 Cross-Over Studies/ (20046)

29 Placebos/ (111054)

30 Randomi?ed controlled trial$.tw. (28060)

31 RCT.tw. (2194)

32 Random allocation.tw. (605)

33 Randomly allocated.tw. (9592)

34 Allocated randomly.tw. (1314)

35 (allocated adj2 random).tw. (552)

36 Single blind$.tw. (7066)

37 Double blind$.tw. (81296)

38 ((treble or triple) adj blind$).tw. (127)

39 Placebo$.tw. (104327)

40 Prospective Studies/ (73142)

41 or/23-40 (651841)

42 Case study/ (5369)

43 Case report.tw. (110903)

44 Abstract report/ or letter/ (461484)

45 or/42-44 (575754)

46 41 not 45 (629234)

47 animal/ (18235)

48 human/ (6058876)

49 47 not 48 (14465)

50 46 not 49 (629138)

51 or/23-50 (6253078)

52 22 and 51 (33)

53 from 52 keep 1-33 (33)

MEDLINE 1950 to Sept 2012

1 exp Fibroma/ (9610)

2 fibroma$.tw. (7047)

3 leiomyom$.tw. (7602)

4 exp Myoma/ (1626)

5 myoma$.tw. (3317)

6 hysteromyom$.tw. (26)

7 fibroma$.tw. (7047)

8 fibroid$.tw. (2244)

9 exp Leiomyoma/ (13308)

10 or/1-9 (29717)

11 exp medicine, traditional/ or exp medicine, oriental traditional/ (17249)

12 traditional medicine$.tw. (2357)

13 exp plant extracts/ or exp drugs, chinese herbal/ (59586)

14 chinese herb$.tw. (2614)

15 plant extract$.tw. (2601)

16 chinese medicine$.tw. (3950)

17 exp Plants, Medicinal/ (44249)

18 (Plant$ adj2 Medicin$).tw. (4189)

19 herb$.tw. (29907)

20 exp Phytotherapy/ (17380)

21 Phytotherap$.tw. (781)

22 alternative medicine$.tw. (3563)

23 or/11-22 (132460)

24 10 and 23 (43)

25 randomised controlled trial.pt. (251334)

26 controlled clinical trial.pt. (77422)

27 randomised controlled trials as topic/ (53023)

28 random allocation/ (60395)

29 double blind method/ (96065)

30 single blind method/ (11789)

31 or/25-30 (424467)

32 animals/ not (animals/ and humans/) (3189559)

33 31 not 32 (397756)

34 clinical trial.pt. (446433)

35 exp clinical trials as topic/ (201557)

36 (clinic$ adj25 trial$).ti,ab. (142061)

37 cross-over studies/ (21493)

38 (crossover or cross-over or cross over).tw. (40169)

39 ((singl$ or doubl$ or trebl$ or tripl$) adj25 (blind$ or mask$)).ti,ab. (95360)

40 placebos/ (26962)

41 placebo$.ti,ab. (108242)

42 random$.ti,ab. (401463)

43 research design/ (51618)

44 or/34-43 (910204)

45 44 not 32 (843399)

46 33 or 45 (865071)

47 24 and 46 (8)

48 from 47 keep 1-8 (8)

PsycINFO 1806 to Sept 2012

1 exp Fibroma/ (0)

2 fibroma$.tw. (15)

3 leiomyom$.tw. (2)

4 exp Myoma/ (0)

5 myoma$.tw. (12)

6 hysteromyom$.tw. (1)

7 fibroma$.tw. (15)

8 fibroid$.tw. (15)

9 exp Leiomyoma/ (0)

10 or/1-9 (44)

11 exp medicine, traditional/ or exp medicine, oriental traditional/ (0)

12 traditional medicine$.tw. (205)

13 exp plant extracts/ or exp drugs, chinese herbal/ (0)

14 chinese herb$.tw. (65)

15 plant extract$.tw. (41)

16 chinese medicine$.tw. (212)

17 exp Plants, Medicinal/ (0)

18 (Plant$ adj2 Medicin$).tw. (68)

19 herb$.tw. (3468)

20 exp Phytotherapy/ (0)

21 Phytotherap$.tw. (14)

22 alternative medicine$.tw. (790)

23 or/11-22 (4537)

24 10 and 23 (1)

25 from 24 keep 1 (1)

 

Appendix 2. Search strategies for Chinese biomedical databases

Since the Chinese databases have different indexing and search functions, we listed below generic string search terms for use in different databases:

1 Zi Gong ji liu (Chinese spelling, in English 'uterine fibroids')

2 Zhong yao (Chinese materia medica)

3 Zhong cheng yao (Chinese patent medicine)

4 Zhong cao yao (Chinese herbal drug)

5 Tang yao (herbal decoction)

6 Lin chuang yan jiu (clinical studies)

7 Lin chuang shi yan (clinical trials)

 

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. Index terms

Last assessed as up-to-date: 28 February 2013.


DateEventDescription

25 February 2013New search has been performed19 randomised trials included: (Deng XL 2010; Dong M 2011; Fu WJ 2005; Gu HH 2011; Lai XL 2010; Liu Y 2009; Liu LY 2010; Lu HJ 2010; Luo SQ 2010; Ma R 2010; Mao CX 2012; Mao XG 2012; Ni XP 2012; Wang XR 2011; Wen Q 2005; Wu JH 2011; Wu YF 2011; Yan LQ 2000; Zhu FH 2006, making the total number of studies 21 in this review. No changes to conclusions.

12 October 2012New citation required but conclusions have not changedThe new studies added did not lead to any change in conclusions.



 

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. Index terms

Protocol first published: Issue 2, 2005
Review first published: Issue 2, 2009


DateEventDescription

16 April 2008AmendedConverted to new review format.

14 April 2008New 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. Index terms

Jianping Liu conceived the review, wrote the protocol, performed quality assessment and data analyses, wrote and updated the review.

Hong Yang identified studies, extracted data, performed quality assessment, and analysed data.

Yun Xia contacted trial authors for confirmation of randomisation and to obtain missing data.

Francesco Cardini revised the protocol and the 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. Index terms

None known

 

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. Index terms
 

Internal sources

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

 

External sources

  • The '111' Project (B08006), China.
  • The Programme for Innovative Research Team (No. 2011-CXTD-09) of Beijing University of Chinese Medicine, China.

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. Characteristics of studies
  19. References to studies included in this review
  20. References to studies excluded from this review
  21. Additional references
Deng XL 2010 {published data only}
  • Zheng XL, Li CR. Clinical observation of Guizhi Fuling capsule combined mifepristone treating 33 cases of uterine myoma. Hebei Journal of Traditional Chinese Medicine 2010;32(11):1670-1.
Dong M 2011 {published data only}
  • Dong M. Clinical research of Guizhi Fuling capsule combined leuprorelin treating premenopause uterine myoma. China Healthcare Innovation 2011;6(19):69-70.
Fu WJ 2005 {published data only}
  • Fu WJ, Ni J, Zheng LJ, Wang XF. [Observation on therapeutic effects of small dosage of Tripterygium Wilfordii Hook for treatment of uterine leiomyoma]. Journal of Hebei North University (Medical Edition) 2005;22(1):46-8.
Gu HH 2011 {published data only}
  • Gu HH, Hu QY. [Effect of integrated Chinese and western medicine in treating uterine myoma]. Strait Pharmaceutical Journal 2011;23(4):126-7.
Hazlina 2005 {published data only}
  • Hazlina NNH, Pazudin MI, Nor Aliza AG, Mohsin Sahil SJ. Clinical study to compare the efficacy and adverse effects of Nona Roguy herbal formulation and gonadotrophin releasing hormone agonist (GnRH) in the treatment of uterine fibroids. International Medical Journal 2005;12(4):295-302.
Lai XL 2010 {published data only}
  • Lai XL, Zheng LZ,  Ma XJ. [Gongliuqing capsule treated 94 cases of uterine myoma]. Jiangxi Journal of Traditional Chinese Medicine 2010;41(328):46-7.
Liu LY 2010 {published data only}
  • Liu LY. [Clinical research of Gongliuqing capsule combined with mifepristone for treating uterine myoma]. China Higher Medical Education 2010;23(12):140-1.
Liu Y 2009 {published data only}
  • Liu Y. [Observation of efficacy on combined therapy of mifepristone and Chinese herbal medicine on 30 cases of hysteromyoma]. World Journal of Integrated Traditional and Western Medicine 2009;4(4):268-70.
Lu HJ 2010 {published data only}
  • Lu HJ. [Curative effect observation of mifepristone combined with Guilin Fuling capsule treating uterine myoma]. Chinese Journal of Clinical Rational Drug Use 2010;3(17):49-50.
Lu JX 2007 {published data only}
  • Lu JX. [Comparison of Huoxue Sanjie decoction with mifepristone in the treatment of uterine fibroids]. Shandong Journal of Medicine and Pharmacology 2007;47(19):109-10.
Luo SQ 2010 {published data only}
  • Luo SQ. [Clinical observation of Jiliu decoction combined with mifepristone in the treatment of uterine myoma]. Journal of Emergency in Traditional Chinese Medicine 2010;19(6):943-4.
Mao CX 2012 {published data only}
  • Mao CX, Cai RR, Wang XP, Wu YL. [Curative effects on treating premenopause hysteromyoma by mifepristone with Guizhi Fuling capsule]. Chinese Archives of Traditional Chinese Medicine 2012;30(3):665-7.
Mao XG 2012 {published data only}
  • Mao XG, Fang SS. [Clinical observation of Guizhi Fuling capsule combined mifepristone for treating 33 cases of uterine myoma]. Asia-Pacific Traditional Medicine 2012;8(4):125-6.
Ma R 2010 {published data only}
  • Ma R, Cheng HL. [Guihong turtle shell pill for treating 68 cases of Qi and blood stagnation uterine myoma]. Henan Traditional Chinese Medicine 2010;30(4):382-3.
Ni XP 2012 {published data only}
  • Ni XP, Ma DZ, Lei LH. [Clinical observation of Xiaozheng decoction for 130 cases of uterine leiomyoma]. Journal of Traditional Chinese Medicine 2012;53(7):588-90, 594.
Wang XR 2011 {published data only}
  • Wang XR. [Clinical effect of GuizhiFuling capsule combined mifepristone in the treatment of uterine myoma]. Strait Pharmaceutical Journal 2011;23(10):127-9.
Wen Q 2005 {published data only}
  • Wen Q. [Therapeutic observation on effect of Tripterygium Wilfordii Hook and mifepristone in treatment of uterine leiomyoma]. Clinical Medicine of China 2005;21(3):277-9.
Wu JH 2011 {published data only}
  • Wu JH. [Analysis of clinical effect of Guizhi Fuling capsule combined mifepristone in the treatment of uterine myoma]. Maternal and Child Health Care of China 2011;26(19):2910-1.
Wu YF 2011 {published data only}
  • Wu YF, He L. Curative effect observation of mifepristone combined Guilin Fuling capsule treating uterine myoma. Progress in Modern Biomedicine 2010;3(17):49-50.
Yan LQ 2000 {published data only}
  • Yan LQ. [Clinical study on uterine fibroids treated by traditional Chinese medicine]. Journal of Changzhi Medical College 2000;14(4):304-5.
Zhu FH 2006 {published data only}
  • Zhu FH. [35 cases of hysteromyoma treated with mifepristone and Eleng Xiaozheng Decoction]. Fujian Journal of Traditional Chinese Medicine 2006;37(3):37.

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. Characteristics of studies
  19. References to studies included in this review
  20. References to studies excluded from this review
  21. Additional references
Akase 2003 {published data only}
  • Akase T, Onodera S, Jobo T, Matsushita R, Kaneko M, Tashiro S-I. [A comparative study of the usefulness of Toki-shakuyaku-san and an oral iron preparation in the treatment of hypochromic anaemia in cases of uterine myoma]. Yakugaku Zasshi 2003;123(9):817-24.
An ZR 2005 {published data only}
  • An ZR. [43 cases of uterine fibroids treated by Gong Liu Tang]. Modern Traditional Chinese Medicine 2005;25(6):30.
Chen QM 2007 {published data only}
  • Chen QM, Li FS, Wang JP. [Observation of therapeutic effects of Rupi Anxiao capsules plus small dosage of methyltestosterone in treatment of hysteromyoma]. Maternal and Child Health Care of China 2007;22(11):1459-61.
Cuan CL 2002 {published data only}
  • Cuan CL, Shang HQ, Fu YP. [30 cases of uterine fibroids treated by Ding Jing Tang]. Shaanxi Journal of Traditional Chinese Medicine 2002;23(11):975-6.
Du WH 1993 {published data only}
  • Du WH. [Retentive enema and oral taking of Guizhi Fuling Wan for treatment of 40 cases of uterine fibroids]. Shandong Journal of Traditional Chinese Medicine 1993;12(2):28-9.
Fang RD 2001 {published data only}
  • Fang RD, Zhang XH, Wang QY, Lin YZ, Yang SP, Rao WN, et al. [Clinical study on the treatment of uterine leiomyoma with Xiao Liu Yin iontophoresis]. Chinese Journal of Information on Traditional Chinese Medicine 2001;12(8):47-9.
Feng FQ 2003 {published data only}
  • Feng FQ. [Therapeutic effect of treating uterine fibroids with Guizhi Fuling capsules]. Modern Practical Medicine 2003;15(6):389.
Feng X 2004 {published data only}
  • Feng X. [Clinical observation of 39 cases of uterine fibroids treated by self-prescribed Ping Liu Tang]. Journal of Hebei Traditional Chinese Medicine and Pharmacology 2004;19(2):17.
Fu 2003 {published data only}
  • Fu J. Treatment of 48 cases of uterine fibroids by Yiqi Guchong and Huayu Sanjie therapy. Journal of Traditional Chinese Medicine 2003;44(9):706.
Fu P 2004 {published data only}
  • Fu P, He JL, Cui L, Chen XC. [Clinical observation on effect of Xuejie Hualiu Granule in treating hysteromyoma]. Chinese Archives of Traditional Chinese Medicine 2004;22(10):1082-4.
Gao SM 2006 {published data only}
  • Gao SM, Liu HY. [Clinical observation of 40 cases of hysteromyoma treated with therapy of nourishing Qi and activating blood circulation]. Journal of Practical Traditional Chinese Internal Medicine 2006;20(2):190-1.
Gao XL 2001 {published data only}
  • Gao XL, Zhang XR. [Clinical observation of 104 cases of hysteromyoma treated by Xiao Zheng No. 1]. Shanxi Journal of Traditional Chinese Medicine 2001;17(1):17-8.
Gao YP 2000 {published data only}
  • Gao YP, Chen DF. [Clinical study on effect of Tripterygium Wilfordii Hook on uterine leiomyoma]. Chinese Journal of Obstetrics and Gynaecology 2000;35(7):430-2.
Gu H 1992 {published data only}
  • Gu H. [Clinical summary of 35 cases of uterine fibroids treated with traditional Chinese medicine]. Jiangsu Journal of Traditional Chinese Medicine 1992;13(12):7-8.
Guo AQ 2000 {published data only}
  • Guo AQ, Guo YL, Wang XQ. [Clinical observation on treatment of 38 cases of climacteric myoma of uterus by combined traditional Chinese and western medicine]. Journal of Heze Medical College 2000;12(1):50-2.
Gu Y 2011 {published data only}
  • Gu Y. Effect of modified Sijunzi decoction combined Guizhi Fuling capsule treating uterine myoma. Journal of Practical Traditional Chinese Medicine 2011;27(12):838-9.
Han HL 1992 {published data only}
  • Han HL, Wang GF, Yang RX. [118 cases of uterine fibroids treated by Xiao Liu Wan]. Chinese Archives of Traditional Chinese Medicine 1992;10(1):36.
Han MX 2002 {published data only}
  • Han MX, Zhu ZS, Liu F. [32 cases of uterine fibroids treated by Qizhi Xiangfu Wan]. Shanxi Journal of Traditional Chinese Medicine 2002;18(1):21.
He H 2003 {published data only}
  • He H. [Treatment of 38 cases of hysteromyoma by Huangqi Danshen decoction]. Journal of Guangming Traditional Chinese Medicine 2003;18(109):36.
Huang XX 2011 {published data only}
Hu TX 2009 {published data only}
  • Hu TX, Shan XL, Shen SF. Comparison of curative effect of Gongliuqing capsule and radiofrequency catheter ablation in the treatment of uterine myoma. Journal of Clinical Medicine 2009;29(1):68-70.
Hu WD 2007 {published data only}
  • Hu WD. [Analysis on clinical efficacy of Shugan Xiaozheng decoction on hysteromyoma]. Modern Diagnosis and Treatment 2007;18(5):283, 320.
Hu WH 2009 {published data only}
  • Hu WH, Yang M. Clinical observation of Guizhi Fuling capsule treating 115 cases of uterine myoma. China Practical Medicine 2009;4(16):30-1.
Jiang JF 2002 {published data only}
  • Jiang JF. [Observation of therapeutic effects in 60 cases of hysteromyoma treated by Eleng Xiaoliu Tang]. Shandong Journal of Traditional Chinese Medicine 2002;21(4):215.
Jiang LG 2006 {published data only}
  • Jiang LG. [Clinical observation of 36 cases of hysteromyoma treated with Chinese herbal medicine compound]. Chinese Journal for Clinicians 2006;34(9):40-1.
Jiang P 2003 {published data only}
  • Jiang P, Zhao Y, Ruan YL, Han Y. [Clinical observation of 70 cases of hysteromyoma treated with integrated traditional Chinese and western medicine]. Modern Journal of Integrated Traditional Chinese and Western Medicine 2003;12(7):707-8.
Jiang XJ 2007 {published data only}
  • Jiang XJ, He FH. [Clinical analysis of mifepristone sequential treatment with Guizhi Fuling capsule on uterine myoma]. Zhejiang Journal of Clinical Medicine 2007;9(10):1338.
Jiang Y 2003 {published data only}
  • Jiang Y, Xie PS. [186 cases of uterine fibroids treated by traditional Chinese medicine]. Chinese Journal of Information on Traditional Chinese Medicine 2003;10(1):44.
Jiao JF 2011 {published data only}
  • Jiao JF. [Mifepristone combined Guilin Fuling capsule treated 39 cases of uterine myoma]. Chinese Journal of Experimental Traditional Medical Formulae 2011;17(12):292-3.
Jiao ML 2005 {published data only}
  • Jiao ML, Jiao XW. [Clinical observation of 53 cases of hysteromyoma treated by Gong Ji Ning pills]. Modern Traditional Chinese Medicine 2005;3(3):49.
Jia WH 2012 {published data only}
  • Jia WH. Treating 50 cases of uterine myoma with integrative medicine. Chinese Medicine Modern Distance Education of China 2012;10(2):58.
Ji CW 2004 {published data only}
  • Ji CW, Li QS, Pei ZY. [Clinical observation on treating hysteromyoma by Kunyaosan capsule]. Chinese Journal of Practical Integrated Chinese and Western Medicine 2004;4(1):117.
Kang YP 2005 {published data only}
  • Kang YP, Zheng SG. [46 cases of hysteromyoma at early stage treated with integrated traditional Chinese and western medicine]. Shaanxi Journal of Traditional Chinese Medicine 2005;26(5):402-3.
Lai HH 2004 {published data only}
  • Lai HH, Gao SF, Deng YM, Zhu ZH, Feng LP, Lai XF. [Clinical observation on Pugui Pill for treatment of 30 cases of hysteromyoma of stagnant heat type]. Journal of Traditional Chinese Medicine 2004;45(3):201-3.
Liang XZ 2011 {published data only}
  • Liang XZ, Zhang L. [Clinical research of Qizhuxiaozheng decoction treating uterine myoma]. Chinese Remedies & Clinics 2011;11(11):1309-10.
Liang YY 2006 {published data only}
  • Liang YY, Huang YH. [Ruanjian Sanjie granule for treatment of 42 cases of uterine fibroids]. Shaanxi Journal of Traditional Chinese Medicine 2006;27(6):677-8.
Li CY 2004 {published data only}
  • Li CY. [Clinical observation of Chinese herbal medicine plus ear acupoints pressing for the treatment of uterine fibroids with blood stasis]. Liaoning Journal of Traditional Chinese Medicine 2004;31(12):1015.
Li DM 1998 {published data only}
  • Li DM, Gao M, Li HM. [Observation of therapeutic effect of self-prescribed Xiao Zheng Yin for the treatment of hysteromyoma]. Chinese Journal of Traditional Medical Science and Technology 1998;5(2):85.
Li FY 1993 {published data only}
  • Li FY. [40 cases of uterine fibroids at early stage treated by Chinese herbal medicine]. New Journal of Traditional Chinese Medicine 1993;25(10):39-40.
Li JX 2005 {published data only}
  • Li JX. [Clinical observation of 125 cases of hysteromyoma with Qi-stagnancy and blood stasis treated with Zigong Xiaoliu tablets]. Practice on Chinese Clinical Medicines 2005;3(29):47-8.
Li JX 2006 {published data only}
  • Li JX, Zhang HZ. [Observation on therapeutic effects in hysteromyoma treated with integrated traditional Chinese and western medicine]. Journal of Changzhi Medical College 2006;20(4):300-1.
Li KY 2005 {published data only}
  • Li KY, Luo SP, Kuang ZS, Deng GP, Tao LL, Xie YH. [Effect of Lizhi Sanjie pill on levels of oestrogen and progestin of hysteromyoma patients]. Journal of Nanjing TCM University 2005;21(4):228-30.
Li LH 2010 {published data only}
  • Li LH. [Xiaoliutang decoction for treatment of 66 cases of uterine myoma]. Guangming Journal of Chinese Medicine. 2010;25(7):1228.
Li LZ 2003 {published data only}
  • Li LZ, Li GH, Chen P. [Clinical observation of Sanjie Xiaoliu Decoction for treatment of hysteromyoma]. Tianjin Journal of Traditional Chinese Medicine 2003;20(5):22-3.
Liu DX 2005 {published data only}
  • Liu DX, Luo X. [Clinical observation on the results in treatment of hyperplasia of mammary glands, hysteromyoma and oviduct blocking cases with Xiaoliu pills]. China Tropical Medicine 2005;5(8):1684-5.
Liu GY 2005 {published data only}
  • Liu GY. [Clinical observation on the treatment of 45 cases of uterine myoma with Zhechong Siwu decoction]. Guiding Journal of TCM 2005;11(2):33-4.
Liu JY 2002 {published data only}
  • Liu JY, Meng FL, Zhu L, Yu B, Liu YH, Nie FH. [Treatment of 64 cases of hysteromyoma in perimenopause women with integrated traditional Chinese and western medicine]. Chinese Journal of Integrated Traditional and Western Medicine 2002;22(4):248.
Liu QP 2001 {published data only}
  • Liu QP, He YN, Guo H. [Clinical observation of Guizhi Fuling Wan Jiawei for treatment of 37 cases of uterine fibroids]. Yunan Journal of Traditional Chinese Medicine and Materia Medica 2001;22(3):35-6.
Liu XF 2011 {published data only}
  • Liu XF. [Clinical observation on Chinese herbal medicine differentiation combined with western drug for treatment of uterine fibroids]. Liaoning Journal of Traditional Chinese Medicine 2011;38(6):1160-1.
Li WY 1999 {published data only}
  • Li WY, Yang GH, Jiang YH. [Clinical observation of Xiao Zheng Pill for treatment of hysteromyoma]. Hebei Journal of Traditional Chinese Medicine 1999;21(6):331-2.
Li WY 2002 {published data only}
  • Li WY. [Clinical study of treating hysteromyoma by Xiao Zheng Wan]. Chinese Journal of the Practical Chinese with Modern Medicine 2002;2(15):839-40.
Li Y 2003 {published data only}
  • Li Y, Qin SF, Wang LN. [Clinical observation of Danqi Huazheng capsule in the treatment of hysteromyoma]. Journal of Henan University of Chinese Medicine 2003;18(3):39-40.
Li YY 2002 {published data only}
  • Li YY. [Oral taking and external application of Chinese herbal medicine for treatment of 98 cases of uterine fibroids]. Hubei Journal of Traditional Chinese Medicine 2002;24(8):38-9.
Lu M 2007 {published data only}
  • Lu M. [Clinical observation of Yiqi Huayu Xiaozheng Tang for treatment of 60 cases of uterine fibroids]. Shandong Journal of Traditional Chinese Medicine 2007;26(9):604-6.
Luo L 2003 {published data only}
  • Luo L, Zhu YP. [Effect of treating 110 cases of uterine fibroids with the use of Qing Gong Liu capsules]. Chinese Journal of Traditional Medical Science and Technology 2003;10(6):382-3.
Lu SQ 2000 {published data only}
  • Lu SQ, Lin YC, Peng ZY. [Clinical observation of Xiaozheng Sanjie tablet in treating 120 cases of hysteromyoma]. Correspondence Journal of Traditional Chinese Medicine 2000;19(5):48-9.
Lu Y 2005 {published data only}
  • Lu Y, Deng ZH. [Clinical observation on the treatment of hysteromyoma with Qi-stagnancy and blood-stasis syndrome with Huazheng Decoction]. Journal of Anhui Traditional Chinese Medical College 2005;24(6):16-7.
Lv 2007 {published data only}
  • Lv M. [Clinical observation of 60 cases of hysteromyoma treated by Yiqi Huayu Xiaozheng Decoction]. Shandong Journal of Traditional Chinese Medicine 2007;26(9):604-6.
Man JP 2009 {published data only}
  • Man JP 2009. Huazhen Xiaoliu decoction treating 72 cases of uterine myoma. Chinese Medicine Modern Distance Education of China 2009;7(8):111.
Ma WX 2003 {published data only}
  • Ma WX, Li CP. [Xiao Liu Tang for treatment of 42 cases of uterine fibroids]. Traditional Chinese Medicine Research 2003;16(4):43-4.
Meng LJ 2010 {published data only}
  • Meng LJ, Li Y. [Efficacy analysis of Shuangju granules combined with mifepristone for treating uterine myoma]. Modern Chinese journal of integrated Chinese and Western Medicine 2010;19(20):2505-6.
Miao XL 2002 {published data only}
  • Miao XL. [Clinical curative observation of Xiao Liu granule for treatment of 130 cases of uterine fibroids]. Yunan Journal of Traditional Chinese Medicine and Materia Medica 2002;23(5):9-10.
Min XL 2007 {published data only}
  • Min XL. [Treatment of 42 cases of hysteromyoma by Xiao Liu formula]. Shaanxi Journal of Traditional Chinese Medicine 2007;28(3):298-9.
Miu XY 2003 {published data only}
  • Miu XY. [Treatment of 280 cases of hysteromyoma by Ji Liu San]. Fujian Journal of Traditional Chinese Medicine 2003;34(6):7-8.
Miu XY 2007 {published data only}
  • Miu XY. [Observation on therapeutic effect on Ji Liu San and Guizhi Fuling Tang for treatment of uterine fibroids]. Guangming Journal of Chinese Medicine 2007;22(2):31-3.
Mo KL 2011 {published data only}
  • Mo KL. [Application of Xiaojie'an combined with mifepristone in treatment of hysteromyoma in perimenopause period]. Chinese Journal of Clinical Rational Drug Use 2011;4(5C):57.
Pan XH 2011 {published data only}
  • Pan XH. [Mifepristone combined with Guizhi Fuling capsule for treating 39 cases of uterine myoma]. Journal of Practical Traditional Chinese Medicine 2011;27(12):851.
Peng XJ 2007 {published data only}
  • Peng XJ, Gao Y, Wang K. [Clinical Study on Huaji-Ye for treatment of uterine leiomyoma]. Shandong Journal of Traditional Chinese Medicine 2007;26(7):459-60.
Peng YS 2010 {published data only}
  • Peng YS, Qian X, Peng GJ. [Study on the theraputic effect of comprehensive treatment by Acupuncture with Chinese herbs on hysteromyoma]. China Medical Herald 2011;7(2):82-3.
Qian L 2007 {published data only}
  • Qian L, Qi C, Zhang QH. [Clinical observation of Bushen Xiaoliu recipe for 80 patients with myoma of uterus]. Journal of Practical Diagnosis and Therapy 2007;21(8):574-6.
Qi C 2003 {published data only}
  • Qi C, Qian B, Zhang QH, Huang ZH. [Clinical observation of 63 cases of hysteromyoma treated with herbal formula of nourishing kidney and activating blood circulation]. Journal of Sichuan of Traditional Chinese Medicine 2003;21(5):45-6.
Qin WP 2010 {published data only}
  • Qin WP, Peng LY, Niu YL, Zhang LJ. [Effective observation of herbal internal and external administration in the treatment of 122 cases of uterine myoma]. Hebei Journal of Traditional Chinese Medicine 2010;32(7):1005-6.
Qiu HN 2006 {published data only}
  • Qiu HN, Li FS. [Clinical observation of mifepristone combined with Guizhi Fuling capsules in perimenopause women with hysteromyoma]. Journal of Clinical Medicine in Practice 2006;10(3):103-4.
Sakamoto 1992 {published data only}
  • Sakamoto S, Yoshino H, Shirahata Y, Shimodairo K, Okamoto R. Pharmacotherapeutic effects of kuei-chih-fu-ling-wan (keishi-bukuryo-gan) on human uterine myomas. American Journal of Chinese Medicine 1992;20(3-4):313-7.
Sakamoto 1998 {published data only}
  • Sakamoto S, Mitamura T, Iwasawa M, Kitsunai H, Shindou K, Yagishita Y, et al. Conservative management for perimenopausal women with uterine leiomyomas using Chinese herbal medicines and synthetic analogs of gonadotropin-releasing hormone. In Vivo 1998;12(3):333-7.
Sang H 2004 {published data only}
  • Sang H, Wu B. [Clinical and experimental research into treatment of hysteromyoma with promoting Qi flow and blood circulation, softening and resolving hard lump]. Journal of Traditional Chinese Medicine 2004;24(4):274-9.
Sang HL 2002 {published data only}
  • Sang HL, Zhang QW, Jia SH. [Treatment of 150 cases of hysteromyoma with Kangfu Xiaozheng tablets]. Shandong Journal of Traditional Chinese Medicine 2002;21(3):143-4.
Sang HL 2003 {published data only}
  • Sang HL, Wu BQ. [Clinical and experimental study on Xingqi Huoxue and Ruanjian Sanjie therapy for treatment of uterine fibroids]. Journal of Traditional Chinese Medicine 2003;44(1):41-3.
Shen D 2006 {published data only}
  • Shen D, Shen XP. [Clinical observation on hysteromyoma treated by testosterone with or without Guizhi Fuling capsules]. Chinese Modern Medicine and Clinics 2006;1(5):12-3.
Shu S 2001 {published data only}
  • Shu S, Shu C. [Clinical observation of 30 cases of hysteromyoma treated with integrated traditional Chinese and western medicine]. Journal of Luoyang Medical College 2001;19(4):308-9.
Song JS 2010 {published data only}
  • Song JS, Gao C, Xiong J, Xue XH, Zhou YF, Shang TG. [Guizhi Fuling capsule versus western medicine for the treatment of uterine myoma: a systematic review. Chinese Journal of Evidence-Based Medicine 2010;10(12):1439-55.
Song SM 2006 {published data only}
  • Song SM, Hou YZ, Wang AF, Qian JY. [Clinical observation of 504 cases of hysteromyoma treated with Guizhi Fuling capsules]. Applied Journal of General Practice 2006;4(3):319.
Su GH 2005 {published data only}
  • Su GH. [Observation on therapeutic effect of Chinese medicine for treatment of uterine fibroids]. Shanxi Journal of Traditional Chinese Medicine 2005;21(6):60.
Sun DJ 2007 {published data only}
  • Sun DJ. [Observation on therapeutic effect of integrated Chinese and western medicine for treatment of 68 cases of uterine fibroids]. Asia-Pacific Traditional Medicine 2007;3(8):55.
Sun L 1995 {published data only}
  • Sun L. [38 cases of hysteromyoma treated with tumour-resolving decoction]. Journal of Traditional Chinese Medicine 1995;15(4):273-6.
Su XC 2005 {published data only}
  • Su XC, Wang YL, Zheng YS, Liu CL, Yan BC, Kong JX, et al. [Summary of 50 cases of uterine fibroids treated selectively by period with Zi Bao Kang capsule]. Hunan Journal of Traditional Chinese Medicine 2005;21(1):19-20.
Tan SY 2003 {published data only}
  • Tan SY. [Therapeutic observation of hysteromyoma treated with integrated traditional Chinese and western medicine]. Practical Clinical Journal of Integrated Traditional Chinese and Western Medicine 2003;3(3):11-2.
Tian LJ 2005 {published data only}
  • Tian LJ. [Clinical observation of Fu Liu Qing No. 1 for treatment of hysteromyoma in perimenopausal women]. Journal of Sichuan of Traditional Chinese Medicine 2005;23(6):69-70.
Tian Y 2011 {published data only}
  • Tian Y. [Clinical observation of mifepristone combined with Gongliuqing capsule in the treatment of uterine myoma]. Shandong Medical Journal 2011;51(1):53-4.
Wang D 2000 {published data only}
  • Wang D, Fan LX. [Treatment of 32 cases of myoma of uterus by Xiao Ji Pills]. Shaanxi Journal of Traditional Chinese Medicine 2000;21(5):199.
Wang DQ 2012 {published data only}
  • Wang DQ. [Effect of Guizhi Fuling capsule combined with mifepristone for treating 38 cases of uterine myoma]. Journal of Military Surgeon in Southwest China 2012;14(2):258.
Wang HM 2009 {published data only}
  • Wang HM, Liang RN, Luo XQ. [Clinical study on hysteromyoma treated with the method of huoxuehuayu after uterine artery embolization]. Modern Medicine Journal of China 2009;11(8):1-3.
Wang HZ 2010 {published data only}
  • Wang HZ, Chang H. [Clinical observation of Guizhi Fuling capsule combined with Danggui Shaoyao-San for treating 52 cases of uterine myoma]. Clinical Journal of Traditional Chinese Medicine 2010;22(4):322-3.
Wang JH 2002 {published data only}
  • Wang JH. [Chinese medicine for treatment of 67 cases of uterine fibroids]. Liaoning Journal of Traditional Chinese Medicine 2002;29(6):335.
Wang JH 2007 {published data only}
  • Wang JH. [Clinical study on Hua Zheng Dan for treatment of uterine leiomyoma]. Liaoning Journal of Traditional Chinese Medicine 2007;34(6):782-3.
Wang MD 1999 {published data only}
  • Wang MD. [Clinical observation of 112 cases of uterine leiomyoma treated by Tripterygium Wilfordii Hook]. Journal of Zhejiang University of Traditional Chinese Medicine 1999;23(6):29.
Wang P 2005 {published data only}
  • Wang P, Wang LM, Li L. [Therapeutic effect observation of 74 cases of uterine myoma treated by integration internal and external body]. Guiding Joumal of Traditional Chinese Medicine 2005;11(5):31-3.
Wang SL 2011 {published data only}
  • Wang SL. Self-prescribed Xiaoliu Capsule treated 50 cases of uterine myoma. Chinese Journal of Traditional Medical Science and Technology 2011;18(1):77.
Wang YH 2006 {published data only}
  • Wang YH, Han N. [Clinical observation of 40 cases of hysteromyoma treated by Huayu Xiaozheng decoction]. Chinese Journal of the Practical Chinese with Modern Medicine 2006;19(24):2947-9.
Wang YL 2004 {published data only}
  • Wang YL. [Clinical observation of 64 cases of hysteromyoma in perimenopause women treated with integrated traditional Chinese and western medicine]. Jilin Journal of Traditional Chinese Medicine 2004;25(1):38-9.
Weng SQ 2010 {published data only}
  • Weng SQ, Huang LH, Wang XY, Xia AJ, Li QL. [Clinical observation of Ankun tablet treating 50 cases of uterine myoma]. Information on Traditional Chinese Medicine 2010;27(3):96-8.
Wen XL 2007 {published data only}
  • Wen XL. [Xiao Liu Fang for treatment of 42 cases of uterine fibroids]. Shaanxi Journal of Traditional Chinese Medicine 2007;28(3):298-9.
Wu N 2002 {published data only}
  • Wu N. [Clinical observation on treatment of 55 cases of hysteromyoma by reinforcing kidney and regulating menstrual cycle]. Jiangsu Journal of Traditional Chinese Medicine 2002;23(6):21-2.
Wu XM 2007 {published data only}
  • Wu XM, Liu F, Liu QZ. [Observation of hysteromyoma treated by combination of traditional Chinese medicine and western medicine]. Hei Long Jiang Medical Journal 2007;31(8):610-1.
Xiao CC 1990 {published data only}
  • Xiao CC, Yang BY, Huangpu X, Guo Y, Zhang SM. [Clinical observation on Jiliu Neixiao Wan for treatment of 125 cases of uterine fibroids]. China Journal of Traditional Chinese Medicine and Pharmacy 1990;5(2):39-41.
Xiong DM 2006 {published data only}
  • Xiong DM, Zhang XL. [Clinical therapeutic observation of 68 cases of hysteromyoma treated with integrated traditional Chinese and western medicine]. Shenzhen Journal of Integrated Traditional Chinese and Western Medicine 2006;16(1):38-40.
  • Xiong DM, Zhao L, Zhang XL. [Treatment of 38 cases of uterine fibroids by Guizhi Fuling capsules]. Shaanxi Journal of Traditional Chinese Medicine 2006;27(6):679-80.
Xu H 2005 {published data only}
  • Xu H, Xu ZX. [Xiao Zheng Tang for treatment of 38 cases of uterine fibroids]. Liaoning Journal of Traditional Chinese Medicine 2005;32(10):1045.
Xu Y 2007 {published data only}
  • Xu Y. [Effect observation of integrated Chinese and western medicine for treatment of uterine fibroids]. Clinical Misdiagnosis and Mistherapy 2007;20(7):60-1.
Yang JL 2001 {published data only}
  • Yang JL, Yan XP. [Clinical observation of 300 cases of hysteromyoma treated with Gong Liu Qing capsule]. Journal of Chengdu University of Traditional Chinese Medicine 2001;24(1):10-3.
Yang YX 2005 {published data only}
  • Yang YX, Huang BZ, Wang MJ, Li RR. [Clinical observation of 148 cases of hysteromyoma treated with integrated traditional Chinese and western medicine]. Modern Journal of Integrated Traditional Chinese and Western Medicine 2005;14(24):3233-4.
Yang ZM 2011 {published data only}
Yan H 1994 {published data only}
  • Yan H, Wang J. [Clinical study on acupuncture for treatment of hysteromyoma]. Acupuncture Research 1994;19(2):14-6.
Yan Y 2001 {published data only}
  • Yan Y. [Clinical observation of Guizhi Fuling capsules combined with mifepristone for the treatment of uterine fibroids]. Acta Academiae Medicinae Xuzhou 2001;21(5):428-9.
Ye JF 2001 {published data only}
  • Ye JF, Wang YX. [Ingredient added "Tumor-Reducing Prescription" for hysteromyoma in 45 cases]. Shanghai Journal of Traditional Chinese Medicine 2001;35(2):33-4.
Ye TH 2002 {published data only}
  • Ye TH. [Clinical observation of 60 cases of hysteromyoma treated with Gong Liu Xiao capsule]. Journal of Sichuan of Traditional Chinese Medicine 2002;20(1):53-4.
Yu JY 2004 {published data only}
  • Yu JY. [Xiao Liu Wan for treatment of 60 cases of uterine fibroids]. Nei Mongol Journal of Traditional Chinese Medicine 2004;23(4):9.
Yu QL 2003 {published data only}
  • Yu QL. [Clinical observation of 30 cases of hysteromyoma treated by Wanying Xiaoliu San]. Chinese Journal of Current Clinical Medicine 2003;1(8):724-5.
Yu T 2002 {published data only}
  • Yu T, Cao SW, Zhi N. [Clinical observation of 30 cases of hysteromyoma treated by Huashi Sanjie Decoction]. Jiangxi Journal of Traditional Chinese Medicine 2002;33(5):23-4.
Zhang H 2005 {published data only}
  • Zhang H. [Chinese herbal medicine combined with transcatheter arterial embolization for treatment of 21 cases of uterine fibroids]. Shandong Journal of Traditional Chinese Medicine 2005;24(12):725-6.
Zhang M 2004 {published data only}
  • Zhang M. [Use of worms for treatment of uterine fibroids]. Liaoning Journal of Traditional Chinese Medicine 2004;31(1):61.
Zhang QM 2007 {published data only}
  • Zhang QM, Chen X, Sun ZY, Yuan JL. [Clinical observation on curative effect of Yuan Xiao Liu decoction for treatment of hysteromyoma]. Liaoning Journal of Traditional Chinese Medicine 2007;34(9):1272-3.
Zhang WH 2011 {published data only}
  • Zhang WH. [Clinical observation of Guizhi Fuling capsule treating 34 cases of uterine myoma]. Seeking Medicine and Asking Drug 2011;9(10):202.
Zhang WL 2005 {published data only}
  • Zhang WL, Shen J. [Clinical observation of mifepristone alone or in combination of Chinese medicine for treatment of uterine fibroids]. Chinese Journal of Clinical Medicine Research 2005;11(17):2463-4.
Zhang XB 2011 {published data only}
  • Zhang BX, Yang JH, Liu YL. [Clinical observation of interventional embolization combined with Xiaozheng Tang for treating uterine myoma]. Medical Information 2011;9(9):4542-3.
Zhang XW 1997 {published data only}
  • Zhang XW, Hao SZ. [The clinical analysis of thirty-eight cases of hysteromyoma treated with Hai Kun decoction]. Chinese Journal of Marine Drugs 1997;16(2):43-5.
Zhang Z 2006 {published data only}
  • Zhang Z. [Jiawei Guizhi Fuling Wan for treatment of 62 cases of uterine fibroids]. Journal of Sichuan of Traditional Chinese Medicine 2006;24(1):88.
Zhan YR 2007 {published data only}
  • Zhan YR. [Analysis of mifepristone and Guizhi Fuling capsule for treatment of uterine fibroids]. International Medicine and Health Guidance News 2007;13(2):63-5.
Zhao LX 2003 {published data only}
  • Zhao LX. [Treatment of 64 cases of uterine fibroids by Tripterygium Wilfordii Hook]. Chinese Journal of Integrated Traditional and Western Medicine 2003;23(10):787-8.
Zheng CY 2003 {published data only}
  • Zheng CY, Zhong QL. [Dahuang Zhechong Wan Jiawei for treatment of 60 cases of uterine fibroids]. Guangxi Journal of Traditional Chinese Medicine 2003;26(5):33.
Zhong Q 2006 {published data only}
  • Zhong Q, Fen JY, Liang SX, Xu YJ. [Clinical observation of hysteromyoma in perimenopause women by conservative treatment of integrated traditional Chinese and western medicine]. Chinese Journal of Clinical Medicine Research 2006;12(7):964-5.
Zhong XR 2010 {published data only}
  • Zhong XR, Lin F, Tang GC. [Clinical observation of mifepristone combined with Gongliuqing capsule in the treatment of uterine myoma]. Practical Clinical Journal of Integrated Traditional Chinese and Western Medicine 2010;10(5):41, 43.
Zhou J 1997 {published data only}
  • Zhou J, Zhu M, Li YX, Shi JR, Yuan MF, Shen ZL, et al. [Clinical and experimental study on improving cellular immunological function of uterine myoma patients by Xiaoliu tablet]. Zhongguo Zhong Xi Yi Jie He Za Zhi 1997;17(5):277-9.
Zhou MY 2003 {published data only}
  • Zhou MY, Wang JJ, Cao LP, Chen CL, Liu P. [Observation on therapeutic effect of Da Huang Tang combined with uterine artery embolization for treatment of uterine fibroids]. Liaoning Journal of Traditional Chinese Medicine 2003;30(7):561-2.
Zhou YJ 2006 {published data only}
  • Zhou YJ, Gao J. [Treatment of 30 cases of hysteromyoma with Guizhi Fuling capsules]. China Journal of Clinical Medicine Hygiene 2006;4(10):66-7.
Zhou YR 1999 {published data only}
  • Zhou YR, Sun FL, Wang CX. [Clinical observation of 48 cases of hysteromyoma treated with Bushen, Poyu and Huatan recipe]. Chinese Journal of Primary Medicine and Pharmacy 1999;6(5):282.
Zhu JY 1997 {published data only}
  • Zhu JY, Chen M, Zhuang CS, Luo ZH. [Treatment of 80 cases of hysteromyoma with LIzhong Sanjie pills]. New Journal of Traditional Chinese Medicine 1997;29(1):34.
Zou DH 1993 {published data only}
  • Zou DH. [Clinical observation on practitioner Gong Zi Fu's differentiation of syndrome for treatment of 93 cases of uterine fibroids]. Jiangxi Journal of Traditional Chinese Medicine 1993;24(6):13-4.

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. Characteristics of studies
  19. References to studies included in this review
  20. References to studies excluded from this review
  21. Additional references
Egger 1997
Egger 2003
  • Egger M, Juni P, Bartlett C, Holenstein F, Sterne J. How important are comprehensive literature searches and the assessment of trial quality in systematic reviews? Empirical study. Health Technology Assessment 2003;7(1):1-76.
Falcone 2002
Farquhar 2002
Fugh-Berman 2004
  • Fugh-Berman A, Balick MJ, Kronenberg F, Ososki AL, O'Connor B, Reiff M, et al. Treatment of fibroids: the use of beets (Beta vulgaris) and molasses (Saccharum officinarum) as an herbal therapy by Dominican healers in New York City. Journal of Ethnopharmacology 2004;92(2-3):337-9.
Griffiths 2006
Grigorieva 2003
  • Grigorieva V, Chen-Mok M, Tarasova M, Mikhailov A. Use of a levonorgestrel-releasing intrauterine system to treat bleeding related to uterine leiomyomas. Fertility and Sterility 2003;79(5):1194-8.
Gupta 2012
Higgins 2011
  • Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane-handbook.org.
Huang 2003
  • Huang YY. [Research advance and prospects of traditional Chinese medicine and western medicine for treatment of uterine fibroids]. Tianjin Journal of Traditional Chinese Medicine 2003;20(6):78-80.
Ji 2011
  • Ji X, Gao J, Cai X, Lu W, Hu C, Wang Z, et al. Immunological regulation of Chinese herb Guizhi Fuling capsule on rat endometriosis model. J Ethnopharmacol 2011;134(3):624-9.
Kjaergard 2001
Klatsky 2008
  • Klatsky PC, Tran ND, Caughey AB, Fujimoto VY. Fibroids and reproductive outcomes: a systematic literature review from conception to delivery. American Journal of Obstetrics and Gynecology 2008;198(4):357-66.
Lethaby 2001
Li J 2008
  • Li J, Jin GL. Current research status of Chinese medicine for treatment of uterine fibroids. Academic Journal of Liaoning University of Traditional Chinese Medicine 2008;10(1):73-4.
Liu J 2002
  • Liu J, Kjaergard LL, Gluud C. Misuse of randomization: a review of Chinese randomized trials of herbal medicines for chronic hepatitis B. American Journal of Chinese Medicine 2002;30(1):173-6.
Marshall 1997
  • Marshall LM, Spiegelman D, Barbieri RL, Goldman MB, Manson JE, Colditz GA, et al. Variation in the incidence of uterine leiomyoma among premenopausal women by age and race. Obstetrics and Gynecology 1997;90(6):967-73.
Maruo 2004
McLucas 2001
Moher 1998
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Munro 2011
  • Munro MG. Uterine leiomyomas, current concepts: pathogenesis, impact on reproductive health, and medical, procedural, and surgical management. Obstetrics and Gynecology Clinics of North America 2011;38(4):703-31.
Newbold 2000
  • Newbold RR, DiAugustine RP, Risinger JI, Everitt JI, Walmer DK, Parrott EC, et al. Advances in uterine leiomyoma research: conference overview, summary, and future research recommendations. Environmental Health Perspectives 2000;108 Suppl 5:769-73.
Okolo 2008
Sang 2004
  • Sang H. Clinical and experimental research into treatment of hysteromyoma with promoting qi flow and blood circulation, softening and resolving hard lump. Journal of Traditional Chinese Medicine 2004;24(4):274-9.
Schulz 1995
  • Schulz KF, Chalmers I, Hayes RJ, Altman DG. Empirical evidence of bias. Dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA 1995;273(5):408-12.
Stewart 2001
Tranquart 2002
  • Tranquart F, Brunereau L, Cottier JP, Marret H, Gallas S, Lebrun JL, et al. Prospective sonographic assessment of uterine artery embolization for the treatment of fibroids. Ultrasound in Obstetrics and Gynecology 2002;19(1):81-7.
Tristan 2012
Vickers 1998
Watson 2002
Xiong 2002
  • Xiong JH, Xiong CY. [Current status of treatment of uterine fibroids by traditional Chinese medicine]. Journal of Jiangxi College of Traditional Chinese Medicine 2002;14(4):61-3.
Yuan 2000
Zimmermann 2012
  • Zimmermann A, Bernuit D, Gerlinger C, Schaefers M, Geppert K. Prevalence, symptoms and management of uterine fibroids: an international internet-based survey of 21,746 women. BMC Womens Health 2012;12:6. doi: 10.1186/1472-6874-12-6.