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Intervention Review

Chinese herbal medicine for diabetic peripheral neuropathy

  1. Wei Chen1,*,
  2. Yin Zhang2,
  3. Jian Ping Liu3

Editorial Group: Cochrane Neuromuscular Disease Group

Published Online: 15 JUN 2011

Assessed as up-to-date: 14 JUN 2010

DOI: 10.1002/14651858.CD007796.pub2

How to Cite

Chen W, Zhang Y, Liu JP. Chinese herbal medicine for diabetic peripheral neuropathy. Cochrane Database of Systematic Reviews 2011, Issue 6. Art. No.: CD007796. DOI: 10.1002/14651858.CD007796.pub2.

Author Information

  1. 1

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

  2. 2

    Guang'anmen Hospital, China Academy of Chinese Medicine, Center of Clinical Evaluation, Beijing, China

  3. 3

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

*Wei Chen, Centre For Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, 11 Bei San Huan Dong Lu, Chaoyang District, Beijing, 100029, China. chen7916@yahoo.com.cn.

Publication History

  1. Publication Status: New
  2. Published Online: 15 JUN 2011

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Abstract

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  4. Resumen

Background

Chinese herbal medicine is frequently used for treating diabetic peripheral neuropathy in China. Many controlled trials have been undertaken to investigate its efficacy.

Objectives

To assess the beneficial effects and harms of Chinese herbal medicine for people with diabetic peripheral neuropathy.

Search methods

We searched the Cochrane Neuromuscular Disease Group Specialized Register (15 June 2010), the Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 2, 2010 in The Cochrane Library), MEDLINE (January 1966 to June 2010), EMBASE (January 1980 to June 2010), AMED (January 1985 to June 2010), Chinese Biomedical Database (CBM) (1979 to June 2010), Chinese National Knowledge Infrastructure Database (CNKI) (1979 to June 2010), and VIP Chinese Science and Technique Journals Database (1989 to June 2010). We searched for unpublished literature in the Chinese Conference Papers Database and Chinese Dissertation Database (from inception to March 2010). No language or publication restrictions were used.

Selection criteria

We included randomized controlled trials of Chinese herbal medicine (with a minimum of four weeks treatment duration) for people with diabetic peripheral neuropathy compared with placebo, no intervention, or conventional interventions. Trials of herbal medicine plus a conventional drug versus the drug alone were also included.

Data collection and analysis

Two authors independently extracted data and evaluated trial quality. We contacted study authors for additional information. The data analyses were carried out using Review Manager 5.1 (Cochrane software).

Main results

Thirty-nine randomized trials involving 2890 participants were included. All trials were conducted and published in China. Thirty different herbal medicines were tested in these trials, including four single herbs (extracts from a single herb), eight traditional Chinese patent medicines, and 18 self-concocted Chinese herbal compound prescriptions. The trials reported on global symptom improvement (including improvement in numbness or pain) and changes in nerve conduction velocity. There was inadequate reporting on adverse events in the included trials. Most of the trials did not mention whether they monitored adverse effects at all. Only two trials reported adverse events: one occurred in the control group in one trial and in which group was unclear in the other trial . Conclusions cannot be drawn from this review about the safety of herbal medicines due to inadequate reporting. Most of the trials were of low methodological quality and therefore the interpretation of any positive findings for the efficacy of the included Chinese herbal medicines for treating diabetic peripheral neuropathy should be made with caution.

Authors' conclusions

Based on this systematic review, there is no evidence to support the objective effectiveness and safety of Chinese herbal medicines for diabetic peripheral neuropathy. No well designed, randomized placebo controlled trial with objective outcome measures has been conducted.

 

Plain language summary

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  2. Abstract
  3. Plain language summary
  4. Resumen

Chinese herbal medicine for treatment of diabetic peripheral neuropathy

Diabetic peripheral neuropathy (DPN) is one of the most common complications of diabetes. It is characterized by a progressive loss of nerve fibres that predisposes the person to painful or insensitive extremities, ulceration and amputation, and results in a large disease burden in terms of incapacity for work, quality of life and use of healthcare resources. This systematic review identified a total of 39 trials that included 2890 participants with DPN. We evaluated the effects of various herbal formulations (including single herbs, Chinese proprietary medicines, and mixtures of different herbs) for treating people with DPN. All the identified clinical trials were performed and published in China. There was inadequate reporting on adverse events in the included trials. Most of the trials did not mention whether they monitored for adverse effects. Only two trials reported adverse events but one occurred in the control group in one trial and it was unclear in which group they occurred in the other trial. Conclusions about the safety of herbal medicines cannot therefore be drawn from this review due to inadequate reporting. Most of the trials were of low methodological quality and the interpretation of any positive findings for the efficacy of the included Chinese herbal medicines for treating DPN should be made with caution. Based on this systematic review, there is no evidence to support the objective effectiveness and safety of Chinese herbal medicines for DPN. No well designed, randomized placebo controlled trial with objective outcome measures has been conducted.

 

Resumen

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  2. Abstract
  3. Plain language summary
  4. Resumen

Antecedentes

Hierbas medicinales chinas para la neuropatía diabética periférica

Las hierbas medicinales chinas se utilizan con frecuencia para tratar la neuropatía diabética periférica en China. Se han realizado muchos ensayos controlados para investigar su eficacia.

Objetivos

Evaluar los efectos beneficiosos y perjudiciales de las hierbas medicinales chinas en pacientes con neuropatía diabética periférica.

Estrategia de búsqueda

Se hicieron búsquedas en el Registro Especializado de Ensayos Controlados del Grupo Cochrane de Enfermedades Neuromusculares (Cochrane Neuromuscular Disease Group) (15 junio 2010), Registro Cochrane Central de Ensayos Controlados (Cochrane Central Register of Controlled Trials, CENTRAL) (número 2, 2010 en Cochrane Library), MEDLINE (enero 1966 hasta junio 2010), EMBASE (enero 1980 hasta junio 2010), AMED (enero 1985 hasta junio 2010), Chinese Biomedical Database (CBM) (1979 hasta junio 2010), Chinese National Knowledge Infrastructure Database (CNKI) (1979 hasta junio 2010), y en la VIP Chinese Science and Technique Journals Database (1989 hasta junio 2010). Se hicieron búsquedas de literatura no publicada en la Chinese Conference Papers Database y en la Chinese Dissertation Database (desde su inicio hasta marzo 2010). No se aplicaron restricciones de idioma o de publicación.

Criterios de selección

Se incluyeron los ensayos controlados con asignación aleatoria de hierbas medicinales chinas (con un mínimo de cuatro semanas de duración del tratamiento) en pacientes con neuropatía diabética periférica comparadas con placebo, ninguna intervención o intervenciones convencionales. También se incluyeron ensayos de hierbas medicinales más un fármaco convencional versus el fármaco solo.

Obtención y análisis de los datos

Dos autores, de forma independiente, extrajeron los datos y evaluaron la calidad de los ensayos. Se contactó con los autores de los estudios para obtener información adicional. Los análisis de datos se realizaron mediante Review Manager 5.1 (programa informático Cochrane).

Resultados principales

Se incluyeron 39 ensayos con asignación aleatoria con 2 890 participantes. Todos los ensayos se realizaron y publicaron en China. En estos ensayos se probaron 30 hierbas medicinales diferentes, incluidas cuatro hierbas únicas (extractos de una única hierba), ocho medicinas tradicionales chinas patentadas y 18 prescripciones de compuestos autoelaboradas de hierbas medicinales chinas. Los ensayos informaron la mejoría de los síntomas generales (que incluye la mejoría en el entumecimiento o el dolor) y los cambios en la velocidad de conducción nerviosa. Había información inadecuada sobre los eventos adversos en los ensayos incluidos. La mayoría de los ensayos no mencionó en absoluto si se monitorizaron los efectos adversos. Solamente dos ensayos informaron eventos adversos: en un ensayo ocurrió uno en el grupo control y en el otro ensayo no estuvo claro en qué grupo ocurrió. Debido al informe inadecuado acerca de la seguridad de las hierbas medicinales no es posible establecer conclusiones a partir de esta revisión. En su mayoría los ensayos tuvieron una calidad metodológica deficiente, por lo que la interpretación de cualquier hallazgo positivo sobre la eficacia de las hierbas medicinales chinas incluidas para tratar la neuropatía diabética periférica debe hacerse con precaución.

Conclusiones de los autores

Según esta revisión sistemática no existen pruebas para apoyar la eficacia objetiva y la seguridad de las hierbas medicinales chinas para la neuropatía diabética periférica. No se han realizado ensayos controlados con placebo con asignación aleatoria bien diseñados que incluyan medidas de resultado objetivas.

Traducción

Traducción realizada por el Centro Cochrane Iberoamericano