Impact of Chinese herbal medicine on sarcopenia in enhancing muscle mass, strength, and function: A systematic review and meta‐analysis of randomized controlled trials

Sarcopenia has become important to the public health with the increase in the aging population in society. However, the therapeutic effects of conventional approaches, including pharmacotherapy, exercise, and nutritional intervention, are far from satisfactory. Chinese herbal medicine is a new treatment format with interesting possibilities in sarcopenia has been widely practiced. The study aims to explore the effectiveness of Chinese herbal medicine in sarcopenia. We comprehensively searched the following electronic databases: Medline, EMBASE, APA PsycInfo, Cochrane Library, Web of Science, PubMed, and Chinese database from the establishment of the database to December 2022 (no language restrictions). Randomized controlled clinical studies on the use of Chinese herbal medicine in sarcopenia were selected in compliance with PRISMA guidelines. Review Manager and Stata were used for statistical analysis and the mean difference and standardized mean difference were adopted. Of 277 identified studies, 17 were eligible and included in our analysis (N = 1440 participants). The results showed that Chinese herbal medicine can improve total efficiency (RR = 1.29, 95% CI [1.21, 1.36], p < 0.00001) in sarcopenia and enhance muscle mass (SMD = 1.02, 95% CI [0.55, 1.50], p < 0.0001), and muscle strength measured by grip strength (SMD = 0.66, 95% CI [0.36, 0.96], p < 0.0001), measured by 60°/s knee extension peak TQ (MD = 5.63, 95% CI [−0.30, 11.57], p = 0.06) and muscle function measured by 6‐meter walking speed (SMD = 1.34, 95% CI [0.60, 2.08], p = 0.0004), measured by the short physical performance battery of 1.50%, 95% CI (1.05, 1.95), measured by the EuroQoL 5‐dimension of (SMD = 0.27, 95% CI [−0.10, 0.65], p = 0.16), suggesting that Chinese herbal medicine alone or combined with conventional treatment has ameliorating effect on sarcopenia. Chinese herbal medicine is a potential therapeutic strategy in sarcopenia. The funnel plot and Egger's test indicated publication bias. To confirm our conclusions, further high‐quality studies should be conducted.

ameliorating effect on sarcopenia.Chinese herbal medicine is a potential therapeutic strategy in sarcopenia.The funnel plot and Egger's test indicated publication bias.To confirm our conclusions, further high-quality studies should be conducted.

K E Y W O R D S
Chinese herbal medicine, meta-analysis, randomized controlled trial, sarcopenia, systematic review

| INTRODUCTION
Sarcopenia (from the Greek sarx, flesh; and penia, poverty) is defined as a progressive and generalized skeletal muscle disorder, which is associated with an increased likelihood of adverse effects such as falls, fractures, disability, and mortality (Bauer et al., 2019;Carvalho do Nascimento et al., 2021;Cruz-Jentoft et al., 2019;Rosenberg, 1997), also recognized as a separate disease entity with the issuance of an ICD-10-CM code (Anker et al., 2016).A metaanalysis of 263 studies on incidence of sarcopenia was reported in 2022, which estimate the prevalence of severe sarcopenia and sarcopenia at the global and regional level by sociodemographic factors (Chen et al., 2014;Cruz-Jentoft et al., 2010;Fielding et al., 2011;Petermann-Rocha et al., 2022;Studenski et al., 2014).
It is estimated that the incidence rates of sarcopenia ranged from 10% and 27%, and approximately 2% to 9% of patients had severe sarcopenia.Aging leads to reduction of skeletal muscle function in terms of muscle mass, strength, and muscular endurance (Deschenes, 2004).Consequently, the growing number of patients with sarcopenia in aging societies is a global concern in view of the link between sarcopenia and a range of adverse health outcomes associated with increased healthcare costs (Greenlund & Nair, 2003;Tsekoura et al., 2017).Therefore, efforts to alleviate sarcopenia for people are quite paramount.
The treatments of sarcopenia can be classified as pharmacotherapy, exercise, and nutritional intervention (Negm et al., 2022).Various drugs and compounds have been investigated for their potential to counteract muscle loss, including myostatin inhibitors, selective androgen receptor modulators (SARMs), and other pharmaceutical agents have shown promise in improving muscle mass and function (Rolland et al., 2023).However, the interventions are still in the experimental stage, and their long-term effectiveness in preventing or treating sarcopenia is not well-established.Exercise therapies, especially resistance training (Vikberg et al., 2019) and aerobic exercise (Shen et al., 2023), have been established as effective interventions to prevent and treat sarcopenia but compliance with exercise regimens, especially resistance training, can be challenging for older individuals due to physical limitations, comorbidities, or lack of motivation.In terms of nutritional interventions, research has consistently highlighted the role of protein (Rogeri et al., 2021), amino acids (Cereda et al., 2022), and other nutrients in preventing muscle loss.
Yet, achieving optimal nutrient intake, especially protein, can be difficult for some older adults due to issues such as decreased appetite, dental problems, or difficulty in preparing meals.
With advancements in medicine, particularly in the context of the treatment of geriatric disease, a new era of comprehensive therapies has emerged.This development underscores the need for the continuous innovation of more effective treatments for sarcopenia.In this regard, Complementary and Alternative Medicine (CAM) has gained significance, assuming a pivotal role in addressing the challenges associated with sarcopenia.Within CAM, Chinese herbal medicines stand out as a particularly promising and suitable option.
Traditional Chinese Medicine (TCM) is popular in East and Southeast Asian countries and has formed a unique theoretical framework, steadily gaining popularity in China and around the world (Chan et al., 2010;Wang et al., 2018).As an essential part of TCM, Chinese herbal medicine has been widely used around the world.Based on the theory of "bian zheng lun zhi" and Chinese philosophy, Chinese herbal medicine has long been used to treat sarcopenia (Guo et al., 2022) and its complications like muscle atrophy (Huang et al., 2022).Additionally, the beneficial therapeutic effects of herbal medicine in sarcopenia have also been proved in the sarcopenic animal models (Ding et al., 2023).Chinese herbal medicine has biological activities that promote skeletal muscle health, showing potential preventive and therapeutic effects on sarcopenia.Moreover, the mechanism by which Chinese herbal medicine affects sarcopenia is not yet clear, and it may be related to enhancing neural recruitment, maintaining protein homeostasis, regulating satellite cell function, reducing autophagy and inflammation (Fernández-Lázaro et al., 2022;Pascual-Fernández et al., 2020).
Given the high prevalence of sarcopenia and the socioeconomic burden it can cause, the treatment options remain limited.Chinese herbal medicine has the potential to be a complementary and alternative therapy because of their naturally low toxicity and various active functions, providing more treatment options for patients.However, although Chinese herbal medicine is widely used in clinical practice, the scientific evidence of its efficacy and effect in the treatment of sarcopenia is still relatively insufficient.The purpose of this paper is to explore the effectiveness of Chinese herbal medicine in the treatment of sarcopenia.Clinically, if the intervention can help protect against muscle atrophy and improve muscle function of older people with sarcopenia, it will fill the knowledge gap, provide more reliable reference information for clinical decision-making, and guide future research directions.

| Study registration
This systematic review and meta-analysis were reported and registered according to the PRISMA statement with registration number CRD42022375444.

| Inclusion and exclusion criteria
The PICOS strategy was defined as follows: "P" (patient)-patients with sarcopenia of any age, gender, or race; "I"(intervention)-TCM; "C" (comparison)-comparison with a blank group or a different intervention group; "O" (outcome)-relevant indicators to evaluate muscle and body function; and "S"(study design)-randomized controlled studies.
We regarded studies as eligible for inclusion if they were randomized clinical trials done on adults of any age, gender, or race with sarcopenia according to the respective diagnostic criteria in different regions (Chen et al., 2020;Cruz-Jentoft et al., 2019), compared Chinese herbal medicine with placebo, or Chinese herbal medicine combined with routine therapy to routine therapy alone, had at least 8 weeks' duration of intervention, and reported changes in muscle and physical function.
Articles were excluded if they met either of the following criteria: studies with incomplete data and the missing data are not available after contacting the original authors; studies had a high risk of bias in the evaluation; studies without relevant outcomes.

| Data sources and search strategy
Medline, EMBASE, APA PsycInfo, Cochrane Library, Web of Science, PubMed, Chinese National Knowledge Infrastructure (CNKI), Wanfang database, and Weipu Database for Chinese Technical Periodicals were screened from the establishment of the database to December 2022.We used the following combined text and MeSH terms: "sarcopenia" and "Chinese herbal medicine."The complete search used for the database is shown in Appendix 1.All studies were considered, regardless of their primary outcome or language.Additionally, a systematic search for gray literature, clinical trials registry platform, and a reference list were performed.There were no language restrictions for literature collection.

| Study selection and data extraction
The two researchers (Yujie Zhang and Kaoqiang Liu) searched the relevant databases according to the preestablished literature search strategy.Checks were made for duplicates in EndNote X9 software after retrieving the literature.The titles and abstracts of the literature were then reviewed independently by two researchers and screened according to the inclusion and exclusion criteria.In the event of disagreements, a third reviewer (Yunfan Zhan) made the final decision.
Articles that met the inclusion criteria were reviewed and appraised before being processed for data extraction, such as basic information (author, year of publication, study design, number of participants, and age range), type of intervention and duration, primary outcomes, and the composition of TCM prescriptions.

| Risk of bias assessment and quality assessment of the certainty of evidence
In accordance with PRISMA guidelines, two reviewers (Yujie Zhang and Kaoqiang Liu) independently evaluated the revised risk of bias of the included articles with the Cochrane Risk of Bias Tool (Sterne et al., 2019) and quality assessment with GRADE profiler (Guyatt et al., 2008).Risk of bias including the following items: randomization process, deviations from intended interventions, missing outcome data, measurement of the outcome, selection of the reported result, and overall bias were classified into three categories: high risk, low risk, and some concerns.The judgment of quality assessment was based on the following items: risk of bias, inconsistency, indirectness, imprecision, and publication bias and classified into four levels: high quality, moderate quality, low quality, and very low quality.In case of disagreements between two reviewers, they were resolved by consensus, or by a third author who mediated their disagreements.

| Endpoints
This meta-analysis compared changes in total efficiency, muscle mass (evaluated by body composition), muscle strength (evaluated by grip strength or 60 /s knee extension peak TQ), and muscle function (evaluated by 6-m walking speed, the short physical performance battery or the EuroQoL 5-dimension) in participants allocated to an experimental or comparator group (placebo or control).

| Statistical analysis
We assessed the effect of Chinese herbal medicine on four outcomes: total efficiency, changes in muscle mass, muscle strength, and muscle function between baseline and end of intervention.
Total efficiency was analyzed as dichotomous variables and the data were expressed as relative risk with 95% confidence intervals.Changes in muscle mass, muscle strength, and muscle function were analyzed as continuous variables and the data were expressed as weighted mean difference (WMD) or standardized mean difference (SMD).
In order to assess publication bias, we constructed funnel plots to the study outcomes with more than 10 articles included.Egger's tests were used to assess funnel plot asymmetry, and p < 0.05 was defined as significant publication bias.A Cochran Q test was used to assess heterogeneity between studies, as well as I 2 analysis to estimate the magnitude of the heterogeneity between studies.An analysis of the data was performed using a fixed-effect model if p ≥ 0.10 and I 2 <50% indicated no significant heterogeneity among studies.A significant heterogeneity in the studies was identified as p < 0.10 and I 2 ≥50%.Subgroup and sensitivity analyses were carried out to identify the source of the heterogeneity, if needed and an analysis of the data was performed using a random-effect model.
We used Review Manager (version 5.4) and Stata (version 16.0) for statistical analyses.

| Description of the included studies
A total of 277 relevant studies were obtained from a preliminary examination.After removing duplicates, 223 studies were obtained.
The basic characteristics of the included studies are shown in Table 1.The intervention group received herbal extracts or Chinese herbal medicine combined with routine therapy of nutritional support and exercise, and the control group received placebo or routine therapy alone.
The changes in muscle mass in the control and treatment groups were assessed by a random-effects model and significant difference was found between the two groups (SMD = 1.02, 95% CI [0.55, 1.50], p < 0.0001) (Figure 5).High Flavonoid Cocoa Supplement (Munguia et al., 2019), and Schisandra chinensis Baillon extracts (Cho et al., 2021).The results showed that regardless of which prescription the participants used, the improvement in muscle mass in the treatment group was higher than that in the control group, except for Fermented Sarco Oyster F I G U R E 3 Risk of bias graph.

| Effects of Chinese herbal medicine on muscle strength
To investigate the effect of herbs on muscle strength, 16 studies (
Subgroup analysis had not found the sources of the significant heterogeneity, then we performed sensitivity analysis further.The observed heterogeneity was caused mainly by the deviating results presented in Ren Xuanxuan (2016) and Hao Yuanyuan (2021).Exclusion of those two studies from the meta-analysis gave rise to a smaller heterogeneity (I 2 = 63%, p < 0.00001), and a smaller but still moderately large SMD of 0.47 (95% CI 0.27-0.67).A minimal difference in the total estimate or heterogeneity measures was observed after excluding other studies from the analysis.
Effect of Chinese herbal medicine on muscle strength (60 /s knee extension peak TQ) A total of two RCTs involving 92 patients were included (Cho et al., 2021;Rheu et al., 2022).There was no statistically significant heterogeneity between studies (p = 0.43, I 2 = 0%).The fixed-effect model was used to calculate the total effective rate in the intervention group and control group.There was a significant difference between the groups (MD = 5.63, 95% CI [À0.30, 11.57], p = 0.06) (Figure 7).

Effect of Chinese herbal medicine on muscle function (6-m walking speed)
A total of nine RCTs involving 1136 patients were included.Heterogeneity test showed that there was statistically significant heterogeneity among the studies (p < 0.00001, I 2 = 95%).The changes in muscle function in the control and treatment group were assessed by a random effects mixed model and significant difference was found between the two groups (SMD = 1.34, 95% CI [0.60, 2.08], p = 0.0004) (Figure 8).
Subgroup analysis had not found the sources of the significant heterogeneity, then we performed sensitivity analysis further.The observed heterogeneity was caused mainly by the deviating results presented in Ren Xuanxuan (2016) and Lv Luoyan (2021).Exclusion of those two studies from the meta-analysis gave rise to a smaller heterogeneity (I 2 = 73%, p = 0.001), and a smaller but still moderately large SMD of 0.53 (95% CI 0.21-0.86).A minimal difference in the total estimate or heterogeneity measures was observed after excluding other studies from the analysis.
Heterogeneity test showed that there was no statistically significant heterogeneity among the studies ( p = 0.49, I 2 = 0%).The changes in muscle function in the control and treatment group were assessed by a fixed effects model and significant difference was found between the two groups (MD = 1.50, 95% CI [1.05, 1.95], p < 0.00001) (Figure 9).As there was only one study included in each group, subgroup analysis and sensitivity analysis were not applicable.

Effect of Chinese herbal medicine on muscle function (EQ-5D)
A total of three RCTs (Cho et al., 2021;Munguia et al., 2019;Rheu et al., 2022) involving 210 patients were included.Heterogeneity test showed that there was moderate heterogeneity among the studies (p = 0.18, I 2 = 41%).The changes in muscle function in the control and treatment group were assessed by a random effects mixed model and significant difference was found between the two groups (SMD = 0.27, 95% CI [À0.10, 0.65], p = 0.16) (Figure 10).As there was only one study included in each group, subgroup analysis and sensitivity analysis were not applicable.

| Sensitivity analysis
A consecutive one by one elimination method was applied in the sensitivity analysis of the above indices.The effect size and p-value changes were evaluated after consecutive one by one exclusion of the included studies.The results showed that the removal of most of the publications had no significant change in effect size of the outcomes of the indices, indicating that the meta-analysis was reliable and stable.We used Stata 16.0 to analyze the sensitivity of the outcome indicators.The data analysis results were found to be robust.
The sensitivity analysis results are shown in Figures S10-S13.

| Publication bias
We used the funnel pattern to detect publication bias of the main outcomes of the indices with more than 10 articles included.As shown in

Total efficiency
The total efficiency in the intervention groups was 1.The improvement in the muscle function (EQ-5D) in the intervention groups was 0.27 higher (À0.10 to 0.65 higher)

(3 studies) L L L L high
Note: GRADE Working Group grades of evidence.High quality: Further research is very unlikely to change our confidence in the estimate of effect.Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.Very low quality: We are very uncertain about the estimate.Abbreviations: ASMI, appendicular skeletal muscle index; EQ-5D, EuroQoL 5-dimension; SPPB, short physical performance battery.

| Evaluation of quality of evidence
According to the GRADE working group guidelines, the evidence for muscle strength (60 /s knee extension peak TQ) and muscle function (EQ-5D) was of high quality; total efficiency, muscle mass, muscle strength (grip strength), muscle function (SPPB) was of moderate quality among the results generated from these studies, while the evidence for the remaining results was of low quality, as shown in Table 2.

| DISCUSSION
The The pathogenesis of sarcopenia is complicated and related to many factors, such as imbalanced protein metabolism, oxidative stress, inflammation, insulin resistance, and apoptosis (Mankhong et al., 2020).In regard to the pathogenesis, studies on Chinese herbal medicine for the treatment of sarcopenia have been carried out worldwide; however, it is still obscured.Bu-Zhong-Yi-Qi decoction was able to reduce inflammatory factors in patients, but due to the small sample size, there was a risk of deviation (Yinyin et al., 2021).In addition, relevant animal studies have shown that Bu-Zhong-Yi-Qi decoction can treat sarcopenia by improving mitochondrial function (Zhu et al., 2017).The other prescriptions demonstrated efficacy in the clinic, nevertheless there is a lack of mechanistic studies.Bagherniya et al (Bagherniya et al., 2022).reported the effects and molecular mechanisms of plant-derived natural products in sarcopenia, printed on the special issue of sarcopenia.The study found that Chinese herbal medicine can inhibit muscle atrophy and sarcopenia by increasing the expression of anabolic factors myosin, Myf5, and MyoD, and enhancing mitochondrial capacity.Ding et al (Ding et al., 2023).
reported the herbal active ingredients exerted beneficial antisarcopenic effects by ameliorating protein metabolism, inflammation, oxidative stress, insulin resistance, mitochondrial function.Our research group did some previous studies on the effect and mechanism of Chinese herbal medicine for treating sarcopenia, and obtained a similar conclusion (Yujie et al., n.d.).
There has been no previous meta-analysis of Chinese herbal medicine in the treatment of sarcopenia.Guo et al (Guo et al., 2022).studied the effect of Traditional Chinese Medicine including Chinese herb, Qigong exercise, and acupuncture on sarcopenia by a systematic review.Although the overall outcome was favorable, the study just employed a systematic review and did not undertake a meta-analysis, nor did it independently investigate the efficacy of Chinese herbal medicine on sarcopenia.There also exists concerns regarding the quality of included studies.Few outcome indicators were available, making it difficult to evaluate the project comprehensively.
Our meta-analysis was the first study to report the results of RCTs comparing Chinese herbal medicine alone or combined with conventional therapy for the treatment of sarcopenia, which incorporated relevant domestic and foreign studies, conducted a comprehensive evaluation of efficacy across various outcome indicators, and yielded a more comprehensive conclusion.Chinese herb medicine plays a positive role in the management of sarcopenia, notably an improvement in muscle mass, strength and function, which not only strengthened our confidence in the validity of assumptions but also offered new insights and expanded the range of therapeutic options for sarcopenia treatment.Given the heterogeneity of the findings, sensitivity analysis and subgroup analysis were performed to explore the sources.We found it was mainly derived from patient characteristics, different herbs and efficacy indicators, and individual studies which may provide more specific information for patients and clinicians, and guide in selecting the best treatment options for patients.
Additionally, Chinese herbal medicine shows promising prospects for sarcopenia treatment, but the mechanism is still unclear.We further discussed the mechanisms in the Discussion section, which may also point to future research directions.
A word of caution to those who put too much faith in natural products: unlike pharmaceuticals, nutraceutical manufacturers often face less stringent requirements to prove the effectiveness and safety of their products before bringing them to market (Williamson et al., 2020).Consequently, there is a higher likelihood of ineffective or even potentially harmful products being made available to consumers.The absence of comprehensive oversight and standardized testing protocols can result in variable product quality and inconsistent results, making it challenging for consumers to make informed choices (Izzo et al., 2016).

| Strengths and limitations
Our research adopted systematic review and meta-analysis methods to ensure more comprehensive and reliable conclusions by synthesizing and analyzing the literature.Studies covered different herbal treatments, patient populations, and study designs.This helps increase the external validity of our study and makes the findings more generalizable.We adopted rigorous methodologies in research design, literature screening, data extraction, and statistical analysis to ensure the credibility and reproducibility of the study.
Although the included RCTs were from various regions of the world, a majority of the studies included were from China with regional restrictions and were not universally applicable.Consequently, additional studies are warranted to assess the effectiveness of Chinese herbal medicine for sarcopenia in diverse populations.
Since there was evidence of low quality in some of the included studies, risk of bias may be present.Another conceivable scenario is that the study investigators may have exhibited a tendency to favorably treat reports from the test groups and selectively disclose nonsignificant results, potentially compromising the reliability of the effect size.
Therefore, in future studies, researchers should strictly adhere to RCTs guidelines to provide more accurate trial results.

| Implications
The implications of Chinese herbal medicine for sarcopenia are promising but also warrant careful consideration.As a traditional form of medicine with a holistic approach, Chinese herbal medicine offers potential benefits in addressing the age-related muscle loss seen in sarcopenia.The herbs' anti-inflammatory and antioxidant properties could help mitigate the chronic inflammation and oxidative stress associated with this condition.Moreover, the individualized nature of Chinese herbal prescriptions allows for personalized treatment, considering a person's unique constitution and lifestyle.However, it is crucial to acknowledge that the scientific evidence supporting the efficacy of Chinese herbal medicine for sarcopenia is relatively limited compared to conventional treatments.Rigorous clinical trials are needed to establish its effectiveness and safety.Additionally, the lack of standardized formulations and potential herb-drug interactions requires caution in its use.Chinese herbal medicine may serve as a valuable complementary approach to sarcopenia management, but it should be integrated judiciously alongside evidence-based treatments and under the guidance of qualified healthcare professionals.

| CONCLUSION
This study systematically evaluated the effect of Chinese herbal medicine in sarcopenia and conducted a meta-analysis that showed improvements in muscle mass, strength, and function.This finding provides important scientific support for expanding treatment options for sarcopenia, especially the application of Chinese herbal medicine.
However, owing to limitations in both the quantity and quality of existing research, coupled with the intricate nature of traditional Chinese medicine ingredients, additional efforts are imperative to delve deeper into these interconnected aspects.In general, Chinese herbal medicine can be used to treat sarcopenia.

F
I G U R E 7 Effect of Chinese herbal medicine on muscle strength (measured by 60 /s knee extension peak TQ).F I G U R E 8 Effect of Chinese herbal medicine on muscle function (measured by 6-m walking speed).F I G U R E 9 Effect of Chinese herbal medicine on muscle function (measured by short physical performance battery).

Figures
Figures S14-S16, the funnel pattern was asymmetric, indicating that there might have been publication bias.This was further confirmed by the Egger's tests, with total efficiency ( p = 0.032), muscle mass (p = 0.007), muscle strength measured by grip strength ( p = 0.116), measured by 60 /s knee extension peak TQ ( p = none), and muscle function measured by 6-m walking speed (p = 0.03), measured by SPPB ( p = 0.002) and measured by EQ-5D ( p = 0.071).

F
I G U R E 1 0 Effect of Chinese herbal medicine on muscle function (measured by EuroQoL 5-dimension).T A B L E 2 Quality of evidence of study outcomes.
present meta-analysis evaluated 17 RCTs that assessed the effect of Chinese herbal medicine in the treatment of sarcopenia.A total of 1440 patients were enrolled in the RCTs and the results unraveled a positive effect in the total effective rate.Moreover, we further analyzed the effect of Chinese herbal medicine on muscle mass, muscle strength, and muscle function.Results with high heterogeneity were then subjected to sensitivity analyses and subgroup analyses to explore the sources of heterogeneity.The evaluation of publication bias, coupled with quality of evidence, provided reassurance regarding the robustness of our study.The results of the meta-analysis clearly support the use of Chinese herbal medicine as a complementary alternative treatment in the prevention and treatment of sarcopenia.Meta-analysis results showed that Chinese herbal medicine could significantly improve the total effective rate of sarcopenia.Better effects were shown in the treatment group than those in the control group in improving muscle mass, muscle strength, and muscle function.Specifically, the total efficiency results showed that the curative effect of the combined treatment was better compared with the use of routine therapy alone.Subgroup analyses showed that compared with continuous intervention for 8 weeks, the 12-week intervention had a greater impact on the total effective rate.Moreover, different prescriptions exhibited the potential to enhance the overall effective rate.In terms of the muscle mass, Chinese herbal medicine could significantly improve the appendicular skeletal muscle mass index.Subgroup analyses showed that different prescriptions and extracts were effective for increasing muscle mass except for Fermented Sarco Oyster.Compared with older individuals, Chinese herbal medicine had a more prominent effect on muscle mass in individuals below 70 years of age.Furthermore, the 12-week intervention proved superior to the 8-week intervention.In terms of the muscle strength, Chinese herbal medicine could significantly improve the grip strength and 60 /s knee extension peak TQ.Subgroup analyses showed that different prescriptions and extracts were effective for increasing muscle strength.Compared with younger individuals, Chinese herbal medicine had a more prominent effect on muscle mass in individuals over 70 years of age.Furthermore, the 12-week intervention proved superior to the 8-week intervention.In terms of the muscle function, Chinese herbal medicine could significantly improve the meter walking speed, SPPB, and EQ-5D score.Subgroup analyses showed that different prescriptions and extracts were effective for increasing muscle function,except for Shen-Ling-Bai-Zhu decoction.Pertaining to the efficacy measure, the results of our meta-analysis highlight the positive effect of Chinese herbal medicine across populations utilizing a longer-term (≥12 weeks) treatment duration worldwide.Furthermore, none of the included studies reported any adverse effects associated with Chinese herbal medicine, indicating its safety.Our results suggest that Chinese herbal medicine, as a complementary medicine can be effective for the treatment of sarcopenia and further decrease falls and fracture risk, which has significant health, social, and economic benefits.
Characteristics of included studies.