Article type
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Abstract
Methods: Complementary/alternative medical therapies in the 'Textbook of Infectious Diseases' published by The People's Publishing House of China was checked for viral hepatitis treatment. The textbook (4th edition) in 1995 is being used for undergraduate medical training in most medical universities and colleges in China. Electronic (MEDLINE and Chinese Biomedical Database) and manual searches (till the end of 2000) were combined to identify potential clinical trials of alternative therapies for viral hepatitis. The trials were included regardless of the publication status and language. Data on study design, participants, interventions, and the study outcome were extracted from each trial.
Results: We identified nine Chinese herbal medicines that were recommended for the treatment of viral hepatitis in the textbook. One herbal medicine Ganyanling (herb extract) was recommended for treatment of acute hepatitis C. Herbal extracts Bifendate (biphenyldimethyl-esterate), Stringy stonecrop herb, caryophyllin, Anisodamine, Krestin, Polyporus umbellatus polysaccharide, Ganyanling and mushroom polysaccharide were recommended for treatment of chronic hepatitis. Herbal injection Salviae miltiorrhizinae was recommended for treatment of severe viral hepatitis. Our searches identified 11 randomised trials and one quasi-randomised trial. They are small trials with average sample of 96 patients per trial (range from 16 to 156). None of the trials used blinding, and their quality was generally low. Only one trial used placebo as control intervention. Others used non-specific drugs like vitamins, and western drugs like interferon as controls. Eleven out of 12 trials had positive outcomes and made recommendation for treatment. Only one trial concluded with negative outcome.
Conclusions: We cannot find sufficient evidence for using Chinese herbal medicines in the treatment of viral hepatitis in the 'Textbook of Infectious Diseases' until now. In general, the methodological quality of Chinese randomised trials on herbs for viral hepatitis is very low. Accordingly, many trials have a considerable risk of producing a biased positive study outcome. It is therefore noteworthy that 92% of all trials reported a positive outcome and made treatment recommendations based on the findings. These treatment recommendations can therefore be misleading and herbal medicines for viral hepatitis cannot be used beyond well-designed randomised trials.
Results: We identified nine Chinese herbal medicines that were recommended for the treatment of viral hepatitis in the textbook. One herbal medicine Ganyanling (herb extract) was recommended for treatment of acute hepatitis C. Herbal extracts Bifendate (biphenyldimethyl-esterate), Stringy stonecrop herb, caryophyllin, Anisodamine, Krestin, Polyporus umbellatus polysaccharide, Ganyanling and mushroom polysaccharide were recommended for treatment of chronic hepatitis. Herbal injection Salviae miltiorrhizinae was recommended for treatment of severe viral hepatitis. Our searches identified 11 randomised trials and one quasi-randomised trial. They are small trials with average sample of 96 patients per trial (range from 16 to 156). None of the trials used blinding, and their quality was generally low. Only one trial used placebo as control intervention. Others used non-specific drugs like vitamins, and western drugs like interferon as controls. Eleven out of 12 trials had positive outcomes and made recommendation for treatment. Only one trial concluded with negative outcome.
Conclusions: We cannot find sufficient evidence for using Chinese herbal medicines in the treatment of viral hepatitis in the 'Textbook of Infectious Diseases' until now. In general, the methodological quality of Chinese randomised trials on herbs for viral hepatitis is very low. Accordingly, many trials have a considerable risk of producing a biased positive study outcome. It is therefore noteworthy that 92% of all trials reported a positive outcome and made treatment recommendations based on the findings. These treatment recommendations can therefore be misleading and herbal medicines for viral hepatitis cannot be used beyond well-designed randomised trials.