Analysis and assessment of systematic reviews of Chinese herbal medicine published in Cochrane Library

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Hu J1, Shang H1, Zhang J1
1Evidence-based Medicine Centre, Tianjin University of Traditional Chinese Medicine, Tianjin 300193, China

Objective: To analyze and assess the systematic reviews of Chinese herbal medicine published in Cochrane Library. Methods: We searched all reviews of Chinese herbal medicine in Issue 1, 2010 of the Cochrane Database of Systematic Reviews. For each review, we collected information of the title of review, publication year, number of authors, country of first author, institution of authors, databases of electronic searches, number of trials included, treatment of disease, interventions used in the treatment groups and types of outcome measures. Results: We identified 57 systematic reviews of Chinese herbal medicine published in Cochrane Library. The number of authors in these reviews ranged from 1 to 10. The first author of 45 (78.9%) reviews came from China, next was UK (n = 8), first author of the remaining 4 reviews came from Netherlands, Canada, USA and Australia. Authors of 43 (75.4%) reviews were without Traditional Chinese Medicine (TCM) experience. Number of electronic searching databases in these reviews ranged from 4 to 15, 10 (17.5%) reviews did not examine any Chinese database. In all 57 reviews, 43 types of diseases were involved, 9 reviews focused on treatment of stroke. The number of trials included in the reviews ranged from 0 to 75, 7 (12.3%) reviews were empty. Twenty four reviews were focused on single herbs, including injection, pill, capsule or Tang, while other 33 (57.9%) reviews concerned comprehensive Chinese herbs, interventions in these reviews were Chinese herbal medicines, Chinese herbs, Chinese medicinal herbs, Herbal medicines, Traditional Chinese medicinal herbs, and so on , the types of included Chinese herbs in these 33 reviews ranged from 0 to 69. Only 5 reviews concerned TCM outcome. Conclusions: Widely varied interventions for systematic reviews of Chinese herbal medicine would lead to the clinical heterogeneity of included studies and not appropriate for Meta-analysis, then limit the generalizability and clinical application of reviews. It would also cause the difficulties of collecting trials and updating reviews. So we suggest systematic reviews of Chinese herbal medicine focus on a specific topic, avoid the selection of comprehensive Chinese herbs. Because the clinical trials of Chinese herbal medicine were mainly published on Chinese journals, so the systematic reviews of Chinese herbal medicine should search Chinese databases, however, in our study, 17 percent reviews did not search any Chinese database, it would lead to selection bias. In addition, because of the unique characteristics of TCM, if there were no TCM practitioners when doing systematic reviews of Chinese herbal medicine, the included studies with clinical heterogeneity may be combined, then affect the reliability of the evidence.