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Meta-Analysis
. 2008 Apr 16;2008(2):CD005288.
doi: 10.1002/14651858.CD005288.pub3.

Chinese herbal medicine for primary dysmenorrhoea

X Zhu  1 , M Proctor, A Bensoussan, E Wu, C A Smith
Affiliations
Meta-Analysis

Chinese herbal medicine for primary dysmenorrhoea

X Zhu et al. Cochrane Database Syst Rev. .

Abstract

Background: Conventional treatment for primary dysmenorrhoea has a failure rate of 20% to 25% and may be contraindicated or not tolerated by some women. Chinese herbal medicine may be a suitable alternative.

Objectives: To determine the efficacy and safety of Chinese herbal medicine for primary dysmenorrhoea when compared with placebo, no treatment, and other treatment.

Search strategy: The Cochrane Menstrual Disorders and Subfertility Group Trials Register (to 2006), MEDLINE (1950 to January 2007), EMBASE (1980 to January 2007), CINAHL (1982 to January 2007), AMED (1985 to January 2007), CENTRAL (The Cochrane Library issue 4, 2006), China National Knowledge Infrastructure (CNKI, 1990 to January 2007), Traditional Chinese Medicine Database System (TCMDS, 1990 to December 2006), and the Chinese BioMedicine Database (CBM, 1990 to December 2006) were searched. Citation lists of included trials were also reviewed.

Selection criteria: Any randomised controlled trials involving Chinese herbal medicine versus placebo, no treatment, conventional therapy, heat compression, another type of Chinese herbal medicine, acupuncture or massage. Exclusion criteria were identifiable pelvic pathology and dysmenorrhoea resulting from the use of an intra-uterine contraceptive device.

Data collection and analysis: Quality assessment, data extraction and data translation were performed independently by two review authors. Attempts were made to contact study authors for additional information and data. Data were combined for meta-analysis using either Peto odds ratios or relative risk (RR) for dichotomous data or weighted mean difference for continuous data. A fixed-effect statistical model was used, where suitable. If data were not suitable for meta-analysis, any available data from the trial were extracted and presented as descriptive data.

Main results: Thirty-nine randomised controlled trials involving a total of 3475 women were included in the review. A number of the trials were of small sample size and poor methodological quality. Results for Chinese herbal medicine compared to placebo were unclear as data could not be combined (3 RCTs). Chinese herbal medicine resulted in significant improvements in pain relief (14 RCTs; RR 1.99, 95% CI 1.52 to 2.60), overall symptoms (6 RCTs; RR 2.17, 95% CI 1.73 to 2.73) and use of additional medication (2 RCTs; RR 1.58, 95% CI 1.30 to 1.93) when compared to use of pharmaceutical drugs. Self-designed Chinese herbal formulae resulted in significant improvements in pain relief (18 RCTs; RR 2.06, 95% CI 1.80 to 2.36), overall symptoms (14 RCTs; RR 1.99, 95% CI 1.65 to 2.40) and use of additional medication (5 RCTs; RR 1.58, 95% CI 1.34 to 1.87) after up to three months of follow-up when compared to commonly used Chinese herbal health products. Chinese herbal medicine also resulted in better pain relief than acupuncture (2 RCTs; RR 1.75, 95% CI 1.09 to 2.82) and heat compression (1 RCT; RR 2.08, 95% CI 2.06 to 499.18).

Authors' conclusions: The review found promising evidence supporting the use of Chinese herbal medicine for primary dysmenorrhoea; however, results are limited by the poor methodological quality of the included trials.

PubMed Disclaimer

Conflict of interest statement

Xiaoshu Zhu recently completed a randomised controlled trial of CHM for primary dysmenorrhoea. There are no other known potential conflicts of interest.

Figures

1
1
Funnel plot of trials comparing CHM with conventional therapy for the outcome of reduction of pain
2
2
Funnel plot of trials comparing CHM with conventional therapy for the outcome of overall symptoms
3
3
Funnel plot of trials comparing CHM (self‐desogned) with CHM (over‐the‐counter) for the outcome of reduction of pain
4
4
Funnel plot of trials comparing CHM (self‐desogned) with CHM (over‐the‐counter) for the outcome of overall symptoms
1.1
1.1. Analysis
Comparison 1 Chinese herbal medicine versus placebo, Outcome 1 Reduction of pain.
1.2
1.2. Analysis
Comparison 1 Chinese herbal medicine versus placebo, Outcome 2 Reduction of pain.
1.3
1.3. Analysis
Comparison 1 Chinese herbal medicine versus placebo, Outcome 3 Overall symptoms.
1.4
1.4. Analysis
Comparison 1 Chinese herbal medicine versus placebo, Outcome 4 Adverse effects.
1.5
1.5. Analysis
Comparison 1 Chinese herbal medicine versus placebo, Outcome 5 Use of additional medication.
2.1
2.1. Analysis
Comparison 2 Chinese herbal medicine versus conventional therapy (NSAIDs or OCP), Outcome 1 Reduction of pain.
2.2
2.2. Analysis
Comparison 2 Chinese herbal medicine versus conventional therapy (NSAIDs or OCP), Outcome 2 Overall symptoms.
2.3
2.3. Analysis
Comparison 2 Chinese herbal medicine versus conventional therapy (NSAIDs or OCP), Outcome 3 Adverse effects.
2.4
2.4. Analysis
Comparison 2 Chinese herbal medicine versus conventional therapy (NSAIDs or OCP), Outcome 4 Use of additional medication.
3.1
3.1. Analysis
Comparison 3 Experimental Chinese herbal formula versus OTC Chinese herbal formula, Outcome 1 Reduction of pain.
3.2
3.2. Analysis
Comparison 3 Experimental Chinese herbal formula versus OTC Chinese herbal formula, Outcome 2 Overall symptoms.
3.3
3.3. Analysis
Comparison 3 Experimental Chinese herbal formula versus OTC Chinese herbal formula, Outcome 3 Adverse effects.
3.4
3.4. Analysis
Comparison 3 Experimental Chinese herbal formula versus OTC Chinese herbal formula, Outcome 4 Use of additional medication.
4.1
4.1. Analysis
Comparison 4 Chinese herbal medicine versus acupuncture, Outcome 1 Reduction of pain.
5.1
5.1. Analysis
Comparison 5 Chinese versus heat compression, Outcome 1 Reduction of pain.
5.2
5.2. Analysis
Comparison 5 Chinese versus heat compression, Outcome 2 Adverse effects.
See this image and copyright information in PMC

Update of

Comment in

References

References to studies included in this review

Deng 2003 {published data only}
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Fan 1999 {published data only}
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Guo 1997 {published data only}
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Huang 2000 {published data only}
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Jiang 2000 {published data only}
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Li 1999 {published data only}
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Li 2004 {published data only}
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Liu 2000 {published data only}
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Liu 2002 {published data only}
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Liu 2003 {published data only}
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Qin 2003 {published data only}
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Shen 2001 {published data only}
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Song 2003 {published data only}
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Sun 2006 {published data only}
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Sun2004 {published data only}
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Wang 1996 {published data only}
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Wang 2000b {published data only}
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Wang 2003 {published data only}
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Wang 2006b {published data only}
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Wu 2006 {published data only}
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Ye 2004 {published data only}
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Yu 2003 {published data only}
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Zhang 2000 {published data only}
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Zhang 2001 {published data only}
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Zhu 2001 {published data only}
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Zhu 2002 {published data only}
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Zhu 2003 {published data only}
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References to studies excluded from this review

Chen 1995 {published data only}
    1. Chen ZL. The use of Tong Jing Yao Fang in the treatment of 78 cases of primary dysmenorrhoea. Nan Jing Zhong Yi Yao Da Xue Xue Bao [Academic Journal of Nanjing University of Traditional Chinese Medicine ] 1995;11(6):47‐9.
Du 2000 {published data only}
    1. Du CY. Clinical observation on the use of modified Jia Wei Shi Xiao San in the treatment of 68 cases of primary dysmenorrhoea. Zhong Guo Min Zu Min Jian Yi Yao Za Zhi [China Journal of Folk Medicine] 2000;44:135‐6.
Huang 2005 {published data only}
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Ji 2001 {published data only}
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Lin 2004 {published data only}
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Liu 2006 {published data only}
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Miao 2006 {published data only}
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Ni 2004 {published data only}
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Pan 2003 {published data only}
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Shi 2003 {published data only}
    1. Shi JH, Yin JH, Jin QY, Xue LN, Wang XX, Hou XM, Ji CH. Clinical research on use of Tong Jing Ling in the treatment of primary dysmenorrhoea. Hebei Zhong Yi [Hebei J TCM] 2003;25(4):250‐52.
Song 2005 {published data only}
    1. Song ZM, Xin SM, Luo MY, Sun SZ, Ha XX, Zhu LP. Clinical observation on the use of Tong Jing Lin Ke Li in the treatment of primary dysmenorrhoea. Zhong Guo Zhong Xi Yi Jie He Za Zhi [CJITWM] 2005;25(7):608.
Sun 2005 {published data only}
    1. Sun H, Li YQ, Song HX. Clinical observation on the use of Tao Hong Shi Xiao Zhi Tong Tang in the treatment of 30 cases of primary dysmenorrhoea. Si Chuan Zhong Yi [Journal of Sichuan of Traditional Chinese Medicine] 2005;23(4):61‐2.
Wang 2000a {published data only}
    1. Wang H, Bei HW, Chang H, Wu XZ, Sun G. Clinical research on the use of series capsule Tiao Jing Mie Tong in the treatment of primary dysmenorrhoea. He Bei Zhong Yi Za Zhi [Hebei Journal of Traditional Chinese Medicine] 2000;22(2):99‐100.
Wang 2002 {published data only}
    1. Wang CL. The use of Wen Jing Huo Xue San in the treatment of 150 cases of primary dysmenorrhoea. Zhong Guo Zhong Yi Ji Zheng [China Chinese Medicine Emergency Treatment] 2002;11(4):311.
Wei 2000 {published data only}
    1. Wei B, Wu J. Injection of Honghua in the treatment of 90 cases of primary dysmenorrhoea. Zhong Yao Cai [Chinese Herbs] 2000;23(7):430‐1.
Wu 2002 {published data only}
    1. Wu JF. The use of Tong Jing Fan in the treatment of 50 cases of primary dysmenorrhoea. Zhe Jiang Zhong Yi Xue Yuan Xue Bao [ Academic Journal of Zhejiang College of Traditional Chinese Medicine] 2002;26(4):40.
Wu 2005 {published data only}
    1. Wu P. The use of modified self‐designed formula in the treatment of 60 cases of primary dysmenorrhoea. Bei Jing Zhong Yi Za Zhi [Beijing Journal of Traditional Chinese Medicine] 2005;24(4):222‐3.
Xu 2000 {published data only}
    1. Xu JY, Yan XJ, Ma GX. Clinical observation on the use of Gui Xin Xiang Cao Tang in the treatment of 60 cases of primary dysmenorrhoea. Ning Xia Yi Yao [Ning Xia Medical Journal] 2000;22(7):435.
Yang 2005 {published data only}
    1. Yang CQ, Yuan J. The use of modified Tiao Gan Tang in the treatment of 40 cases of primary dysmenorrhoea. He Nan Zhong Yi [Henan Traditional Chinese Medicine] 2005;25(2):52.
Zhang 2003 {published data only}
    1. Zhang AL. Clinical observation on the use of Chinese herbs with a principle of 'reinforcing body and warming meridians for removing blood stasis' in the treatment of 50 cases of primary dysmenorrhoea. Jiang Su Zhong Yi [Jiangsu Journal of Traditional Chinese Medicine] 2003;24(1):25‐6.
Zhang Y 2003 {published data only}
    1. Zhang Y, Li ZP. The use of Wen Jing San Han Tang in the treatment of 30 cases of dysmenorrhoea. Shang Xi Zhong Yi [Shanxi Journal of Traditional Chinese Medicine] 2003;24(5):401‐2.
Zhao 2006 {published data only}
    1. Zhao C. Clinical observation on use of Hua Yu Tong Jing Jiao Nang in the treatment of 318 cases of primary dysmenorrhoea. Zhong Yi Yao Guan Li [Chinese Journal of Management in Chinese Medicine] 2006;14(10):67.
Zhen 1996 {published data only}
    1. Zhen C, Xu J, Xu HX, Wei Y. Clincial and laboratory research on use of Tong Jing Ting Tea in the treatment of primary dysmenorrhoea of the pattern of retention of cold and blood stasis. Zhong Guo Zhong Yi Yao Ke Ji [China Chinese Medicine Scientific Technology] 1996;3(1):10‐4.
Zhen 2002 {published data only}
    1. Zhen C, Xu J, Zhang ZH. The use of Tong Jing Ting in the treatment of primary dysmenorrhoea of a pattern of 'retention of cold and blood stasis'. Hunan Guiding Journal of TCMP 2002;8(5):269.

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