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Objective: To systematically evaluate the efficacy and safety of Buzhong Yiqi Tang (BZYQT) for stable chronic obstructive pulmonary disease (COPD).Methods: Three electronic English databases (PubMed, EMBASE and CENTRAL) and four Chinese databases (CBM, CNKI, CQVIP and WFMO) were searched from their inceptions until 30th June 2016. Participants were diagnosed with COPD according to the Chinese Medical Association's COPD diagnosis and treatment guidelines or Global Initiative for Chronic Obstructive Lung Disease (GOLD), and were in stable stage. Randomized controlled trials (RCTs) of oral BZYQT, alone or combined with conventional treatment, compared with conventional treatment alone or plus placebo were included in the review. Clinical improvement and the six-minute walking test (6MWT) were the primary outcome measures. The secondary outcome measures were defined as forced expiratory volume in one second (FEV1), forced vital capacity (FVC), respiratory muscle strength index with maximum inspiratory pressure (MIP), COPD Assessment Test (CAT), and frequency of acute exacerbations. To assess risk of bias the Cochrane, Risk of Bias tool was used, and statistical analysis was performed using RevMan 5.3.0 software.Results: Sixteen studies (1400 participants) were included. The results of meta-analysis indicated patients receiving BZYQT alone or BZYQT in combination with conventional treatment showed a significant increase in clinical improvement (RR 1.25, 95% CI 1.18 to 1.33, I2=0%), enhanced exercise capacity 6MWT (MD 51.22m, 95% CI 45.56 to 56.89, I2=44%), improved lung function FVC (L) (MD 0.26 liters, 95% CI 0.18 to 0.33, I2=37%), reduced respiratory muscle fatigue MIP (MD 0.46 liters, 95% CI 0.11 to 0.80, I2=0%), and improved quality of life CAT (MD -2.56 points, 95% CI -3.40 to -1.72, I2=0%) when compared with conventional treatment alone, or plus placebo. BZYQT also showed small but significant improvements in FEV1% and decreased acute exacerbations of COPD. Four studies reported that no adverse events occurred, other studies did not mention adverse events. The finding should be considered with caution because the included studies had methodological shortfalls.Conclusions: BZYQT improves clinically important outcomes for patients with stable COPD, such as improved clinical symptoms, exercise capacity, lung function and quality of life. Moreover, it has an excellent safety profile. However further evaluation is needed to validate these preliminary findings in high quality RCTs. [ABSTRACT FROM AUTHOR]

Objective: Acupuncture is widely used in Asia and increasingly in Western countries. We performed a systematic review and meta-analysis to examine the effects of acupuncture for insomnia.Methods: We identified randomized controlled trials from English and Chinese databases. Data were extracted using a predefined form and analysed using RevMan 5.2. We included studies that compared acupuncture to sham/placebo, standard pharmacotherapy or cognitive behavioral therapy. Risk of bias was assessed using the Cochrane risk of bias tool. The primary outcome was sleep quality assessed by the Pittsburgh Sleep Quality Index (PSQI).Results: A total of 30 studies involving 2363 participants were included. Acupuncture point combinations included the use of at least one of the recommended points for insomnia, HT7, GV20, SP6. Pharmacotherapy control was used in 27 studies and sham/placebo in three studies. Cognitive behavioral therapy was not used in any of the studies. Pharmacotherapies in all studies were benzodiazepine receptor agonists, except for one that used an antidepressant. Acupuncture was superior to sham/placebo in terms of PSQI (MD -0.79, 95% CI -1.38, -0.19, I(2)=49%). Acupuncture was also more effective than pharmacotherapy (MD -2.76, 95% CI -3.67, -1.85, I(2)=94%). Most studies were at risk of bias. Some mild adverse events were reported but they were not causally related to the acupuncture treatments.Conclusions: Acupuncture compared to sham/placebo and pharmacotherapy showed statistically significant results. However, the evidence is limited by bias in the included studies and heterogeneity. Well-designed studies are needed to confirm the results identified in this review. [ABSTRACT FROM AUTHOR]

This systematic review is to evaluate the efficacy and safety of Chinese herbal medicine (CHM) for people with insomnia. Randomized controlled trials (RCTs) investigating oral CHM alone or in combination with conventional therapies for primary insomnia were identified by searching English and Chinese publications and databases of clinical trial registration. Risk of bias was assessed according to the Cochrane Handbook 5.1. Meta-analysis was conducted using RevMan 5.2.4. Seventy-nine trials (7886 participants) were finally included in the review, and 76 were included in the meta-analysis. Twenty-seven trials reported the methods of random sequence generation, and five of them used the allocation concealment. Blinding of participants and personnel were used in 10 studies. The main meta-analysis showed that CHM alone was more effective than placebo by reducing scores of Pittsburgh Sleep Quality Index (mean difference, MD: -3.06, 95% confidence interval, CI: -5.14 to -0.98, I(2) = 97%) and benzodiazepine drugs (BZDs) (MD: -1.94, 95% CI: -2.45 to -1.43, I(2) = 96%). The effect was also seen when CHM was combined with BZDs compared with placebo plus BZDs (MD: -1.88, 95% CI: -2.78 to -0.97, I(2) = 0%) or cognitive and behavioral therapy (MD: -3.80, 95% CI: -4.91 to -2.68, I(2) = 68%) alone. There was no significant difference between CHM and placebo regarding the frequency of adverse events (relative risk, RR: 1.65, 95% CI: 0.67-4.10, I(2) = 0). Overall, oral CHM used as a monotherapy or as an adjunct to conventional therapies appears safe, and it may improve subjective sleep in people with insomnia. However, the typical effect of CHM for insomnia cannot be determined due to heterogeneity. Further study focusing on individual CHM formula for insomnia is needed. The development of a comparable placebo is also needed to improve the successful blinding in RCTs. [ABSTRACT FROM AUTHOR]

Summary: Ginseng alone or combined with other herbs has been increasingly used for chronic obstructive pulmonary disease (COPD). This review aims to evaluate the effectiveness and safety of oral Ginseng formulae for stable COPD. Four English databases and three Chinese databases were searched to identify randomized controlled trials. Methodological quality was assessed by Cochrane risk of bias and Jadad’s scale. Data were analyzed using Review Manager 5.0. Twelve studies overall of low quality, involving 1560 participants were included. Results of three studies showed a mean difference (MD) of 0.30 (95%CI 0.02 to 0.58) for forced expiratory volume in 1 s (FEV1) improvement of Ginseng formulae versus placebo control. Findings of three studies revealed an MD of 9.43 (95%CI 3.64 to 15.21) of FEV1 % predicted between Ginseng formulae and placebo control. Quality of life (Qol) measured by St. George’s Respiratory Questionnaire was improved (MD −10.32, 95%CI −14.99 to −5.65) with Ginseng formulae plus pharmacotherapy versus pharmacotherapy alone in one study. There were no severe adverse events reported. Ginseng formulae for stable COPD patients show promising evidence of lung functions and Qol improvement. However, the degree of benefit is uncertain due to potential risk of bias of the included studies. [ABSTRACT FROM AUTHOR]

Historical literature and pharmacological studies both suggest that Astragalus membranaceus (A. membranaceus) holds potential benefits for diabetic kidney disease (DKD), which is a growing burden with limited proven renal protective options. Aim of the study : An updated systematic review was conducted to evaluate the efficacy and safety of A. membranaceus preparations as an adjunctive therapy to conventional therapies for DKD. Nine databases and five clinical trial registries were searched for randomized controlled trials (RCTs) of A. membranaceus preparations added to conventional therapies compared with conventional therapies alone for people with DKD. Study screening, data collection, and quality assessment were performed independently by two reviewers. Estimated effects were pooled as mean differences or standardized mean differences with 95% confidence intervals by using a random-effects model. Sixty-six studies, involving 4785 DKD participants, were included. The quality of the included studies was low due to methodological shortfalls. Meta-analysis showed that additional use of A. membranaceus injection reduced more albuminuria (32 RCTs, 2253 participants; SMD: 2.05 [–2.49, −1.61], I2 = 94%), proteinuria (26 RCTs, 1812 participants; SMD: 1.85 [–2.34, −1.37], I2 = 95%), and serum creatinine levels (32 RCTs, 2880 participants; −14.78 μmol/L [–19.22, −10.33], I2 = 97%) than conventional therapies alone did. An anti-albuminuria effect was also observed in the oral A. membranaceus preparation group (four RCTs, 236 participants; SMD: 1.27 [–1.82, −0.73], I2 = 73%). Meta-regression suggested that the treatment effect of A. membranaceus injection was associated with the baseline serum creatinine level. The adverse-events profile was similar between the additional A. membranaceus and control groups. The low quality of evidence suggested that adjunctive use of A. membranaceus preparations in addition to conventional therapies may be effective and tolerated for short-term reduction of albuminuria, proteinuria, and serum creatinine in DKD patients. The findings should be considered with caution due to the lack of high-quality RCTs and significant heterogeneity and publication bias. Further RCTs are needed to confirm the long-term efficacy and safety of A. membranaceus preparations, especially of the oral form, in patient-important outcomes. Image 1 [ABSTRACT FROM AUTHOR]