Efficacy and Safety of Chinese Medicinal Herbs for Endometriosis: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

WANG Hongjing ¹ , HUANG Qian ² , AN Han ² , OU Yalong ³ , WU Taixiang ⁴

1. West China Second University Hospital; Sichuan University; Chengdu 610041; China2.School of Medicine; Sichuan University; Chengdu 610041; China3.Chinese Medicine Institute of Sichuan Academy of Chinese Medicine and Pharmacology; Chengdu 610031; China4.Chinese Evidence-Based Medicine Centre/Clinical Epidemiology Resource and Training Centre （Chengdu）; West China Hospital; Sichuan University; Chengdu 610041; China;

Corresponding author：

Keywords：

Chinese medicinal herbs; Endometriosis; Systematic review; Randomized controlled trials; Meta-analysis

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Objective 　To assess the efficacy and safety of Chinese medicinal herbs for treating endometriosis.
Methods 　We searched Cochrane Library, MEDLINE, EMBASE, CBM (from establishment to 2003). Randomized controlled trials (RCTs) and quasi-randomized controlled trials of patients with endometriosis were included. The quality of included studies such as randomization, blinding, allocation concealment and loss of follow up were evaluated and meta-analysis was performed by RevMan 4.3 software.
Results 　Ten RCTs or quasi-RCTs involving 1 120 patients were included. Because of different therapies in the treatment and control groups, the results of outcome were described separately. Most of included studies suggested that the effects of traditional Chinese medicine (TCM) on general effect, pregnancy rate improvement and alleviating dysmenorrhoea were similar to Danazol or Tamoxifen, only a few studies showed better effects. There was no evidence to support that TCM was more effective than western medicine in reducing the size of endometriotic cysts. Only one study mentioned the recurrence rate and showed that TCM enema had lower recurrence rate than oral Tamoxifen with OR 0.17, 95%CI 0.04 to 0.67. Five studies mentioned adverse reactions and showed TCM had fewer adverse effects than western medicine.
Conclusions 　Chinese medicinal herbs are effective in treating endometriosis with fewer adverse effects. The evidence is not b enough because of low quality of the included studies. Therefore, more high quality randomized controlled trials are required.

Citation： WANG Hongjing,HUANG Qian,AN Han,OU Yalong,WU Taixiang. Efficacy and Safety of Chinese Medicinal Herbs for Endometriosis: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2004, 04(9): 602-608. doi: Copy

1.	［1］Adamson GD. Diagnosis and clinical presentation of endometriosis[J]. Am J Obstet Gynecol, 1990; 162(2): 568-569.
2.	［2］Rock JA. Endometriosis and pelvic pain[J]. Fertility and Sterility, 1993; 60(No.6): 950-951.
3.	［3］Rawson JMR. Prevalence of endometriosis in asymptomaticwomen[J]. J Reprod Med, 1991; 36: 513.
4.	［4］Liu MR Chief editor. Traditional Chinese Medicine for Gynecology and Obstetrics[M]. Beijing : People Health Press, 2001. p.335-337.
5.	刘敏如, 主编. 中医妇产科学[M]. 北京:人民卫生出版社; 2001.p.335～337.
6.	［5］Group of Gynecology & Obstetrics in Chinese Association of Integrated Traditional & Western Medicine. The criteria of diagnosis and treatment for endometriosis, pregnancy-induced hypertension syndrome and infertility[J]. Chinese Journal of Integrated Traditional Chinese and Western Medicine, 1991; 11(6): 376-379.
7.	中国中西医结合学会妇产科专业委员会.子宫内膜异位症,妊娠高血压综合征及女性不孕症的中西医结合诊疗标准[J].中西医结合杂志, 1991; 11(6): 376～379.
8.	［6］Juni P, Altman DG, Egger M. Assessing the quality of controlled clinical trials[J]. BMJ, 2001; 323(7 303): 42-46.
9.	［7］Cai H, Gu QS, Zhou SY, Su YH, Yu DY. Clinical Study for Huo Xue Tiao Jing Fang in the Treatment of Endometriosis[J]. Acta Chinese Medicine and Pharmacology, 1996; (1): 19-20.
10.	蔡辉, 顾秋善, 周珊英, 苏延华, 于德勇. 活血调经方治疗子宫内膜异位症的临床研究[J]. 中医药学报, 1996; (1) : 19～20.
11.	［8］Hu SQ, Yu P, Li M, Guan XY. Clinical Observation on Qu Zheng Ling Enema in the Treatment of Endometriosis[J]. Shandong Journal of TCM, 2000; 19(8): 458-459.
12.	胡淑琴, 于萍, 李明, 管晓燕. 祛症灵灌肠治疗子宫内膜异位症临床观察[J]. 山东中医杂志, 2000; 19(8): 458～459.
13.	［9］Li J, Zheng J, Wang DZ. Clinical Observation on Treatment of Endometriosis by Tonifying Qi and Promoting Blood Circulation to Remove Stasis and Purgation Principle [J] . Chinese Journal of Integrated Traditional Chinese and Western Medicine, 1999; 19(9): 533-535.
14.	李佶, 郑锦, 王大增. 益气活血、化瘀痛腑法治疗子宫内膜异位症的临床观察[J]. 中国中西医结合杂志, 1999; 19(9): 533～535.
15.	［10］Liu J, Li XY,Hu XM. Clinical Observations on Treatment of Endometriosis by Tonifying Kidney and Removing Blood Stasis[J]. Chinese Journal of Integrated Traditional Chinese and Western Medicine, 1998; 18(3): 145-147.
16.	刘健, 李祥云, 胡晓梅. 补肾祛瘀法治疗子宫内膜异位症的临床观察[J]. 中国中西医结合杂志, 1998; 18(3): 145～147.
17.	［11］Lv WP, Wang JY. Clinical study for Yi Wei An Granule in the Treatment of Endometriosis[J]. Modern Journal of Integrated Traditional Chinese and Western Medicine, 2003; 12(8): 1 930-1 933.
18.	吕卫平, 王静远. 异位安颗粒治疗子宫内膜异位症的临床研究[J]. 现代中西医结合杂志, 2003; 12(18): 1 930～1 933.
19.	［12］Si TY, Liang XF, Xiang DF, Hang JL, Chen L.Clinical Observation on E’Ling capsule in the treatment of 65 cases of Endometriosis[J]. Journal of TCM, 1999; 40(11): 680-682.
20.	司徒仪, 梁雪芳, 向东方, 黄健玲, 程兰. 莪棱胶囊治疗子宫内膜异位症65例临床观察[J]. 中医杂志, 1999; 40(11): 680～682.
21.	［13］Wang JL, Luo YK, Ouyang HQ, Liu YQ, Luo SP. A Clinical Study for Luo’s Nei Yi Fang for Endometriosis[J]. Acta Guangzhou TCM university, 1996; 13(1): 9-12.
22.	王俊玲, 罗元恺, 欧阳惠卿, 刘宇权, 罗颂平. 罗氏内异方治疗子宫内膜异位症的临床研究[J]. 广州中医药大学学报, 1996; 13(1): 9～12.
23.	［14］Wang JY, Lv WP,Yu P,Wang W. Evaluation on Clinical Effect of Tongjingling Granules for Endometriosis[J]. Chinese Traditional Patent Medicine, 2002; 24(4): 274-277.
24.	王静远, 吕卫平, 于萍, 王薇. 痛经灵颗粒治疗子宫内膜异位症的临床研究[J]. 中成药, 2002; 24(4): 274～277.
25.	［15］Wu YN,Hua L,Jin Y, Zhang XH,Shi TS,Fu J,Teng XX.Clinical Study on Endometrial Ovarian Cyst Treated by Intergrated Laparoscopy and Chinese Herbal Medicine [J]. Chinese Journal of Integrated Traditional Chinese and Western Medicine, 2000; 20(3): 183-186.
26.	吴育宁, 华苓, 金延, 张晓辉, 石同淑, 付洁, 滕秀香. 腹腔镜与中药结合治疗卵巢子宫内膜囊肿的临床研究[J]. 中国中西医结合杂志, 2000; 20(3): 183～186.
27.	［16］Zhu JH.TCM Enema plus Mifepristone in the Treatment of 20 Cases of Endometriosis [J]. Shanxi Journal of Tradtional Chinese Medicine, 2000; 16(5): 33.
28.	朱剑红. 中药灌肠配合米非司酮治疗子宫内膜异位症20例[J]. 山西中医, 2000; 16(5): 33.

1. ［1］Adamson GD. Diagnosis and clinical presentation of endometriosis[J]. Am J Obstet Gynecol, 1990; 162(2): 568-569.
2. ［2］Rock JA. Endometriosis and pelvic pain[J]. Fertility and Sterility, 1993; 60(No.6): 950-951.
3. ［3］Rawson JMR. Prevalence of endometriosis in asymptomaticwomen[J]. J Reprod Med, 1991; 36: 513.
4. ［4］Liu MR Chief editor. Traditional Chinese Medicine for Gynecology and Obstetrics[M]. Beijing : People Health Press, 2001. p.335-337.
5. 刘敏如, 主编. 中医妇产科学[M]. 北京:人民卫生出版社; 2001.p.335～337.
6. ［5］Group of Gynecology & Obstetrics in Chinese Association of Integrated Traditional & Western Medicine. The criteria of diagnosis and treatment for endometriosis, pregnancy-induced hypertension syndrome and infertility[J]. Chinese Journal of Integrated Traditional Chinese and Western Medicine, 1991; 11(6): 376-379.
7. 中国中西医结合学会妇产科专业委员会.子宫内膜异位症,妊娠高血压综合征及女性不孕症的中西医结合诊疗标准[J].中西医结合杂志, 1991; 11(6): 376～379.
8. ［6］Juni P, Altman DG, Egger M. Assessing the quality of controlled clinical trials[J]. BMJ, 2001; 323(7 303): 42-46.
9. ［7］Cai H, Gu QS, Zhou SY, Su YH, Yu DY. Clinical Study for Huo Xue Tiao Jing Fang in the Treatment of Endometriosis[J]. Acta Chinese Medicine and Pharmacology, 1996; (1): 19-20.
10. 蔡辉, 顾秋善, 周珊英, 苏延华, 于德勇. 活血调经方治疗子宫内膜异位症的临床研究[J]. 中医药学报, 1996; (1) : 19～20.
11. ［8］Hu SQ, Yu P, Li M, Guan XY. Clinical Observation on Qu Zheng Ling Enema in the Treatment of Endometriosis[J]. Shandong Journal of TCM, 2000; 19(8): 458-459.
12. 胡淑琴, 于萍, 李明, 管晓燕. 祛症灵灌肠治疗子宫内膜异位症临床观察[J]. 山东中医杂志, 2000; 19(8): 458～459.
13. ［9］Li J, Zheng J, Wang DZ. Clinical Observation on Treatment of Endometriosis by Tonifying Qi and Promoting Blood Circulation to Remove Stasis and Purgation Principle [J] . Chinese Journal of Integrated Traditional Chinese and Western Medicine, 1999; 19(9): 533-535.
14. 李佶, 郑锦, 王大增. 益气活血、化瘀痛腑法治疗子宫内膜异位症的临床观察[J]. 中国中西医结合杂志, 1999; 19(9): 533～535.
15. ［10］Liu J, Li XY,Hu XM. Clinical Observations on Treatment of Endometriosis by Tonifying Kidney and Removing Blood Stasis[J]. Chinese Journal of Integrated Traditional Chinese and Western Medicine, 1998; 18(3): 145-147.
16. 刘健, 李祥云, 胡晓梅. 补肾祛瘀法治疗子宫内膜异位症的临床观察[J]. 中国中西医结合杂志, 1998; 18(3): 145～147.
17. ［11］Lv WP, Wang JY. Clinical study for Yi Wei An Granule in the Treatment of Endometriosis[J]. Modern Journal of Integrated Traditional Chinese and Western Medicine, 2003; 12(8): 1 930-1 933.
18. 吕卫平, 王静远. 异位安颗粒治疗子宫内膜异位症的临床研究[J]. 现代中西医结合杂志, 2003; 12(18): 1 930～1 933.
19. ［12］Si TY, Liang XF, Xiang DF, Hang JL, Chen L.Clinical Observation on E’Ling capsule in the treatment of 65 cases of Endometriosis[J]. Journal of TCM, 1999; 40(11): 680-682.
20. 司徒仪, 梁雪芳, 向东方, 黄健玲, 程兰. 莪棱胶囊治疗子宫内膜异位症65例临床观察[J]. 中医杂志, 1999; 40(11): 680～682.
21. ［13］Wang JL, Luo YK, Ouyang HQ, Liu YQ, Luo SP. A Clinical Study for Luo’s Nei Yi Fang for Endometriosis[J]. Acta Guangzhou TCM university, 1996; 13(1): 9-12.
22. 王俊玲, 罗元恺, 欧阳惠卿, 刘宇权, 罗颂平. 罗氏内异方治疗子宫内膜异位症的临床研究[J]. 广州中医药大学学报, 1996; 13(1): 9～12.
23. ［14］Wang JY, Lv WP,Yu P,Wang W. Evaluation on Clinical Effect of Tongjingling Granules for Endometriosis[J]. Chinese Traditional Patent Medicine, 2002; 24(4): 274-277.
24. 王静远, 吕卫平, 于萍, 王薇. 痛经灵颗粒治疗子宫内膜异位症的临床研究[J]. 中成药, 2002; 24(4): 274～277.
25. ［15］Wu YN,Hua L,Jin Y, Zhang XH,Shi TS,Fu J,Teng XX.Clinical Study on Endometrial Ovarian Cyst Treated by Intergrated Laparoscopy and Chinese Herbal Medicine [J]. Chinese Journal of Integrated Traditional Chinese and Western Medicine, 2000; 20(3): 183-186.
26. 吴育宁, 华苓, 金延, 张晓辉, 石同淑, 付洁, 滕秀香. 腹腔镜与中药结合治疗卵巢子宫内膜囊肿的临床研究[J]. 中国中西医结合杂志, 2000; 20(3): 183～186.
27. ［16］Zhu JH.TCM Enema plus Mifepristone in the Treatment of 20 Cases of Endometriosis [J]. Shanxi Journal of Tradtional Chinese Medicine, 2000; 16(5): 33.
28. 朱剑红. 中药灌肠配合米非司酮治疗子宫内膜异位症20例[J]. 山西中医, 2000; 16(5): 33.

Chinese Journal of Evidence-Based Medicine

Efficacy and Safety of Chinese Medicinal Herbs for Endometriosis: A Systematic Review

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