Herbal medicines for fatty liver diseases (Review) Liu ZL, Xie LZ, Zhu J, Li GQ, Grant SJ, Liu JP This is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library 2013, Issue 8 http://www.thecochranelibrary.com Herbal medicines for fatty liver diseases (Review) Copyright © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. TABLE OF CONTENTS HEADER....................................... 1 ABSTRACT ...................................... 1 PLAINLANGUAGESUMMARY . 2 BACKGROUND .................................... 3 Figure1. ..................................... 4 OBJECTIVES ..................................... 5 METHODS ...................................... 5 RESULTS....................................... 9 Figure2. ..................................... 10 Figure3. ..................................... 13 Figure4. ..................................... 14 DISCUSSION ..................................... 18 AUTHORS’CONCLUSIONS . 19 ACKNOWLEDGEMENTS . 20 REFERENCES ..................................... 20 CHARACTERISTICSOFSTUDIES . 29 DATAANDANALYSES. 141 Analysis 1.1. Comparison 1 Medicinal herbs versus placebo, Outcome 1 ALT (U/L). 158 Analysis 1.2. Comparison 1 Medicinal herbs versus placebo, Outcome 2 AST (U/L). 159 Analysis 1.3. Comparison 1 Medicinal herbs versus placebo, Outcome 3 Liver/spleen CT ratio. 159 Analysis 2.1. Comparison 2 Herbal medicines plus lifestyle intervention versus placebo plus lifestyle intervention, Outcome 1AST(U/L)................................... 160 Analysis 2.2. Comparison 2 Herbal medicines plus lifestyle intervention versus placebo plus lifestyle intervention, Outcome 2ALT(U/L)................................... 160 Analysis 2.3. Comparison 2 Herbal medicines plus lifestyle intervention versus placebo plus lifestyle intervention, Outcome 3ALP(U/L)................................... 161 Analysis 2.4. Comparison 2 Herbal medicines plus lifestyle intervention versus placebo plus lifestyle intervention, Outcome 4Liver/spleenCTratio. 161 Analysis 3.1. Comparison 3 Herbal medicines plus lifestyle intervention versus lifestyle intervention, Outcome 1 ALT (IU/L)..................................... 162 Analysis 3.2. Comparison 3 Herbal medicines plus lifestyle intervention versus lifestyle intervention, Outcome 2 AST (IU/L)..................................... 163 Analysis 3.3. Comparison 3 Herbal medicines plus lifestyle intervention versus lifestyle intervention, Outcome 3 Ultrasound:liverscore. 163 Analysis 3.4. Comparison 3 Herbal medicines plus lifestyle intervention versus lifestyle intervention, Outcome 4 Liver CT withoutimprovement.. 164 Analysis 3.5. Comparison 3 Herbal medicines plus lifestyle intervention versus lifestyle intervention, Outcome 5 Adverse events. .................................... 164 Analysis 3.6. Comparison 3 Herbal medicines plus lifestyle intervention versus lifestyle intervention, Outcome 6 GGT (U/L). .................................... 165 Analysis 4.1. Comparison 4 Herbal medicines versus conventional therapy, Outcome 1 ALT (IU/L). 165 Analysis 4.2. Comparison 4 Herbal medicines versus conventional therapy, Outcome 2 AST (IU/L). 167 Analysis 4.3. Comparison 4 Herbal medicines versus conventional therapy, Outcome 3 GGT (U/L). 168 Analysis 4.4. Comparison 4 Herbal medicines versus conventional therapy, Outcome 4 ALP (U/L). 169 Analysis 4.5. Comparison 4 Herbal medicines versus conventional therapy, Outcome 5 Abnormal ultrasound. 170 Analysis 4.6. Comparison 4 Herbal medicines versus conventional therapy, Outcome 6 Abnormal AST (> 50 U/L). 170 Analysis 4.7. Comparison 4 Herbal medicines versus conventional therapy, Outcome 7 Abnormal ALT (> 50 U/L). 171 Analysis 4.8. Comparison 4 Herbal medicines versus conventional therapy, Outcome 8 Adverse events. 172 Analysis 5.1. Comparison 5 Herbal medicines plus conventional therapy versus conventional therapy, Outcome 1 ALT (IU/L)..................................... 172 Herbal medicines for fatty liver diseases (Review) i Copyright © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. Analysis 5.2. Comparison 5 Herbal medicines plus conventional therapy versus conventional therapy, Outcome 2 AST (IU/L)..................................... 173 Analysis 5.3. Comparison 5 Herbal medicines plus conventional therapy versus conventional therapy, Outcome 3 GGT (IU/L)..................................... 173 Analysis 5.4. Comparison 5 Herbal medicines plus conventional therapy versus conventional therapy, Outcome 4 Hepatic ultrasound without improvement. 174 Analysis 6.1. Comparison 6 Herbal medicines plus lifestyle intervention versus conventional therapy plus lifestyle intervention,Outcome1ALT(IU/L). 175 Analysis 6.2. Comparison 6 Herbal medicines plus lifestyle intervention versus conventional therapy plus lifestyle intervention,Outcome2AST(IU/L). 177 Analysis 6.3. Comparison 6 Herbal medicines plus lifestyle intervention versus conventional therapy plus lifestyle intervention, Outcome 3 GGT (IU/L). 182 Analysis 6.4. Comparison 6 Herbal medicines plus lifestyle intervention versus conventional therapy plus lifestyle intervention, Outcome 4 L/S CT ratio. 185 Analysis 6.5. Comparison 6 Herbal medicines plus lifestyle intervention versus conventional therapy plus lifestyle intervention, Outcome 5 Ultrasound without improvement. ................ 186 Analysis 6.6. Comparison 6 Herbal medicines plus lifestyle intervention versus conventional therapy plus lifestyle intervention, Outcome 6 Ultrasound: proximal diffuse high echogenic dots. 187 Analysis 6.7. Comparison 6 Herbal medicines plus lifestyle intervention versus conventional therapy plus lifestyle intervention, Outcome 7 Ultrasound: distal end echo attenuation................. 187 Analysis 6.8. Comparison 6 Herbal medicines plus lifestyle intervention versus conventional therapy plus lifestyle intervention, Outcome 8 Ultrasound: unclear hepatic vessel structure. 188 Analysis 6.9. Comparison 6 Herbal medicines plus lifestyle intervention versus conventional therapy plus lifestyle intervention, Outcome 9 Ultrasound: reduction of blood flow. ................ 188 Analysis 6.10. Comparison 6 Herbal medicines plus lifestyle intervention versus conventional therapy plus lifestyle intervention, Outcome 10 Liver CT without improvement. .............. 189 Analysis 6.11. Comparison 6 Herbal medicines plus lifestyle intervention versus conventional therapy plus lifestyle intervention, Outcome 11 Adverse events. ........ 189 Analysis 6.12. Comparison 6 Herbal medicines plus lifestyle intervention versus conventional therapy plus lifestyle intervention, Outcome 12 Ultrasound: liver score. ............ 190 Analysis 7.1. Comparison 7 Herbal medicines plus lifestyle intervention plus conventional therapy versus lifestyle intervention plus conventional therapy, Outcome 1 Liver/spleenCTratio.. 190 Analysis 7.2. Comparison 7 Herbal medicines plus lifestyle intervention plus conventional therapy versus lifestyle intervention plus conventional therapy, Outcome 2 ALT (U/L). .............. 191 Analysis 7.3. Comparison 7 Herbal medicines plus lifestyle intervention plus conventional therapy versus lifestyle intervention plus conventional therapy, Outcome 3 AST (U/L). .............. 192 Analysis 7.4. Comparison 7 Herbal medicines plus lifestyle intervention plus conventional therapy versus lifestyle intervention plus conventional therapy, Outcome 4 GGT (U/L). .............. 193 Analysis 7.5. Comparison 7 Herbal medicines plus lifestyle intervention plus conventional therapy versus lifestyle intervention plus conventional therapy, Outcome 5 Ultrasound: liver echo intensity. 194 Analysis 7.6. Comparison 7 Herbal medicines plus lifestyle intervention plus conventional therapy versus lifestyle intervention plus conventional therapy, Outcome 6 Abnormal ultrasound. 195 Analysis 7.7. Comparison 7 Herbal medicines plus lifestyle intervention plus conventional therapy versus lifestyle intervention plus conventional therapy, Outcome 7 Liver CT value. ............... 195 Analysis 7.8. Comparison 7 Herbal medicines plus lifestyle intervention plus conventional therapy versus lifestyle intervention plus conventional therapy, Outcome 8 Adverse events. ............... 196 ADDITIONALTABLES. 196 APPENDICES ..................................... 242 CONTRIBUTIONSOFAUTHORS . 248 DECLARATIONSOFINTEREST . 248 SOURCESOFSUPPORT . 248 DIFFERENCES BETWEEN PROTOCOL AND REVIEW . .... 249 INDEXTERMS .................................... 249 Herbal medicines for fatty liver diseases (Review) ii Copyright © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. [Intervention Review] Herbal medicines for fatty liver diseases Zhao Lan Liu1, Liang Zhen Xie2, Jiang Zhu3, George Q Li4, Suzanne J Grant5, Jian Ping Liu1 1Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China. 2First Hospital Affiliated to Heilongjiang University of Traditional Chinese Medicine, Haerbin, Heilongjiang Province, China. 3College of Humanities, Beijing University of Chinese Medicine, Beijing, China. 4Faculty of Pharmacy, University of Sydney, Sydney, Australia. 5Center for Comple- mentary Medicine Research, University of Western Sydney, Sydney, Australia Contact address: Jian Ping Liu, Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, 11 Bei San Huan Dong Lu, Chaoyang District, Beijing, 100029, China. [email protected]. Editorial group: Cochrane Hepato-Biliary Group.