Review
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 21, 2015; 21(15): 4466-4490
Published online Apr 21, 2015. doi: 10.3748/wjg.v21.i15.4466
Herbal traditional Chinese medicine and its evidence base in gastrointestinal disorders
Rolf Teschke, Albrecht Wolff, Christian Frenzel, Axel Eickhoff, Johannes Schulze
Rolf Teschke, Axel Eickhoff, Department of Internal Medicine II, Division of Gastroenterology and Hepatology, Klinikum Hanau, Teaching Hospital of the Medical Faculty of the Goethe University Frankfurt/Main, D-63450 Hanau, Germany
Albrecht Wolff, Department of Internal Medicine II, Division of Gastroenterology, Hepatology and Infectious Diseases, Friedrich Schiller University Jena, D-07747 Jena, Germany
Christian Frenzel, Department of Medicine I, University Medical Center Hamburg Eppendorf, D-20246 Hamburg, Germany
Johannes Schulze, Institute of Industrial, Environmental and Social Medicine, Medical Faculty of the Goethe University Frankfurt/Main, D-60591 Frankfurt/Main, Germany
Author contributions: Teschke R had the idea for this work; Wolff A, Frenzel C and Eickhoff A designed the report and performed the literature search; Eickhoff A and Schulze J analyzed the publications; Schulze J provided the tables; Teschke R and Schulze J wrote the paper.
Conflict-of-interest: None of the authors has a conflict of interest in relation to the preparation of this work.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Rolf Teschke, MD, Professor, Department of Internal Medicine II, Division of Gastroenterology and Hepatology, Klinikum Hanau, Teaching Hospital of the Medical Faculty of the Goethe University Frankfurt/Main, Leimenstrasse 20, D-63450 Hanau, Germany. rolf.teschke@gmx.de
Telephone: +49-61-8121859
Received: November 22, 2014
Peer-review started: November 23, 2014
First decision: January 8, 2015
Revised: January 22, 2015
Accepted: February 11, 2015
Article in press: February 11, 2015
Published online: April 21, 2015
Processing time: 148 Days and 18.2 Hours
Abstract

Herbal traditional Chinese medicine (TCM) is used to treat several ailments, but its efficiency is poorly documented and hence debated, as opposed to modern medicine commonly providing effective therapies. The aim of this review article is to present a practical reference guide on the role of herbal TCM in managing gastrointestinal disorders, supported by systematic reviews and evidence based trials. A literature search using herbal TCM combined with terms for gastrointestinal disorders in PubMed and the Cochrane database identified publications of herbal TCM trials. Results were analyzed for study type, inclusion criteria, and outcome parameters. Quality of placebo controlled, randomized, double-blind clinical trials was poor, mostly neglecting stringent evidence based diagnostic and therapeutic criteria. Accordingly, appropriate Cochrane reviews and meta-analyses were limited and failed to support valid, clinically relevant evidence based efficiency of herbal TCM in gastrointestinal diseases, including gastroesophageal reflux disease, gastric or duodenal ulcer, dyspepsia, irritable bowel syndrome, ulcerative colitis, and Crohn’s disease. In conclusion, the use of herbal TCM to treat various diseases has an interesting philosophical background with a long history, but it received increasing skepticism due to the lack of evidence based efficiency as shown by high quality trials; this has now been summarized for gastrointestinal disorders, with TCM not recommended for most gastrointestinal diseases. Future studies should focus on placebo controlled, randomized, double-blind clinical trials, herbal product quality and standard criteria for diagnosis, treatment, outcome, and assessment of adverse herb reactions. This approach will provide figures of risk/benefit profiles that hopefully are positive for at least some treatment modalities of herbal TCM. Proponents of modern herbal TCM best face these promising challenges of pragmatic modern medicine by bridging the gap between the two medicinal cultures.

Keywords: Evidence based trials; Traditional Chinese medicine; Herbal traditional Chinese medicine; Gastrointestinal disorders

Core tip: This review focuses on evidence based trials of herbal traditional Chinese medicine (TCM) in managing gastrointestinal disorders and presents a practical reference guide on its role for treating these diseases. Overall quality of placebo controlled, randomized, controlled, double-blind clinical trials was poor; mostly neglecting stringent evidence based diagnostic and therapeutic criteria. Accordingly, appropriate Cochrane reviews and meta-analyses were limited and failed to support valid, clinically relevant evidence based efficiency of herbal TCM in most gastrointestinal diseases, including gastroesophageal reflux disease, gastric or duodenal ulcer, dyspepsia, irritable bowel syndrome, ulcerative colitis, and Crohn’s disease. Despite its interesting philosophical background with a long history, the general use of herbal TCM to treat various gastrointestinal diseases cannot be recommended due to lacking evidence based efficiency and a negative risk/benefit profile. Thus, substantial skepticism remains, proposing future studies with focus on well performed placebo controlled, randomized, double-blind clinical trials. Herbal product quality and standard criteria for diagnosis, treatment, and outcome should also be considered.