Intervention and Co-intervention/Comparator

CHM were administrated orally as decoction in 21 studies, as granules in three studies (103, 105, 106), as capsules in one study (107) and one study (108) did not report the preparation type (see Table 1). Although CHM formulae were diverse across the studies (see Table 6.2), the most frequently used herbs were fang feng 防风 (Saposhnikovia divaricata [Turcz.]

Schischk.) (19 studies), gan cao 甘草 (Gycyrrhiza spp) (17 studies), dang gui 当归 (Angelica sinensis [Oliv.] Diels.) (13 studies), huang qi 黄芪 (Astragalus membranaceus [Fisch.]) (13 studies) and jing jie 荆芥 (Schizonepeta tenuifolia Briq.) (13 studies). All studies used second-generation H1-antihistamines as the comparator, most commonly cetirizine, levocetirizine or loratadine. Oral administration of antihistamines was administered in dosages of five milligrams (mg) or 10 mg daily.

Figure 6.1: PRISMA Flow Chart of Study Selection Process: Chinese Herbal Medicine v.

Second-Generation Antihistamines for Chronic Urticaria

Notes: CHM: Chinese herbal medicine; RCT: randomised controlled trial

ScreeningIdentificationEligibilityIncluded

Records identified through Chinese language database

searching (n = 6,146)

Records identified through English language database

searching (n = 1,483)

Records identified through other sources (n = 2)

RCTs included in meta-analysis (n = 26)

Full-text articles assessed for eligibility (n = 1,925)

Records after duplicates removed (n = 5,666)

Title and abstract screened (n = 5,666)

RCTs included in review (n = 26)

Records excluded (n = 3,741)

Full-text articles excluded, with reasons (n = 1,899)

Not chronic urticaria (n = 613) Not CHM (n = 353)

CHM as add-on (n = 131) Not comparator recommended by international guideline (n = 207)

Not defined outcome (n = 493) Not clinical studies (n = 39) Not RCT (n = 47)

Not in English or Chinese (n = 3)

Not meeting inclusion criteria (n = 4)

Duplicate in Chinese language database (n = 9)

Table 6.1: Characteristics of Included Randomised Controlled Trials: Chinese Herbal Medicine v. Antihistamines for Chronic Urticaria

Intervention Control Adverse

events

First

Intervention Control Adverse

events

First

Intervention Control Adverse

events

First

Intervention Control Adverse

events

First

Intervention Control Adverse

events

First

Intervention Control Adverse

events

First

Intervention Control Adverse

events

Notes: C: Control; I: Intervention; m: months; mg: milligram; ml: milliliter; NS: not stated; po: administrated orally; qd: once daily; qn: once per night; tid: three times daily;

w: weeks, y: years.

Table 6.2: Details of Chinese Herbal Medicine Formula: Chinese Herbal Medicine v. Antihistamines for Chronic Urticaria First author,

publication year

Key ingredients of Chinese herbal medicine

Bian XL 2006 (107) Dan long zhi yang jiao nang (capsule): he shou wu, bai shao, mu dan pi, di long, quan xie, bai xian pi, and other (NS) Chen H 2009 (109) Gui zhi tang modification: huang qi, gui zhi, bai shao, dang gui, sheng jiang, fang feng, mu dan pi, quan xie, da zao,

zhi gan cao

Chen XJ 2009 (101) Dang gui yin zi (modified): dang gui, mu dan pi, bai shao, sheng di huang, bai ji li, huang qi, jing jie, fang feng, he shou wu, ji xue teng, yu zhu

Huang N 2011 (110) Qu shi hua zhi jie du tang: fu ping, xu chang qing, wei ling xian, dan shen, ji xue teng, san qi, sheng di huang, tu fu ling, bai xian pi, chen pi, hua shi, gan cao

Jin RJ 2006 (111) Wu wei zi tang: wu wei zi, fang feng, bai zhu, bai shao, huang qi, dang shen, gui zhi, zhi gan cao, sheng jiang, da zao Kong DY 2015 (105) Yu ping feng san modification: huang qi, jing jie, dang gui, bai zhu, fang feng, chen pi, fu ling, gui zhi, da fu pi, sang

bai pi, gan cao

Li AJ 2012 (112) Ma huang fu zi xi xin tang modification: ma huang, fu zi, xi xin, dang gui, he shou wu

Li JY 2009 (103) Kang guo min ke li (granule): jing jie, fang feng, huang qin, huang bo, ku shen, bai xian pi, zi cao, di fu zi, chan tui, bai zhu, gan cao

Li YB 2013 (102) Man xun yin: huang qi, bai xian pi, fang feng, wu wei zi

Luo B 2006 (106) Xiao feng zhi yang ke li : huang qi, fang feng, jing jie, mu dan pi, bai ji li, fu ping, bai zhu, yin chai hu, zi cao, zhi gan cao and other (NS)

Luo MY 2006 (113) Kang xun fang: sheng di huang, bai shao, dang gui, chuan xiong, jing jie, fang feng, he shou wu, bai ji li, gan cao Shi CR 2013 (99) Dang gui yin zi: dang gui, bai shao, chuan xiong, sheng di huang, bai ji li, fang feng, jing jie, he shou wu, huang qi,

zhi gan cao

Wang HL 2010 (104) Ma huang lian qiao chi xiao dou tang: ma huang, lian qiao, xing ren, sang bai pi, sheng jiang, chi xiao dou, zhi gan cao, da zao

Wang L 2006 (115) Shu feng chu shi tang: jing jie, fang feng, yi yi ren, zhi ke, bai zhu, huang bo, sang ye, xu chang qing, sheng di huang, yin chen, gan cao

Wo LY 2008 (116) Self-designed Ping min jian modification: long gu, mu li, he shou wu, chai hu, fang feng, jing jie, bai xian pi, jiang can, zhi ke, fu ping, wu mei, wu wei zi, mu dan pi, di gu pi, dang gui

Wu H 2003 (114) Yu ping feng guo min jian: huang qi, bai zhu, fang feng, wu mei, wu wei zi, yin chai hu, zhi gan cao

Xiao HL 2002 (117) Dang gui yin zi: dang gui, bai shao, chuan xiong, sheng di huang, bai ji li, fang feng, jing jie, he shou wu, huang qi, gan cao

First author, publication year

Key ingredients of Chinese herbal medicine

Xue CL 2009 (100) Kang man min jian: chai hu, bai shao, fang feng, chan tui, di long, bai xian pi, tu fu ling, lian qiao, mu dan pi, huang qi, dang shen, bai zhu, dang gui, gan cao

Yan X 2009 (118) Xiao xun fang: gui zhi, bai shao, di fu zi, sang bai pi, di gu pi, bai zhu, chi shao, gan cao

Yang GH 2012 (120) Yang zhen tang: sheng di huang, dang gui, bai shao, sang ji sheng, chuan xiong, jing jie, fang feng, cang zhu, ku shen, zhi mu, niu bang zi, chan tui, gan cao

Yang SR 2014 (121) Ma xing shi gan tang modification: ma huang, xing ren, shi gao, gan cao, shui niu jiao, xiao hong shen, bai xian pi, di fu zi, sheng di huang, mu dan pi, jiu li guang, bai hua she she cao

Yu GH 2009 (119) Ping min jian modification: long gu, mu li, he shou wu, chai hu, fang feng, jing jie, bai xian pi, jiang can, zhi ke, fu ping, wu mei, wu wei zi, mu dan pi, di gu pi, dang gui

Zhang BX 2013 (123) Ma huang lian qiao chi xiao dou tang plus modified Dang gui yin zi: ma huang, lian qiao, he shou wu, bai ji li, sang bai pi, sheng di huang, di gu pi, fu ling pi, chi xiao dou, fang feng, jing jie, huang qi, dang gui, chi shao, zhi zi, da qing ye, bai zhu, chan tui, bian dou yi, chuan xiong

Zhang CJ 2011(108) Shu gan huo xue qu feng fang: chai hu, dang gui, chi shao, hong hua, bai zhu, chen pi, fang feng, jiang can, bai ji li, he huan pi

Zhang EH 2007 (122) Guo min jian modification: jing jie, fang feng, yin chai hu, wu wei zi, wu mei, huang qi, bai zhu, huang qin, gan cao Zhu WR 2011 (124) Di shen qu feng he ji: sheng di huang, ku shen, cang er zi, and other (NS)

Notes: NS: not stated