Background: The conventional therapy for chronic hepatitis C is the combination of interferon-alpha and ribavirin. However, it has some adverse effects and does not response to some patients, and it is also very expensive. Objective: To assess the efficacy and safety of Chinese medicinal herbs for chronic hepatitis C virus infection. Search strategy: Electronic and manual searches were conducted and the search ended in July 2009. Inclusion criteria: We included randomized clinical trials testing Chinese herbal medicine vs placebo, non-specific treatment, antiviral treatment, or Chinese herbal medicine combined with antiviral treatment vs antiviral treatment alone. Data extraction and analysis: Selection of trials for inclusion, assessment of methodological quality, data extraction and data syntheses were conducted according to the protocol of a Cochrane systematic review by the authors. Results: Fifty-one randomized trials (involving 3 678 patients) with various methodological quality were included. The studies published in English had good quality, while studies published in Chinese were of poor quality. The pooled results showed that Chinese herbal medicine alone or in combination with antiviral treatment was generally better than non-specific treatment or antiviral treatment alone, and herbal medicine appeared equal to antiviral treatment regarding comprehensive clinical effect in terms of symptoms, liver function and virological response. Regarding virological response including loss of serum hepatitis C virus (HCV) RNA and anti-HCV antibodies, herbal medicine was better than non-specific treatment, equal to antiviral treatment, and the combination of herbs and antiviral treatment was better than antiviral treatment alone. Similar positive findings were found for liver function improvement. Adverse effects were observed among herbal injections and interferon treatment, and few cases had severe adverse effects. Conclusion: Herbal medicines included in this review have effects in improving symptoms, liver function, and loss of HCV markers in patients with chronic hepatitis C. However, for majority of the included trials were published in Chinese and had low quality, the promising effects from some herbs need to be confirmed in rigorous clinical trials, and the design and reporting of trials should follow international standards. Systematic review registration: http://www.cochrane.org, 380700081611301089.

Objectives To assess the efficacy and safety of Xiaoyao Powder (Carefree Powder) in the treatment of depression using the method of systematic review of evidence-based medicine.Method Data published before December 2009 were searched from MEDLINE,Cochrane library,CNKI,VIP,CBM.We included randomize-controlled trials (RCT) testing Xiaoyao Powder against placebo or antidepressants,and Xiaoyao Powder combined with antidepressants against antidepressants alone.Two researchers collected data independently.The assessment of methodological quality was based on Cochrane handbook and the materials were analyzed with software RevMan 5.017.The outcome measure index was relative risk or difference of mean value (95% confidence interval).Results Thirty-two RCTs involving 2 253 patients were included.Involved trials published in Chinese were of low quality.In the trials of comparison between Xiaoyao Powder and placebo,only decrease of self-rating depression scale (SDS) score was not significantly different.For general clinical improvement and decrease of Hamilton rating scale for depression (HAMD) and SDS scores,Xiaoyao Powder combined with antidepressants was more effective than antidepressants alone,but the effect of Xiaoyao Powder was equal to antidepressants.No adverse effect was reported in the trials regarding Xiaoyao Powder.Conclusions Xiaoyao Powder appears to be effective for depression.However,the exact effect needs to be confirmed in well-designed large-sampled clinical trials.

Background: Xiaochaihu Tang was a compound traditional Chinese herbal medicine recorded in ancient Chinese medical book Shanghanlun, and has been widely used for chronic liver diseases especially in Japan. Objective: To assess the beneficial effects and safety of Xiaochaihu Tang, for chronic hepatitis B (CHB). Search strategy: Electronic and manual searches were conducted and the search ended in November 2009. Inclusion criteria: We included randomized clinical trials testing Xiaochaihu Tang against placebo, non-specific treatment, antivirals, or combined with antivirals against antivirals alone. Data extraction and analysis: Selection of trials for inclusion, assessment of methodological quality by Jadad score, data extraction and data syntheses were conducted according to the Cochrane Hepato-Biliary Group methods. Results: Sixteen randomized trials (involving 1 601 CHB patients) with various methodological quality were included. One trial published in English had good quality, while other trials published in Chinese were of poor quality. The pooled results showed that Xiaochaihu Tang combined with antiviral drugs was more effective in serum loss of hepatitis B viral markers and in improving liver function compared with antiviral drugs alone. Xiaochaihu Tang was not different from placebo in terms of viral clearance or improving liver function. However, Xiaochaihu Tang was superior to non-specific treatment in liver function improvement. There were no adverse effects reported in the trials regarding Xiaochaihu Tang, but adverse effects were reported in patients treated by interferon, and severe adverse effects occurred in few cases. Conclusion: Xiaochaihu Tang in this review appears to be effective in improving liver function and clearance of serum hepatitis B viral markers in patients with chronic hepatitis B. However, due to poor methodological quality in the majority of included trials the potential benefits need to be confirmed in rigorous clinical trials following international standards.