Herbal Formula Shenling Baizhu San for Chronic Diarrhea in Adults: A Systematic Review and Meta-analysis

Abstract

Background: Shenling Baizhu San (SBS), a well-known Chinese medicine herbal formula, has been widely used for treating chronic diarrhea for thousands of years. However, the efficacy and safety of SBS in treating chronic diarrhea have not been fully assessed. Objective: This study evaluates the efficacy and safety of the herbal formula SBS in symptomatic relief of chronic diarrhea. Methods: English and Chinese language databases (PubMed, Cochrane Library, China National Knowledge Infrastructure, China Science and Technology Journal Database, Wanfang Data, and SinoMed electronic databases) were searched through April 2020 for relevant randomized controlled trials (RCTs). The outcomes in these RCTs included stool frequency, stool consistency, patient-reported satisfaction of chronic diarrhea treatment, quality of life and adverse events. Paired reviewers independently extracted data and conducted qualitative and quantitative analyses. The Cochrane revised risk of bias RoB-2 tool was applied to assess the risk of bias for each trial whereas the RevMan 5.3 software was used for outcomes data synthesis and meta-analysis. Mean difference (MD) and the 95% confidence interval (CI) were used to measure continuous data. The dichotomous data were analyzed via the relative risk (RR) with 95% CIs. Results: Fourteen RCTs including 1158 participants (54% males) with chronic diarrhea were included. Shenling Baizhu San combined with or without conventional medicine (CM) was associated with greater patient-reported satisfaction than CM alone. There was no increased risk of adverse events (AEs) during treatment. Conclusion: Treatment with SBS was associated with significant improvement in patient-reported satisfaction, irrespective of conventional medicine use. Rigorous and powered RCTs with objective outcome measures are needed to confirm the effects of SBS in specific gastrointestinal disease populations with chronic diarrhea symptoms. Systematic review registration number (PROSPERO): CRD42020178073

Integrating Herbal Medicine into Oncology Care Delivery: Development, Implementation and Evaluation of a Novel Program

“…The major challenge in herbal oncology practice lies in the limited evidence of e cacy, despite extensive empirical use in other cultures over long periods of time [35]. To this end, HOP is carefully tracking bene ts and adverse events; we have also simultaneously conducted systematic appraisals of the existing literature on TCM and other CAM products, focusing on assessing the current evidence and identifying limitations and knowledge gaps [16][17][18]. Ultimately, however, more clinical trials are urgently needed to build a robust evidence base for the safety and effectiveness of these therapies in the contemporary oncology setting.…”

“…In collaboration with the MSK pharmacy department, IMS established an herbal formulary and dispensary to offer patients quality-controlled traditional Chinese medicine (TCM) herbal formulas with evidence of empirical use, safety, and preliminary e cacy for mood [14], insomnia [15] and gastrointestinal issues such as constipation or diarrhea [16,17], which are frequently encountered in oncology settings. This herbal formulary was prepared after careful discussions among experienced integrative medicine physicians on common, challenging symptoms encountered in our practice, where conventional medications do not meet the needs of some patients.…”

“…This herbal formulary was prepared after careful discussions among experienced integrative medicine physicians on common, challenging symptoms encountered in our practice, where conventional medications do not meet the needs of some patients. In addition, we reviewed classic herbal medicine textbooks, conducted systematic reviews of the available literature, [16][17][18] and had extensive discussions with TCM oncologists in China, where TCM herbs and formulas are commonly used to treat common cancer-related symptoms and sequelae associated with treatments [19].…”

“…This herbal formulary was prepared after careful discussions among experienced integrative medicine physicians on common, challenging symptoms encountered in our practice, where conventional medications do not meet the needs of some patients. In addition, we reviewed classic herbal medicine textbooks, conducted systematic reviews of the available literature, [16][17][18] and had extensive discussions with TCM oncologists in China, where TCM herbs and formulas are commonly used to treat common cancer-related symptoms and sequelae associated with treatments [19].The formulary was approved by MSK's Pharmaceutical & Therapeutics (P&T) committee with the understanding that all herbal products were to be treated the same as prescription drugs, with identical procedures for stocking, prescribing, and dispensing. An IMS pharmacist with training in both conventional pharmacy and TCM herbology (YNH) then identi ed suppliers.…”

Integrating herbal medicine into oncology care delivery: development, implementation, and evaluation of a novel program

“…In collaboration with the MSK Pharmacy department, IMS established an herbal formulary and dispensary to offer patients quality-controlled traditional Chinese medicine (TCM) herbal formulas with evidence of empirical use, safety, and preliminary efficacy for mood [ 16 ], insomnia [ 17 ], and gastrointestinal issues such as constipation or diarrhea [ 18 , 19 ], which are frequently encountered in oncology settings. This herbal formulary was prepared after careful discussions among experienced integrative medicine physicians on common, challenging symptoms encountered in our practice, where conventional medications do not meet the needs of some patients.…”