Chaihu Shugan San for Non-Alcoholic Fatty Liver Disease: A Systematic Review and Meta-Analysis
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Abstract
Objective: This study aimed to explore the therapeutic efficacy and risk profile of Chaihu Shugan San (CS) as an intervention for non-alcoholic fatty liver disease (NAFLD) through a comprehensive, up-to-date meta-analysis of published randomized controlled trials (RCTs)
Methods: We searched the following databases: PubMed, Web of Science, China Biomedical Literature Database (CBM), VIP, China National Knowledge Infrastructure (CNKI), and Wanfang Data for RCTs on CS for NAFLD from database inception to May 31, 2025. Having been screened according to the pre-defined criteria, the selected studies underwent data extraction and risk of bias assessment. The meta-analysis was conducted utilizing RevMan 5.4 software. Primary outcome measures consisted of overall clinical efficacy rate, liver function, and lipid profiles.
Results: A total of 27 RCTs concerning 2,592 patients were selected. Meta-analysis results demonstrated that in contrast to the control group, CS significantly enhanced the overall clinical efficacy rate (odds ratio(OR) = 4.17, 95% confidence intervals(CI): 3.19–5.47, P < 0.00001, I² = 0%). Regarding liver function, CS significantly reduced aspartate aminotransferase(AST) (mean differences(MD) = -11.44, 95% CI: -14.75 to -8.13, P = 0.0003; I² = 61%), alanine aminotransferase(ALT) (MD = -13.57, 95% CI: -15.64 to -11.49, P < 0.00001; I² = 31%), and γ-glutamyl transpeptadase(GGT) (MD = -10.41, 95% CI: -15.75 to -5.07, P < 0.00001; I² = 0%); Regarding lipid profiles, CS significantly improved total cholesterol(TC) (MD = -1.24, 95% CI: -1.73 to -0.75, P < 0.00001; I² = 92%), triglyceride(TG) (MD = -0.76, 95% CI: -0.98 to -0.53, P < 0.00001; I² = 82%), high-density lipoprotein cholesterol(HDL-C) (MD = 0.26, 95% CI: 0.09–0.42, P < 0.00001; I² = 84%), and reduced low-density lipoprotein cholesterol(LDL-C) (MD = -0.56, 95% CI: -0.96 to -0.15, P < 0.00001; I² = 92%). Subgroup analysis indicated that the use of CS alone demonstrated greater efficacy in reducing liver function indicators (AST and ALT) than CS combined with traditional Chinese medicine, Western medicine, or even a composite of both traditional Chinese and Western medicines. Furthermore, the analysis showed that better outcomes were particularly evident in older patients and those with a shorter duration of disease. No significant adverse reactions were reported in either group.
Conclusion: CS effectively improves multiple liver function and lipid metabolism indicators in NAFLD patients, with superior efficacy in older patients. However, existing evidence primarily stems from studies with small sample sizes or methodological limitations. Future high-quality, large-scale, rigorously designed RCTs are necessary to substantiate its long-term efficacy and safety further.
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References
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