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JKM > Volume 41(3); 2020 > Article
Song, Kim, and Nam: Benefit of chuna for managing symptoms in chronic fatigue syndrome patients: A systematic review and meta-analysis

Abstract

Objectives

The aim of this review is to assess the clinical benefit of chuna for managing symptoms in chronic fatigue syndrome (CFS)

Methods

We searched eligible studies from the following 11 databases with no language restriction: Pubmed, CENTRAL, Embase, CNKI, CQVIP, Wanfang, CiNii, OASIS, RISS and Koreamed. We selected randomized controlled trial (RCT), quasi-randomized controlled trial (Quasi-RCT) and controlled clinical trial (CCT) in which patients with chronic fatigue syndrome were treated with chuna. The results of the included studies were synthesized through meta-analysis, and their risk of bias were also assessed.

Results

We searched 914 potentially relevant studies, and only 20 studies were selected for this systematic review. Meta-analysis showed that chuna was more effective in improving general symptoms (n=291, RR 0.19 [95% CI 0.11 to 0.32], Z=6.08, p<0.00001, I2=0%), fatigue (n=487, SMD −0.95 [95% CI −1.19 to −0.71], Z=7.76, p<0.00001, I2=37%) and sleep disorder (n=139, SMD −0.58 [95% CI −0.92 to −0.24], Z=3.36, p=0.0008, I2=0%) compared to health supplements or usual care. When chuna was used as an added intervention, it was more effective in improving general symptoms(n=729, RR 0.25 [95% CI 0.15 to 0.42], Z=5.19, p<0.00001, I2=0%) and fatigue severity alone(n=217, SMD −1.21 [95% CI −1.53 to −0.89], Z=7.45, p<0.00001, I2=15%) compared to control.

Conclusion

We found that chuna was beneficial for improving severity of general symptoms and fatigue at post treatment in CFS patients.

Notes

이 연구는 보건복지부 한의약선도기술개발사업 한의표준임상진료지침개발사업(HB16C0055)의 지원에 의하여 이루어졌습니다. This work was supported by the Traditional Korean Medicine R&D Program, which was funded by the Ministry of Health and Welfare, Korea, through the National Development Institute of Korean Medicine (HB16C0055).

Fig. 1
PRISMA chart
jkm-41-3-205f1.gif
Fig. 2
(A) Risk of bias and (B) funnel plot for effectiveness. KM means Korea medicine.
jkm-41-3-205f2.gif
Fig. 3
Forest plots of effectiveness. Chuna as (A) a single intervention and (B) an added intervention.
jkm-41-3-205f3.gif
Fig. 4
Forest plots of fatigue severity. Chuna as (A) a single intervention and (B) an added intervention.
jkm-41-3-205f4.gif
Table 1
Summary table of the included studies.
Author Year Diagnostic criteria No. of case (male : female) [experimental : control] Intervention Outcomes Adverse event

Experimental control Duration
E JS36) 2005 CDC 1988 64 (46:18) [33:31] Chuna+acupuncture Acupuncture 2 months Effectiveness N.R.
Zhao XD18) 2008 CDC 1988 60 (38:22) [30:30] Chuna Health supplements 4 weeks Effectiveness N.R.
Lei W20) 2011 CDC 1994 60(17:43) [30:30] Chuna+cupping Cupping 1 month Effectiveness, Fatigue severity N.A.E.
Wang Y21) 2011 CDC 1994 52 (20:32) [26:26] Chuna+SGT SGT 30 days Effectiveness N.R.
Chen YQ19) 2011 CDC 1994 129 (66:63) [65:64] Chuna+SGT+SST SGT+SST 2 months Effectiveness N.R.
Yao F22) 2012 CDC 1994 100 [50:50] Chuna Usual care 46 days Fatigue severity N.R.
Yao F28) 2013 CDC 1994 60 [30:30] Chuna Usual care 10 days Sleep disorder N.R.
Xiang H27) 2013 CDC 1988 82 [41:41] Chuna+acupuncture Acupuncture 2 months Effectiveness N.R.
Peng L26) 2013 N.R. 120 (49:71) [60:60] Chuna+SYS SYS 3 months Effectiveness N.R.
Fan YX23) 2013 CDC 1994 86 (34:52) [43:43] Chuna+acupuncture Acupuncture 22 days Effectiveness N.R.
Mao W25) 2013 CDC 1994 60 (25:35) [30:30] Chuna+acupuncture Acupuncture 6 weeks Effectiveness, Fatigue severity N.R.
Qi L30) 2014 CDC 1994 54 (22:32) [27:27] Chuna+usual care Usual care 10 days Sleep disorder N.R.
Chen H29) 2014 CDC 1994 51 (18:33) [27:24] Chuna Usual care 2 months Effectiveness, Fatigue severity N.R.
Qian LF37) 2016 CDC 2003 60 [30:30] Chuna+usual care Usual care 8weeks Fatigue severity, Sleep disorder N.R.
Wang HG31) 2016 CDC 1994 79 (40:39) [39:40] Chuna Usual care 10 days Fatigue severity, Sleep disorder N.A.E.
He CL24) 2013 CDC 1994 61 (23:38) [30:31] Chuna+scraping Scraping 2 weeks Effectiveness N.A.E.
Chen FT32) 2017 CDC 1994 60 (35:25) [31:29] Chuna Health supplements 4 weeks Effectiveness, Fatigue severity N.R.
Xu YX34) 2018 CDC 1994 73 (22:51) [37:36] Chuna+usual care Usual care 4 weeks Fatigue severity, Sleep disorder N.R.
Wang J33) 2018 CDC 1994 120 (70:50) [60:60] Chuna Usual care 15 days Effectiveness N.R.
Tang XN35) 2019 CDC 1994 40 (16:24) [20:20] Chuna+moxibustion moxibustion 3 weeks Effectiveness, Fatigue severity N.R.

SJT means seogeun-tang (舒筋湯); SGT, Sagunja-tang (四君子湯); SST, Sihosogan-tang (柴胡疏肝湯); SYS, Soyo-san (逍遙散); N.A.E., no adverse event; N.R., not reported.

Table 2
The Quality of evidence.
Outcome Certainty assessment Summary of findings

Study design Risk of bias Inconsistency Indirectness Imprecision Other considerations Effect (95% CI) Certainty
Effectiveness Chuna versus health supplements or usual care: 4 studies
RCT Seriousa Not seriousb Not seriousc Not seriousd Nonee RR 0.19 (0.11 ~ 0.32) ⊖⊖⊖○ MODERATE

Chuna versus health supplements: 2 studies
RCT Seriousa Not seriousb Not seriousc Seriousf Nonee RR 0.16 (0.05~ 0.52) ⊖⊖○○ LOW

Chuna versus usual care: 2 studies
RCT Seriousa Not seriousb Not seriousc Seriousf Nonee RR 0.19 (0.11 ~ 0.36) ⊖⊖○○ LOW

Chuna added to KM interventions versus KM interventions: 10 studies
RCT Seriousa Not seriousb Not seriousc Not seriousd Nonee RR 0.25 (0.15 ~ 0.42) ⊖⊖⊖○ MODERATE

Fatigue Chuna versus health supplements or usual care: 4 studies
RCT Seriousa Not seriousb Not seriousc Not seriousg Nonee SMD −0.73(−0.98 ~ −0.48) ⊖⊖⊖○ MODERATE

Chuna versus health supplements: 1 study
RCT Seriousa Serioush Not seriousc Seriousi Nonee SMD −0.85 (−1.38 ~ −0.32) ⊖○○○ VERY LOW

Chuna versus usual care: 3 studies
RCT Not seriousj Not seriousb Not seriousc Not seriousg Nonee SMD −0.69 (−0.97 ~ −0.41) ⊖⊖⊖⊖ HIGH

Chuna added to KM interventions or usual care versus control: 4 studies
RCT Seriousa Not seriousb Not seriousc Not seriousg Nonee SMD −1.21 (−1.53 ~ −0.89) ⊖⊖⊖○ MODERATE

Chuna added to KM interventions versus KM interventions: 3 studies
RCT Seriousa Not seriousb Not seriousc Seriousi Nonee SMD −1.29 (−1.70 ~ −0.87) ⊖⊖○○ LOW

Chuna added to usual care versus usual care: 1 study
RCT Seriousa Serioush Not seriousc Seriousi Nonee SMD −1.02 (−1.56 ~ −0.48) ⊖○○○ VERY LOW

Sleep disorder Chuna versus usual care: 2 studies
RCT Not seriousj Not seriousb Not seriousc Seriousi Nonee SMD −0.58 (−0.92 ~ −0.24) ⊖⊖⊖○ MODERATE

Chuna added to usual care versus usual care: 3 studies
RCT Not seriousj Very seriousk Not seriousc Seriousi None SMD −1.47 (−2.43 ~ −0.51) ⊖○○○ VERY LOW

RCT means randomized controlled trial; CI, confidence interval; RR, relative risk; SMD, standardized mean difference; KM, Korean medicine.

a the proportion of studies assessed as low risk of bias was between 30% and 50%;

b I2 was less than 50%;

c directness was undoubted;

d total sample size was more than 200, and 95% CI of RR did not cross 1;

e publication bias was not assessed;

f total sample size was less than 200, but 95% CI of RR did not cross 1;

g total sample size was more than 200, and 95% CI of SMD did not cross zero;

h only 1 study was included;

i total sample size was less than 200, but 95% CI of SMD did not cross zero;

j the proportion of studies assessed as low risk of bias was more than 50%;

k I2 was more than 75%;

l total sample size was less than 100, and 95% CI of SMD crossed zero.

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