Efficacy of traditional Chinese medicine for the management of constipation: a systematic review

OBJECTIVES: The aim of this systematic review was to critically appraise published clinical trials designed to assess the effect of Traditional Chinese Medicine (TCM) on the management of constipation. METHODS: Databases searched included both English and non-English articles published in the Cochrane library, MEDLINE, CINAHL, AMED, EMBASE, China National Knowledge Infrastructure (CNKI), and the Chinese Electronic Periodical Services (CEPS). Studies reviewed included randomized controlled trials and controlled clinical trials. Methodological quality was assessed using the modified Jadad scale. RESULTS: One hundred and thirty-seven (137) studies met the inclusion criteria, of which 21 were high-quality trials (n = 2449). Eighteen (18) were Chinese herbal medicine (CHM) and 3 were acupuncture trials. The primary outcome measure was total effective rate. CHM was more effective than conventional medicines in eight trials. Of the 10 remaining CHM trials, 9 compared the study CHM with another CHM and the results were significant in 4 trials. The effective rate was significantly higher in the intervention group than in the placebo group in the last CHM study. One (1) of the three acupuncture trials compared acupuncture with a conventional medicine, one trial with Sennae folium, and one trial with deeper acupuncture on Tianshu (ST 25). The therapeutic effect in the treatment group was more effective than that in the control group in all three studies. CONCLUSIONS: TCM interventions appear to be useful to manage constipation. Significant positive results were found in 15 high-quality studies. However, only 21 of the 137 publications identified attained high Jadad scores. There was heterogeneity in diagnostic procedures and interventions among the studies. Outcome indicators were also different. Hence, the results should be interpreted cautiously.