Is Oral Administration of Chinese Herbal Medicine Effective and Safe as an Adjunctive Therapy for Managing Diabetic Foot Ulcers? A Systematic Review and Meta-Analysis

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Abstract
Objective: This meta-analysis aimed to assess the effectiveness and safety of Chinese herbal medicine (CHM) as an adjunctive method to standard therapy for patients with diabetic foot ulcers (DFU). Methods: Randomized controlled trials (RCTs) of CHM to treat DFU were searched in the following electronic databases: MEDLINE®; EMBASE; Chinese Biomedical Database (CBM); Cochrane Central Register of Controlled Trials (CENTRAL); Allied & Complementary Medicine Resources (AMED); and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Two (2) researchers independently assessed the quality and validity of included trials and extracted outcome data for synthesis. Results: Six (6) trials were included for analysis. Compared to using standard therapy alone, CHM combined with standard therapy significantly increased the number of patients whose ulcers healed (risk ratio [RR], 0.62, [95% confidence interval (CI), 0.39–0.97]) and number of patients with at least a 30% reduction in the ulcer area (RR, 0.81 [95%CI, 0.71–0.92]). In addition, the two therapies combined significantly decreased the number of patients without any improvement (RR, 0.34 [95%CI, 0.21–0.53]). However, with respect to blood flow volume in the dorsal artery of the foot, no significant difference between the two therapies was observed (standardized mean difference, 1.71 [95% CI −1.25–4.67]), but the result favored the CHM combined with standard therapy group. Only 2 of 6 trials reported adverse events, which included nausea, epigastric pain, and dry mouth. Conclusions: CHM may be effective and safe as an adjunctive therapy for treating DFU. However, a firm conclusion could not be reached because of the poor quality of the included trials. Further trials with higher quality are justified.

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