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Background Chinese herbal medicine is widely used in combination with usual care for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) in China. Chinese patent medicine Shufeng Jiedu (SFJD) capsules is widely used for respiratory infectious diseases. This review aims to evaluate effectiveness and safety of SFJD for AECOPD. Methods A systematic review of randomised controlled trials (RCTs) in patients with AECOPD, who received SFJD as a single intervention or as add-on treatment to usual care. PubMed, the Cochrane Library, EMBASE, Scopus, Web of Science and four Chinese databases were searched from inception to April 2019. Two authors screened trials, extracted data, and assessed risk of bias, independently. Meta-analysis was performed using RevMan 5.3 software. We performed subgroup analyses and sensitivity analyses according to the predefined protocol. Quality of evidence was assessed using GRADE. Results Thirteen RCTs (1036 patients, with 936 inpatients) were included, all compared SFJD in combination with usual care (including antibiotics) to usual care alone. The mean age of participants ranged from 52 to 67 years, with approximately 60% male. Due to lack of blinding and other factors, all trials were of high risk of bias. SFJD was associated with a significant reduction in treatment failure, from 20.1 to 8.3% (11 trials; 815 patients; relative risk 0.43, 95% confidence interval [CI] 0.30 to 0.62), and duration of hospital stay (2 trials; 79 patients; mean difference − 4.32 days, 95% CI − 5.89 to − 2.75 days). No significant difference in adverse events was found between SFJD and control groups. Conclusion Low certainty evidence suggests SFJD may bring additional benefit in reducing treatment failure, shorten hospital stay, and improving symptoms. Further large, high quality RCTs are needed to confirm its benefit and safety. Trial registration PROSPERO CRD42019133682.

Insomnia is a symptom of physical or mental disorder and refers to decreased sleep time and potentially low quality. There is evidence showing that acupuncture could enhance management of insomnia, and Sanyinjiao (SP 6) is one of the promising acupoints. This review aimed to evaluate the effectiveness of stimulating single acupoint SP 6 in managing insomnia. The study was registered under PROSPERO CRD42019140855. English and Chinese databases were searched for randomized controlled trials on single acupoint SP 6 stimulation in management of insomnia. Quality of methodology was assessed by two authors independently using the Cochrane Risk of Bias Tool, and reporting quality was assessed by the STRICTA checklist. The primary outcome was the Pittsburgh Sleep Quality Index (PSQI), and secondary outcomes were improvement in clinical effect and sleep duration assessed by polysomnogram (PSG). The extracted data were pooled and meta-analyzed with RevMan 5.3 software. Four trials involving 288 participants were included in this review. The findings showed that SP 6 stimulation could improve sleep quality (MD -0.30, 95% CI [-0.52, -0.08]), lengthen deep sleep duration (MD 80.46, 95% CI [56.47, 104.45]), rapid eye movement (REM) duration (MD 91.53, 95% CI [68.41, 114.65]), and increase improvement in clinical effect. Quality of reporting and methodology was limited in all included trials. Some limited evidence showed that single acupoint stimulation of SP 6 could improve sleep quality, lengthen deep sleep and REM duration of patients with insomnia. However, the findings in this review should be interpreted with caution due to methodological limitations.

Background Practitioners who enhance how they express empathy and create positive expectations of benefit could improve patient outcomes. However, the evidence in this area has not been recently synthesised. Objective To estimate the effects of empathy and expectations interventions for any clinical condition. Design Systematic review and meta-analysis of randomised trials. Data sources Six databases from inception to August 2017. Study selection Randomised trials of empathy or expectations interventions in any clinical setting with patients aged 12 years or older. Review methods Two reviewers independently screened citations, extracted data, assessed risk of bias and graded quality of evidence using GRADE. Random effects model was used for meta-analysis. Results We identified 28 eligible (n = 6017). In seven trials, empathic consultations improved pain, anxiety and satisfaction by a small amount (standardised mean difference −0.18 [95% confidence interval −0.32 to −0.03]). Twenty-two trials tested the effects of positive expectations. Eighteen of these (n = 2014) reported psychological outcomes (mostly pain) and showed a modest benefit (standardised mean difference −0.43 [95% confidence interval −0.65 to −0.21]); 11 (n = 1790) reported physical outcomes (including bronchial function/ length of hospital stay) and showed a small benefit (standardised mean difference −0.18 [95% confidence interval −0.32 to −0.05]). Within 11 trials (n = 2706) assessing harms, there was no evidence of adverse effects (odds ratio 1.04; 95% confidence interval 0.67 to 1.63). The risk of bias was low. The main limitations were difficulties in blinding and high heterogeneity for some comparisons. Conclusions Greater practitioner empathy or communication of positive messages can have small patient benefits for a range of clinical conditions, especially pain. Protocol registration Cochrane Database of Systematic Reviews (protocol) DOI: 10.1002/14651858.CD011934.pub2.

Antimicrobial resistance (AMR) is a substantial threat to public health. Safe and effective alternatives are required to reduce unnecessary antibiotic prescribing. Andrographis Paniculata (A. Paniculata, Chuān Xīn Lián) has traditionally been used in Indian and Chinese herbal medicine for cough, cold and influenza, suggesting a role in respiratory tract infections (RTIs). This systematic review aimed to evaluate the clinical effectiveness and safety of A. Paniculata for symptoms of acute RTIs (ARTIs).English and Chinese databases were searched from their inception to March 2016 for randomised controlled trials (RCTs) evaluating oral A. Paniculata without language barriers (Protocol ID: CRD42016035679). The primary outcomes were improvement in ARTI symptoms and adverse events (AEs). A random effects model was used to pool the mean differences and risk ratio with 95% CI reported. Methodological quality was evaluated using the Cochrane risk of bias tool; two reviewers independently screened eligibility and extracted data.Thirty-three RCTs (7175 patients) were included. Most trials evaluated A. Paniculata (as a monotherapy and as a herbal mixture) provided commercially but seldom reported manufacturing or quality control details. A. Paniculata improved cough (n = 596, standardised mean difference SMD: -0.39, 95% confidence interval CI [-0.67, -0.10]) and sore throat (n = 314, SMD: -1.13, 95% CI [-1.37, -0.89]) when compared with placebo. A. Paniculata (alone or plus usual care) has a statistically significant effect in improving overall symptoms of ARTIs when compared to placebo, usual care, and other herbal therapies. Evidence also suggested that A. Paniculata (alone or plus usual care) shortened the duration of cough, sore throat and sick leave/time to resolution when compared versus usual care. No major AEs were reported and minor AEs were mainly gastrointestinal. The methodological quality of included trials was overall poor.A. Paniculata appears beneficial and safe for relieving ARTI symptoms and shortening time to symptom resolution. However, these findings should be interpreted cautiously owing to poor study quality and heterogeneity. Well-designed trials evaluating the effectiveness and potential to reduce antibiotic use of A. Paniculata are warranted.

Background GV26 is well known as an emergency and a revival acupoint. It has been most commonly used for acute neurological conditions and acute low back strain (ALBS). This systematic review evaluates the effectiveness and occurrence of adverse effects of using GV26 for a variety conditions; and to determine the appropriate parameters to inform its use in practice. Methods Randomized controlled trials evaluating stimulation of GV26 as a sole or as an adjunct to treatment for any condition were included. Quality of reporting and methodology were assessed using STRICTA and the Cochrane risk of bias tool. Meta-analysis was pooled with RevMan 5.2 software (Protocol ID: CRD42013006528). Results Fifteen trials investigated conditions which included shock, epilepsy, vascular dementia, febrile seizures in children, post general anesthesia, acute low back strain, functional enuresis, and intractable hiccups. The reporting quality and methodological quality of all included trials was limited. Data from eleven trials were pooled. Significant favorable improvements were shown for GV26 used in addition to other common acupoints as measured by efficacy rate; GV26 in addition to usual care as measured by blood pressure. No study reported any adverse effects. Conclusions There appears to be evidence on the use of GV26 for improving efficacy rate in ALBS, functional enuresis and intractable hiccups, and it appears to be effective in increasing blood pressure and reducing heart rate during revival. However, the findings should be interpreted with caution due to the limited methodological quality of included trials.

Introduction: antimicrobial resistance (AMR) is a substantial threat to public health. Safe and effective alternatives are required to reduce unnecessary antibiotic prescribing. Andrographis Paniculata (A. Paniculata, Chuān Xīn Lián) has traditionally been used in Indian and Chinese herbal medicine for cough, cold and influenza, suggesting a role in respiratory tract infections (RTIs). This systematic review aimed to evaluate the clinical effectiveness and safety of A. Paniculata for symptoms of acute RTIs (ARTIs).Materials and methods: English and Chinese databases were searched from their inception to March 2016 for randomised controlled trials (RCTs) evaluating oral A. Paniculata without language barriers (Protocol ID: CRD42016035679). The primary outcomes were improvement in ARTI symptoms and adverse events (AEs). A random effects model was used to pool the mean differences and risk ratio with 95% CI reported. Methodological quality was evaluated using the Cochrane risk of bias tool; two reviewers independently screened eligibility and extracted data.Results: thirty-three RCTs (7175 patients) were included. Most trials evaluated A. Paniculata (as a monotherapy and as a herbal mixture) provided commercially but seldom reported manufacturing or quality control details. A. Paniculata improved cough (n = 596, standardised mean difference SMD: -0.39, 95% confidence interval CI [-0.67, -0.10]) and sore throat (n = 314, SMD: -1.13, 95% CI [-1.37, -0.89]) when compared with placebo. A. Paniculata (alone or plus usual care) has a statistically significant effect in improving overall symptoms of ARTIs when compared to placebo, usual care, and other herbal therapies. Evidence also suggested that A. Paniculata (alone or plus usual care) shortened the duration of cough, sore throat and sick leave/time to resolution when compared versus usual care. No major AEs were reported and minor AEs were mainly gastrointestinal. The methodological quality of included trials was overall poor.Conclusions: A. Paniculata appears beneficial and safe for relieving ARTI symptoms and shortening time to symptom resolution. However, these findings should be interpreted cautiously owing to poor study quality and heterogeneity. Well-designed trials evaluating the effectiveness and potential to reduce antibiotic use of A. Paniculata are warranted.

Introduction Epilepsy is a chronic brain disorder with high morbidity and mortality. Self-management for epileptic patients is a complex and targeted process requiring taking medication, tracking seizures, ensuring medication adherence, managing negative events, adapting to the environment, keeping healthy lifestyle and maintaining good relationship with family and friends. An increasing number of studies have reported that self-management has become an important adjuvant for controlling epilepsy. However there have been no systematic reviews carried out to evaluate the effectiveness of self-management to improve the quality of life in adult epileptics. Methods Randomized controlled trials on self-management for adult epilepsy were included. Web of Science, PubMed, Science Direct, Cochrane Library, CNKI, VIP and Wanfang databases were searched. Reporting quality of trials was assessed by two reviewers independently using the Cochrane Risk of Bias Tool. The study was registered on PROSPERO registration number CRD42017078356. Results Eleven trials involving 1217 participants were identified. Meta-analysis showed that self-management interventions could improve quality of life (SMD 0.69, 95% CI [0.26, 1.11]; I2 = 90%), reduce depression (SMD −0.31, 95% CI [−0.60, −0.01]; I2 = 78%), increase self-efficacy (SMD 0.52, 95% CI [0.34, 0.69]; I2 = 44%) and self-management (MD 3.35, 95% CI [0.33, 6.37]; I2 = 87%), and improve medical adherence (MD 0.21, 95% CI [0.06, 0.36]; I2 = 0%) for adult epileptics, but had no effect on seizure frequency (MD −0.73, 95% CI [−5.63, 4.16]; I2 = 54%) and negative health events (MD −2.30, 95% CI [−8.31, 3.27]; I2 = 71%). Reporting and methodological quality was limited for all included trials. Conclusion Self-management may be effective in improving for quality of life in adult epileptics. However, these findings should be interpreted with caution due to the methodological quality of included trials. Furthermore, strict trials with precise methodological design and rigorous reporting on clinical efficacy and adverse events controlling self-management for epilepsy may be promising.

Low back pain (LBP) is a common musculoskeletal condition often treated using integrative medicine (IM). Most reviews have focused on a single complementary and alternative medicine (CAM) therapy for LBP rather than evaluating wider integrative approaches. This exploratory systematic review aimed to identify randomized controlled trials (RCTs) and provide evidence on the effectiveness, cost effectiveness and adverse effects of integrative treatment for LBP.A literature search was conducted in 12 English and Chinese databases. RCTs evaluating an integrative treatment for musculoskeletal related LBP were included. Reporting, methodological quality and relevant clinical characteristics were assessed and appraised. Metaanalyses were performed for outcomes where trials were sufficiently homogenous.Fifty-six RCTs were identified evaluating integrative treatment for LBP. Although reporting and methodological qualities were poor, meta-analysis showed a favourable effect for integrative treatment over conventional and CAM treatment for back pain and function at 3 months or less follow-up. Two trials investigated costs, reporting £ 5332 per quality adjusted life years with 6 Alexander technique lessons plus exercise at 12 months follow-up; and an increased total costs of $244 when giving an additional up to 15 sessions of CAM package of care at 12 weeks. Sixteen trials mentioned safety; no severe adverse effects were reported.Integrative treatment that combines CAM with conventional therapies appeared to have beneficial effects on pain and function. However, evidence is limited due to heterogeneity, the relatively small numbers available for subgroup analyses and the low methodological quality of the included trials. Identification of studies of true IM was not possible due to lack of reporting of the intervention details (registration No. CRD42013003916).