Herbal medicines for viral myocarditis.
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Journal: 2004/November - Cochrane Database of Systematic Reviews
ISSN: 1469-493X
Abstract:
BACKGROUND
Herbal medicines are being used for treating viral diseases including viral myocarditis, and many controlled trials have been done to investigate their efficacy.
OBJECTIVE
To assess the effects of herbal medicines on clinical and indirect outcomes in patients with viral myocarditis.
METHODS
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochrane Library 2003, Issue 3, MEDLINE (January 1966 to October 2003), EMBASE (January 1998 to October 2003), Chinese Biomedical Database (1979-2003), AMED (1985-2003), LILACS accessed in October 2003 and the trials register of the Cochrane Complementary Medicine Field. We handsearched Chinese journals and conference proceedings. No language or publication restrictions were used.
METHODS
Randomised controlled trials of herbal medicines (with a minimum of seven days treatment duration) compared with placebo, no intervention, or conventional interventions were included. Trials of herbal medicine plus conventional drug versus drug alone were also included.
METHODS
Two reviewers independently extracted data and evaluated trial quality. Study authors were contacted for additional information. Adverse effects information was collected from the trials.
RESULTS
Forty randomised trials, involving 3448 people were included. All trials were conducted and published in China, and the methodological quality was assessed as generally low. No trial had diagnosis of viral myocarditis confirmed histologically, and few trials attempted to establish viral aetiology for the myocarditis. Twenty-five different herbal medicines were tested in the included trials, which compared herbs with supportive therapy (17 trials), other controls (three trials), or treatment of herbs plus supportive therapy with supportive therapy alone (20 trials). The trials reported electrocardiogram, myocardial enzymes, cardiac function, symptoms, and adverse effects. Astragalus membranaceus (either as single herb or compound of herbs) showed significantly effects on improving arrhythmia, CPK levels, and cardiac function. Salviae miltiorrhizae injection showed significant effects on decreasing the arrhythmia and reducing LDH levels. Shenmai and Shengmai injection (Ginseng preparation) showed significantly effects on reducing myocardial enzymes and improving cardiac function. No serious adverse effect was reported.
CONCLUSIONS
Some herbal medicines may have anti-arrhythmia effect in suspected viral myocarditis. However, interpretation of these findings should be careful due to the low methodological quality, small sample size, and limited number of trials on individual herbs. In the light of the findings, some herbal medicines deserve further examination in rigorous trials.
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Cochrane Database Syst Rev undefined(3): CD003711
PMID: 15266498

Herbal medicines for viral myocarditis

Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China.
The Department of Clinical Immunology,WestChinaHospital, SichuanUniversity,Chengdu,China.
Department of Epidemiology&PopulationHealth, London School of Hygiene & Tropical Medicine, London, UK
Contact address: Jian Ping Liu, Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, 11 Bei San Huan Dong Lu, Chaoyang District, Beijing, 100029, China. moc.liamtoh@l_gnipnaij. on.tiu.demgaf@gnipnaij.
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Abstract

Background

Herbal medicines are being used for treating viral diseases including viral myocarditis, and many controlled trials have been done to investigate their efficacy.

Objectives

To assess the effects of herbal medicines on clinical and indirect outcomes in patients with viral myocarditis.

Search strategy

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library Issue 3, 2009, MEDLINE (January 1966 - July 2009), EMBASE (January 1998 - July 2009), Chinese Biomedical Database (1979 - 2009), China National Knowledge Infrastructure (1979 - 2009), Chinese VIP Information (1989 - 2009), Chinese Academic Conference Papers Database and Chinese Dissertation Database (1980 - 2009), AMED (1985 - 2009), LILACS accessed in July 2009 and the trials register of the Cochrane Complementary Medicine Field. We handsearched Chinese journals and conference proceedings. No language restrictions were applied.

Selection criteria

Randomised controlled trials of herbal medicines (with a minimum of seven days treatment duration) compared with placebo, no intervention, or conventional interventions were included. Trials of herbal medicine plus conventional drug versus drug alone were also included. Only trials that reported adequate description of allocation sequence generation were included.

Data collection and analysis

Two review authors independently extracted data and evaluated trial quality. Adverse effects information was collected from the trials.

Main results

Fourteen randomised trials involving 1463 people were included. All trials were conducted and published in China. Quality of the trials was assessed to be low. No trial had diagnosis of viral myocarditis confirmed histologically, and only a few trials attempted to establish viral aetiology. Nine different herbal medicines were tested in the included trials. The trials reported electrocardiogram results, level of myocardial enzymes, cardiac function, symptoms, and adverse effects.

Astragalus membranaceus (either as an injection or granules) showed significant positive effects in symptom improvement, normalisation of electrocardiogram results, CPK levels, and cardiac function. Shengmai injection also showed significant effects in symptom improvement. Shengmai decoction triggered significant improvement in quality of life measured by SF-36. No serious adverse effects were reported.

Authors’ conclusions

Some herbal medicines may lead to improvement of symptoms, ventricular premature beat, electrocardiogram, level of myocardial enzymes, and cardiac function in viral myocarditis. However, interpretation of these findings should be taken with care due to the low methodological quality, small sample size, and limited number of trials on individual herbs. Further robust trials are needed to explore the use of herbal medicines in viral myocarditis.

Medical Subject Headings (MeSH) Astragalus membranaceus; Drug Combinations; Drugs, Chinese Herbal [adverse effects; *therapeutic use]; Myocarditis [*drug therapy; virology]; Phytotherapy [adverse effects; *methods]; Randomized Controlled Trials as Topic; Virus Diseases [*drug therapy]
MeSH check words: Humans
Abstract
PLAIN LANGUAGE SUMMARY

Footnotes

CONTRIBUTIONS OF AUTHORS Jianping Liu: defined the review question, developed the protocol and search strategy, selected studies, assessed quality, extracted data, analysed data, developed the final review.

Zhaolan Liu: searched for trials, selected studies, assessed quality of trials, extracted data, analysed data, and updated the review.

Zhijun Liu: searched for trials, selected studies, assessed quality of trials, extracted data.

Min Yang: selected studies and extracted data.

Joey Kwong: interpretated data and their analyses; provided methodological perspective and general advice on this review update.

DECLARATIONS OF INTEREST None known.

DIFFERENCES BETWEEN PROTOCOL AND REVIEW During the updating of the published review, we applied a more strict inclusion criteria regarding the study design. We restricted all randomised trials to adequate description of the generation of allocation sequence. Therefore, some RCTs included in original review were excluded due to unclear method for generation of the allocation sequence. This resulted in 40 trials (43 references) that were included in the previous version of the review being excluded from this update. Searches were updated and 14 new trials were identified.

Footnotes

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