- 2026-05-13
- Frontiers in medicine 13
- Weiru Liu
- Like Xu
- Jing Jia
- Min Xu
- Yingzhou Tian
Study Design
- Type
- Systematic Review
- Sample size
- n = 107
- Population
- women with endometriosis
- Methods
- Systematic review and network meta-analysis of randomized controlled trials; searched 8 databases from inception to 16 June 2025; two reviewers independently screened, extracted data, assessed risk of bias; random-effects network meta-analysis under frequentist framework with Stata 17.0
Objective
To systematically evaluate the efficacy and safety of blood-invigorating and stasis-resolving Chinese herbal medicines (BISMs) when combined with conventional clinical therapy for endometriosis, and to provide evidence-based guidance for clinical decision-making.Methods
Eight databases (CNKI, WanFang, VIP, SinoMed, PubMed, EMBASE, Cochrane Library, and Web of Science) were searched from inception to 16 June 2025 for randomized controlled trials (RCTs). Two reviewers independently screened studies, extracted data, and assessed risk of bias using a modified Cochrane tool. A random-effects network meta-analysis under a frequentist framework was performed with Stata 17.0 (mvmeta command). Surface under the cumulative ranking curve (SUCRA) values were used to rank interventions. Primary outcomes were overall clinical efficacy, pain visual analog scale (VAS), sex hormones (E2, FSH, LH), serum CA125, endometriotic cyst diameter, recurrence rate, and incidence of adverse events.Results
A total of 107 RCTs were included. 1. Global efficacy: BISMs plus modern medical therapy significantly improved overall response; the combination of Guizhi Fuling pills/capsules with biomedicine ranked first (SUCRA = 87.4%). 2. Symptom relief: Regimens such as Sanjie Zhentong capsules and Xiaojin pills provided an additional 1-2-point reduction in VAS compared with modern medical therapy alone. 3. Hormonal regulation: Bushen Huoxue Sanyu decoction, Dan'e Fukang paste, and Gongliuxiao capsules showed prominent reductions in E2, FSH, and/or LH.4. Inflammation and lesion control: Danggui Shaoyao powder and Shaofu Zhuyu granules ranked highest for lowering CA125 and shrinking cyst diameter. 5. Recurrence and safety: Xiaojin pills, Bushen Huoxue Sanyu decoction, and Shaofu Zhuyu granules markedly reduced recurrence, while Dan'e Fukang paste, Guizhi Fuling pills/capsules, and Sanjie Zhentong capsules were associated with fewer adverse events. Funnel plots revealed no evident publication bias.Conclusion
Combining BISMs with conventional modern medical treatment offers superior multidimensional benefits-pain alleviation, hormonal balance, inflammatory control, cyst reduction, and recurrence prevention-over modern medical therapy alone, with a favorable safety profile. Among the evaluated regimens, Guizhi Fulingpills/capsules, Dan'e Fukang paste, Shaofu Zhuyu granules, and Gongliuxiao capsules demonstrated the most consistent overall performance. High-quality, large-scale RCTs with long-term follow-up are warranted to confirm and refine these findings.