What Cochrane Reviews Say About Chinese Herbal Medicine
A plain summary of what Cochrane systematic reviews found for Chinese herbal medicine, organized by condition, with the certainty of the evidence and why most reviews end inconclusive.
Content last updated . This page has not been medically reviewed.
What a Cochrane review is
Cochrane reviews are systematic reviews: the authors search for every eligible trial on a question, judge each trial's risk of bias, pool results where reasonable, and rate how certain the overall evidence is. They are widely used to inform health care decisions, which makes them a useful, fairly neutral lens on Chinese herbal medicine (CHM). [1] This page summarizes what the reviews read for it concluded. Cochrane reviews are updated or withdrawn over time, so check the Cochrane Library for the current version before relying on any single one.The big picture
- Overview of all TCM reviews (2022). Up to May 2021 there were 104 Cochrane reviews on TCM, of which 70 covered Chinese herbal medicine. [1] Only 5 of the 104 drew overall positive conclusions, 42 said the evidence was insufficient, and 54 failed to draw firm conclusions. [1] About half (51, or 49.0%) were rated low quality on the AMSTAR 2 tool, and GRADE ratings were mostly low or very low. [1]
- Overview of herbal reviews (2011). Of 58 Cochrane reviews of Chinese herbal medicines, 51 included at least one trial. Of those, 23 were reported as inconclusive and 27 concluded there might be benefit, limited by poor quality or too few studies. [2] Only 16% of included studies used adequate sequence generation and 7% used adequate allocation concealment. [2]
In other words, "inconclusive, and better trials are needed" is the most common ending. That is a statement about the trials, not a verdict that the herbs are useless or useful.
Selected reviews by condition
These are examples taken from review abstracts; this is not a complete list. Evidence labels follow the review authors' own conclusions.| Condition | What the review found | Evidence label |
|---|---|---|
| Subfertility with polycystic ovary syndrome (2021) | Eight trials with 609 participants. The authors concluded there is insufficient evidence to support CHM for subfertile women with PCOS. No trial reported live birth. [3] | Insufficient evidence |
| Menopausal hot flushes (2016) | 22 trials with 2,902 women. Insufficient evidence that CHM was any more or less effective than placebo or hormone therapy; safety findings inconclusive. [4] | Insufficient evidence |
| Influenza (2013) | 18 studies with 2,521 participants, 17 of poor methodological quality. Most herbs showed effects similar to antiviral drugs, few were superior, and the authors called the evidence weak. [5] | Insufficient evidence (weak) |
| Vascular dementia (2018) | 47 studies, 3,581 participants, all conducted in China. Moderate to very low-quality evidence of both benefit and harm; three formulas were flagged as research priorities. [6] | Promising but very uncertain |
| Chronic kidney disease, Astragalus as an add-on (2014) | 22 studies with 1,323 participants. Some promising effects on protein in urine, hemoglobin and albumin, but poor quality and reporting meant no definitive conclusions. [7] | Insufficient evidence |
| Recurrent urinary tract infection in women (2015) | Seven small studies with 542 women, all at high risk of bias. CHM may be beneficial, but robust conclusions were not possible. [8] | Insufficient evidence |
| Atopic eczema (2013) | 28 studies with 2,306 participants. Most were at high risk of bias with substantial inconsistency, so any positive effect "must be treated with caution." [9] | Insufficient evidence |
Reading the eczema review: an example of how reviews change
An earlier version of the eczema review (2004) found only inconclusive evidence. The 2013 update widened the scope to include herbal products applied to the skin. [9] The older version was formally withdrawn because it was replaced by the new, expanded review. [10] The 2013 authors also excluded four earlier studies because the herbal product they tested had been withdrawn from the market since 2004. [9] This is how evidence normally moves: slowly, and sometimes by changing the question.Why so many reviews end "insufficient"
- Small trials, often with fewer than 100 participants.
- Unclear randomization, no blinding, and incomplete reporting; see Quality of TCM Clinical Trials.
- Different herbal mixtures pooled together: in the 2011 overview, 39 reviews addressed broad questions and 9 combined studies of different herbal medicines. [2]
- Concern about positive-result bias; see Publication Bias and Positive-Result Concerns. The 2011 overview also noted that 10 reviews had not searched any Chinese database. [2]
What these results do and do not say
They do not say a particular formula is unsafe or ineffective for you. They do not say a prescription medicine can be replaced. A review that finds "insufficient evidence" about a herbal formula still leaves open interaction and quality risks; see Chinese Herbs and Prescription Medicines. Cochrane reviews of acupuncture are covered on the acupuncture pages. For a broader summary, see Does TCM Work? and TCM Evidence by Use.Frequently asked questions
What do Cochrane reviews say about Chinese herbal medicine overall?
Most are inconclusive. Of 104 Cochrane reviews on TCM, 5 were overall positive, 42 found insufficient evidence and 54 could not draw firm conclusions. [1]
Do TCM practitioners take part in writing these reviews?
Sometimes. An overview of 58 Cochrane reviews of Chinese herbal medicine found that 21 had at least one TCM practitioner as a co-author, and it suggested more involvement would improve the reviews. [2]
Do Cochrane reviews ever find benefit?
Some reviews found promising signals, such as for add-on use in kidney disease or for certain formulas in vascular dementia, but the authors said the quality of evidence was too low for firm conclusions. [7][6]
Do these reviews cover safety?
Partly. Many trials report adverse events poorly. The menopause review called its safety findings inconclusive, and the vascular dementia review noted incomplete reporting of adverse events. [4][6]
Where can I find the current version of a review?
On the Cochrane Library. Reviews are revised, and some are withdrawn and replaced, as the eczema example shows. [10]
References
- Dai Z, et al. Cochrane systematic reviews on traditional Chinese medicine: what matters, the quantity or quality of evidence? Phytomedicine 2022. PubMed 35104758. Read 2026-10-22.
- Hu J, et al. Cochrane systematic reviews of Chinese herbal medicines: an overview. PLoS One 2011. PubMed 22174870. Read 2026-10-22.
- Cochrane review: Chinese herbal medicine for subfertile women with polycystic ovarian syndrome. Cochrane Database Syst Rev 2021. PubMed 34085287. Read 2026-10-22.
- Cochrane review: Chinese herbal medicine for menopausal symptoms. Cochrane Database Syst Rev 2016. PubMed 26976671. Read 2026-10-22.
- Cochrane review: Chinese medicinal herbs for influenza. Cochrane Database Syst Rev 2013. PubMed 23543533. Read 2026-10-22.
- Cochrane review: Traditional Chinese herbal medicine for vascular dementia. Cochrane Database Syst Rev 2018. PubMed 30520514. Read 2026-10-22.
- Cochrane review: Astragalus (a traditional Chinese medicine) for treating chronic kidney disease. Cochrane Database Syst Rev 2014. PubMed 25335553. Read 2026-10-22.
- Cochrane review: Chinese herbal medicine for treating recurrent urinary tract infections in women. Cochrane Database Syst Rev 2015. PubMed 26040964. Read 2026-10-22.
- Gu S, et al. Chinese herbal medicine for atopic eczema. Cochrane Database Syst Rev 2013. PubMed 24018636. Read 2026-10-22.
- Withdrawn Cochrane review: Chinese herbal medicine for atopic eczema (2013 notice). PubMed 24027064. Read 2026-10-22.
Education, not medical advice. This page is for general information. It does not diagnose or treat any condition and is not a substitute for care from a qualified health professional. Natural does not automatically mean safe. Ask a clinician or pharmacist before changing your care, especially if you take medication, are pregnant or breastfeeding, or have a health condition.