Unveiling the therapeutic role of Dachaihu decoction in acute cholecystitis: a comprehensive systematic review and meta-analysis of its efficacy and safety

Xin-Xin Liu; Ying-Qi Ma; Ling-Yao Kong; You-Zhu Su; Nicola Robinson; Jian-Ping Liu

doi:10.3389/fphar.2024.1497072

Unveiling the therapeutic role of Dachaihu decoction in acute cholecystitis: a comprehensive systematic review and meta-analysis of its efficacy and safety

Front Pharmacol. 2024 Nov 27:15:1497072. doi: 10.3389/fphar.2024.1497072. eCollection 2024.

Authors

Xin-Xin Liu^#¹, Ying-Qi Ma^#², Ling-Yao Kong¹, You-Zhu Su¹, Nicola Robinson^{1

3}, Jian-Ping Liu^{1

4}

Affiliations

¹ Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China.
² The First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China.
³ School of Health and Social Care, London South Bank University, London, United Kingdom.
⁴ Department of Community Medicine, The National Research Center in Complementary and Alternative Medicine (NAFKAM), Faculty of Health Science, UiT The Arctic University of Norway, Tromsø, Norway.

^# Contributed equally.

Abstract

Background: Dachaihu decoction (Dachaihu tang) plays a crucial role in treating acute illnesses. Recently, a significant number of clinical studies on Dachaihu decoction for acute cholecystitis (AC) have been published. This study was conducted to assess the efficacy and safety of Dachaihu decoction in patients with this condition.

Methods: To identify relevant randomized controlled trials (RCTs), eight databases and three clinical trial registries were searched from inception to 30 June 2024. Two researchers independently screened and extracted data from eligible studies using EndNote X9 and Microsoft Office Excel 2019. RoB 2.0 was used to assess the risk of bias in the included studies. Stata 17.0 was used for data analysis. Publication bias and its impact on result stability were evaluated using a funnel plot and the "trim-and-fill" method. The quality of evidence was graded using the GRADE assessment system.

Results: Thirty-three RCTs involving 2,851 participants were included. The treatment group demonstrated improved clinical efficacy (RR = 1.18; 95% CI = 1.13 to 1.24), significantly reduced length of hospital stay (MD = -1.78 days; 95% CI = -2.02 to -1.53), and the incidence of adverse events (RR = 0.31; 95% CI = 0.20 to 0.48). Additionally, there appeared to be reductions in the time for abdominal pain to resolve (MD = -1.92 days; 95% CI = -2.33 to -1.51), fever to disappear (MD = -1.52 days; 95% CI = -1.90 to -1.14), white blood cell count to return to normal (MD = -2.89 days; 95% CI = -3.32 to -2.46), alanine aminotransferase (ALT) levels (MD = -11.88 U/L; 95% CI = -15.29 to -8.47), aspartate aminotransferase (AST) levels (MD = -8.74 U/L; 95% CI = -9.76 to -7.72), neutrophil percentage (MD = -9.68; 95% CI = -11.33 to -8.03), TNF-α levels (SMD = -2.10 pg/L; 95% CI = -2.43 to -2.78), and certainty of evidence (moderate-to-low certainty).

Conclusion: Dachaihu decoction may be an effective botanical formula for managing AC and a lower incidence of adverse events. However, due to the substantial risk of bias and heterogeneity across the included studies, these findings should be interpreted with caution and require further validation through well-designed, high-quality trials.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=573332.

Keywords: Dachaihu decoction; acute cholecystitis; clinical efficacy; meta-analysis; systematic review.

Publication types

Systematic Review

Grants and funding

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. This work was funded by the High-Level Talent Research Start-up Fund (90011451310039) and project “Research and Development of Evidence-Based Chinese Medicine” (B23041). Funders did not play any role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.