Long-term efficacy and safety of Huangqi (Radix Astragali Mongolici)-based Traditional Chinese Medicine in diabetic peripheral neuropathy: a Meta-analysis of randomized controlled trials

doi:10.19852/j.cnki.jtcm.2024.02.004

Abstract

Abstract:

OBJECTIVE: To assess the long-term effectiveness of Huangqi (Radix Astragali Mongolici, HQ)-based Traditional Chinese Medicine (TCM) in the treatment of diabetic peripheral neuropathy (DPN).

METHODS: Nine databases were searched to retrieve available randomized controlled trials that compared HQ-based TCM and Western Medicines in the treatment of DPN. The methodological quality of the included studies was assessed using the Cochrane bias risk tool, and RevMan 5.4 was used for data analysis. The effect estimates of interest were risk ratio (RR), mean difference (MD) or standardized mean difference (SMD) with 95% confidence interval (CI).

RESULTS: The results from 48 available studies assessing 3759 patients demonstrated that cases administered HQ-based TCM [RR = 1.30, 95% CI (1.21, 1.40), P < 0.000 01] or HQ-based TCM combined with Western Medicines [RR = 1.25, 95% CI (1.19, 1.31), P < 0.000 01] exhibited higher total efficacy rates than individuals who received Western Medicine alone. The results showed that the HQ-based TCM group had decreased Toronto Clinical Scoring System scores [MD =－1.50, 95% CI (－1.83, －1.17), P < 0.000 01], and reduced serum interleukin 6 [SMD = －0.57, 95% CI (－0.87, －0.27), P = 0.0002] and tumor necrosis factors-α levels [SMD = －0.60, 95% CI (－0.95, －0.25), P = 0.0009]. In addition, both HQ-based TCM and HQ-based TCM combined with Western Medicine increased nerve conduction velocity and decreased glycaemia compared with Western Medicine alone. In terms of blood lipids, oxidative stress and adverse drug reactions, there were no significant differences between the HQ-based TCM groups and the Western Medicine control group.

CONCLUSION: The current Meta-analysis revealed that HQ-based TCM yields higher efficacy and safety than Western Medicine alone for the treatment of DPN, although further well-designed RCTs are required to validate these findings.

Key words: Huangqi (Radix Astragali Mongolici), medicine, Chinese traditional, diabetic peripheral neuropathy, Meta-analysis

PING Jing, HAO Hongzheng, WU Zhenqi, ZOU Meijuan, LI Zuojing, CHENG Gang. Long-term efficacy and safety of Huangqi (Radix Astragali Mongolici)-based Traditional Chinese Medicine in diabetic peripheral neuropathy: a Meta-analysis of randomized controlled trials[J]. Journal of Traditional Chinese Medicine, 2024, 44(2): 229-242.

Figures/Tables 7

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Study	No. (T/C)	Age		Intervention		FBG (mmol/L)		2h PBG (mmol/L)		HbA1c (%)		Duration	Outcome
Study	No. (T/C)	Trial	Control	Trial	Control	Trial	Control	Trial	Control	Trial	Control	Duration	Outcome
Cheng RD 2016³⁴	108 (72/36)	57.278±9.205	57.03±9.52	Yiqi Huoxue Tongluo prescription	Vitamin B12 5 Capsules tid	Nr.	Nr.	Nr.	Nr.	Nr.	Nr.	12 w	①②④⑧
Dai AQ et al 2020³⁵	106 (53/53)	52.22 ±3.63	52.13± 3.52	Yiqi Huayu Tongbi prescription	Vitamin B12 0.5 mg tid	Nr.	Nr.	Nr.	Nr.	Nr.	Nr.	12 w	①⑥
Ding Q 2021³⁶	70 (35/35)	61.54 ±8.35	61.94± 11.36	Compound Qiying granules	Epalrestat 50 mg tid	8.31±3.36	7.50±3.57	8.11± 1.70	8.69±2.06	Nr.	Nr.	12 w	①②④⑦
Ding YM et al 2010³⁷	62 (32/30)	56.12 ±3.87	58.32± 2.78	Yiqi Yangxue Huoxue prescription	Vitamin B12 0.5 mg tid	8.23±1.69	9.11±1.85	11.58± 2.32	10.01±1.25	8.9± 1.05	8.2± 1.89	3 m	①②④
Du T 2019³⁸	70 (35/35)	60.52 ±8.90	59.65± 9.14	Yiqi Huoxue Tongluo prescription	Vitamin B12 0.5 mg tid	Nr.	Nr.	Nr.	Nr.	7.05± 0.58	7.11± 0.56	12 w	①②⑧
Du ZL et al 2012³⁹	60 (30/30)	Nr.	Nr.	Modified Buyang Huanwu decoction	Vitamin B12 1 mg tid	Nr.	Nr.	Nr.	Nr.	Nr.	Nr.	12 w	①⑧
Du ZL et al 2012³⁹	60 (30/30)	Nr.	Nr.	Modified Buyang Huanwu decoction	Vitamin B1 20 mg tid	Nr.	Nr.	Nr.	Nr.	Nr.	Nr.	12 w	①⑧
Feng HY 2020⁴⁰	63 (34/29)	58.68 ±7.50	59.84± 7.00	Tongluo Zuzuo prescription	Vitamin B12 0.5 mg tid	6.52±0.71	6.58±0.65	9.61± 0.88	9.51±0.69	6.96± 0.72	6.89± 0.67	12 w	①③④⑧
Han YB 2014⁴¹	72 (36/36)	53.08 ±8.07	53.69± 8.11	Quyidi capsules	Vitamin B12 0.5 mg tid	6.58±0.20	6.56±0.21	9.34± 0.23	9.42±0.21	7.03± 0.20	7.02± 0.19	12 w	①②④⑤⑦⑧
Hou N 2017⁴²	60 (30/30)	54.43 ±7.48	54.93± 7.25	Xiaoke Tongbi capsules	Vitamin B12 0.5 mg tid	6.07±0.37	6.09±0.39	8.70± 0.34	8.67±0.36	6.59± 0.19	6.61± 0.16	12 w	①②④
Hou Y et al 2012⁴³	75 (3936)	55.38 ±10.63	56.44± 11.70	Yiqi Yangyin Huoxue prescription	Vitamin B12 0.5 mg tid	11.34±2.86	10.85±2.61	16.48± 2.52	15.80±2.77	9.49± 1.54	9.28± 1.71	3 m	①④⑤⑥
Lan BY 2016⁴⁴	60 (30/30)	53.27 ±8.36	50.67± 8.91	Xiaoke Bitong capsules	Epalrestat 50 mg tid	5.99±0.66	6.24±0.52	9.05± 0.58	9.26±0.67	6.58± 0.20	6.67± 0.14	12 w	①②④⑧
Lei LL 2020⁴⁵	60 (30/30)	37.71 ±12.54	37.45± 12.32	Huangqi Guizhi Wuwu decoction	Vitamin B12 0.5 mg tid	Nr.	Nr.	Nr.	Nr.	Nr.	Nr.	12 w	①②
Lin CY 2021⁴⁶	60 (30/30)	54.30 ±10.3	53.53± 8.50	Yiqi Zhuyu Tongluo decoction	α-Lipoic acid 0.2 mg tid	6.97±0.59	6.65±0.58	9.84± 0.71	9.75±0.68	7.36± 0.36	7.37± 0.42	12 w	①②④⑤⑦⑧
Wang HZ 2009⁴⁷	60 (30/30)	55.3± 7.9	55.9± 7.6	Xiaoke Xubi decoction	Vitamin B12 0.5 mg tid	7.14±0.32	7.14±0.38	9.53± 0.49	9.83±0.43	7.05± 0.30	7.10± 0.31	12 w	①⑧
Wang JJ 2017⁴⁸	62 (32/30)	59.00±11.54	60.07± 13.29	Huangqi Guizhi Wuwu decoction and Siteng Yixian decoction	Vitamin B12 0.5 mg tid	8.37±1.26	8.27±1.07	12.69± 1.83	12.20±1.86	8.45± 0.93	8.62± 1.04	12 w	①⑧
Zhang SL et al 2013⁴⁹	100 (50/50)	58.1± 11.5	57.9± 10.8	Matong granules	Vitamin B12 0.5 mg tid	Nr.	Nr.	Nr.	Nr.	Nr.	Nr.	12 w	①②⑦
Zhang YX 2014⁵⁰	74 (38/36)	55.23± 4.71	58.68± 3.22	Tangbikang prescription	Vitamin B12 0.5 mg tid	7.43± 1.71	7.67±1.25	9.79± 2.40	9.76±2.36	6.94±0.73	6.74± 0.60	12 w	①②④⑤⑧
Bao WP et al 2022⁵¹	60 (30/30)	54.30± 12.61	57.40± 10.74	Jiangtang Tongbi decoction+C	Epalrestat 50 mg tid	10.00± 2.50	9.70±2.60	14.30± 3.00	13.60±3.60	9.50±1.40	10.10± 2.20	12 w	①③④
Ding HY 2018⁵²	92 (46/46)	55.91± 4.23	56.75± 3.63	Modified Huangqi Guizhi Wuwu decoction+C	Vitamin B12 0.5 mg tid	Nr.	Nr.	Nr.	Nr.	Nr.	Nr.	12 w	①②⑧
Fan LH 2014⁵³	60 (30/30)	59.33± 7.46	60.58± 7.81	Qigui Tangtongning granules+C	Alprostadil 10 μg qd	Nr.	Nr.	Nr.	Nr.	Nr.	Nr.	12 w	①④⑤⑧
Jia ZH 2021⁵⁴	90 (45/45)	60.16± 8.03	59.84± 7.98	Yiqi Huoxue Tangtong prescription+C	Vitamin B12 0.5 mg tid	Nr.	Nr.	Nr.	Nr.	8.61±1.02	8.54± 0.97	12 w	①④
Li AQ et al 2022⁵⁵	120 (60/60)	50.40± 5.59	50.98± 5.22	Wenjing Huoxue prescription+C	Vitamin B12 0.5 mg tid	6.17± 0.84	6.23±0.64	10.65± 0.93	10.34±0.97	7.24±0.76	7.12± 0.92	12 w	①②③⑦⑧
Li WD et al 2016⁵⁶	90 (45/45)	62.19± 2.93	68.68± 3.96	Modified Huangqi Guizhi Wuwu decoction+C	Vitamin B12 0.5 mg tid	8.45± 0.53	8.36±0.66	12.74± 0.80	12.79±0 84	8.76±0.58	8.58± 0.62	3 m	①②④⑤
Li XF 2014⁵⁷	60 (30/30)	59.83± 7.29	60.03± 9.41	Wenyang Tongluo prescription+C	Vitamin B12 0.5 mg tid；Epalrestat 50 mg tid	9.31± 2.09	9.10±1.91	13.54± 2.69	13.40±2.34	9.67±1.67	9.40± 1.78	12 w	①②④⑥⑧
Lin ZH et al 2015⁵⁸	102 (50/52)	62.88	64.58	Qutan Huoxue Tongluo prescription+C	Vitamin B12 0.5 mg tid	Nr.	Nr.	Nr.	Nr.	Nr.	Nr.	12 w	①②⑧
Liu XJ et al 2019⁵⁹	70 (35/35)	Nr.	Nr.	Self-made Huangqi Mugua prescription+C	Vitamin B12 0.5 mg tid	Nr.	Nr.	Nr.	Nr.	Nr.	Nr.	12 w	①②
Lu SM et al 2013⁶⁰	120 (60/60)	55.23± 4.71	58.68± 3.22	Tangbikang decoction+C	Vitamin B12 0.5 mg bid	8.59± 1.55	8.61±1.55	12.79± 2.40	12.76±2.36	9.14±1.17	9.05± 1.16	12 w	①②④⑤
					Vitamin B1 100 mg tid
					Vitamin B6 100 mg tid
Lu WF et al 2021⁶¹	96 (48/48)	64.76± 9.17	64.76± 9.17	Compound Qidan prescription+C	Vitamin B12 0.5 mg tid	Nr.	Nr.	Nr.	Nr.	Nr.	Nr.	12 w	①②③⑦
Ning RZ et al 2020⁶²	60 (30/30)	62.53± 3.67	61.43± 4.29	Modified Buyang Huanwu decoction+C	Vitamin B12 0.5 mg tid	Nr.	Nr.	Nr.	Nr.	Nr.	Nr.	12 w	①⑧
Ouyang CL 2022⁶³	60 (30/30)	61.27± 8.95	62.63± 8.75	Juanbi Tongluo oral liquid+C	Vitamin B12 0.5 mg tid Epalrestat 50 mg tid	9.01± 1.42	8.61±2.21	15.20± 2.52	14.91±3.70	8.97±1.29	8.95± 1.67	12 w	①③④⑤⑧
Pan XJ 2017⁶⁴	60 (3030)	50.74± 9.25	49.62± 9.83	Modified Buyang Huanwu decoction+C	Vitamin B12 0.5 mg tid	7.62± 0.17	7.59±0.23	10.36± 0.48	10.57±0.53	7.75±0.49	7.81± 0.52	12 w	①②③④⑧
Qian LW et al 2011⁶⁵	80 (40/40)	57.5± 7.9	57.2± 8.4	Yiqi Huoxue Tongbi prescription+C	Vitamin B12 0.5 mg tid	Nr.	Nr.	Nr.	Nr.	Nr.	Nr.	3 m	①②
Sun JJ et al 2021⁶⁶	60 (30/30)	56.38± 9.32	57.89±9.27	Shenqi Jiangtang granules+C	Vitamin B12 0.5 mg tid	Nr.	Nr.	Nr.	Nr.	Nr.	Nr.	6 m	①②③⑧
Sun XY et al 2020⁶⁷	60 (30/30)	66.83± 2.12	65.93±3.24	Mudan granules+C	Vitamin B12 0.5 mg tid	6.90± 0.67	7.09±0.66	11.46± 3.26	10.19±2.72	7.26±0.49	7.25±0.63	12 w	①⑧
Tian SL 2019⁶⁸	60 (30/30)	Nr.	Nr.	Qigui Jiedu Tongluo decoction+C	Vitamin B12 0.5 mg tid	9.91± 1.11	9.60±0.88	11.93± 1.35	11.60±0.88	8.38±0.89	8.32±1.07	12 w	①④⑤⑧
Wang ZF et al 2010⁶⁹	159 (80/79)	62.68± 7.3	62.78±7.57	Huangqi Guizhi Wuwu decoction+C	Vitamin B12 0.5 mg tid	Nr.	Nr.	Nr.	Nr.	Nr.	Nr.	12 w	①②
Wei Q et al 2018⁷⁰	60 (30/30)	65.1±6.3	64.5± 5.8	Taditional Chinese Medicine+C	Vitamin B12 0.5 mg tid	Nr.	Nr.	Nr.	Nr.	8.37±0.98	8.44±1.39	12 w	①④
Wu Y et al 2015⁷¹	120 (60/60)	Nr.	Nr.	Buyang Huanwu decoction+C	Vitamin B12 0.5-1 mg qd	Nr.	Nr.	Nr.	Nr.	Nr.	Nr.	12 w	①②
Xu S 2021⁷²	60 (30/30)	61.07± 6.87	61.87±6.68	Yiqi Yangyin Zhuyu decoction+C	Vitamin B12 0.5 mg tid	7.20± 0.93	7.11±1.01	11.08± 1.44	11.26±1.58	7.37±1.24	7.28±0.91	12 w	①②③④
Xu XJ 2019⁷³	60 (30/30)	52.67± 8.96	56.63±8.18	Yiqi Yangyin Tongluo prescription+C	Vitamin B12 0.5 mg tid	5.97± 0.75	6.15±0.59	8.31± 0.68	8.10±0.55	9.75±2.09	9.55±1.45	12 w	①②③④⑤⑧
Yan J et al 2021⁷⁴	98 (49/49)	57.24± 10.83	56,55±11.22	Zicui Juanbi prescription+C	Vitamin B12 0.5 mg tid	Nr.	Nr.	Nr.	Nr.	Nr.	Nr.	12 w	①②⑦
Yang WJ et al 2021⁷⁵	60 (30/30)	52.8± 7.46	55.3± 6.417	Bushen Tongluo prescription+C	Vitamin B12 0.5 mg tid	6.02± 0.56	6.14±0.65	8.76± 0.70	8.63±0.88	8.48±0.68	8.50±0.47	12 w	①③④⑧
Yang XQ et al 2016⁷⁶	96 (48/48)	55.3± 11.4	56.6± 10.8	Huangqi Guizhi Wuwu decoction+C	Epalrestat 50 mg tid	8.60± 1.40	8.80±1.20	14.40± 2.20	14.60±2.30	8.20±1.60	8.50±1.30	12 w	②④
Yang XQ et al 2016⁷⁶	96 (48/48)	55.3± 11.4	56.6± 10.8	Huangqi Guizhi Wuwu decoction+C	Vinpocetine 30 mg qd	8.60± 1.40	8.80±1.20	14.40± 2.20	14.60±2.30	8.20±1.60	8.50±1.30	12 w	②④
Zhang Y et al 2008⁷⁷	60 (30/30)	60.13± 10.38	60.87±11.51	Huoxue Jiangtang capsules+C	Vitamin B12 0.5 mg tid	10.30± 2.00	10.00±1.70	15.90± 2.70	14.50±2.30	Nr.	Nr.	3 m	①②④
Zhao W et al 2008⁷⁸	60 (30/30)	58.3± 5.4	57.3± 4.0	Tangluoan capsules+C	Vitamin B12 0.5 mg tid	6.30± 0.70	6.20±0.80	8.70± 0.70	8.40±0.70	Nr.	Nr.	3 m	①②④⑧
Zhao YY 2019⁷⁹	80 (40/40)	52.04± 12.02	53.58±11.80	Qigui Tongluo granules+C	α-Lipoic acid 0.3 mg bid	8.54± 0.78	9.02±1.12	12.43± 1.30	11.09±0.66	7.80±0.74	7.55±0.42	12 w	①②④⑦
Zhou YH 2015⁸⁰	102 (52/50)	56.4± 10.1	54.9± 9.8	Xiaoma Zhitong granules+C	Vitamin B12 0.5 mg tid	Nr.	Nr.	Nr.	Nr.	Nr.	Nr.	12 w	①②③⑦
Zhou ZN et al 2015⁸¹	122 (64/58)	63.6±9.7	65.2± 10.7	Xiaoke Tongbi prescription+C	Vitamin B12 0.5 mg tid	Nr.	Nr.	Nr.	Nr.	Nr.	Nr.	12 w	②

Study	No. (T/C)	Age		Intervention		FBG (mmol/L)		2h PBG (mmol/L)		HbA1c (%)		Duration	Outcome
Study	No. (T/C)	Trial	Control	Trial	Control	Trial	Control	Trial	Control	Trial	Control	Duration	Outcome
Cheng RD 2016³⁴	108 (72/36)	57.278±9.205	57.03±9.52	Yiqi Huoxue Tongluo prescription	Vitamin B12 5 Capsules tid	Nr.	Nr.	Nr.	Nr.	Nr.	Nr.	12 w	①②④⑧
Dai AQ et al 2020³⁵	106 (53/53)	52.22 ±3.63	52.13± 3.52	Yiqi Huayu Tongbi prescription	Vitamin B12 0.5 mg tid	Nr.	Nr.	Nr.	Nr.	Nr.	Nr.	12 w	①⑥
Ding Q 2021³⁶	70 (35/35)	61.54 ±8.35	61.94± 11.36	Compound Qiying granules	Epalrestat 50 mg tid	8.31±3.36	7.50±3.57	8.11± 1.70	8.69±2.06	Nr.	Nr.	12 w	①②④⑦
Ding YM et al 2010³⁷	62 (32/30)	56.12 ±3.87	58.32± 2.78	Yiqi Yangxue Huoxue prescription	Vitamin B12 0.5 mg tid	8.23±1.69	9.11±1.85	11.58± 2.32	10.01±1.25	8.9± 1.05	8.2± 1.89	3 m	①②④
Du T 2019³⁸	70 (35/35)	60.52 ±8.90	59.65± 9.14	Yiqi Huoxue Tongluo prescription	Vitamin B12 0.5 mg tid	Nr.	Nr.	Nr.	Nr.	7.05± 0.58	7.11± 0.56	12 w	①②⑧
Du ZL et al 2012³⁹	60 (30/30)	Nr.	Nr.	Modified Buyang Huanwu decoction	Vitamin B12 1 mg tid	Nr.	Nr.	Nr.	Nr.	Nr.	Nr.	12 w	①⑧
Du ZL et al 2012³⁹	60 (30/30)	Nr.	Nr.	Modified Buyang Huanwu decoction	Vitamin B1 20 mg tid	Nr.	Nr.	Nr.	Nr.	Nr.	Nr.	12 w	①⑧
Feng HY 2020⁴⁰	63 (34/29)	58.68 ±7.50	59.84± 7.00	Tongluo Zuzuo prescription	Vitamin B12 0.5 mg tid	6.52±0.71	6.58±0.65	9.61± 0.88	9.51±0.69	6.96± 0.72	6.89± 0.67	12 w	①③④⑧
Han YB 2014⁴¹	72 (36/36)	53.08 ±8.07	53.69± 8.11	Quyidi capsules	Vitamin B12 0.5 mg tid	6.58±0.20	6.56±0.21	9.34± 0.23	9.42±0.21	7.03± 0.20	7.02± 0.19	12 w	①②④⑤⑦⑧
Hou N 2017⁴²	60 (30/30)	54.43 ±7.48	54.93± 7.25	Xiaoke Tongbi capsules	Vitamin B12 0.5 mg tid	6.07±0.37	6.09±0.39	8.70± 0.34	8.67±0.36	6.59± 0.19	6.61± 0.16	12 w	①②④
Hou Y et al 2012⁴³	75 (3936)	55.38 ±10.63	56.44± 11.70	Yiqi Yangyin Huoxue prescription	Vitamin B12 0.5 mg tid	11.34±2.86	10.85±2.61	16.48± 2.52	15.80±2.77	9.49± 1.54	9.28± 1.71	3 m	①④⑤⑥
Lan BY 2016⁴⁴	60 (30/30)	53.27 ±8.36	50.67± 8.91	Xiaoke Bitong capsules	Epalrestat 50 mg tid	5.99±0.66	6.24±0.52	9.05± 0.58	9.26±0.67	6.58± 0.20	6.67± 0.14	12 w	①②④⑧
Lei LL 2020⁴⁵	60 (30/30)	37.71 ±12.54	37.45± 12.32	Huangqi Guizhi Wuwu decoction	Vitamin B12 0.5 mg tid	Nr.	Nr.	Nr.	Nr.	Nr.	Nr.	12 w	①②
Lin CY 2021⁴⁶	60 (30/30)	54.30 ±10.3	53.53± 8.50	Yiqi Zhuyu Tongluo decoction	α-Lipoic acid 0.2 mg tid	6.97±0.59	6.65±0.58	9.84± 0.71	9.75±0.68	7.36± 0.36	7.37± 0.42	12 w	①②④⑤⑦⑧
Wang HZ 2009⁴⁷	60 (30/30)	55.3± 7.9	55.9± 7.6	Xiaoke Xubi decoction	Vitamin B12 0.5 mg tid	7.14±0.32	7.14±0.38	9.53± 0.49	9.83±0.43	7.05± 0.30	7.10± 0.31	12 w	①⑧
Wang JJ 2017⁴⁸	62 (32/30)	59.00±11.54	60.07± 13.29	Huangqi Guizhi Wuwu decoction and Siteng Yixian decoction	Vitamin B12 0.5 mg tid	8.37±1.26	8.27±1.07	12.69± 1.83	12.20±1.86	8.45± 0.93	8.62± 1.04	12 w	①⑧
Zhang SL et al 2013⁴⁹	100 (50/50)	58.1± 11.5	57.9± 10.8	Matong granules	Vitamin B12 0.5 mg tid	Nr.	Nr.	Nr.	Nr.	Nr.	Nr.	12 w	①②⑦
Zhang YX 2014⁵⁰	74 (38/36)	55.23± 4.71	58.68± 3.22	Tangbikang prescription	Vitamin B12 0.5 mg tid	7.43± 1.71	7.67±1.25	9.79± 2.40	9.76±2.36	6.94±0.73	6.74± 0.60	12 w	①②④⑤⑧
Bao WP et al 2022⁵¹	60 (30/30)	54.30± 12.61	57.40± 10.74	Jiangtang Tongbi decoction+C	Epalrestat 50 mg tid	10.00± 2.50	9.70±2.60	14.30± 3.00	13.60±3.60	9.50±1.40	10.10± 2.20	12 w	①③④
Ding HY 2018⁵²	92 (46/46)	55.91± 4.23	56.75± 3.63	Modified Huangqi Guizhi Wuwu decoction+C	Vitamin B12 0.5 mg tid	Nr.	Nr.	Nr.	Nr.	Nr.	Nr.	12 w	①②⑧
Fan LH 2014⁵³	60 (30/30)	59.33± 7.46	60.58± 7.81	Qigui Tangtongning granules+C	Alprostadil 10 μg qd	Nr.	Nr.	Nr.	Nr.	Nr.	Nr.	12 w	①④⑤⑧
Jia ZH 2021⁵⁴	90 (45/45)	60.16± 8.03	59.84± 7.98	Yiqi Huoxue Tangtong prescription+C	Vitamin B12 0.5 mg tid	Nr.	Nr.	Nr.	Nr.	8.61±1.02	8.54± 0.97	12 w	①④
Li AQ et al 2022⁵⁵	120 (60/60)	50.40± 5.59	50.98± 5.22	Wenjing Huoxue prescription+C	Vitamin B12 0.5 mg tid	6.17± 0.84	6.23±0.64	10.65± 0.93	10.34±0.97	7.24±0.76	7.12± 0.92	12 w	①②③⑦⑧
Li WD et al 2016⁵⁶	90 (45/45)	62.19± 2.93	68.68± 3.96	Modified Huangqi Guizhi Wuwu decoction+C	Vitamin B12 0.5 mg tid	8.45± 0.53	8.36±0.66	12.74± 0.80	12.79±0 84	8.76±0.58	8.58± 0.62	3 m	①②④⑤
Li XF 2014⁵⁷	60 (30/30)	59.83± 7.29	60.03± 9.41	Wenyang Tongluo prescription+C	Vitamin B12 0.5 mg tid；Epalrestat 50 mg tid	9.31± 2.09	9.10±1.91	13.54± 2.69	13.40±2.34	9.67±1.67	9.40± 1.78	12 w	①②④⑥⑧
Lin ZH et al 2015⁵⁸	102 (50/52)	62.88	64.58	Qutan Huoxue Tongluo prescription+C	Vitamin B12 0.5 mg tid	Nr.	Nr.	Nr.	Nr.	Nr.	Nr.	12 w	①②⑧
Liu XJ et al 2019⁵⁹	70 (35/35)	Nr.	Nr.	Self-made Huangqi Mugua prescription+C	Vitamin B12 0.5 mg tid	Nr.	Nr.	Nr.	Nr.	Nr.	Nr.	12 w	①②
Lu SM et al 2013⁶⁰	120 (60/60)	55.23± 4.71	58.68± 3.22	Tangbikang decoction+C	Vitamin B12 0.5 mg bid	8.59± 1.55	8.61±1.55	12.79± 2.40	12.76±2.36	9.14±1.17	9.05± 1.16	12 w	①②④⑤
					Vitamin B1 100 mg tid
					Vitamin B6 100 mg tid
Lu WF et al 2021⁶¹	96 (48/48)	64.76± 9.17	64.76± 9.17	Compound Qidan prescription+C	Vitamin B12 0.5 mg tid	Nr.	Nr.	Nr.	Nr.	Nr.	Nr.	12 w	①②③⑦
Ning RZ et al 2020⁶²	60 (30/30)	62.53± 3.67	61.43± 4.29	Modified Buyang Huanwu decoction+C	Vitamin B12 0.5 mg tid	Nr.	Nr.	Nr.	Nr.	Nr.	Nr.	12 w	①⑧
Ouyang CL 2022⁶³	60 (30/30)	61.27± 8.95	62.63± 8.75	Juanbi Tongluo oral liquid+C	Vitamin B12 0.5 mg tid Epalrestat 50 mg tid	9.01± 1.42	8.61±2.21	15.20± 2.52	14.91±3.70	8.97±1.29	8.95± 1.67	12 w	①③④⑤⑧
Pan XJ 2017⁶⁴	60 (3030)	50.74± 9.25	49.62± 9.83	Modified Buyang Huanwu decoction+C	Vitamin B12 0.5 mg tid	7.62± 0.17	7.59±0.23	10.36± 0.48	10.57±0.53	7.75±0.49	7.81± 0.52	12 w	①②③④⑧
Qian LW et al 2011⁶⁵	80 (40/40)	57.5± 7.9	57.2± 8.4	Yiqi Huoxue Tongbi prescription+C	Vitamin B12 0.5 mg tid	Nr.	Nr.	Nr.	Nr.	Nr.	Nr.	3 m	①②
Sun JJ et al 2021⁶⁶	60 (30/30)	56.38± 9.32	57.89±9.27	Shenqi Jiangtang granules+C	Vitamin B12 0.5 mg tid	Nr.	Nr.	Nr.	Nr.	Nr.	Nr.	6 m	①②③⑧
Sun XY et al 2020⁶⁷	60 (30/30)	66.83± 2.12	65.93±3.24	Mudan granules+C	Vitamin B12 0.5 mg tid	6.90± 0.67	7.09±0.66	11.46± 3.26	10.19±2.72	7.26±0.49	7.25±0.63	12 w	①⑧
Tian SL 2019⁶⁸	60 (30/30)	Nr.	Nr.	Qigui Jiedu Tongluo decoction+C	Vitamin B12 0.5 mg tid	9.91± 1.11	9.60±0.88	11.93± 1.35	11.60±0.88	8.38±0.89	8.32±1.07	12 w	①④⑤⑧
Wang ZF et al 2010⁶⁹	159 (80/79)	62.68± 7.3	62.78±7.57	Huangqi Guizhi Wuwu decoction+C	Vitamin B12 0.5 mg tid	Nr.	Nr.	Nr.	Nr.	Nr.	Nr.	12 w	①②
Wei Q et al 2018⁷⁰	60 (30/30)	65.1±6.3	64.5± 5.8	Taditional Chinese Medicine+C	Vitamin B12 0.5 mg tid	Nr.	Nr.	Nr.	Nr.	8.37±0.98	8.44±1.39	12 w	①④
Wu Y et al 2015⁷¹	120 (60/60)	Nr.	Nr.	Buyang Huanwu decoction+C	Vitamin B12 0.5-1 mg qd	Nr.	Nr.	Nr.	Nr.	Nr.	Nr.	12 w	①②
Xu S 2021⁷²	60 (30/30)	61.07± 6.87	61.87±6.68	Yiqi Yangyin Zhuyu decoction+C	Vitamin B12 0.5 mg tid	7.20± 0.93	7.11±1.01	11.08± 1.44	11.26±1.58	7.37±1.24	7.28±0.91	12 w	①②③④
Xu XJ 2019⁷³	60 (30/30)	52.67± 8.96	56.63±8.18	Yiqi Yangyin Tongluo prescription+C	Vitamin B12 0.5 mg tid	5.97± 0.75	6.15±0.59	8.31± 0.68	8.10±0.55	9.75±2.09	9.55±1.45	12 w	①②③④⑤⑧
Yan J et al 2021⁷⁴	98 (49/49)	57.24± 10.83	56,55±11.22	Zicui Juanbi prescription+C	Vitamin B12 0.5 mg tid	Nr.	Nr.	Nr.	Nr.	Nr.	Nr.	12 w	①②⑦
Yang WJ et al 2021⁷⁵	60 (30/30)	52.8± 7.46	55.3± 6.417	Bushen Tongluo prescription+C	Vitamin B12 0.5 mg tid	6.02± 0.56	6.14±0.65	8.76± 0.70	8.63±0.88	8.48±0.68	8.50±0.47	12 w	①③④⑧
Yang XQ et al 2016⁷⁶	96 (48/48)	55.3± 11.4	56.6± 10.8	Huangqi Guizhi Wuwu decoction+C	Epalrestat 50 mg tid	8.60± 1.40	8.80±1.20	14.40± 2.20	14.60±2.30	8.20±1.60	8.50±1.30	12 w	②④
Yang XQ et al 2016⁷⁶	96 (48/48)	55.3± 11.4	56.6± 10.8	Huangqi Guizhi Wuwu decoction+C	Vinpocetine 30 mg qd	8.60± 1.40	8.80±1.20	14.40± 2.20	14.60±2.30	8.20±1.60	8.50±1.30	12 w	②④
Zhang Y et al 2008⁷⁷	60 (30/30)	60.13± 10.38	60.87±11.51	Huoxue Jiangtang capsules+C	Vitamin B12 0.5 mg tid	10.30± 2.00	10.00±1.70	15.90± 2.70	14.50±2.30	Nr.	Nr.	3 m	①②④
Zhao W et al 2008⁷⁸	60 (30/30)	58.3± 5.4	57.3± 4.0	Tangluoan capsules+C	Vitamin B12 0.5 mg tid	6.30± 0.70	6.20±0.80	8.70± 0.70	8.40±0.70	Nr.	Nr.	3 m	①②④⑧
Zhao YY 2019⁷⁹	80 (40/40)	52.04± 12.02	53.58±11.80	Qigui Tongluo granules+C	α-Lipoic acid 0.3 mg bid	8.54± 0.78	9.02±1.12	12.43± 1.30	11.09±0.66	7.80±0.74	7.55±0.42	12 w	①②④⑦
Zhou YH 2015⁸⁰	102 (52/50)	56.4± 10.1	54.9± 9.8	Xiaoma Zhitong granules+C	Vitamin B12 0.5 mg tid	Nr.	Nr.	Nr.	Nr.	Nr.	Nr.	12 w	①②③⑦
Zhou ZN et al 2015⁸¹	122 (64/58)	63.6±9.7	65.2± 10.7	Xiaoke Tongbi prescription+C	Vitamin B12 0.5 mg tid	Nr.	Nr.	Nr.	Nr.	Nr.	Nr.	12 w	②

Outcome	Egger’s test (P value)
Total efficacy rate	0.0000
peroneal motor nerve conduction velocity	0.5524
peroneal sensory nerve conduction velocity	0.5363
median motor nerve conduction velocity	0.3716
median sensory nerve conduction velocity	0.1531
TCSS score	0.4086

Outcome	Egger’s test (P value)
Total efficacy rate	0.0000
peroneal motor nerve conduction velocity	0.5524
peroneal sensory nerve conduction velocity	0.5363
median motor nerve conduction velocity	0.3716
median sensory nerve conduction velocity	0.1531
TCSS score	0.4086

Outcome	Certainty assessment							No. of patients		Effect Size		Certainty
Outcome	No. of studies	Study design	Risk of bias	Inconsistency	Indirectness	Imprecision	Publication bias	Intervention group	Control group	Relative effects (95% CI)	Absolute effects (95% CI)	Certainty
TER	40	RCTs	Serious^a	Not serious	Not serious	Not serious	Serious^c	1381/1574 (87.7%)	1060/1552 (68.3%)	RR 1.25 (1.21 to 1.30)	171 per 1000 ( 143 to 205 )	???? low
PMNCV	26	RCTs	Serious^a	Not serious	Not serious	Not serious	Not serious	1111	1098	-	MD 2.94 more (2.39 more to 3.48 more)	???? Moderate
PSNCV	24	RCTs	Serious^a	Not serious	Not serious	Not serious	Not serious	1073	1026	-	MD 2.71 more (2.21 more to 3.22 more)	???? Moderate
MMNCV	23	RCTs	Serious^a	serious^b	Not serious	Not serious	Not serious	994	955	-	MD 3.16 more (2.45 more to 3.87 more)	???? low
MSNCV	19	RCTs	Serious^a	serious^b	Not serious	Not serious	Not serious	792	787	-	MD 2.68 more (1.88 more to 3.48 more)	???? low
TCSS	11	RCTs	Serious^a	Not serious	Not serious	Not serious	Not serious	396	389	-	MD 1.5 fewer (1.83fewer to 1.17 fewer)	???? Moderate

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