Efficacy of Jianpi formulas (健脾剂) in reducing the recurrence of colorectal adenoma after polypectomy: a systematic review and Meta-analysis

doi:10.19852/j.cnki.jtcm.2025.02.008

Abstract

Abstract:

OBJECTIVES: To systematically review the efficacy and safety of Jianpi formulas (健脾剂) in reducing the recurrence of colorectal adenoma (CRA) after poly-pectomy.

METHODS: Randomized controlled trials (RCTs) investigating Jianpi formulas for CRA post-polypectomy were systematically retrieved from eight electronic databases. The quality of the methodology was assessed using the Cochrane collaboration tool. The Grades of Recommendations Assessment Development and Evaluation (GRADE) approach was employed for evidence assessment. Statistical analyses were conducted using Statistics and Data Analysis (STATA) 17 (StataCorp (College Station, TX, USA) and Review Manager (RevMan) 5.4 (The Cochrane Collaboration (London, UK).

RESULTS: The Meta-analysis, encompassing 18 RCTs with 1838 patients, revealed that Jianpi formulas significantly outperformed postoperative routine treatment. It demonstrated a reduction in the half-year recurrence rate [relative risk (RR) = 0.41, 95% confidence interval (CI) = 0.33-0.49, Z = 9.08, P < 0.000 01], the one-year recurrence rate [RR = 0.58, 95% CI= 0.49-0.69, Z= 6.12, P < 0.000 01], and an enhancement in the clinical effective rate [RR = 1.27, 95% CI = 1.19-1.36, Z= 7.06, P < 0.000 01]. The half-year recurrence rate and the clinical effective rate were medium-quality evidence. The one-year recurrence rate was low-quality evidence. Additionally, Jianpi formulas appear to be safe and do not increase adverse reactions compared to postoperative routine treatment alone.

CONCLUSION: Jianpi formulas exhibit efficacy in reducing postoperative half-year and one-year recurrence rates while improving the clinical effective rate after polypectomy for CRA.

Key words: recurrence, colorectal adenoma, Meta-analysis, randomized controlled trial, Jianpi formulas

XIAO Jing, SONG Danlei, LIANG Caiming, HE Yinuo, ZHENG Weifang, WU Xiaqiu. Efficacy of Jianpi formulas (健脾剂) in reducing the recurrence of colorectal adenoma after polypectomy: a systematic review and Meta-analysis[J]. Journal of Traditional Chinese Medicine, 2025, 45(2): 225-233.

Figures/Tables 7

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Study ID	Participants		RCT design (randomization)	Intervention		Duration (months)	Outcome assessment
Study ID	T	C	RCT design (randomization)	T	C	Duration (months)	Outcome assessment
Xiong XJ et al 2020²⁵	60	60	Random number table method	Jianpi Qushi Fang+PRT	PRT	3	a
Li L et al 2020²⁶	32	32	Random number table method	Jianpi Xingqi Tang+PRT	PRT	3	a, c
Niu XL et al 2015²⁷	30	30	Randomized	Jianpi Xiaotan Tang+PRT	PRT	12	a, b
Chen QT et al 2020²⁸	48	49	Random number table method	Jianpi Lichang Tang+PRT	PRT	2	a, b, c
Zhang R et al 2019²⁹	29	29	Random number table method	Jiawei Wuyao Wan+PRT	PRT	3	a, b, c
Wang HM et al 2021³⁰	40	40	Admission number randomized	Qingchang Quxi Tang+PRT	PRT	3	a, b
Pan ZM 2021³¹	53	53	Random number table method	Liqi Liujunzi Tang+PRT	PRT	2	a, c
Meng K et al 2016³²	40	40	Random number table method	Fuzi Lizhong Tang and Xiangsha Liujunzi Tang+PRT	PRT	2	c
Xie JJ 2021³³	43	43	Random number table method	Jiedu Huoxue Jianpi Fang+PRT	PRT	2	a, c
Zhang BP et al 2020³⁴	176	183	Randomized	Tiaochang Xiaoliu Tang+PRT	PRT	3	b
Zhao L et al 2020³⁵	53	53	Random number table method	Jianpi Xiaoji Jiedu Tang+PRT	PRT	2	a
Guo HJ et al 2020³⁶	43	43	Randomized	Jianpi Xiaoji Qingre Tang+PRT	PRT	2	a, c
Fang MH et al 2018³⁷	30	30	Randomized	Jianpi Xiaoji Qingchang Tang+PRT	PRT	2	a, b, c
Xu YP et al 2021³⁸	48	48	Random number table method	Jianpi Huazhuo Tang+PRT	PRT	3	a, b, c
Yang JW et al 2022³⁹	30	30	Random number table method	Yuchang Tang+PRT	PRT	1.5	c
Yan XJ et al 2018⁴⁰	90	90	Randomized	Zhushao Keli+PRT	PRT	1.5	a
Li Y et al 2021⁴¹	41	40	Random number table method	Tiaochang Xiaoliu Tang+PRT	PRT	3	b
Xiao J 2018⁴²	29	30	Randomized	Wumei Tang+PRT	PRT	3	a

Study ID	Participants		RCT design (randomization)	Intervention		Duration (months)	Outcome assessment
Study ID	T	C	RCT design (randomization)	T	C	Duration (months)	Outcome assessment
Xiong XJ et al 2020²⁵	60	60	Random number table method	Jianpi Qushi Fang+PRT	PRT	3	a
Li L et al 2020²⁶	32	32	Random number table method	Jianpi Xingqi Tang+PRT	PRT	3	a, c
Niu XL et al 2015²⁷	30	30	Randomized	Jianpi Xiaotan Tang+PRT	PRT	12	a, b
Chen QT et al 2020²⁸	48	49	Random number table method	Jianpi Lichang Tang+PRT	PRT	2	a, b, c
Zhang R et al 2019²⁹	29	29	Random number table method	Jiawei Wuyao Wan+PRT	PRT	3	a, b, c
Wang HM et al 2021³⁰	40	40	Admission number randomized	Qingchang Quxi Tang+PRT	PRT	3	a, b
Pan ZM 2021³¹	53	53	Random number table method	Liqi Liujunzi Tang+PRT	PRT	2	a, c
Meng K et al 2016³²	40	40	Random number table method	Fuzi Lizhong Tang and Xiangsha Liujunzi Tang+PRT	PRT	2	c
Xie JJ 2021³³	43	43	Random number table method	Jiedu Huoxue Jianpi Fang+PRT	PRT	2	a, c
Zhang BP et al 2020³⁴	176	183	Randomized	Tiaochang Xiaoliu Tang+PRT	PRT	3	b
Zhao L et al 2020³⁵	53	53	Random number table method	Jianpi Xiaoji Jiedu Tang+PRT	PRT	2	a
Guo HJ et al 2020³⁶	43	43	Randomized	Jianpi Xiaoji Qingre Tang+PRT	PRT	2	a, c
Fang MH et al 2018³⁷	30	30	Randomized	Jianpi Xiaoji Qingchang Tang+PRT	PRT	2	a, b, c
Xu YP et al 2021³⁸	48	48	Random number table method	Jianpi Huazhuo Tang+PRT	PRT	3	a, b, c
Yang JW et al 2022³⁹	30	30	Random number table method	Yuchang Tang+PRT	PRT	1.5	c
Yan XJ et al 2018⁴⁰	90	90	Randomized	Zhushao Keli+PRT	PRT	1.5	a
Li Y et al 2021⁴¹	41	40	Random number table method	Tiaochang Xiaoliu Tang+PRT	PRT	3	b
Xiao J 2018⁴²	29	30	Randomized	Wumei Tang+PRT	PRT	3	a

TCM Category	Chinese herbs	Frequency	Rate (%)
Invigorating spleen and reinforcing Qi	Baizhu (Rhizoma Atractylodis Macrocephalae)	17	7.7
	Gancao (Radix Glycyrrhizae)	16	7.3
	Dangshen (Radix Codonopsis)	14	6.4
	Huangqi (Radix Astragali Mongolici)	8	3.6
Resolving dampness	Fuling (Poria)	12	5.5
	Yiyiren (Semen Coicis)	8	3.6
	Banxia (Rhizoma Pinelliae)	5	2.3
Regulating Qi	Chenpi (Pericarpium Citri Reticulatae)	9	4.1
Regulating Qi	Muxiang (Radix Aucklandiae)	5	2.3
Blood activiatingand stasis dissolving	Ezhu (Rhizoma Curcumae Phaeocaulis)	5	2.3
Blood activiatingand stasis dissolving	Sanqi (Radix Notoginseng)	5	2.3
Clearing away heat	Baihuasheshecao (Herba Hedyotdis)	5	2.3
Promoting digestion and relieving stasis	Shanzha (Fructus Crataegus Pinnatifidae)	6	2.7
Astringency of contraction	Wumei (Fructus Mume)	5	2.3

TCM Category	Chinese herbs	Frequency	Rate (%)
Invigorating spleen and reinforcing Qi	Baizhu (Rhizoma Atractylodis Macrocephalae)	17	7.7
	Gancao (Radix Glycyrrhizae)	16	7.3
	Dangshen (Radix Codonopsis)	14	6.4
	Huangqi (Radix Astragali Mongolici)	8	3.6
Resolving dampness	Fuling (Poria)	12	5.5
	Yiyiren (Semen Coicis)	8	3.6
	Banxia (Rhizoma Pinelliae)	5	2.3
Regulating Qi	Chenpi (Pericarpium Citri Reticulatae)	9	4.1
Regulating Qi	Muxiang (Radix Aucklandiae)	5	2.3
Blood activiatingand stasis dissolving	Ezhu (Rhizoma Curcumae Phaeocaulis)	5	2.3
Blood activiatingand stasis dissolving	Sanqi (Radix Notoginseng)	5	2.3
Clearing away heat	Baihuasheshecao (Herba Hedyotdis)	5	2.3
Promoting digestion and relieving stasis	Shanzha (Fructus Crataegus Pinnatifidae)	6	2.7
Astringency of contraction	Wumei (Fructus Mume)	5	2.3

Outcome	No. of studies	Risk of bias^a	Inconsistency	Indirectness	Imprecision	Other considerations	RR	95% CI	Quality of the evidence
Half-year recurrence rate	14	Serious	Not serious	Not serious	Not serious	None	0.41	0.33-0.49	Moderate
One-year recurrence rate	8	Serious	Not serious	Not serious	Not serious	Publication bias	0.58	0.49-0.69	Low
Clinical effective rate	10	Serious	Not serious	Not serious	Not serious	None	1.27	1.19-1.36	Moderate

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