No assured evidence on traditional Chinese medicine herbs (TCMHs) stopping bleeding from haemorrhoids but limited evidence on TCMHs alleviating some symptoms caused by haemorrhoids.

Haemorrhoids, one of the common perianal diseases, may easily lead to haematochezia, perianal inflammation, perianal venous prolapse or incarceration once it progresses to a serious stage. Besides surgical operation or minimally invasive treatment, a variety of Traditional Chinese Medicine herbs (TCMHs) have been used for treating bleeding haemorrhoids in many patients in China. TCMHs might be effective for this illness and provide an alternative therapeutic measure. However, our primary research for this review showed that there was no strong evidence concerning the effectiveness of TCMHs in stopping bleeding from haemorrhoids. The included studies were few and of low quality. Limited, weak evidence showed that some formulae, when including Radix Sanguisorbae, Radix Rehmanniae, Fructus Sophorae, etc., may alleviate some symptoms caused by haemorrhoids. These symptoms include hematochezia and congestive haemorrhoidal cushions, in the short term. Additional, standardised trials are needed for meta-analysis to draw a final conclusion.

Authors' conclusions: 

This review did not provide strong evidence concerning the effectiveness of TCMHs for stopping bleeding from haemorrhoids. Most of the included studies were of low quality and there was a scarcity of eligible trials and numbers of participants. Limited, weak evidence showed that some herbal formulae, when including Radix Sanguisorbae, Radix Rehmanniae, Fructus Sophorae, Radix Angelicae Sinensis, Radix Scutellariae, etc., may alleviate some symptoms caused by haemorrhoids. These include hematochezia, congestive haemorrhoidal cushions and inflammation of perianal mucosa in the short term. Well-designed clinical trials are required urgently before any confident conclusions can be drawn about the value of TCMHs for stopping bleeding from haemorrhoids.

At present, the evidence is not enough that clinical practice should be changed immediately on the basis of these results.

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Background: 

Haemorrhoids is a common perianal disease, which often causes haematochezia. Besides a surgical operation or minimally invasive treatment, a variety of traditional Chinese medicinal herbs (TCMHs) have been used to treat bleeding haemorrhoids.

Objectives: 

To assess the effectiveness of traditional Chinese medicinal herbs for stopping bleeding from haemorrhoids and the adverse effects caused by these herbs.

Search strategy: 

We searched the Cochrane Colorectal Cancer Group Trials Register, Cochrane Central Register of Contolled Trials (CENTRAL) (The Cochrane Library), MEDLINE, EMBASE, CMCD (Chinese Medicine Conference Disc) and CBMD (Chinese Bio-Medicine Disc).

Selection criteria: 

All randomised clinical trials (RCTs) of Chinese herbs for bleeding haemorrhoids were included.

Data collection and analysis: 

Two authors independently extracted the data, which were analysed using RevMan 5.0 software. We estimated the relative risk for dichotomous data and calculated the weighted mean difference for continuous data.

Main results: 

Nine trials involving 1822 patients with bleeding haemorrhoids were identified. The included trials were generally not of high quality and used one TCMH preparation compared with another TCMH preparation (Type I) (five trials) or western medicines (Type II) (four trials). We could not pool the data to perform a meta-analysis as only two of the included trials used the same intervention or comparison.

In the nine trials, TCMHs showed a statistically significant difference for the improvement in the general curative effects or total grade of symptoms in six trials (P < 0.05; P < 0.01), of hematochezia in three trials (P < 0.05; P < 0.001), and of inflammation of perianal mucosa in one trial (P < 0.05). The adverse effects reported were not serious and were scarce.

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