Review articleHerbal medicine (Danggui Shaoyao San) for treating primary dysmenorrhea: A systematic review and meta-analysis of randomized controlled trials
Introduction
Primary dysmenorrhea is menstrual pain without pelvic pathology occurring with ovulatory menstrual cycle and is the most common gynaecologic problem in women [1], [2], [3]. The reported estimated prevalence of dysmenorrhea is from 25% to 95% [2], [4], [5], [6], [7], [8]. Non-steroidal anti-inflammatory drugs (NSAIDs) reduce moderate to severe pain compared with placebo, while simple analgesics including aspirin and paracetamol may also be beneficial [9]. Severe adverse events associated with such treatments lead patients to seek supportive complementary and alternative medicine (CAM) [10], [11]. One systematic review showed that 32.9% of menopausal women were current CAM users and 47.7% had used CAM in the past 12 months [12]. Examples of CAM therapies for dysmenorrhea include acupuncture related therapies [13], [14], [15], [16], [17] and Chinese herbal medicine (CHM) [18], [19], [20], [21], [22], [23], [24]. In particular, CHM is a potential CAM therapy for dysmenorrhea that is widely used in East Asia [19], [20], [22], [25]. Danggui Shaoyao San (DSS), a CHM, is a traditional medicinal prescription that has long been used for the treatment of menopause-related symptoms in East Asia [25], [26]. DSS is composed of the following six herbs: Paeoniae Radix, Cnidii Rhizoma, Alismatis Rhizoma, Angelicae Radix, Poria Sclerotium, and Atractylodis Rhizoma alba. The mechanisms of DSS are believed to include improvement of ovarian hormones [27], oestrogenic action [28] and neurotoxicity effects [29] under postmenopausal conditions.
Only one systematic review (SR) of Chinese herbal medicine (CHM) for primary dysmenorrhea has been conducted. This SR included 39 randomized clinical trials (RCTs) comparing all types of CHM [18]. The findings of this review suggested that CHM was promising for managing primary dysmenorrhea. However, as this review included all types of CHM, a need remains for a study that focuses on specific type of prescription. Furthermore, there is a language bias because the literature search included only English and Chinese databases and this review is also outdated.
Therefore, the aim of this article was to update and provide a thorough, critical evaluation of the current evidence from RCTs of DSS for primary dysmenorrhea.
Section snippets
Study registration
The protocol for this SR was registered in PROSPERO 2015: CRD42015026423.
Data source
The following electronic databases were searched from their inception through October 2015: PubMed; Cochrane Library; EMBASE; five Korean medical databases (Korea Med, DBPIA, OASIS, Research Information Sharing Service [RISS], and Korean Studies Information Service System [KISS]); three Chinese medical databases (China National Knowledge [CNKI], Wan Fang Database, and Journal integration platform [VIP]); and one Japanese
Description of included trials
The searches identified 746 potentially relevant studies, of which three met our inclusion criteria (Fig. 1). The key data from all included RCTs are summarized in Table 1. Three RCTs originated from China [31], [32], [33] and one from Japan [34]. The three trials evaluated 435 women with primary dysmenorrhea. Modified DSS was used alone in three trials [31], [32], [33], and DSS was combined with diclofenac in one trial [34]. The details of the formula compositions of DSS are listed in Table 2.
Discussion
Few rigorous trials testing the effects of DSS for dysmenorrhea are currently available. Our systematic review and meta-analysis provide suggestive evidence of the superiority of DSS over analgesics and placebo treatment (Table 3). The quality of evidence for this finding was low to moderate because of a high risk of bias. The quality of reporting was generally poor in the included RCTs. Furthermore, the total number of RCTs and the total sample size included in our analysis were not sufficient
Conflict of interest
None declared.
Funding
No external funding received.
Provenance and peer review
Not commissioned; externally peer reviewed.
Acknowledgement
HWL and BSK were supported by Korea Institute of Oriental Medicine (K15290).
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2021, Journal of EthnopharmacologyCitation Excerpt :Bai-zhu in Chinese). In recent years, with various pharmacological effects in vitro and in vivo, DSS has been a reputable prescription widely used in treating dysmenorrhea, neurodegenerative disorders and AS (Ahn et al., 2019; Fu et al., 2016; Lee et al., 2016). It has been reported that DSS prominently lessens triglyceride (TG), total cholesterol (TC) and low-density lipoprotein (LDL) and inhibits the expression of vascular cell adhesion molecule-1 (VCAM1) in rats with hyperlipidemia (Yan et al., 2007).
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2020, Integrative Medicine ResearchCitation Excerpt :Previous studies reported that DJS could influence the function of corticotropin-releasing hormone, inhibit hyperactivity of the adrenal axis,13 improve luteal insufficiency,14 have estrogenic effects,15 and exert neuroprotective effects on postmenopausal neurodegenerative diseases.16 A previous systematic review17 showed that DJS was significantly more effective than analgesics in terms of risk ratio (RR) (1.31, 95% confidence interval (CI) 1.06–1.63), and was superior to the placebo. However, the number of studies included in this review was small, and the overall risk of bias was high, so a large, well-designed study with rigorous guidelines is needed.