Efficacy of Chinese herbal medicines combined with high-intensity focused ultrasound for patients with uterine fibroids: A meta-analysis with core herbs exploration

Uterine fibroids (UFs) are prevalent benign tumours affecting women; they often present with symptoms such as excessive menstrual bleeding, pelvic discomfort, recurrent pregnancy loss, and infertility. High-intensity focused ultrasound (HIFU) has emerged as a non-invasive treatment option. Recent studies suggest that Chinese herbal medicines (CHMs) may enhance the efficacy of HIFU, but a comprehensive evaluation of their combined effects is lacking. To evaluate the effectiveness of CHMs combined with HIFU for UFs through a meta-analysis on randomised controlled trials (RCTs) and identify core herbal patterns that may potentiate HIFU outcomes. English and Chinese databases were searched to identify relevant studies until May 2024. The risk of bias was evaluated using the Cochrane Risk of Bias 2 tool. A meta-analysis was performed using RevMan 5.4 software. The primary outcomes were changes in UF volume and clinical efficacy; secondary outcomes were changes in uterus volume, Traditional Chinese Medicine syndrome scores, incidence of recurrences and adverse reactions. Network analysis was performed to identify core herbs. Nineteen RCTs were included. The effects of reducing UFs volumes in the CHM group were more significant than those in the control group (SMD:0.34; 95 % CI:0.44 to -0.23, p < 0.001, I² = 0 %). The clinical effectiveness rate was higher in the CHM group than with HIFU therapy alone (risk ratio: 1.13; 95 % CI: 1.08 to 1.18; p < 0.001; I2 = 37 %). Core pattern analysis revealed a total of 26 single herbs and 93 commonly used herbal combinations. Among these, Curcumae Rhizoma, Sparganii Rhizoma, Astragalus membranaceus, Poria cocos, Paeonia suffruticosa, and Trionyx sinensis were the most frequently utilized herbs. This is the first meta-analysis to evaluate the clinical effectiveness of combining CHMs with HIFU for UFs, integrating both quantitative outcome and computational core herb pattern analyses to identify CHMs that may enhance the efficacy of HIFU. In addition to demonstrating superior clinical effectiveness, this study proposes a novel hypothesis: core CHMs may enhance HIFU efficacy through a dual-phase mechanism-promoting apoptosis during thermal ablation and modulating fibrotic and proliferative signaling pathways in the post-ablation phase. These findings provide an evidence-based foundation for developing integrated therapeutic strategies.