Efficacy of traditional Chinese medicine-based clearing heat and laxative method against nonalcoholic fatty liver disease: A systematic review and meta-analysis

Background: Increasing evidences support the effectiveness of traditional Chinese medicine (TCM) in the treatment of nonalcoholic fatty liver disease (NAFLD), but it involves a wide variety of therapeutic methods. We aimed to evaluate the efficacy and safety of the TCM-based clearing heat and laxative (CHL) Method for intervention in NAFLD. Methods: Randomized controlled trials (RCTs) of CHL method for NAFLD were included. We searched Pubmed, Scopus, Web of science, CNKI, CBM, VIP, Wanfang databases from the inception to October 2023. We performed separate meta-analyses of clinical outcomes for liver enzymes, lipid profile, and total efficiency. The quality of the evidence was assessed with the Cochrane risk of bias tool. This study is registered on INPLASY, number INPLASY2022100002. Results: Nine trials involving 856 participants were included in this meta-analysis. The meta-analysis showed that compared with the control group, the experimental group was more conducive to ameliorating the levels of ALT [MD = −8.00, 95% CI (−9.43, −6.56), P < .00001], AST [MD = −7.41, 95% CI (−8.75, −6.07), P < .00001], GGT [MD = −29.41, 95% CI (−42.25, −16.56), P < .00001], TC [MD = −0.76, 95% CI (−1.18, −0.35), P = .0003], TG [MD = −0.54, 95% CI (−0.82, −0.27), P = .0001], HDL-C [MD = 0.15, 95% CI (−0.01, 0.31), P = .07], LDL-C [MD = −0.47, 95% CI (−0.62, −0.32), P < .00001], and the total effective rate [OR = 3.11, 95% CI (1.94, 4.99), P < .00001]. Adverse events were observed in 2 trials, mainly milder gastrointestinal symptoms. Conclusion: Significant differences in the clinical efficacy were found between the experimental and control groups in treating NAFLD. Thus, the TCM-based CHL method brings significant advantages in treating NAFLD. Further, it is recommended that patients in NAFLD with abnormal liver enzymes be treated with CHL for at least 3 months, and the proportion of laxatives in TCM prescription can be appropriately increased to improve the overall curative effect.