Efficacy and safety of Chinese herbal compounds for lumbar disc herniation: a systematic review of randomized controlled trials.

BACKGROUND: Lumbar disc herniation (LDH) is a leading cause of back pain, and its management remains challenging due to limited therapeutic options. Traditional Chinese medicine (TCM), particularly Chinese herbal compounds (CHC), has been used to treat LDH based on empirical clinical experience. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of CHC in treating LDH, comparing it with conventional Western medicine treatments. METHODS: A systematic search was conducted across multiple electronic databases, including PubMed, Embase, CENTRAL, and Chinese databases (CNKI, WanFang, VIP, and SinoMed), up to May 2023. Randomized controlled trials (RCTs) comparing TCM with Western medicine for LDH were included. Data extraction and bias assessment were performed independently by two reviewers using the Cochrane Risk of Bias tool. Statistical analysis was conducted using RevMan 5.0 software. The review protocol was registered with PROSPERO (number CRD42023434493). RESULTS: Twenty-seven RCTs with 3133 patients were included. Meta-analysis showed that CHC had superior outcomes compared to Western medicine in several key measures: effective rate (RR = 1.12, 95% CI: 1.08-1.16, P < 0.00001), final follow-up (RR = 1.13, 95% CI: 1.08-1.18, P < 0.00001), Japanese Orthopaedic Association (JOA) score (SMD = 0.86, 95% CI: 0.17-1.55, P = 0.01), visual analog scale (VAS) score (SMD = 0.66, 95% CI: 0.29-1.03, P = 0.0004), and safety (RR = 0.05, 95% CI: 0.01-0.25, P = 0.0003). Subgroup analyses indicated that CHC was particularly beneficial for patients with longstanding disease (LDH > 18 months) and those intolerant to NSAIDs. CONCLUSIONS: This meta-analysis suggests that CHC is more effective than Western medicine in treating LDH, with benefits in pain relief and functional improvement. However, the evidence quality was downgraded due to significant risks of bias, high heterogeneity in outcomes, and the limited number of studies reporting safety data. Future studies should address these limitations through more rigorous study designs, longer follow-up periods, and standardized protocols. If future trials confirm these findings, CHC may be a valuable complementary treatment for LDH, particularly in patients with NSAID intolerance or chronic conditions.