SYSTEMATIC REVIEW article
Front. Pharmacol.
Sec. Ethnopharmacology
Efficacy Comparison of Four Different Chinese Herbal Mediciness in Intervening Acute Respiratory Distress Syndrome: A Bayesian Network Meta-Analysis
Provisionally accepted
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Background: Acute Respiratory Distress Syndrome (ARDS) is a critical condition with high ICU mortality. Despite standard biomedical treatments such as mechanical ventilation, patient outcomes remain poor, with in-hospital mortality rates reaching approximately 40% and multiple complications negatively affecting prognosis. Chinese Herbal Medicines (CHMs) have shown potential as adjunctive therapies with favorable safety profiles. When combined with standard biomedical treatments, CHMs may exert synergistic effects, improving overall therapeutic efficacy and patient outcomes. Objective: This study aimed to evaluate the relative efficacy of four commonly used CHM formulas in the treatment of ARDS, providing evidence-based guidance for clinical decision-making. Methods: A comprehensive search of seven major Chinese and international databases identified four CHM formulas frequently prescribed for ARDS management: Xuanbai Chengqi Decoction (XBCQD), Dachengqi Decoction (DCQD), Liangge Powder (LGP), and Fusu Agent (FSA). A Bayesian network meta-analysis (NMA) was conducted to systematically compare and rank the efficacy of these interventions based on key clinical endpoints, including mechanical ventilation duration (MVD), intensive care unit length of stay (ICU LOS), and the PaO₂/FiO₂ (P/F) ratio. Results: Eighteen clinical studies involving 1,134 participants were included to assess the comparative efficacy of the four CHMs. XBCQD ranked highest in reducing MVD (SUCRA = 87.8%), followed by FSA (64.3%). FSA demonstrated superior efficacy in shortening ICU LOS (SUCRA = 73.9%) and improving the P/F ratio (92.2%), with XBCQD ranking second (67.6% and 72.6%, respectively). A significant difference was observed between FSA and LGP in improving the P/F ratio (MD = 41.08; 95% CrI: 5.95, 76.22). In contrast, DCQD and LGP showed lower performance across most outcomes, and the improvement in oxygenation with LGP compared to placebo was not statistically significant (MD = 22.06; 95% CrI: −2.22, 46.35). Conclusion: When combined with standard biomedical treatments, XBCQD appears to be the most effective intervention for reducing MVD in ARDS patients, while FSA shows superior efficacy in improving the P/F ratio and shortening ICU LOS. However, these findings require further clinical validation through large-scale, high-quality randomized controlled trials to confirm their clinical applicability.
Keywords: Acute Respiratory Distress Syndrome, Chinese herbal medicines, Xuanbai chengqi decoction, Fusu Agent, Network meta-analysis
Received: 23 Jul 2025; Accepted: 27 Oct 2025.
Copyright: © 2025 Feng, Wu, Dai, Liu, Luo and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Fei Wang, wangfei896@163.com
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