SYSTEMATIC REVIEW article
Front. Pharmacol.
Sec. Ethnopharmacology
This article is part of the Research TopicHerbal Medicine for the Treatment of Chronic Metabolic Diseases, Volume IIView all 43 articles
Traditional Chinese Medicine for Non-Alcoholic Fatty Liver Disease: An Overview of Systematic Reviews with Evidence Mapping and Metabolic Outcome Assessment
Provisionally accepted
Juanjuan Li1
Ruumin Jiao1
Wenquan Su1Wei Chen2Xiangyu Hu3Shuai Xu1Lie Xu1Weiwei Yao1Kejia Liu1
Hong You4*
Jingjie Zhao1*- 1Beijing Friendship Hospital, Capital Medical University, Beijing, China
- 2Department of Acupuncture, Beijing Dong zhi men Hospital, Beijing University of Chinese Medicine, Beijing, China
- 3China Academy of Chinese Medical Sciences Institute of Basic Research in Clinical Medicine, Beijing, China
- 4Liver Research Center, Beijing Friendship Hospital, National Clinical Research Center of Digestive Diseases, Beijing, China
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The paradigm shift from non-alcoholic fatty liver disease (NAFLD) to metabolic dysfunction-associated fatty liver disease (MAFLD) emphasizes metabolic pathogenesis, yet the efficacy of Traditional Chinese Medicine (TCM) under this framework remains unevaluated. Prior reviews focused on NAFLD with outdated data (<2020), lacking clinical translation tools and methodological standards for TCM systematic reviews and meta-analyses (SRs/MAs). This overview integrates NAFLD criteria, visualizes TCM efficacy via evidence mapping, proposes a methodological framework to standardize TCM SRs/MAs, and focuses on evaluating metabolism-related indicators. Nine databases were searched (from database inception to December 30, 2024) for TCM SRs/MAs in NAFLD. Methodological quality was assessed via AMSTAR-2, PRISMA/PRISMA-CHM, and GRADE. Evidence mapping visualized outcomes (liver enzymes, metabolism) to identify clinical priorities. Standardized reporting guidelines for TCM preparations were adhered to, and a ConPhYMP tool assessment evaluated botanical drugs composition and processing disclosure. Thirty-seven SRs/MAs (35 low/critically low quality) reported trends of reduced ALT (-8.2 U/L, 95% CI: -10.1 to -6.3), improved metabolic parameters (e.g., TG: -0.5 mmol/L), and enhanced B-ultrasound resolution (RR: 1.62), though these findings are limited by methodological flaws and low-quality evidence. Evidence mapping highlighted Xiaoyao Powder and Danning Tablet as top-performing formulas. A methodological framework addressing TCM heterogeneity (formula standardization, dosage) and reporting biases was proposed. This is the first overview integrating
Keywords: Non-alcoholic fatty liver disease, Traditional Chinese Medicine, Systematic review, Meta-analysis, Overview
Received: 29 Jul 2025; Accepted: 21 Nov 2025.
Copyright: © 2025 Li, Jiao, Su, Chen, Hu, Xu, Xu, Yao, Liu, You and Zhao. 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:
Hong You, youhongliver@ccmu.edu.cn
Jingjie Zhao, zhaojj@ccmu.edu.cn
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