Network meta-analysis of 107 RCTs on blood-invigorating Chinese herbal medicines for endometriosis

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Frontiers in Medicine Published May 14, 2026 Medically reviewed May 14, 2026 Study authors: Weiru Liu, Like Xu, Jing Jia, Min Xu, Yingzhou Tian DOI ↗ By Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

Key Takeaway

Consider BISMs plus conventional therapy for endometriosis based on a network meta-analysis of 107 RCTs.

This network meta-analysis evaluates the efficacy and safety of blood-invigorating and stasis-resolving Chinese herbal medicines (BISMs) combined with conventional clinical therapy compared to conventional clinical therapy alone in patients with endometriosis. The review synthesizes evidence from 107 randomized controlled trials to assess overall clinical efficacy, pain visual analog scale (VAS), sex hormones (E2, FSH, LH), serum CA125, endometriotic cyst diameter, recurrence rate, and incidence of adverse events.

The analysis indicates that Guizhi Fuling pills/capsules with biomedicine achieved a SUCRA of 87.4% for overall response. Patients experienced an additional 1–2-point reduction in pain VAS and prominent reductions in sex hormones. Additionally, serum CA125 and endometriotic cyst diameter showed lowering and shrinking trends, while the recurrence rate was markedly reduced. The incidence of adverse events was fewer with Dan'e Fukang paste, Guizhi Fuling pills/capsules, and Sanjie Zhentong capsules, reflecting a favorable safety profile.

The authors note that high-quality, large-scale RCTs with long-term follow-up are warranted to confirm and refine these findings. While the evidence supports potential benefits, the lack of reported follow-up duration and specific absolute numbers limits the precision of long-term outcome estimates. This review provides evidence-based guidance for clinical decision-making regarding the integration of these herbal medicines into conventional treatment regimens.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedMay 2026

View Original Abstract ↓

To systematically evaluate the efficacy and safety of blood-invigorating and stasis-resolving Chinese herbal medicines (BISMs) when combined with conventional clinical therapy for endometriosis, and to provide evidence-based guidance for clinical decision-making. Eight databases (CNKI, WanFang, VIP, SinoMed, PubMed, EMBASE, Cochrane Library, and Web of Science) were searched from inception to 16 June 2025 for randomized controlled trials (RCTs). Two reviewers independently screened studies, extracted data, and assessed risk of bias using a modified Cochrane tool. A random-effects network meta-analysis under a frequentist framework was performed with Stata 17.0 (mvmeta command). Surface under the cumulative ranking curve (SUCRA) values were used to rank interventions. Primary outcomes were overall clinical efficacy, pain visual analog scale (VAS), sex hormones (E2, FSH, LH), serum CA125, endometriotic cyst diameter, recurrence rate, and incidence of adverse events. A total of 107 RCTs were included. 1. Global efficacy: BISMs plus modern medical therapy significantly improved overall response; the combination of Guizhi Fuling pills/capsules with biomedicine ranked first (SUCRA = 87.4%). 2. Symptom relief: Regimens such as Sanjie Zhentong capsules and Xiaojin pills provided an additional 1–2-point reduction in VAS compared with modern medical therapy alone. 3. Hormonal regulation: Bushen Huoxue Sanyu decoction, Dan’e Fukang paste, and Gongliuxiao capsules showed prominent reductions in E2, FSH, and/or LH.4. Inflammation and lesion control: Danggui Shaoyao powder and Shaofu Zhuyu granules ranked highest for lowering CA125 and shrinking cyst diameter. 5. Recurrence and safety: Xiaojin pills, Bushen Huoxue Sanyu decoction, and Shaofu Zhuyu granules markedly reduced recurrence, while Dan’e Fukang paste, Guizhi Fuling pills/capsules, and Sanjie Zhentong capsules were associated with fewer adverse events. Funnel plots revealed no evident publication bias. Combining BISMs with conventional modern medical treatment offers superior multidimensional benefits—pain alleviation, hormonal balance, inflammatory control, cyst reduction, and recurrence prevention—over modern medical therapy alone, with a favorable safety profile. Among the evaluated regimens, Guizhi Fulingpills/capsules, Dan’e Fukang paste, Shaofu Zhuyu granules, and Gongliuxiao capsules demonstrated the most consistent overall performance. High-quality, large-scale RCTs with long-term follow-up are warranted to confirm and refine these findings.