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Network meta-analysis suggests Chinese patent medicines plus Western medicine may improve functional constipation in elderlyChinese herbal medicines combined with Western drugs may help elderly constipation

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Key Takeaway
Consider SUCRA rankings for CPMs in elderly constipation as exploratory due to low-certainty evidence and safety reporting gaps.

This network meta-analysis evaluated the efficacy and safety of six Chinese patent medicines (CPMs) combined with Western medicine (WM) versus WM alone for functional constipation in elderly patients. The analysis included 23 randomized controlled trials with a total of 2065 participants. The main finding was that CPMs plus WM generally improved overall response compared with WM alone, though specific effect sizes, absolute numbers, and confidence intervals were not reported. Congrong Tongbian Oral Liquid + WM and Liuwei Anxiao Capsule + WM had higher probabilities of being top options for overall response in SUCRA-based rankings.

Safety reporting across the included trials was inconsistent. Adverse events were mostly described as mild reactions, such as abdominal pain, diarrhea, and bloating, but definitions and ascertainment methods were often not described. Participant-level incidence of adverse events was frequently unavailable, and serious adverse events and discontinuation rates were not reported. The authors noted that the absence of reported serious adverse events should not be interpreted as evidence that serious events did not occur.

Key limitations include low or very low certainty of evidence for all outcomes, unclear or high risk of bias in the included trials that may have overestimated treatment effects, and several comparisons informed by few trials. The SUCRA-based rankings should be considered exploratory and hypothesis-generating rather than definitive indicators of clinical superiority. In terms of practice relevance, the authors state that no strong clinical recommendations favoring any specific CPM can be made based on the current evidence.

Researchers reviewed 23 existing studies to see if adding one of six specific Chinese herbal medicines to standard Western treatments could help elderly people with functional constipation. The studies involved a total of 2,065 older patients. The analysis suggested that combining these herbal medicines with Western drugs might improve overall treatment response better than using Western drugs alone. Two combinations—Congrong Tongbian Oral Liquid and Liuwei Anxiao Capsule—appeared more likely to be top options in a statistical ranking.

It is very important to understand the limitations of this research. The quality of the evidence from the reviewed studies was rated as low or very low. Many of the original studies had design problems that could have made the treatments seem more effective than they really are. The reporting of side effects was inconsistent and often poorly described, making it hard to know the true safety profile.

While the findings are interesting, they are not strong enough to change medical practice. The statistical rankings of the different herbal medicines should be seen as exploratory, not as proof that one is better than another. No strong recommendations can be made for using any specific Chinese herbal medicine for this condition based on this review alone.

Readers should take away that this is early, low-certainty evidence. More high-quality research is needed to confirm if these combinations are truly effective and safe for elderly patients with constipation. Anyone considering these treatments should discuss the potential benefits and unknown risks with their doctor.

What this means for you:
Early, low-certainty evidence suggests some Chinese herbal medicines may help with constipation in the elderly, but more research is needed.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedMar 2026
View Original Abstract ↓
Functional constipation (FC) is a prevalent condition in the elderly that greatly reduces quality of life. Combined treatment using Chinese Patent Medicine (CPM) and Western Medicine (WM) is frequently employed; however, the comparative efficacy and safety of various CPMs are unclear. To assess and compare the efficacy and safety of six regularly used CPMs combined with WM in the treatment of elderly FC patients. A systematic search was performed in eight electronic databases from their inception through May 31, 2025. Two reviewers independently evaluated studies, gathered data, and calculated the risk of bias using the Risk of Bias 2 tool. The level of evidence certainty was rated using GRADE. The Bayesian network meta-analysis (NMA) was conducted using R software (version 4.5.0). The effect sizes were shown as relative risk, mean difference, standardized mean difference, and 95% credible intervals (CrIs). Interventions were ranked according to the surface under the cumulative ranking curve (SUCRA). Twenty-three randomized controlled trials (2,065 participants) involving six CPMs were included. The certainty of evidence for all outcomes was rated as low or very low, and an unclear or high risk of bias, which may have overestimated treatment effects. CPMs plus WM generally improved overall response compared with WM alone. SUCRA rankings suggested that Congrong Tongbian Oral Liquid + WM and Liuwei Anxiao Capsule + WM had higher probabilities of being among the top options for overall response; however, several comparisons were informed by few trials, and the evidence was of low/very low certainty. Therefore, SUCRA-based rankings should be considered exploratory and hypothesis-generating rather than definitive indicators of clinical superiority. Adverse-event reporting was inconsistent and mostly involved mild reactions (e.g., abdominal pain, diarrhea, bloating); however, definitions and ascertainment were often not described and participant-level incidence was frequently unavailable, limiting comparative safety conclusions, and the absence of reported serious adverse events should not be interpreted as evidence that serious events did not occur. CPMs plus WM may offer potential benefits for elderly patients with FC. However, given the low/very low certainty of evidence, prevalent risk-of-bias concerns, and limitations in safety reporting, definitive comparative conclusions or practice recommendations cannot currently be made. These findings should be regarded as exploratory signals requiring confirmation in adequately powered, rigorously designed multicenter randomized controlled trials with stringent adverse-event monitoring and extended follow-up. Accordingly, no strong clinical recommendations favoring any specific CPM can be made based on current evidence. https://www.crd.york.ac.uk/PROSPERO/view/CRD420251087886, identifier CRD420251087886.
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