TCM and Integrated Medicine for Hyperuricemia: Umbrella Review Finds Superiority with Low Certainty

ObjectiveThis study aimed to comprehensively evaluate the methodological quality, reporting quality, and certainty of evidence of systematic reviews (SRs) on Traditional Chinese Medicine (TCM) for hyperuricemia (HUA) using an umbrella review integrated with evidence mapping.MethodsSystematic searches were performed in PubMed, The Cochrane Library, Embase, Web of Science (WOS), CNKI, WanFang, SinoMed, and VIP to identify SRs evaluating TCM for HUA published up to December 2025. Methodological quality was assessed using the AMSTAR 2 tool, reporting completeness was evaluated according to the PRISMA statement, and the certainty of evidence for outcome measures was graded using the GRADE system.ResultsEleven SRs were ultimately included in the analysis. Eight SRs evaluated the total effective rate, demonstrating that both TCM monotherapy and integrated Traditional Chinese and Western medicine (ITCW) treatments were superior to Western medicine (WM) alone. Ten SRs assessed serum uric acid (sUA) levels, showing that both TCM and ITCW regimens outperformed WM or placebo. Six SRs analyzed adverse reaction incidence, demonstrating that the application of TCM and ITCW was associated with a lower incidence of adverse events compared with WM. The AMSTAR 2 assessment revealed that the methodological quality of all included studies was rated as critically low, with primary deficiencies being the lack of protocol registration and the failure to provide a list of excluded studies. The PRISMA evaluations showed a polarization in reporting quality, with severe deficiencies in key items such as protocol registration, funding disclosure, and conflict of interest reporting. The GRADE assessments indicated that the certainty of evidence for the majority of outcome measures was low or very low, primarily downgraded due to study limitations and inconsistency.ConclusionAlthough TCM and ITCW interventions showed potential benefits for favorable efficacy and safety in managing hyperuricemia, the pooled results are derived from studies of critically low methodological quality and therefore do not support definitive clinical recommendations. Existing systematic reviews suffer from poor methodological rigor and suboptimal reporting, highlighting an urgent need for standardized reporting guidelines. Future research should emphasize rigorous study design and mandatory protocol registration to generate high-quality evidence from well-conducted randomized controlled trials (RCTs).