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sweat, generally have a high temperature, develop a thin, white fur
on the tongue, and experience a productive cough. ’Fever cold’,
on the other hand, is defined by the fact that patients do not feel
chilly, have an elevated temperature, develop a thin and slightly
yellow fur on the tongue, and experience a productive cough.
Herbs are indicated and dispensed in accordance with the symptoms
or causes of the cold. For example Shi Gao (Gypsum Fibrosum)
compounds can markedly abate fever (Deng 1998a),
and Chai Hu (Bupleurum chinesenes DC) and Jing Jie (Herba
Schizonepetae) act as analgesics (Wang 1998; Xu 1998). Ma
Huang (Herba Ephedrae) can be used to induce perspiration and
as an analgesic (Gong 1998); while Ban Xia (Rhizoma Pinelliae) is
dispensed to loosen sputumand suppress coughs (Xue 1998). Fang
Feng (Radix Saposhnikiviae) and Zhi Shu Ye (Folium Perillae) are
given for what is commonly termed ’chill cough’; Jin Ying Hua
(Flos Lonicerae) and Bo He (Herba Menthae) for ’fever cough’;
and Fructus Gardeniae for fever and convulsions.
Why it is important to do this review
Modern pharmacological experiments demonstrate that some
herbs, such as Jin Ying Hua (Flos Lonicerae) (Deng 1998b), Yu
Xin Chao (Herba Houttuyniae) (Deng 1998c), and Ban Lan Gen
(Radix Isatidis) (Deng 1998d) do have antiviral or antibacterial
functions. The principles of traditional Chinese medicine (TCM)
state that the ideal effect will result from using Chinese medicinal
herbs according to its guidelines. Using the herbs incorrectly may
cause harm rather than benefit; for example, the herbs for ’fever
cold’ should never be used for a ’chills cold’.
In China, more than 100 varieties of herbal preparation are used
in the prevention and treatment of the common cold. Hundreds
of millions of dollars are spent on treating colds each year (Zuo
2006). Hundreds of clinical studies have been carried out on Chinese
medicinal herbs for the common cold. These include five
randomised controlled trials (RCTs) involving 880 participants
conducted on “Huang Zhi Hua oral preparation” (Cheng 1999;
He 1999; Pan 1999; Wang 1999a; Yi 1999a). Almost all of these
studies have reported a positive effect.
In high-income countries there is increasing public interest in,
and use of, a wide range of therapies which lie outside the ’mainstream’
or traditionalWesternmedical practice. The recentHouse
of Lords Select Committee report on Complementary and Alternative
Medicine (CAM) heard that “we are now experiencing a
rapid increase in the use of CAM across the Western World” (
HLSC 2000). Whether we support or criticise their effectiveness,
herbal medicines are widely used.
There is evidence to indicate that not all herbs are risk-free. There
are concerns about adverse events, including allergic reactions and
Chinese herbal nephropathy (CHN) (Lampert 2002; Lord 2001;
Nortier 2000). Scientific evidence which indicates that Chinese
herbal medicines are more effective than antibiotics in the treatment
of acute respiratory infections is insufficient (Liu 1998).
O B J E C T I V E S
To assess the efficacy and safety of Chinese medicinal herbs for the
treatment of the common cold in children and adults.
Secondary objectives were to compare the efficacy of different
Chinese medicinal herbs and record any related adverse events.
When making comparisons between groups intended for treatment
with Chinese medicinal herbs and groups allocated to the
placebo or other current treatment regimes, or various Chinese
medicinal herbs, we tested the following hypotheses:
1. that there is no difference in the number of people cured
by the end of the third day; and
2. that there is no difference in the number of adverse
events.
M E T H O D S
Criteria for considering studies for this review
Types of studies
Randomised controlled trials (RCTs) studying the efficacy of Chinese
medicinal herbs for the common cold. If trials did not report
the outcome we were looking for, we contacted the trial authors
to ask for this additional information; the trials were excluded if
this information was not available.
Types of participants
Children (17 years or younger) and adults (18 years or older) with
the common cold.
The common cold is defined as acute inflammation of the nasal
cavity, pharynx or larynx, caused by viral infection(s). Typical
symptoms include runny nose, nasal congestion, sneezing, sore or
scratchy throat, cough, fatigue and fever. Ideally, the diagnostic
criteria for the common cold should be described in the trial. To
allow for changes in classification and diagnostic criteria of the disease,
the diagnosis should be established using the standard criteria
valid at the time of conducting the trial. Changes in diagnostic
criteriamay have produced variability in the clinical characteristics
of the patients included and the results obtained. We considered,
documented and explored these changes in a sensitivity analysis.
We excluded colds caused by influenza in this review - symptoms
always included headache, muscle ache and fatigue, high fever,
usually a cough, sometimes a runny nose, sneezing, sore throat,
and itching eyes, nose, or throat.We also excluded acute bronchitis
developing froma case of common cold.These illnesses are assessed
in other Cochrane Reviews (Chen 2005; Wei 2005).
Chinese medicinal herbs for the common cold (Review) 3
Copyright 2009 The Cochrane Collaboration. Published by JohnWiley & Sons, Ltd.
We excluded patients concurrently suffering fromother infectious
or febrile diseases, or both.
Types of interventions
Chinese herbal medicines compared with placebo or other treatments
for the common cold.We excluded prohibited or suspended
Chinese herbal preparations.
Types of outcome measures
Primary outcomes
Recovery refers to whether the symptoms of common cold were
cleared within three days after treatment. Trials use the following
outcome measures:
1. ’fast effect’ - which means that the fever abated within
two to four hours after treatment, with symptoms subsiding
after 24 hours. This was considered as a ’recovery’;
2. ’marked effect’ - which means that the fever abated
within 24 to 48 hours after treatment, with symptoms
of the common cold subsiding after 48 hours. This was
also considered as a ’recovery’.
Secondary outcomes
1. Fever clearance time: fever clearance time refers to the
time between commencing treatment and temperature
returning to normal.
2. Improvement: temperature returns to normal and most
of the symptoms disappear within three days of administration
of the Chinese herbal preparation.
3. Partial improvement: fever abatement and some symptoms
disappear within three days of administration of
the Chinese herbal preparation.
4. No improvement: no significant change in symptoms
was noted at the end of the third day following the administration
of theChinese herbal preparation. Patients
with a high fever treated with physiotherapy or antibiotics
(for clearance of fever during the treatment) were
considered in this category.
5. Adverse events: we defined serious adverse events according
to the ICHGuidelines (ICHEWG1997) as any
event that leads to death, is life-threatening, requires inpatient
hospitalisation or prolongation of existing hospitalisation,
results in persistent or significant disability,
and any important medical event whichmay have jeopardised
the patient or required intervention to prevent
it. We considered all other adverse events to be nonserious.
6. Additional outcomes: we attempted to analyse the effects
of the interventions on TCM signs, which follow
a particular theoretical and methodological pathway, as
additional outcomes in this review. See the final point in
the Discussion section with regards to validating methods
used to measure TCM signs.
Search methods for identification of studies
Electronic searches
We searched the Cochrane Central Register of Controlled Trials
(CENTRAL) (TheCochrane Library 2008, issue 2) which contains
the Cochrane Acute Respiratory Infections Group’s Specialised
Register; MEDLINE (1966 to May 2008); EMBASE (1980 to
May 2008); AMED(1985 toMay 2008); the Chinese Biomedical
Database (CBMdisc) (1978 to May 2008)
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