Bupleuri radix for Acute Uncomplicated Respiratory Tract Infection: A Systematic Review of Randomized Controlled Trials

Systematic review of 7 randomized controlled trials from China including 910 patients with acute uncomplicated respiratory tract infections, mainly acute upper respiratory tract infection and fever. Most participants were children or infants, with one trial in adults with viral common cold; comparators included usual care, placebo, or other control treatments.

Bupleuri radix was tested in multiple forms, including solution for injection, injection by nebulization, intramuscular injection, pills, decoction, and acupoint injection. Doses and schedules varied by trial, including 1~2 ml to 2~3 ml tid in young children, 2 ml nebulized daily for 5 days, 10 mg/kg/day intramuscularly, 25 mg/kg orally as pills, 15 g decoction twice daily for 7 days, and age-based acupoint injection volumes.

Overall, the evidence was low to very low certainty and did not support firm clinical recommendations. Bupleuri radix pills and solution for injection may have an antipyretic effect in febrile AURTI, with some trials showing faster temperature reduction, such as Song (2020) global symptom resolution RR 2.23 (95% CI 1.32, 3.77) and Xu and Mao (2001) temperature change at 8 hours MD -0.74 (95% CI -0.96, -0.52), but other symptom outcomes were largely null or inconsistent. Examples include Cao (2012) global symptom resolution RR 1.42 (95% CI 0.73, 2.76), Gui (2012) cough resolution RR 1.62 (95% CI 0.80, 3.27), and Huang (2014) cure rate RR 0.78 (95% CI 0.42, 1.43). Safety reporting was sparse, with no adverse events in one trial and limited event reporting overall.

The included trials were generally poor quality, with low to very low certainty evidence, small and variable sample sizes, and inconsistent reporting of allocation and outcomes. Safety data were sparse, follow-up was short, and interventions, populations, and outcome measures were heterogeneous, limiting confidence and generalizability.