Herbal Medicine for the Treatment of Anorexia in Children: A Systematic Review and Meta-Analysis

Systematic review and meta-analysis of randomized trials in children with anorexia without organic disease. Most studies were conducted in China, published in Chinese, and used traditional pattern identifications such as spleen-stomach qi deficiency or spleen failing in transportation.

Herbal medicine was given as monotherapy or as an adjunct to other treatments for pediatric anorexia. Formulations included decoctions, granules, and pills; treatment duration ranged from 5 days to 3 months, with 4 weeks and 2 weeks the most common durations. Doses were not consistently reported in the source packet.

Overall, herbal medicine improved anorexia outcomes and some appetite- and growth-related measures, especially when used alone or added to active treatment, but the evidence was limited by bias and heterogeneity. Versus placebo, total effective rate was higher (RR 1.58, 95% CI 1.34 to 1.85) and adverse events were not clearly different (RR 0.66, 95% CI 0.25 to 1.75). Versus active control, total effective rate improved (RR 1.25, 95% CI 1.22 to 1.28), with lower recurrence (RR 0.15, 95% CI 0.09 to 0.25) and fewer adverse events (RR 0.34, 95% CI 0.14 to 0.80). Herbal medicine plus active control also shortened appetite recovery time by 2.09 days and increased food intake, body weight, BMI, and subcutaneous fat thickness versus active control alone.

The evidence base was generally low to moderate quality, with high risk of bias and substantial heterogeneity in herbal formulations, comparators, and outcome measures. Many analyses relied on Chinese-language studies from China, and several endpoints were supported by only a small number of trials, including the placebo comparison. Treatment durations were often short, and dosing details were inconsistently reported.