Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Sep 15, 2023; 14(9): 1422-1449
Published online Sep 15, 2023. doi: 10.4239/wjd.v14.i9.1422
Effectiveness and safety of traditional Chinese medicine for diabetic retinopathy: A systematic review and network meta-analysis of randomized clinical trials
Hong-Dian Li, Ming-Xuan Li, Wen-Hua Zhang, Shu-Wen Zhang, Yan-Bing Gong
Hong-Dian Li, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
Ming-Xuan Li, Capital Medical University, Beijing Hospital of Traditional Chinese Medicine, Beijing 100010, China
Wen-Hua Zhang, Shu-Wen Zhang, Yan-Bing Gong, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
Author contributions: Li HD and Li MX conceived and designed the study, performed the initial search and screening of the literature; Zhang SW was involved in the decision of literature inclusion; Zhang WH assessed the quality of the literature; Li HD and Li MX entered the literature data, including author information, year of publication, outcome indicators, and the profile of the study population; Li MX performed the network meta-analysis and produced the figures; Li HD performed the first draft of the manuscript; Zhang WH and Zhang SW performed the preliminary check and revision of the first draft; Gong YB performed the final revision of the manuscript and critically reviewed the results of the data; In addition, all personnel were familiar with the content of the manuscript; Li HD and Li MX contributed equally to this study.
Supported by The National Administration of Traditional Chinese Medicine for the Youth Qihuang Scholar Support Project.
Conflict-of-interest statement: All authors have no conflict of interest of any kind.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Yan-Bing Gong, PhD, Dean, Dongzhimen Hospital, Beijing University of Chinese Medicine, No. 5 Haiyuncang Hutong, Dongcheng District, Beijing 100700, China.
Received: April 17, 2023
Peer-review started: April 17, 2023
First decision: June 1, 2023
Revised: June 14, 2023
Accepted: July 29, 2023
Article in press: July 29, 2023
Published online: September 15, 2023

Diabetic retinopathy (DR) is currently recognized as one of the most serious diabetic microangiopathies and a major cause of adult blindness. Commonly used clinical approaches include etiological control, microvascular improvement, and surgical intervention, but they are ineffective and have many side effects. Oral Chinese medicine (OCM) has been used for thousands of years to treat DR and is still widely used today, but it is unclear which OCM is more effective for DR.


To estimate relative effectiveness and safety profiles for different classes of OCMs for DR, and provide rankings of the available OCMs.


The search time frame was from the creation of the database to January 2023. RevMan 5.3 and Stata 14.0 software were used to perform the systematic review and Network meta-analyses (NMA).


A total of 107 studies and 9710 patients were included, including 4767 cases in the test group and 4973 cases in the control group. Based on previous studies and clinical reports, and combined with the recommendations of Chinese guidelines for the prevention and treatment of DR, 9 OCMs were finally included in this study, namely Compound Xueshuantong Capsules, Qiming Granules, Compound Danshen Dripping Pills, Hexue Mingmu Tablets (HXMM), Qiju Dihuang Pills (QJDH), Shuangdan Mingmu Capsules (SDMM), Danggui Buxue Decoction (DGBX), Xuefu Zhuyu Decoction and Buyang Huanwu Decoction. When these nine OCMs were analyzed in combination with conventional western medicine treatment (CT) compared with CT alone, the NMA results showed that HXMM + CT has better intervention effect on the overall efficacy of DR patients, HXMM + CT has better effect on improving patients' visual acuity, SDMM + CT has better effect on inhibiting vascular endothelial growth factor, DGBX + CT has better effect on reducing fundus hemorrhage area, HXMM + CT has better effect on reducing fasting blood glucose, and QJDH + CT has better effect on reducing glycated hemoglobin. When there are not enough clinical indicators for reference, SDMM + CT or HXMM + CT treatments can be chosen because they are effective for more indicators and demonstrate multidimensional efficacy.


This study provides evidence that combining OCMs with CT leads to better outcomes in all aspects of DR compared to using CT alone. Based on the findings, we highly recommend the use of SDMM or HXMM for the treatment of DR. These two OCMs have demonstrated outstanding efficacy across multiple indicators.

Keywords: Diabetic retinopathy, Network meta-analysis, Traditional Chinese medicine, Therapeutic effect, Systematic review

Core Tip: To our knowledge, this study represents the first network meta-analysis (NMA) examining the effectiveness of traditional Chinese medicine in treating diabetic retinopathy (DR). Notably, this NMA includes the largest number of original studies, subjects, and variety of Chinese medicines to date. While the efficacy of Chinese medicine for DR has been widely recognized in China, no previous studies have systematically evaluated which Chinese medicine treatment is the most effective. Therefore, this study fills an important gap in the field.