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The Journal of Internal Korean Medicine > Volume 46(6); 2025 > Article
Hong and Lim: Herbal Medicine for Oral Mucositis Induced by Chemoradiation Therapy: A Systematic Review and Meta-analysis
Original Article

The Journal of Internal Korean Medicine 2025; 46(6): 1532-1571.

Published online: December 30, 2025

DOI: https://doi.org/10.22246/jikm.2025.46.6.1532

Herbal Medicine for Oral Mucositis Induced by Chemoradiation Therapy: A Systematic Review and Meta-analysis

Junghwa Hong, Seong-woo Lim

Dept. of Oriental Internal Medicine, Graduate School, Dongguk University

·Corresponding author: Seong-woo Lim Dept. of Oriental Internal Medicine, Dongguk University Ilsan Oriental medicine hospital, 27 Dongguk-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, Republic of Korea TEL: +82-31-961-9043 FAX: +82-31-961-9049 E-mail: omdlsw@naver.com

·This thesis is a master’s thesis in the Department of Oriental Medicine, Graduate School, Dongguk University, 2025.

Received November 30, 2025       Revised December 24, 2025       Accepted December 24, 2025

Copyright: © The Society of Internal Korean Medicine

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background:

This systematic review evaluated the therapeutic and preventive effects of herbal medicines on chemoradiation-induced oral mucositis (OM).

Methods:

Randomized controlled trials sourced from nine electronic databases that evaluated the effectiveness of herbal medicine for OM caused by chemoradiation therapy were included. Risk-of-bias assessment and meta-analysis were conducted for selected studies.

Results:

This review included 63 studies involving 5,052 patients. In the meta-analysis, herbal medicine treatment significantly decreased the incidence of OM compared with the control group (n=1670; random-effects OR: 0.28, 95% CI 0.21-0.37, p<0.00001; heterogeneity I²=15%) and significantly improved the total effective rate compared with the control group (n=2874; random-effects OR: 5.10, 95% CI 3.73 -6.97, p<0.00001; heterogeneity I²=33%). Furthermore, despite high heterogeneity among studies, the herbal treatment group showed significant effects on the degree, duration, and area of OM.

Conclusion:

Herbal medicines may reduce the incidence of oral mucositis and improve the total effective rate in individuals undergoing cancer treatment. Therefore, herbal medicines may be used to prevent and manage OM during cancer therapy. However, conclusive interpretation is limited by the quality of evidence and heterogeneity among included studies. Further well-designed studies are required.

Keywords: herbal medicine, oral mucositis, chemoradiation therapy, systematic review, meta-analysis

I. Introduction

Oral mucositis (OM) is a common complication that is difficult to prevent in patients undergoing systemic chemotherapy or radiation therapy to the head and neck region1. Depending on the dose and cytotoxicity of the medicine, approximately 20% to 40% of solid tumor patients receiving chemotherapy are affected by oral mucositis2. Almost all patients receiving radiation therapy for head and neck cancer develop oral mucositis3.
Oral mucositis not only causes severe pain in many patients, resulting in poor quality of life, but it is also a clinically important disease as a high-risk factor for sepsis in cancer patients with neutropenia. In some patients, oral mucositis either prevents them from receiving an appropriate dose of chemotherapy or forces them to cancel or delay their planned treatment. In addition, the reduction in oral nutritional intake as a result of pain leads to a higher demand for intravenous feeding, seriously impacting patients by increasing the risk of systemic infection, prolonging hospitalization, and adding to the costs of treatment4.
In the past, mucositis was thought to result only from damage to basal epithelial cells caused by chemotherapy or radiation. The pathogenesis is now understood to be much more complex, involving the generation of damaging reactive oxygen species, activation of transcription factors such as nuclear factor-κB, inflammatory pathways such as the cyclooxygenase pathway, and the upregulation of proinflammatory cytokines such as tumor necrosis factor-α (TNF-α) and interleukin(IL)-1β5.
In terms of treatment, previously, the focus was on pain control after oral mucositis had occurred. Several treatment methods including debridement, disinfection, topical or systemic analgesics, and control of bleeding have been introduced to treat oral mucositis. Many agents, such as allopurinol, chlorhexidine, diphenhydramine, aluminum hydroxide, and palifermin, have been used to prevent or alleviate oral mucositis6. However, it is currently unclear which treatment is effective against oral mucositis that has already occurred in patients who have received standard chemotherapy7. Since oral mucositis is caused by the cytotoxicity of anticancer treatment, there has been significant interest in the use of natural compounds perceived to have fewer side effects than synthetic medicines8.
As the interest in natural compounds increases, the number of patients seeking herbal medicine to prevent or treat oral mucositis induced by chemoradiation therapy is rising. A previous study shows that herbal medicine has anti-inflammatory and analgesic efficacy and is effective for oral mucositis9. Herbal medicine contains antioxidants that reduce the production of reactive oxygen species, thereby reducing mucositis10.
As studies on the effects of herbal medicines on chemoradiation-induced oral mucositis have progressed, several systematic reviews have also been reported. However, most systematic reviews include only studies that have been published in the English language. This study aimed to conduct a literature review focused on East Asia, where the use of herbal medicine complexes is prevalent, in order to evaluate the therapeutic and preventive effects of herbal medicine on chemoradiation-induced oral mucositis through research without any language restrictions.

II. Methods

1. Study Registration

This systematic review with meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines 2020 state. The protocol for this study was registered with PROSPERO prior to conducting the review. (University of York, Centre for Reviews and Dissemination, York, UK. Registration number: CRD42024566397)

2. Search Strategy

A comprehensive literature search was performed on nine electronic databases from inception to November 2025, using search terms including “Oral mucositis,” “Stomatitis,” “Cancer,” “Chemotherapy,” “Radiotherapy,” and “Herbal medicine.” Detailed search strategies are prescribed in Appendix 1. A list of databases is presented in Table 1.
Table 1
Databases Used in Systematic Literature Search
Language Database Count
English Medline (via PubMed), EMBASE, and Cochrane 3
Korean Oriental Medicine Advanced Searching Integrated System (OASIS), Research Information Service System (RISS), and Korean Citation Index (KCI) 3
Chinese Chinese National Knowledge Infrastructure Databases (CNKI) and Wanfang data 2
Japanese Citation Information by Nii (CiNii) 1

3. Criteria for inclusion and exclusion

1) Types of studies

Only randomized controlled trials (RCTs) in humans were included in this study. Other designs such as experimental studies, case reports, or retrospective studies were excluded. No restrictions were placed on language and time to minimize publication bias.

2) Types of patients

The included studies involved patients with oral mucositis induced by chemotherapy or radiotherapy, without restrictions on sex, race, nationality, age, or type of cancer. Studies involving oral mucositis unrelated to chemotherapy or radiotherapy were excluded.

3) Types of interventions

All types of herbal medicine (e.g., decoctions, granules, powders, oral liquids, tablets, and pills) were included. The routes of administration for the herbal medicine were limited to oral intake or gargling. Studies confirming the composition of herbal medicine were included, even in cases where the components could be identified because they were produced by pharmaceutical companies. Studies in which the composition of herbal medicine could not be verified were excluded. Studies in which supplementary interventions, such as lidocaine, Amphotericin B, or laser, were performed in conjunction with herbal medicine, were excluded. However, cases in which additional interventions were identical to those of the control group were also included.

4) Types of control groups

The control groups included placebo or conventional treatment for oral mucositis. Conventional treatments included routine oral care, mouthwashes, or pharmacological agents commonly used for the prevention or management of oral mucositis. Studies in which the control group received the same co-interventions as the intervention group, except for the herbal medicine, were included. Studies comparing different types of herbal medicine without a non-herbal control group were excluded.

5) Types of outcome measurements

The primary outcomes were the incidence of oral mucositis and the total effective rate (TER). In the case of the total effective rate, the standards for each study were slightly different. In the majority of studies, the severity of oral mucositis was evaluated by the World Health Organization (WHO) scale and the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE). Furthermore, this study assessed various outcomes, including the degree of oral mucositis pain, and duration of oral mucositis.
As a secondary outcome, adverse events (AEs) that were reported in the studies were analyzed.

4. Study Selection and Data Extraction

Two researchers independently conducted searches within the database to identify studies that met the inclusion criteria. After elimination of duplicates, the initial screening process was based on the titles and abstracts of all articles retrieved from each database search. Following the initial screening, the full text of articles was reviewed. The initial data extraction was first conducted by one researcher, followed by a review of the extracted data by another researcher. Any disagreement between the two researchers was resolved by discussion.

5. Risk of Bias Assessment

Two researchers assessed the risk of bias to confirm the validity of the included RCTs. Version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB 2) was used to evaluate the risk of bias. Two researchers performed a risk of bias assessment using the above program, and any disagreement between the two researchers was resolved by discussion. They evaluated five domains for each study - randomization process, deviations from the intended interventions, missing outcome data, measurement of the outcome, and selection of the reported result - scoring each domain as high risk, some concerns, or low risk.

6. Data analysis

A meta-analysis was performed using Review Manager version 5.4 when there were more than five studies reporting the same outcome measure. Since the design of the included studies was inconsistent, the random-effect model was used for data analysis. Odds ratios (ORs) with two-sided 95% confidence intervals (CIs) were calculated for dichotomous outcomes. Mean differences (MDs) with 95% CIs were calculated for continuous outcomes. When the same outcome was evaluated using different measurements, the intervention impact was expressed using the standardized mean difference (SMD) with 95% CIs.
A chi-square test and Higgins I2 statistics were used to assess the statistical heterogeneity among the included studies. The heterogeneity was considered statistically significant when the Higgins I2 reached 50% or higher. If heterogeneity was identified in the results of the meta-analysis, further analyses were performed via subgroup analyses. If there were more than ten studies included in the meta-analysis, publication bias was assessed using a funnel plot.
The evidence level for each outcome was evaluated by GRADEpro, a software for the Grading of Recommendations Assessment, Development, and Evaluation (GRADE).

III. Result

1. Search results and Study Selection

An initial study search was conducted in July 2024, followed by an update on November, 2025.

1) Initial search

A total of 1,713 studies were searched from 9 electronic databases: 249 studies in MEDLINE (via PubMed), 382 studies in EMBASE, 72 studies in Cochrane Library, 10 studies in KCI, 28 studies in RISS, 12 studies in OASIS, 308 studies in CNKI, 276 studies in Wangfang, and 89 studies in CiNii.
Excluding 354 duplicate studies, 1,359 studies were screened. After screening the titles and abstracts, a total of 1,235 studies were excluded for the following reasons: 182 were non-RCT, 101 were not human studies, 362 were not related to cancer or OM, 570 were not related to herbal medicine, 16 had inappropriate interventions, and 4 were from grey literature sources. Of the remaining 124 studies, seven were not published, and nineteen were not retrieved. Consequently, the full texts of 98 studies have been downloaded.
After reviewing the full text of the remaining studies, 38 studies were excluded for various reasons: 16 studies were not RCTs (e.g., retrospective studies), 1 study included inappropriate participants (e.g., tuberculosis), 3 studies were not related to cancer or oral mucositis, 1 study was not related to herbal medicine, 9 studies included inappropriate interventions (e.g., herbal medicine with lidocaine, chlorhexidine, vitamins, or Amphotericin B), 1 study had no information about the composition of herbal medicine, and 7 studies included inappropriate route of administration for herbal medicine (e.g., spray or application).

2) Updated search

A total of 134 studies were searched from 9 electronic databases: 42 studies in MEDLINE (via PubMed), 48 studies in EMBASE, 12 studies in Cochrane Library, one study in KCI, one study in RISS, one study in OASIS, 12 studies in CNKI, 15 studies in Wangfang, and two studies in CiNii.
According to the screening of titles and abstracts, 118 studies were excluded: 30 were non-RCT, 6 were not human studies, 57 were not related to cancer or OM, 24 were not related to herbal medicine, one was including inappropriate intervention.
Additionally, five duplicate studies identified by manual screening and unpublished two studies were excluded. Consequently, the full texts of 9 studies have been downloaded.
After reviewing the full text of studies, 6 studies were excluded for the following reasons: five studies were not related to herbal medicine, and one study included inappropriate route of administration for herbal medicine.
In total, combining the initial and updated searches, 63 studies were finally selected. The study selection process was summarized using the PRISMA flow diagram (Fig. 1).
Fig. 1
PRISMA flow diagram of the study selection process.
KCI : Korea Citation Index, RISS : Research Information Service System, OASIS : Oriental Medicine Advanced Searching Integrated System, CNKI : Chinese National Knowledge Infrastructure Database, CiNii : Citation Information by NII, RCT : Randomized Controlled Trial, OM : Oral Mucositis
jikm-46-6-1532-g001.jpg

2. Selected Studies Analysis

A total of 57 studies were published in China, while 6 studies were published in Japan. In terms of publication language, 9 studies were published in English, 53 in Chinese, and 1 in Japanese. All RCTs included in this study were published between 1997 and 2024. A total of 5,052 patients undergoing chemoradiation therapy were included in this study. There were 47 studies on oral mucositis caused by chemotherapy, 7 studies caused by radiation therapy (RT), and 7 studies caused by combined chemoradiation therapy (CCRT). The two studies evaluated the CT and RT groups independently.
Out of all the studies included, 48 investigated herbal medicine monotherapy, while 15 investigated herbal medicine combined therapy with Western medicine. All Western medicine, including antibiotics, lidocaine, chlorhexidine, vitamins, granulocyte colony- stimulating factor (G-CSF), and over-the-counter medicines, was used in the same manner as the control group.
Within the treatment group, the administration route of herbal medicine included 28 studies on oral intake, 26 on gargling, and 9 on intake after gargling. The duration of the treatment periods in the studies varied between three days and seven weeks. Detailed information on the selected studies is presented in Table 2 and Appendix 2.
Table 2
General Characteristics of the Selected Studies
Author (Year) Sample Size (male/female)
Range of Age (mean±SD)		 Type of cancer Intervention
Experimental Control Experimental Control
Li11 (2023) 48/21 (48.90±9.58) 44/25 (49.71±9.09) Nasopharyngeal cancer Jiandu granule No treatment
Wang12 (2018) 30/5 18-76 (52.26, mean) 23/12 17-75 (52.63, mean) Head and neck cancer Herbal decoction (CHIN) rhEGF spray
Zheng13 (2018) 84/36 19-69 (47.63±10.28) 75/44 24-68 (48.86±9.36) Nasopharyngeal cancer Shuanghua Baihe tablets placebo
Wu14 (2007) 15/15 42-62 (52.0±5.6) 17/13 34-64 (49.0±7.7) Head and neck cancer Qingre Liyan Decoction Dobell’s solution
Yoshimatsu15 (2023) 10/5 IQR 56.0 [52.0-62.5] 9/6 IQR 58.0 [51.5-60.5] Hematopoietic stem cell transplantation Hangeshashinto (半夏瀉心湯) Saline gargle
Taira16 (2020) 7/1 53-83 (64.00±9.83) 7/1 49-79 (63.25±10.00) Head and neck cancer Hangeshashinto (半夏瀉心湯) Placebo (lactose)
Moriyama17 (2018) (1) 5/2 NI (67.1±8.3) (2) 7/0 NI (66.6±6.2) 8/1 NI (61.8±7.9) Esophageal cancer (1) Daiokanzoto (大黃甘草湯)
(2) Hangeshashinto (半夏瀉心湯)		 No treatment
Matsuda18 (2015) 27/16 49.0-84.0 (67.0, med) 23/24 29.0-85.0 (67.0, med) Colorectal cancer Hangeshashinto (半夏瀉心湯) placebo
Aoyama19 (2014) 28/17 36.0-84.0 (68.0, med) 28/18 42.0-89.0 (67.5, med) Gastric cancer Hangeshashinto (半夏瀉心湯) placebo
Li20 (2024) 13/17 (12.54±2.11) 14/16 (11.98±1.87) ALL Double Flower Lily Tablets (双花百合片) chlorhexidine mouthwash
Sun21 (2024) 19/15 62-71 (69.28±6.81) 21/13 63-72 (69.44±6.85) AML Chinese medicine mouthwash (中药漱口液) Kangfuxin Liquid
Yang22 (2024) NI (n=45) 20-68 (39.25±4.08) NI (n=45) 21-70 (40.17±4.31) Breast cancer Modified Gancao Xiexin decoction (甘草瀉心湯加减) Chlorhexidine acetate solution
Cao23 (2021) 21/23 19-75 (45.9±9.8) 24/20 18-74 (45.1±9.1) ALL, AML Yingyuan-gancao Decoction (銀花甘草湯) with control intervention Multivitamin B, Thalidomide tablets
He24 (2021) 0/30 35-55 (45.47±3.62) 0/30 36-55 (45.18±3.29) Breast cancer Sijunzi Decoction (四君子湯) Kangfuxin Liquid
Li25 (2021) 14/13 21-76 (50.72±7.81) 15/12 20-75 (50.26±7.63) NI Huanglian Bingpian Xixin decoction (黃連冰片細辛湯) with control intervention Saline gargle etc.
Liang26 (2021) 26/19 21-80 (56.7±2.3) 24/21 20-79 (55.4±3.1) Nasopharyngeal cancer, Lung cancer, Colorectal cancer, etc. Self-made Xiehuang Xiaoyang Decoction (自擬瀉黃消瘍湯) Multivitamin B
Lin27 (2021) 22/12 32mo-17y (8.04±3.47) 11/11 38mo-14y (7.34±3.60) Pediatric leukemia Herbal anti-cancer capsule (消癌平膠囊) Kangfuxin Liquid
Liu28 (2021) 134/106 (n=120 each in experimental & control) 18-60 (42.36±2.29) GIST, Lung cancer, etc. Gancao Xiexin decoction (甘草瀉心湯) Triamcinolone cream, Chlorhexidine gargle
Liu29 (2019) 11/4 IQR 54.5 [51.5-62.5] 10/3 IQR 53.0 [49.5-66.0] Renal cell carcinoma, HCC Compound Xiexin decoction(複方瀉心湯) Gentamicin + lidocaine gargle
Cai30 (2018) 22/18 35-78 (48±6) 24/16 32-75 (45±7) Head and neck cancer fire-deposit and hair-raising therapy (火鬱發之論) Kangfuxin Liquid
Jia31 (2018) 30/17 18-74 (40.65±6.32) 28/19 17-72 (41.44±5.89) NI Gancao Xiexin decoction (甘草瀉心湯) Vitamin B, Dexamethasone patch
Liu32 (2018) NI (n=20) NI (57.3±10.60) NI (n=20) NI (60.8±9.02) Esophageal cancer, Lung cancer, Breast cancer, etc. Gancao Xiexin decoction (甘草瀉心湯) + G-CSF apply Saline gargle + G-CSF apply
Sun33 (2018) 21/14 47-63 (55.4±3.5) 20/15 48-62 (55.3±3.6) GIST Self-made Stomach Nourishing and Cleansing decoction (自擬養胃清營湯) with control intervention OTC powder
Wang HB34 (2017) 19/31 34-65 (53.57±3.58) 21/29 36-65 (54.32±2.99) Lung cancer, Gastric cancer, Rectum cancer, etc. Self-made Heat and Toxin Clearing Formula (自擬清熱解毒方劑) OTC powder
Wang XL35 (2017) 24/19 33-63 (47.07±9.62) 25/17 32-67 (44.83±9.97) NI Kouyanqing Granules (口炎清顆粒) Chlorhexidine gargle
Wang Y36 (2017) 25/31 (n=28 each in experimental & control) 16-72 (55, mean) Lung cancer, Colorectal cancer, Breast cancer, etc. Pipa Qingwei Decoction (枇杷清胃飲) bFGF spray, Gentamicin + lidocaine gargle
Yuan37 (2017) NI (n=34) 31-68 (55.6±3.2) NI (n=34) 31-69 (55.4±3.1) Breast cancer Xiehuang Powder (瀉黃散) with control intervention Vitamin B, Gentamicin gargle
Zhao38 (2017) 31/19 28-78 (58.4±9.3) 31/19 28-78 (58.4±9.3) Nasopharyngeal cancer, Lung cancer, Gastric cancer, etc. Modified Qianyang Fengsui Dan (加味潛陽封髓丹) Oral ulcer film
Chen39 (2016) 18/7 29-70 (51±11) 9/17 39-72 (46±10) NI Herbal decoction (中藥湯劑) with control intervention Gentamicin + lidocaine gargle
Qian40 (2016) 33/31 28-74 (61.3, mean) 30/33 30-75 (63.2, mean) Gastric cancer, Colorectal cancer, Breast cancer, etc. Gancao Xiexin decoction (甘草瀉心湯) Saline gargle
Wang41 (2016) 27/13 38-66 (57.4±10.7) 25/15 36-65 (55.2±11.8) Nasopharyngeal cancer Self-made cooling blood and generating body fluid decoction (自擬涼血生津方) with control intervention Dobell’s solution
Yang42 (2016) 26/19 18-55 (38.6, mean) 23/20 22-60 (40.3, mean) AML, ALL TCM Mouth Ulcer Gargle (口腔潰瘍含漱液) OTC powder
Zou43 (2016) 43/37 (n=40 each in experimental & control) 5-75 (48.29±14.30) Acute leukemia Compound scutellaria gargle (複方黃芩含漱液) + Multivitamin B Multivitamin B, Gentamicin + lidocaine gargle
He44 (2014) 20/18 40-70 17/21 43-68 Colorectal cancer, Lung cancer, Breast cancer, etc. Chinese herbal medicine (中藥) Gentamicin gargle
Su45 (2014) 23/19 32-80 (63.2, mean) 21/20 35-79 (61.3, mean) NI Gancao Xiexin decoction (甘草瀉心湯) Saline gargle
Wang46 (2014) 51/35 (n=43 each in experimental & control) 49-72 (61.58±5.88) Gastric cancer Yingyuan-gancao Decoction (銀花甘草湯) 1% hydrogen peroxide gargle
Zhang47 (2014) 15/15 29-62 (NI) 17/13 31-67 NI) Gastric cancer Kougan Formula (口疳方) Vitamin B and C
Duan48 (2013) 37/21 8-61 (NI) 32/25 6-57 (NI) ALL, AML, CLL, CML Yingyuan juhua Compound (複方銀菊合劑) Chlorhexidine gargle
Liao49 (2013) 10/12 24.1±6.3 12/10 22.7±7.1 Osteosarcoma, ALL Self-made Yuyang Decoction (自擬愈瘍湯) with control intervention Chlorhexidine gargle
Luo50 (2013) 92/66 (n=79 each in experimental & control) NI (57, mean) Lung cancer, Gastric cancer, Colorectal cancer, etc. Chrysanthemum solution (銀菊花液) 0.02% Nitrofurazone 1~4% bicarbonate
Xu51 (2013) 21/15 NI 14/16 NI Colorectal cancer, Gastric cancer Yinxuan Tang (銀玄湯) 1% iodic acid
Zhang52 (2013) 13/9 32-80 (62.3, mean) 11/9 35-78 (60.8, mean) NI Gancao Xiexin decoction (甘草瀉心湯) Saline gargle
Zou53 (2013) (1) NI (n=20) NI (2) NI (n=28) NI (1) NI (n=20) NI (2) NI (n=28) NI (1) Breast cancer, Nasopharyngeal cancer (2) Breast cancer, Colorectal cancer, Lung cancer, etc. Easy-convenient Gargle with Traditional Chinese Medicine (簡便中藥漱口防) (1) No treatment (2) 1% Tert-Butyl Chloride
Duan54 (2012) 19/18 20-6 (45.6±9.8) 23/14 22-63 (44.8±8.9) NI combined Chinese and Western medicine (中西醫結合) IV metronidazole, Povidone iodine apply
Hu55 (2012) 12/18 NI (52.57±9.34) 16/14 NI (54.73±7.58) NI Gancao Xiexin decoction (甘草瀉心湯) Clenbuterol gargle
Li56 (2012) 17/23 NI (51.77±8.472) 21/19 NI (53.27±7.793) NI Sancai Fengsui tang (三才封髓湯) Mouthwash gargle
Zhang YX57 (2012) 69/57 (experimental n=60, control n=66) 26-77 (50.2±5.6) NI Compound scutellaria gargle (複方黃芩含漱液) Nystatin tablet
Zhou58 (2012) 12/28 (n=40 each in experimental & control) 26-63 (50, med) AML, ALL, CML, MM, Myelodysplastic syndrome nourishing yin and clearing heat gargle (養陰清熱漱口方) Chloride gargle
Wang CL59 (2011) 17/13 42-83 (64.60±12.27) 19/11 42-81 (60.00±12.67) MM compound goji berry and chrysanthemum soup (複方杞菊湯) Cetylpyridinium chloride gargle
Wang P60 (2011) 23/7 28-60 (50.5, mean) 24/6 27-60 (51.3, mean) Nasopharyngeal cancer Sha Shen Maidong Tang (沙蔘麥冬湯) Chlorhexidine gargle
Wu61 (2010) 15/18 27-74 (45.1, mean) 17/16 NI Esophageal cancer, Head and neck cancer Qinggong San (清胃散) Gentamicin gargle, Vitamin C powder
Jin62 (2009) 16/14 26-80 (59.12, mean) (1) 17/13 13-83 (58.28, mean) (2) 15/13 16-78 (59.46, mean) NI Shuizhongcao Decoction (水中草湯) (1) Gentamicin gargle (2) Oryzanol
Bao63 (2008) 46/4 32-84 (52.0, mean) 37/10 36-80 (59.0, mean) Colorectal cancer Self-made Gargle Solution (自制中藥漱口液防) Mouthwash gargle
Sun64 (2007) 20/30 18-76 (48.5, mean) 13/27 22-74 (46.5, mean) Leukemia, MM, Lymphoma, etc. Xiehuang Powder (瀉黃散) Vitamin B and C
Qin65 (2007) 26/6 23-68 (45.5, mean) 22/6 26-60 (44, mean) Leukemia Self-made Clearing Heat and Dampness decoction (自擬清熱祛溼湯) Yikou gargle
Zeng66 (2005) 0/43 29-63 (42.1±11.3) 0/43 32-60 (41.6±10.1) Choriocarcinoma, Hydatidiform mole, Breast cancer, Cervical cancer Yingyuan-gancao Decoction (銀花甘草湯) 1% hydrogen peroxide
Zhou67 (2005) 55/45 28-72 (51, mean) (1) n=20 each in experimental & control (2) n=30 each in experimental & control (1) Nasopharyngeal cancer (2) Lung cancer, Breast cancer, Lymphoma, etc. Herbal decoction (1) No treatment (2) Vitamin B, Gentamicin gargle
Ning68 (2002) 21/9 29-65 (48.97±9.7) (1) 21/9 30-65 (49.70±9.8) (2) 20/10 23-65 (44.27±10.34) Nasopharyngeal cancer Shenjinyuye Mixture (生津玉液合劑) OTC granule
Wang JY69 (2002) 62/85 (experimental n=76, control n=71) 31-68 (NI) Lymphoma, Breast cancer, Lung cancer Chinese herbs decoction (中藥煎劑) Dobell’s solution
Zhang70 (2000) 19/13 32-75 (NI) 9/6 NI Gastric cancer, Lung cancer, Esophageal cancer, etc. self-made film-containing herbal gargle (自擬愈膜含漱液) 0.5% Chlorhexidine gargle
Liu71 (1999) 26/14 12-72 (NI) 23/12 15-68 (NI) Gastroesophageal cancer, Nasopharyngeal cancer, Non-Hodgkin lymphoma, etc. Qiji Decoction (七及湯) Nitrofurazone gargle, Multivitamin B, IV metronidazole
Qiao72 (1997) 21/15 17-68 (36.6, mean) 7/6 15-58 (35.8, mean) Leukemia Self-made mouth healing decoction (自擬口愈湯) IV antibiotics (penicillin), Guilin Watermelon Frost
OhOka73 (2018) NI (n=12) (69.0±1.3) NI (n=10) (71.5±1.9) Metastatic renal cancer Hangeshashinto (半夏瀉心湯) Local anesthetic, NSAIDs, anti-inflammatory agent, zinc, etc.

Standard deviation (SD), No information (NI), Interquartile Range (IQR), Median (med), Months (mo), Years (y)

Notes: When there is no sex or age information, the total number of participants(n) was marked.

Gastrointestinal stromal tumor (GIST), Multiple myeloma (MM), Hepatocellular carcinoma (HCC), Acute lymphoblastic leukemia (ALL), Acute myeloid leukemia (AML), Chronic lymphocytic leukemia (CLL), Chronic myeloid leukemia (CML), Over-the-counter(OTC)

3. Risk of Bias

All 63 included studies were evaluated for the risk of bias, and the results are visualized in Fig. 2 and summarized in Fig. 3.
Fig. 2
Summary of the risk of bias for all included studies.
jikm-46-6-1532-g002.jpg
Fig. 3
Risk of bias graph for all included studies.
jikm-46-6-1532-g003.jpg

1) Risk of bias arising from the randomization process

A total of 31 studies described the methods for generating random sequences, such as computer-generated random numbers, random number tables, the envelope method, lot-drawing, and coin flipping. Among these, 8 studies that mentioned concealment of allocation were judged as low risk in domain 1; however, 23 were judged as some concern because there was no information of concealment of allocation. Due to using the allocation method based on the order of admission or patient characteristics, two studies were judged as some concern of bias. The remaining 30 studies, where there was no information on the randomization method, were also judged as some concerns in domain 1.

2) Risk of bias due to deviations from the intended interventions

In 24 studies, the risk of bias was evaluated as low when the blinding method of intervention was mentioned or a placebo was used. The 39 remaining studies, in which the intervention between two groups was so different that the participants or the researchers could recognize this difference (e.g., herbal decoction vs no intervention), were evaluated as some concern.

3) Risk of bias due to missing outcome data

In 55 studies where no participants were eliminated, or where the number of remaining patients is lower than the calculated sample size required for analysis, the risk of bias was evaluated as low. Eight studies were evaluated as high risk, as the number of patients required was not calculated and measurements that were not available for all participants were used.

4) Risk of bias in measurement of the outcome

In most studies, appropriate measurement methods were used according to the outcomes, and the measurements were not significantly affected by blinding. Therefore, there were low risks of bias in domain 4.

5) Risk of bias in selection of the reported result

Except for four studies, most of the studies in domain 5 were evaluated as some concerns due to a lack of a pre-registered protocol.

4. Outcome Measurements

1) Incidence of oral mucositis

A total of 23 studies that evaluated the incidence of oral mucositis or the maximum grade of oral mucositis that occurred were included. The severity of oral mucositis was evaluated using the WHO scale and NCI-CTCAE in most studies, while the Radiation Therapy Oncology Group (RTOG) criteria 2.0 was used in one study.
Among the included studies, 16 studies evaluated the incidence of oral mucositis across all grades (grade Ⅰ to Ⅳ). Five studies reported the overall incidence of oral mucositis without stratification by grade, while two studies reported only the incidence of severe oral mucositis (grade Ⅲ or Ⅳ). Consequently, 21 studies were included in the analysis of OM incidence of grade Ⅰ or higher, and 18 studies were included in the analysis of severe OM incidence (grade Ⅲ or Ⅳ).
In the incidence of grade Ⅰ or higher oral mucositis, data from 841 participants in the treatment group and 829 in the control group were synthesized. As a result, the herbal treatment group had a 0.28-fold lower incidence of oral mucositis after chemoradiation therapy compared to the control group, and this difference was statistically significant (OR 0.28, 95% CI 0.21 to 0.37, p<0.00001). Furthermore, the heterogeneity between studies was low (Heterogeneity: Chi2=23.44, p=0.27; I2=15%)(Fig. 4).
Fig. 4
Forest plot for incidence of oral mucositis.
jikm-46-6-1532-g004.jpg
In the incidence of grade Ⅲ or Ⅳ severe oral mucositis, data from 852 participants in the treatment group and 843 in the control group were synthesized. As a result, the herbal treatment group had a 0.16-fold lower incidence of severe oral mucositis than the control group, and this difference was statistically significant (OR 0.16, 95% CI 0.11 to 0.22, p<0.00001). Also, the heterogeneity between studies was low (Heterogeneity: Chi2=12.40, p=0.78, I2=0%) (Fig. 4).

2) Total effective rate

Overall, 38 studies used the total effective rate to describe clinical effectiveness based on the clinical symptoms and signs of oral mucositis. The total effective rate was defined as the proportion of patients classified as having a therapeutic response according to the criteria used in each included study. For the purpose of meta-analysis, TER was analyzed as a dichotomous outcome by combining all response categories defined as effective in the included studies.
Thirty-two studies showed the TER by classifying them into three stages: ‘markedly effective,’ ‘effective,’ and ‘ineffective,’ while 6 studies showed the TER by classifying them into four stages: ‘totally healed,’ ‘markedly effective, ‘effective,’ and ‘ineffective.’
Data from 1,463 participants in the treatment group and 1,411 in the control group were synthesized in 38 studies. As a result, the herbal treatment group had a 5.10-fold higher total effective rate than the control group, and this difference was statistically significant (OR 5.10, 95% CI 3.73 to 6.97, p <0.00001). Additionally, the heterogeneity among studies was found to be low (Heterogeneity: Chi2=55.14, p=0.03, I2=33%) (Fig. 5).
Fig. 5
Forest plot for total effective rate of oral mucositis.
jikm-46-6-1532-g005.jpg

3) Degree of oral mucositis pain

A total of 20 studies presented the degree of pain in oral mucositis. Among these, 13 studies evaluated the mean and standard deviation (SD) of the visual analogue scale (VAS) of pain before and after treatment, which were included in the meta-analysis. Substantial heterogeneity was observed among the included studies. Therefore, a subgroup analysis was conducted. Of the 13 studies examined, 8 focused on herbal medicine monotherapy, while the remaining 5 explored herbal medicine combined therapy with Western medicine.
In monotherapy subgroup of herbal medicine, data from 323 participants in the treatment group and 322 in the control group were synthesized in 8 studies. As a result, the pain VAS after intervention in the herbal treatment group showed a reduction of 1.37mm compared to the control group, with a statistically significant difference (MD -1.37, 95% CI -1.65 to -1.09, p <0.00001). There was a high level of heterogeneity among the studies (Heterogeneity: Chi2=201.46, p <0.00001, I2=97%) as shown in Fig. 6.
Fig. 6
Forest plot for pain of oral mucositis.
jikm-46-6-1532-g006.jpg
In herbal medicine combined subgroup, data from 166 participants in the treatment group and also 166 in the control group were synthesized from 5 studies. As a result, the pain VAS after intervention in the herbal treatment group showed a reduction of 1.64mm compared to the control group, indicating a statistically significant difference (MD -1.64, 95% CI -2.03 to -1.24, p <0.00001). The heterogeneity among the studies was high (Heterogeneity: Chi2=11.84, p=0.02, I2=66%) (Fig. 6).
The seven studies that were excluded from the meta-analysis are listed below:
(1) In one study, oral pain scores during the course of treatment were recorded according to CTCAE 3.0 criteria and visualized as a graph. The area under the curve of the graph for each of the two groups was calculated and compared.
(2) In a study, pain scores were calculated in quartiles according to the duration of treatment.
(3) In four studies, the VAS of pain was categorized into three levels: mild (VAS 1-3), moderate (VAS 4-6), and severe (VAS 7-9).
(4) In a study, the mean and SD of the change in pain scores before and after treatment were documented.
In each of the seven studies, the herbal medicine group showed a significant decrease in oral mucositis-related pain in comparison to the control group.

4) Duration of oral mucositis

A total of 21 studies presented the duration of oral mucositis. Among these, 17 studies that evaluated the mean and SD of oral mucositis duration during the treatment were included in the meta-analysis.
Data from 534 participants in the treatment group and 547 in the control group were synthesized in 17 studies. As a result, the duration of oral mucositis during treatment in the herbal treatment group was 2.76 days shorter than that of the control group, with a statistically significant difference (SMD -2.76, 95% CI -3.45 to -2.07, p <0.00001). There was a significant level of heterogeneity among the studies (Heterogeneity: Chi2=278.93, p <0.00001, I2=94%) (Fig. 7).
Fig. 7
Forest plot for duration of oral mucositis.
jikm-46-6-1532-g007.jpg
Four studies were excluded from the meta-analysis because they reported only means or medians of the duration of OM without accompanying SD. Nevertheless, all four studies consistently showed a significantly shorter duration of oral mucositis in the herbal medicine group compared to the control group.

5. Adverse events

Among the 63 studies included in this review, AEs were reported in 18 studies. Of these, 11 studies reported no clinically significant AEs in either the treatment or control groups.
The remaining seven studies reported AEs and were grouped according to the type of control intervention to facilitate interpretation of whether reported events were related to the intervention.
Two studies compared herbal medicine with OTC gargle interventions. In one study, there was vomiting and mild elevation of liver function only in the treatment group, which resolved after stopping the intervention. In another study, one gastrointestinal AE was reported in the treatment group, along with three gastrointestinal AEs, two cases of liver or kidney dysfunction, and two cases of phlebitis in the control group.
Five studies compared herbal medicine with placebo controls. In these studies, hematologic, gastrointestinal, and dermatologic adverse events were reported in both the treatment and placebo groups. These adverse events were considered unrelated to the study interventions and were instead attributed to the cytotoxicity of the anti-cancer treatments. No severe AEs were reported in any of the placebo-controlled trials.

6. Publication bias

Funnel plot analysis was conducted to explore the potential publication bias for outcomes that were commonly reported in more than 10 studies. The funnel plot for the incidence of OM, TER, and duration of OM is shown in Fig. 8. In the funnel plot for duration of OM (Fig. 8-c), publication bias could not be excluded completely.
Fig. 8
Funnel plot for each outcome
(a) Incidence of oral mucositis; (b) Total effective rate; (c) duration of oral mucositis
jikm-46-6-1532-g008.jpg

7. Subgroup analyses

In the incidence of OM and TER, additional analysis was not required due to no significant heterogeneity.
Subgroup analyses were conducted on the pain of OM based on the initial level of pain, whether the herbal treatment was monotherapy or combined therapy, and the type of anti-cancer treatment. The subgroup analysis based on whether the herbal treatment was monotherapy or combined therapy was reported, showing a slight improvement in heterogeneity, although it still remains high.
In duration of OM, subgroup analysis based on whether the herbal treatment was monotherapy or combined therapy is used was done. The subgroup analysis also showed high heterogeneity; therefore, it was not reported.

8. Summary of findings

Table 3 lists the GRADE evidence profile in detail.
Table 3
The level of evidence for the results in this meta-analysis
Certainty assessment Certainty
Study design Risk of bias Inconsistency Indirectness Imprecision Other considerations Absolute (95% CI)
OM incidence (above grade 1)
randomised trials very serious not serious not serious not serious none ⊖⊖◯◯ Low
Severe OM incidence (grade 3 or 4)
randomised trials very serious not serious not serious not serious none ⊖⊖◯◯ Low
TER
randomised trials very serious not serious serious not serious none ⊖◯◯◯ Very low
Pain of OM (Herbal medicine monotherapy)
randomised trials serious very serious serious serious none MD 1.37 lower (1.65 lower to 1.09 lower) ⊖◯◯◯ Very low
Pain of OM (Herbal medicine combined therapy)
randomised trials serious very serious serious serious none MD 1.64 lower (2.03 lower to 1.24 lower) ⊖◯◯◯ Very low
Duration of OM
randomised trials very serious very serious not serious not serious publication bias strongly suspected SMD 3.08 SD lower (3.92 higher to 2.25 lower) ⊖◯◯◯ Very low

confidence interval (CI), oral mucositis (OM), total effective rate (TER), mean difference (MD), standardised mean difference (SMD).

1) Since all included studies were RCTs, the levels of evidence were not lowered in the study design area.
2) In the area of risk of bias, if studies with some concerns regarding evaluation results in the RoB 2 tool were included, the level of evidence judged as serious; and if studies with high risk of bias were included, the level of evidence judged as very serious. Therefore, the grade of OM incidence, TER, and duration of OM were judged to be very serious, while the grades of pain was judged as serious.
3) The inconsistency area was evaluated as heterogeneity between studies using the Higgins I2 statistic. The criteria for evaluation are as follows: I2<50% means the levels of inconsistency were not lowered, 50%≤I2<75% means it was lowered by one level, and I2≥75% means it was lowered by two levels. Therefore, the grades of OM incidence and TER were judged as not serious, while the grades of pain, and duration of OM were judged as very serious.
4) In the indirectness area, the grades of objective measurements such as incidence, and duration of oral mucositis were not lowered, while subjective measurements such as TER and pain of oral mucositis were lowered by one level.
5) In the imprecision area, most outcomes with more than 400 participants did not lower the evidence level. However, in the pain of OM, the grade was lowered by one level due to the number of participants being less than 400.
6) In the area of other considerations, all outcomes were evaluated to not be lowered except for the duration of OM. In the duration of OM, the grade was lowered due to strong suspicion of publication bias.
Due to the high risk of bias and heterogeneity, all outcomes were evaluated as low or very low quality.

9. Analysis of herbal medicine prescriptions

Several studies have been modified to align with clinical symptoms, which is the unique property of herbal medicines. For analyses of herbal medicines in this study, the standard prescription compositions were extracted. Appendix 3 presents the composition of the herbal medicines used in each included study.
The Gancao Xiexin decoction (甘草瀉心湯) was mentioned 8 times as frequently used prescription in the studies, followed by Hangeshashinto (半夏瀉心湯) six times and Yingyuan Gancao Decoction (銀花甘草湯) three times. All studies on Gancao Xiexin decoction (甘草瀉心湯) and Yingyuan Gancao Decoction (銀花甘草湯) were exclusively conducted in China and published in Chinese, while studies on Hangeshashinto (半夏瀉心湯) were conducted in Japan, with 5 publications in English and 1 in Japanese.
The ten most frequently used herbs in the studies were as follows: Glycyrrhizae Radix et Rhizoma (甘草) was used 39 times, Coptidis Rhizoma (黃連) 28 times, Scutellariae Radix (黃芩) 22 times, Lonicerae Flos (金銀花) 20 times, Rehmanniae Radix (地黃) 17 times, Pinelliae Tuber (半夏) and Zizyphi Fructus (大棗) 15 times each, Forsythiae Fructus (連翹) and Zingiberis Rhizoma Recens (生薑) 14 times each, and Phellodendri Cortex (黃柏) 12 times.

IV. Discussion

This systematic review and meta-analysis demonstrated that herbal medicine significantly reduced the incidence and severity of chemoradiation-induced oral mucositis, while also improving pain and duration without clinically significant adverse events. These findings should be interpreted within the current understanding that oral mucositis is a complex, multifactorial process involving not only direct epithelial injury but also microvascular damage and inflammatory cascades. In particular, apoptosis of vascular endothelial cells74 and the subsequent upregulation of proinflammatory cytokines such as TNF-α, IL-1, and IL-675 are considered key events in the initiation and amplification of mucosal injury. Considering that the primary outcomes reflect both the onset and progression, these clinical benefits suggest that herbal medicine may modulate these underlying pathogenic pathways. These mechanisms may also be related to oxidative stress induced by chemoradiation, which has been suggested to contribute to the initiation of mucosal injury76.
Among the included studies, Gancao Xiexin decoction (甘草瀉心湯) and Hangeshashinto (半夏瀉心湯) were the most frequently used prescriptions, appearing eight and six times, respectively. Although these prescriptions are distinct, they share several key herbal components, including Coptidis Rhizoma (黃連), Scutellariae Radix (黃芩), and Pinelliae Tuber (半夏). In East Asian medicine, these herbs are commonly classified as having heat-clearing (淸熱) properties, a concept that is often associated with anti-inflammatory and antioxidant effects in contemporary biomedical research.
Previous experimental studies have suggested that Coptidis rhizome (黃連) is involved in immune regulation through modulation of T-cell subtypes and interleukin expression77. In addition, the compositions of Scutellariae Radix (黃芩) and Coptidis rhizome (黃連) have been reported to exert anti-inflammatory and anti-oxidative stress effects78. Pinelliae Tuber (半夏) has also been shown to contain numerous bioactive compounds with diverse pharmacological activities, including anti-inflammatory, antioxidant, and anticancer effects79. Overall, the shared bioactive components among these frequently used prescriptions may help explain the preventive and therapeutic effects observed.
Previous systematic reviews have also examined the efficacy of herbal interventions for chemoradiation-induced oral mucositis, although their scope and methodological approaches differed from the present study. One earlier review, published in 2013, focused on individual Chinese herbal medicines across chemotherapy induced oral mucositis studies, assessing clinical effectiveness primarily using TER80. However, due to heterogeneity in study designs and the wide variety of herbal components, the authors did not perform a meta-analysis, highlighting concerns regarding risk of bias and the limited applicability of findings to standardized clinical prescriptions. Another, more recent review published in 2025 specifically evaluated studies using modified Xiexin decoction (加減瀉心湯), considering outcomes such as incidence, TER, and symptom scores including TCM symptom score, NRS, and VAS81. While this review provided quantitative synthesis for a single prescription, its scope was restricted to a single formula and did not encompass the broader range of herbal prescriptions commonly used in East Asian clinical practice.
In comparison, the present study integrates data from 63 RCTs using multiple herbal prescriptions, assessing both preventive and therapeutic outcomes, including incidence, TER, pain, and duration of oral mucositis. This broader scope allows for a more comprehensive evaluation of the clinical utility of herbal medicine in chemoradiation-induced oral mucositis, while also enabling preliminary insights into the potential mechanisms associated with frequently used prescriptions and shared bioactive components. The findings of the current meta-analysis thus complement and extend previous evidence by combining quantitative synthesis with prescription-level analysis, providing a more clinically applicable overview of herbal medicine interventions in East Asian contexts.
The incidence of oral mucositis after herbal medicine intervention can be considered a preventive effect, whereas improvements in TER, pain, and duration may reflect therapeutic effects after mucositis onset.
In this study, herbal medicine significantly reduced the incidence of overall oral mucositis and, notably, the incidence of severe oral mucositis of Grade III or Ⅳ was 16% lower than that in control group. Considering that severe oral mucositis often leads to dose reduction or delay of subsequent chemotherapy, even a relatively modest reduction like 5-15% in incidence may have substantial clinical implications7. Therefore, the observed preventive effect of herbal medicine against severe oral mucositis is of great clinical significance.
With respect to therapeutic outcomes, the herbal medicine group showed a significantly higher TER and showed meaningful improvements in pain intensity and duration of oral mucositis compared with the control group. Although substantial heterogeneity was observed in the meta-analyses of pain and duration, all included studies consistently reported favorable outcomes in the herbal medicine group. The magnitude of pain reduction, as measured by the VAS, ranged from approximately 1.4 to 1.6mm, indicating clinically meaningful alleviation of oral mucositis related discomfort. However, the timing of herbal medicine administration was not uniformly reported across studies, which should be considered when interpreting the distinction between preventive and therapeutic effects. The overall consistency of directionality across outcomes supports the potential role of herbal medicine in both the prevention and management of chemoradiation-induced oral mucositis.
This systematic review and meta-analysis has several limitations that should be considered when interpreting the results.
First, a substantial proportion of the included studies were conducted in China and published in Chinese. Although no language restrictions were applied to minimize publication bias, this regional concentration may limit the generalizability of the findings to other populations and healthcare settings.
Second, the methodological quality of the included studies was generally low. Many studies did not clearly report key aspects of trial design, such as allocation concealment, blinding of participants or outcome assessors, and pre-registered study protocols. As reflected in the risk-of-bias assessment and GRADE evaluation, these limitations resulted in low or very low certainty of evidence for most outcomes. Therefore, the observed effects should be interpreted with caution.
Third, considerable heterogeneity was observed in outcomes related to pain intensity and duration of oral mucositis. This heterogeneity may be attributable to variations in outcome assessment methods (e.g., different pain scales or grading systems), patient characteristics (such as cancer type and treatment modality), and differences in herbal medicine compositions, dosage forms, and duration of administration across studies. Although subgroup analyses were conducted to explore potential sources of heterogeneity, substantial heterogeneity remained, limiting the robustness of pooled estimates.
Finally, there was marked variability in the composition and clinical application of herbal medicine interventions. Because this review aimed to comprehensively evaluate the potential of herbal medicine for chemoradiation-induced oral mucositis, no restrictions were placed on specific prescriptions. While this approach reflects real clinical practice, it also hinders the identification of standardized treatment strategies. Future well-designed randomized controlled trials using standardized herbal interventions are warranted to strengthen the evidence.
This study provides comprehensive evidence suggesting that herbal medicine may have both preventive and therapeutic benefits for chemoradiation-induced oral mucositis. By considering clinical outcomes alongside commonly used prescriptions and findings from previous preclinical studies, this study offers insights into the potential role of herbal medicine as a complementary approach in the management of oral mucositis. Further rigorously designed randomized controlled trials with standardized interventions are needed to confirm these findings and to establish optimal clinical strategies.

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38. Zhao CG, Chen YL, Wu SY, Zhao SY, Wang LK. Clinical Effect of Using Modified Qianyang Fengsui Dan Which is Empirical Formula of WU Shengyuan in Treating Oral Ulcer after Radiotherapy and Chemotherapy. Journal of Sichuan of Traditional Chinese Medicine 2017:35(5):180–2.

39. Chen DX, Zhang Y, Wang MY, Cao LP, Wang YX. Efficacy of integrated traditional Chinese and western medicine gargarism treating oral ulcer caused by radiotherapy and chemotherapy. China Medicine 2016:11(11):1691–4.

40. Qian WH, Liu LF, Pan YY. Clinical study on 64 cases of oral ulcers after chemotherapy treated with modified Gancao Xiexin decoction gargle. Jiangsu Journal of Traditional Chinese Medicine 2016:48(9):39–40,43.

41. Wang ZX, Shi Y, Huang P. Evaluation of clinical efficacy of Chinese medicine cooling the blood and generating fluids in the treatment of radiological oral mucositis of nasopharyngeal carcinoma. Hebei Medicine 2016:22(08):1382–4.

42. Yang WT. Clinical Research of TCM Mouth Ulcer Gargle in Treatment of Acute Leukemia with Mouth Ulcers. Acta Chinese Medicine 2016:31(03):322–4.

43. Zou YM, Zhang CS, Zhang LB. Prophylaxis of chemotherapy-induced stomatitis by Compound Gargle of Scutellaria Baicalensis Georgi in leukemia. Journal of Qiqihar University of Medicine 2016:37(2):204–5.

44. He NY. Chinese herbal medicine gargling against post-chemotherapy stomatitis, 38 cases. Henan Traditional Chinese Medicine 2014:34(11):2233.

45. Su F, Zhou ZH, Ran R, Zhang WP. Observation on 42 cases of oral ulcers after chemotherapy treated by gargling with modified Gancao Xiexin decoction. Zhejiang Journal of Traditional Chinese Medicine. 2014:49(11):799–800.

46. Wang DH. Clinical nursing study of stomatitis in chemotherapy patients treated with Yingyuan -gancao Decoction. China Continuing Medical Education 2014:(7):179–80.

47. Zhang WW, Zheng M, Chen L, Li X, Chen J, He TL, et al. Clinical observation of “Kougan Formula”for the treatment of oral ulcer following gastric cancer chemotherapy. Shanghai Journal of Traditional Chinese Medicine 2014:48(04):42–3.

48. Duan E, LI XS, Xia XJ, Kai JL, Yao JH. Yingyuan juhua Compound gargling to prevent and control oral ulcers after chemotherapy for leukemia in 58 cases. Traditional Chinese Medicinal Research 2013:26(3):23–5.

49. Liao TH, Cai K, Huang CJ. Clinical Observation of Self-made Yuyang Decoction on Treating Oral Ulcer after High-dose of MTX Chemotherapy. Journal of Sichuan of Traditional Chinese Medicine 2013:31(05):93–5.

50. Luo WY, Yang YF. 79 cases of post-chemotherapy oral ulcers treated by gargling with chrysanthemum solution. Chinese Journal of Traditional Medical Science and Technology 2013:20(2):207–8.

51. Xu P, Liu LJ. Yinxuan Tang against stomatitis induced by chemotherapy with DCF and FOLFOX regimens in 36 cases. Jilin Journal of Traditional Chinese Medicine 2013:33(6):598–9.

52. Zhang WP, Ran R, Wang J, Xu K. Observation on the therapeutic effect of gargling with modified Gancao Xiexin decoction in the treatment of oral ulcers in chemotherapy patients. China Higher Medical Education 2013:(6):136–7.

53. Zou Y. Clinical Observation of Prevention and Treatment of Easy-convenient Gargle with Traditional Chinese Medicine for Oral Ulcer Caused by Radiotherapy and Chemotherapy. Journal of Yunnan University of Traditional Chinese Medicine 2013:(6):78–9,82.

54. Duan JJ. Analysis of the efficacy of combined Chinese and Western medicine in the treatment of patients with chemotherapeutic oral ulcers. Guide of China Medicine 2012:10(36):298–9.

55. Hu AQ. Clinical observation on the prevention of oral ulcers caused by chemotherapy with modified Gancao Xiexin decoction. Journal of New Chinese Medicine 2012:44(8):69–70.

56. Li ZY. 40 cases of oral ulcers after chemotherapy treated with Sancai Fengsui tang. Jiangxi Journal of Traditional Chinese Medicine 2012:43(10):39–40.

57. Zhang YX. Observation on the effect of compound Scutellaria baicalensis gargle on the prevention and control of stomatitis in chemotherapy patients. Medical Journal of Chinese People's Health 2012:24(12):1463–4.

58. Zhou X, Dai ZX, Shi ZX, Chen MX. Effect of nourishing yin and clearing heat gargle on the prevention and treatment of mouth ulcer of patients with leukemia during chemotherapy. Journal of Qilu Nursing 2012:18(36):1–2.

59. Wang CL, Dai ZX, Dai XJ. Effect of mouth gargle with compound goji berry and chrysanthemum soup in patients with oral ulcer. Journal of Nursing Science 2011:26(11):3–5.

60. Wang P. Clinical observation on the prevention and treatment of acute radiation stomatitis of nasopharyngeal carcinoma by the addition and subtraction of Sha Shen Maidong Tang. Hubei Journal of Traditional Chinese Medicine 2011:33(09):14–5.

61. Wu ML, Zhou H, Deng J. Observations on the clinical efficacy of the treatment of oral ulcers after radiotherapy with the addition of Qinggong San. Journal of Sichuan of Traditional Chinese Medicine 2010:28(12):96–7.

62. Jin T, Shen MH, Sun YF, Zhang J. Observe the Effect of Shuizhongcao Decoction Treating Chemotherapy-induced Oral Ulcer. Chinese Archives of Traditional Chinese Medicine 2009:27(2):303–5.

63. Bao NX, Zeng GZ, Zhou LW, Shu XY, Yang L. Preventive Effect of Self-made Gargle Solution on Chemotherapy-induced Oral Ulcer in Patient with Colorectal Carcinoma. Journal of Nursing Science 2008:23(20):44–5.

64. Sun JH. Clinical observation on the treatment of post-chemotherapy oral ulcers by modified Xiehuang Powder. Modern Journal of Integrated Traditional Chinese and Western Medicine 2007:16(7):900–1.

65. Qin L, Li XZ. Clinical Observations on Chinese Herbal Gargling for the Treatment of Oral Ulcers. Xinjiang Journal of Traditional Chinese Medicine 2007:(04):127.

66. Zeng YX. Yingyuan-gancao Decoction Was Used to Treat the Stomatitis Caused by Chemical Therapy. Guiding Journal of TCM 2005:11(12):50–1.

67. Zhou ZX, Zhang ZR, Qian HX, Li ZQ, Wu WM, Luo J. Prevention and Treatment with Traditional Chinese Medicine for Dental Ulcer Caused by Radiotherapy and Chemotherapy. Henan Journal of Oncology 2005:23(10):93–4.

68. Ning XM, Yang ST, Jin QM, Hu B, Liu HY, Tang WP. Observation on applying Shenjinyuye Mixture to preventing and treating acute radiation stomatitis. Hunan Guiding Journal of Traditional Chinese Medicine and Pharmacology 2002:(05):248–9.

69. Wang JY. Effect on Chinese Herbs Decoction Gargling to Treat and to Prevent Chemotherapy Caused Stomatitis. Shanxi Nursing Journal 2002:16(10):578–9.

70. Zhang JF. 32 cases of oral ulcers after chemotherapy and radiotherapy treated with self-made film-containing herbal gargle. Gansu Science and Technology 2000:16(1):53.

71. Liu L, Zhao ZL. Clinical Observation on Using Qiji Decoction Gargle to Treat Chemotherapy Patients With Oral Ulcer. Shanxi Nursing Journal 1999:(2):86.

72. Qiao HX, Zhang JS, Lu Q. Self-made mouth healing decoction for the treatment of side effects after chemotherapy for leukemia - clinical observation on 36 cases of oral cavity disorders. Beijing Journal of Traditional Chinese Medicine 1997:(2):19–21.

73. Oh-oka H. The clinical usefulness of gargling with hangeshashinto for the treatment of oral mucositis caused by sunitinib in patients with metastatic renal cancer. International journal of urology 2018:25:392.

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Appendices

【Appendix 1】 Search Terms used in Each Database and Results

Search strategy for Mediline via PubMed
No. Search strategy Initial results (searched in 2024.07.07.) followed results (searched in 2025.11.28.)
#1. Stomatitis[MeSH Terms] OR Stomatitis[tiab] OR Oral mucositis[tiab] OR Oromucositis[tiab] OR “Candidiasis, oral”[MeSH Terms]
#2. Neoplasm[MeSH Terms] OR Cancer[tiab] OR Malignant[tiab] OR Malignancy[tiab] OR Leukemia[MeSH Terms] OR Lymphoma[MeSH Terms] OR blastoma[tiab] OR Sarcoma[tiab] OR Neutropenia[MeSH Terms] OR Carcinoma[MeSH Terms] OR Adenocarcinoma[MeSH Terms] OR oncolog*[tiab]
#3. “Drug Therapy”[MeSH Terms] OR Chemotherapy[tiab] OR Chemo*[tiab] OR Pharmacotherapy[tiab] OR “Antineoplastic Agents”[MeSH Terms] OR Radiotherapy [MeSH Terms] OR Radiat*[tiab]
#4. #1 AND (#2 OR #3) 12,574 699
#5. “Herbal Medicine"[MeSH Terms] OR medicine, herbal[tiab] OR herb*[tiab] OR “Drugs, Chinese Herbal"[MeSH Terms] OR Chinese Drugs, Plant[tiab] OR Plant Extracts, Chinese[tiab] OR “Plants, Medicinal"[MeSH Terms] OR “Plant Extracts"[MeSH Terms] OR “Complementary Therapies"[MeSH Terms]
#6. “Medicine, Traditional"[MeSH Terms] OR “Medicine, Korean Traditional" [MeSH Terms] OR “Medicine, Chinese Traditional"[MeSH Terms] OR “Medicine, East Asian Traditional"[MeSH Terms] OR “Medicine, Kampo" [MeSH Terms] OR ((Korean[tiab] OR Chinese[tiab] OR Japanese[tiab] OR “East Asian"[tiab]) AND Tradition*[tiab]) OR tang[tiab] OR san[tiab] OR hwan[tiab] OR decoction[tiab] OR formula*[tiab] OR granule
#7. #5 OR #6 1,181,513 102,755
#8. Randomized Controlled Trial[Publication Type] OR Controlled Clinical Trial[Publication Type] OR Randomized[tiab] OR Randomised[tiab] OR Randomly[tiab] OR Clinical[tiab] OR Trial*[tiab] OR Clinical Trial[tiab]
#9. #4 AND #7 AND #8 298 42
Search strategy for EMBASE
No. Search strategy Initial results (searched in 2024.07.07.) followed results (searched in 2025.11.28.)
#1. (‘stomatitis’/exp OR ‘stomatitis’ OR ‘oral mucositis’/exp OR ‘oral mucositis’ OR oromucositi*:ti,ab,kw) AND [embase]/lim 65,755
#2. (‘neoplasm’/exp OR ‘neoplasm’ OR ‘malignant neoplasm’/exp OR ‘malignant neoplasm’ OR ‘blastoma’/exp OR ‘blastoma’ OR ‘sarcoma’/exp OR ‘sarcoma’ OR ‘carcinoma’/exp OR ‘carcinoma’ OR ‘adenocarcinoma’/exp OR ‘adenocarcinoma’ OR ‘leukemia’/exp OR ‘leukemia’ OR ‘lymphoma’/exp OR ‘lymphoma’ OR ‘neutropenia’/exp OR ‘neutropenia’ OR malignan*:ti,ab,kw OR oncolog*:ti,ab,kw) AND [embase]/lim 5,658,404
#3. (‘drug therapy’/exp OR ‘drug therapy’ OR ‘chemotherapy’/exp OR ‘chemotherapy’ OR ‘antineoplastic agent’/exp OR ‘antineoplastic agent’ OR ‘radiotherapy’/exp OR ‘radiotherapy’ OR ‘radiation’/exp OR ‘radiation’ OR pharmacotherapy:ti,ab,kw OR chemo*:ti,ab,kw OR radiat*:ti,ab,kw) AND [embase]/lim 8,612,597
#4. #1 AND (#2 OR #3) 48,881 3,597
#5. (‘herbal medicine’/exp OR ‘herbal medicine’ OR ‘herb’/exp OR ‘herb’ OR ‘herbaceous agent’/exp OR ‘herbaceous agent’ OR ‘medicinal plant’/exp OR ‘medicinal plant’ OR ‘plant extract’/exp OR ‘plant extract’) AND [embase]/lim 464,894
#6. ((‘traditional medicine’/exp OR ‘traditional medicine’ OR ‘korean medicine’/exp OR ‘korean medicine’) AND (‘chinese medicine’/exp OR ‘chinese medicine’) OR ‘kampo medicine’/exp OR ‘kampo medicine’ OR ‘oriental medicine’/exp OR ‘oriental medicine’) AND [embase]/lim 87,595
#7. ((korean:ti,ab,kw OR chinese:ti,ab,kw OR japanese:ti,ab,kw OR ‘east asian’:ti,ab,kw) AND tradition*:ti,ab,kw OR tang:ti,ab,kw OR san:ti,ab,kw OR hwan:ti,ab,kw OR decoction:ti,ab,kw OR formula*:ti,ab,kw OR granule:ti,ab,kw) AND [embase]/lim 670,302
#8. #5 OR #6 OR #7 1,105,243 137,338
#9. (‘controlled clinical trial’/exp OR ‘controlled clinical trial’ OR ‘randomized controlled trial’/exp OR ‘randomized controlled trial’ OR randomi?ed:ti,ab,kw OR randomly:ti,ab,kw OR clinical:ti,ab,kw OR trial*:ti,ab,kw OR ‘clinical’/exp OR clinical) AND trial:ti,ab,kw AND [embase]/lim 1,062,102
#10. #4 AND #8 AND #9 386 48
Search strategy for Cochrane
No. Search strategy Initial results (searched in 2024.07.07.) followed results (searched in 2025.11.28.)
#1. MeSH descriptor: [Stomatitis] explode all trees 1534
#2. oral mucositis OR “Oromucositis" 2160
#3. MeSH descriptor: [Neoplasms] explode all trees 125512
#4. MeSH descriptor: [Neutropenia] explode all trees 2284
#5. cancer OR (Malignan*) OR “blastoma" OR “sarcoma" OR (oncolog*) 263913
#6. MeSH descriptor: [Drug Therapy] explode all trees 185319
#7. MeSH descriptor: [Antineoplastic Agents] explode all trees 19693
#8. MeSH descriptor: [Radiotherapy] explode all trees 10050
#9. chemotherapy OR (chemo*) OR “Pharmacotherapy" OR (radiat*) 159374
#10. (#1 OR #2) AND (#3 OR #4 OR #5 OR #6 OR #7 OR #8 OR #9) 2468 276
#11. MeSH descriptor: [Herbal Medicine] explode all trees 100
#12. MeSH descriptor: [Medicine, Korean Traditional] explode all trees 42
#13. MeSH descriptor: [Medicine, Chinese Traditional] explode all trees 1778
#14. MeSH descriptor: [Drugs, Chinese Herbal] explode all trees 4642
#15. MeSH descriptor: [Medicine, Kampo] explode all trees 67
#16. MeSH descriptor: [Plants, Medicinal] explode all trees 1149
#17. traditional Korean medicine OR “traditional Chinese medicine" OR “traditional oriental medicine" OR “Kampo medicine" OR herb* OR decoction* OR botanic* 37029
#18. #10 AND (#11 OR #12 OR #13 OR #14 OR #15 OR #16 OR #17) 92 12
Search strategy for KCI
Search strategy Initial results (searched in 2024.07.07.) followed results (searched in 2025.11.28.)
KEYALL:(구내염 OR 구강궤양 OR stomatitis OR “oral mucositis" OR oromucositis) AND KEYALL:(항암 OR 화학요법 OR 방사선 OR cancer OR chemotherapy OR radiotherapy) AND KEYALL:(Herb* OR 한약 OR 한의학 OR 한방) 11
Search strategy for RISS
Search strategy Initial results (searched in 2024.07.18.) followed results (searched in 2025.11.28.)
(전체 : 구내염 <OR> 전체 : 구강궤양 <OR> 전체 : stomatitis <OR> 전체 : oral mucositis <OR> 전체 : oromucositis) (전체 : 항암 <OR> 전체 : 화학요법 <OR> 전체 : 방사선 <OR> 전체 : cancer) (전체 : 한약 <OR> 전체 : 한의 <OR> 전체 : 한방 <OR> 전체 : herbal) 94 1
Search strategy for OASIS
Search strategy Initial results (searched in 2024.07.18.) followed results (searched in 2025.11.28.)
구내염 OR 구강궤양 OR stomatitis OR oral mucositis 27 1
Search strategy for CNKI
Search strategy Initial results (searched in 2024.07.07.) followed results (searched in 2025.11.28.)
(Title, Keyword and Abstract=‘口腔炎’ + ‘口炎’ + ‘口腔溃疡’) AND (Title, Keyword and Abstract=‘抗癌’ + ‘化学疗法’ + ‘化疗’ + ‘化学治疗’ + ‘放射线’ + ‘射线’) AND (Title, Keyword and Abstract =’中药’ + ‘中医药’ + ‘本草’ + ‘汤’ + ‘丸’ + ‘散’ + ‘方’ + ‘颗粒’ + ‘胶囊’ + ‘自拟’) 431 12
Search strategy for Wangfang
Search strategy Initial results (searched in 2024.07.07.) followed results (searched in 2025.11.28.)
(题名或关键词=(“口腔炎" OR “口炎" OR “口腔溃疡") AND 题名或关键词=(“抗癌" OR “化学疗法" OR “化疗" OR “化学治疗" OR “放射线" OR “射线") AND 题名或关键词=(“中药” OR “中医药” OR “本草” OR “汤” OR “丸” OR “散” OR “方” OR “颗粒” OR “胶囊” OR “自拟”)) 284 15
Search strategy for CiNii
Search strategy Initial results (searched in 2024.07.07.) followed results (searched in 2025.11.28.)
(“口内炎" OR “口腔潰瘍" OR “Stomatitis") AND (“抗がん" OR “制癌" OR “化学療法" OR “放射線" OR “Cancer" OR “Chemotherapy" OR “Radiation") AND (漢方薬 OR ハーブ OR “Kampo medicine" OR “traditional Korean medicine” OR “traditional Chinese medicine” OR “Traditional oriental medicine” OR herb OR decoction OR botanic OR 散 OR 汤 OR 丸) 90 2

【Appendix 2】 Additional information on the selected studies

First Author Type of cancer (Experimental/Control) Type of anticancer Course of treatment Main outcomes
Li11 (2023) Nasopharyngeal cancer CCRT NI Incidence of SOM, Pain, Opioid usage, Radiation dose, Malnutrition risk, Short-term efficacy, etc.
Wang12 (2018) Head and neck cancer CCRT 7 weeks Grade of OM, Pain, Dry mouth, BMI
Zheng13 (2018) Nasopharyngeal cancer CCRT Up to 7 weeks Incidence of OM, Time for occurrence, Grade of OM, OAG score, Short-term efficacy, etc.
Wu14 (2007) Head and neck cancer RT NI Grade of OM, TER, Serum WBC and PLT, Salivary EGF
Yoshimatsu15 (2023) Hematopoietic stem cell transplantation CT NI Incidence of OM, Duration of OM
Taira16 (2020) Head and neck cancer CT 14 days Incidence of OM and SOM, Time for occurrence, Duration of OM and SOM
Moriyama17 (2018) Esophageal cancer CT 2 weeks Grade of OM, Number of bacteria, Salivary flow rate, TCI, GI
Matsuda18 (2015) Colorectal cancer CT 14 days Incidence of SOM, Duration of SOM
Aoyama19 (2014) Gastric cancer CT NI Incidence of SOM, Duration of SOM and OM, CT completion rate
Li20 (2024) ALL CT 10 days TER, incidence of OM, VAS
Sun21 (2024) AML CT 2 weeks incidence of OM, area of OM, syndrome scores
Yang22 (2024) Breast cancer CT 5 days TER, duration of OM, syndrome scores, incidence of OM, Immune function
Cao23 (2021) ALL, AML CT 14 days Grade of OM, Duration of OM, Oral cleanliness, Number of oral bacteria
He24 (2021) Breast cancer CT 14 days TER, Immune function, QoL
Li25 (2021) NI CT 8 days VAS, Duration of OM, TER
Liang26 (2021) Nasopharyngeal cancer, Lung cancer, Colorectal cancer, etc. CT NI TER, Pain, TCM syndrome scores
Lin27 (2021) Pediatric leukemia CT 7-10 days Grade of OM, TER
Liu28 (2021) GIST, Lung cancer, etc. CCRT 2 weeks TER
Liu29 (2019) Renal cell carcinoma, HCC CT 7 days TER, Pain
Cai30 (2018) Head and neck cancer RT 3 days Pain, TER
Jia31 (2018) NI CT 7 days TER, TCM syndrome scores
Liu32 (2018) Esophageal cancer, Lung cancer, Breast cancer, etc. CT 7 days Duration of OM, TER, Grade of OM, Pain relief rate
Sun33 (2018) GIST CT NI TER, Pain, Duration of OM, Area of OM
Wang HB 34 (2017) Lung cancer, Gastric cancer, Rectum cancer, etc. CT 7 days Pain, TER
Wang XL 35 (2017) NI CT 8 days TER, Pain, Oral comfort assessment
Wang Y 36 (2017) Lung cancer, Colorectal cancer, Breast cancer, etc. CT 4 days TER, Pain
Yuan37 (2017) Breast cancer CT 7 days Duration of OM, Area of OM, Pain, Grade of OM, TER, Immune function
Zhao38 (2017) Nasopharyngeal cancer, Lung cancer, Gastric cancer, etc. RT 7 days TER, Area of OM, Pain
Chen39 (2016) NI RT 7 days Grade of OM, Duration of OM
Qian40 (2016) Gastric cancer, Colorectal cancer, Breast cancer, etc. CT 7 days Duration of OM, TER, Immune function
Wang41 (2016) Nasopharyngeal cancer CCRT During RT Oral pH, Pain, Duration of OM
Yang42 (2016) AML, ALL CT NI Grade of OM, TER, Duration of OM
Zou43 (2016) Acute leukemia CT 14 days Incidence of OM, Duration of OM, Grade of OM
He44 (2014) Colorectal cancer, Lung cancer, Breast cancer, etc. CT During CT 1 cycle Incidence of OM, Grade of OM
Su45 (2014) NI CT 7 days TER, QoL, Pain
Wang46 (2014) Gastric cancer CT NI TER, Duration of OM
Zhang47 (2014) Gastric cancer CT 21 days TER, Area of OM, Pain
Duan48 (2013) ALL, AML, CLL, CML CT During CT TER, Grade of OM
Liao49 (2013) Osteosarcoma, ALL CT 7 days Incidence of OM, Grade of OM, Duration of OM
Luo50 (2013) Lung cancer, Gastric cancer, Colorectal cancer, etc. CT 5-7 days TER, Time for NRD resumption, Time for fever subside, Duration of OM
Xu51 (2013) Colorectal cancer, Gastric cancer CT 10 days CT completion rate, Incidence of OM
Zhang52 (2013) NI CT 7 days Duration of OM, TER, Pain
Zou53 (2013) (1) Breast cancer, Nasopharyngeal cancer (2) Breast cancer, Colorectal cancer, Lung cancer, etc. (1) RT (2) CT (1) During RT (2) 7 days (1) Incidence of OM (2) TER
Duan54 (2012) NI CT 7 days TER
Hu55 (2012) NI CT 7 days Incidence of OM, Grade of OM, Pain
Li56 (2012) NI CT 7 days TER, Pain, Night sweats, Anorexia
Zhang YX57 (2012) NI CT 15 days Grade of OM
Zhou58 (2012) AML, ALL, CML, MM, etc. CT During CT Incidence of OM, Grade of OM, Duration of OM
Wang CL59 (2011) MM CT 7 days Pain, Area of OM, Duration of OM, TER
Wang P60 (2011) Nasopharyngeal cancer CCRT During RT Time for occurrence
Wu61 (2010) Esophageal cancer, Head and neck cancer CCRT 7 days TER
Jin62 (2009) NI CT 7 days TER, Pain, QoL, Immune function
Bao63 (2008) Colorectal cancer CT 7 days Grade of OM, Duration of OM
Sun64 (2007) Leukemia, MM, Lymphoma, etc. CT 7 days TER
Qin65 (2007) Leukemia CT 10 days TER
Zeng66 (2005) Choriocarcinoma, Hydatidiform mole, Breast cancer, etc. CT NI TER
Zhou67 (2005) (1) Nasopharyngeal cancer (2) Lung cancer, Breast cancer, Lymphoma, etc. (1) RT (2) CT (1) During RT (2) 7 days (1) Incidence of OM (2) TER
Ning68 (2002) Nasopharyngeal cancer RT NI Radiation dose, Grade of OM
Wang JY69 (2002) Lymphoma, Breast cancer, Lung cancer CT NI Incidence of OM, Grade of OM, Duration of OM
Zhang70 (2000) Gastric cancer, Lung cancer, Esophageal cancer, HCC, etc. CCRT 5 days TER
Liu71 (1999) Gastroesophageal cancer, Nasopharyngeal cancer, Non-Hodgkin lymphoma, etc. CT 7 days TER
Qiao72 (1997) Leukemia CT 7 days TER
OhOka73 Metastatic renal cancer CT NI KPS scale, Grade of OM, Bodyweight, Serum albumin and Hb, GSA score

Gastrointestinal stromal tumor (GIST); Multiple myeloma (MM); Hepatocellular carcinoma (HCC); Acute lymphoblastic leukemia (ALL); Acute myeloid leukemia (AML); Chronic lymphocytic leukemia (CLL); Chronic myeloid leukemia (CML); Radiation therapy (RT); Chemotherapy (CT); Combined cheomo-radiation therapy (CCRT); No information (NI); Oral mucositis (OM); Total effective rate (TER); White blood cell (WBC); Platelet (PLT); Epidermal Growth Factor (EGF); Oral Assessment Guide (OAG); Severe oral mucositis (SOM); Tongue coating index (TCI); Gingival index (GI); Body mass index (BMI); Karnofsky Performance Scale (KPS); Hemoglobin (Hb); Global self assessment of OM (GSA); Visual analogue scale (VAS); Normal regular diet (NRD); Quality of life (QoL).

【Appendix 3】 Composition of herbal medicine

Author (Year) Herbal prescription name Composition of herbal medicine Latin name (Chinese name)
Li11 (2023) Jiandu granule Dioscoreae Rhizoma (山藥), Poria Sclerotium (茯苓), Adenophorae Radix (沙蔘), Liriopis seu Ophiopogonis Tuber (麥門冬), Astragali Radix (黃芪), Lonicerae Flos (金銀花), Forsythiae Fructus (連翹), Pinelliae Tuber (半夏), Lasiosphaera seu Calvatia (Lasiosphaera seu Calvatia (馬勃), Belamcandae Rhizoma (射干), Notoginseng Radix Et Rhizoma (三七), Glycyrrhizae Radix et Rhizoma (甘草)
Wang12 (2018) Herbal decoction (CHIN) Rhei Radix et Rhizoma (大黃), Glycyrrhizae Radix et Rhizoma (甘草), Menthae Herba (薄荷), Scutellariae Radix (黃芩), Liriopis seu Ophiopogonis Tuber (麥門冬), Paeoniae Radix (芍藥), Lumbricus (蚯蚓), Scrophulariae Radix (玄蔘), Forsythiae Fructus (連翹)
Zheng13 (2018) Shuanghua Baihe tablets Coptidis Rhizoma (黃連), Corydalis bungeanae herba, Isatidis Radix (板藍根), Lithospermi Radix (紫草), Lonicerae Flos (金銀花), Lophatheri Herba (淡竹葉), Snake bile, Rehmanniae Radix (地黃), Lilii Bulbus (百合), Asiasari Radix et Rhizoma (細辛)
Wu14 (2007) Qingre Liyan Decoction Lonicerae Flos (金銀花), Belamcandae Rhizoma (射干), Lasiosphaera seu Calvatia (Lasiosphaera seu Calvatia (馬勃), Angelicae Gigantis Radix (當歸), Adenophorae Radix (沙蔘), Liriopis seu Ophiopogonis Tuber (麥門冬), Trichosanthis Radix (天花粉), Scrophulariae Radix (玄蔘), Cnidii Rhizoma (川芎), Agrimoniae Herba (龍牙草), Imperatae Rhizoma (茅根), Glycyrrhizae Radix et Rhizoma (甘草)
Yoshimatsu15 (2023) Hangeshashinto (半夏瀉心湯) Pinelliae Tuber (半夏), Scutellariae Radix (黃芩), Glycyrrhizae Radix et Rhizoma (甘草), Zizyphi Fructus (大棗), Ginseng Radix (人蔘), Coptidis Rhizoma (黃連), Zingiberis Rhizoma Recens (生薑)
Taira16 (2020) Hangeshashinto (半夏瀉心湯) Pinelliae Tuber (半夏), Scutellariae Radix (黃芩), Glycyrrhizae Radix et Rhizoma (甘草), Zizyphi Fructus (大棗), Ginseng Radix (人蔘), Coptidis Rhizoma (黃連), Zingiberis Rhizoma Recens (生薑)
Moriyama17 (2018) (1) Daiokanzoto (大黃甘草湯) (2) Hangeshashinto (半夏瀉心湯) Rhei Radix et Rhizoma (大黃), Glycyrrhizae Radix et Rhizoma (甘草), Pinelliae Tuber (半夏), Scutellariae Radix (黃芩), Zizyphi Fructus (大棗), Ginseng Radix (人蔘), Coptidis Rhizoma (黃連), Zingiberis Rhizoma Recens (生薑)
Matsuda18 (2015) Hangeshashinto (半夏瀉心湯) Pinelliae Tuber (半夏), Scutellariae Radix (黃芩), Glycyrrhizae Radix et Rhizoma (甘草), Zizyphi Fructus (大棗), Ginseng Radix (人蔘), Coptidis Rhizoma (黃連), Zingiberis Rhizoma Recens (生薑)
Aoyama19 (2014) Hangeshashinto (半夏瀉心湯) Pinelliae Tuber (半夏), Scutellariae Radix (黃芩), Glycyrrhizae Radix et Rhizoma (甘草), Zizyphi Fructus (大棗), Ginseng Radix (人蔘), Coptidis Rhizoma (黃連), Zingiberis Rhizoma Recens (生薑)
Li20 (2024) Double Flower Lily Tablets (双花百合片) Coptidis Rhizoma (黃連), Corydalis bungeana Turcz (苦地丁), Rehmanniae Radix (地黃), Isatidis Radix (板藍根), Lithospermi Radix (紫草), Lonicerae Flos (金銀花), Lophatheri Herba (淡竹葉), Serpentis Fel (乾蛇膽), Lilii Bulbus (百合), Asiasari Radix et Rhizoma (細辛)
Sun21 (2024) Chinese medicine mouthwash (中药漱口液) Isatidis Folium (大靑葉), Lonicerae Flos (金銀花), Chrysanthmi Flos (菊花), Menthae Herba (薄荷)
Yang22 (2024) Modified Gancao Xiexin decoction (甘草瀉心湯加减) Glycyrrhizae Radix et Rhizoma (甘草), Taraxaci Herba (蒲公英), Astragali Radix (黃芪), Atractylodis Rhizoma Alba (白朮), Zingiberis Rhizoma (乾薑), Zizyphi Fructus (大棗), Pinelliae Tuber (半夏), Codonopsis Pilosulae Radix (黨參), Bletillae Rhizoma (白芨), Lithospermi Radix (紫草), Coptidis Rhizoma (黃連)
Cao23 (2021) Yingyuan-gancao Decoction (銀花甘草湯) Adenophorae Radix (沙蔘), Liriopis seu Ophiopogonis Tuber (麥門冬), Angelicae Gigantis Radix (當歸), Rehmanniae Radix (地黃), Atractylodis Rhizoma (蒼朮), Paeoniae Radix (芍藥), Agastachis Herba (藿香), Astragali Radix (黃芪), Anemarrhenae Rhizoma (知母), Menthae Herba (薄荷), Gypsum Fibrosum (石膏), Sesami Semen (胡麻仁)
He24 (2021) Sijunzi Decoction (四君子湯) Codonopsis Pilosulae Radix (黨參), Atractylodis Rhizoma Alba (白朮), Poria Sclerotium (茯苓), Glycyrrhizae Radix et Rhizoma (甘草)
Li25 (2021) Huanglian Bingpian Xixin decoction (黃連冰片細辛湯) Adenophorae Radix (沙蔘), Bomeolum (氷片), Coptidis Rhizoma (黃連), Asiasari Radix et Rhizoma (細辛), Glycyrrhizae Radix et Rhizoma (甘草)
Liang26 (2021) Self-made Xiehuang Xiaoyang Decoction (自擬瀉黃消瘍湯) Gypsum Fibrosum (石膏), Gardeniae Fructus (梔子), Phellodendri Cortex (黃柏), Amomi Fructus (砂仁), Saposhnikoviae Radix (防風), Agastachis Herba (藿香), Ostreae Testa (牡蠣), Pelodiscis Carapax (鱉甲), Glycyrrhizae Radix et Rhizoma (甘草)
Lin27 (2021) Herbal anti-cancer capsule (消癌平膠囊) Radix fissistigmae glaucescentis (乌骨藤)
Liu28 (2021) Gancao Xiexin decoction (甘草瀉心湯) Astragali Radix (黃芪), Taraxaci Herba (蒲公英), Scutellariae Radix (黃芩), Pinelliae Tuber (半夏), Zingiberis Rhizoma Recens (生薑), Codonopsis Pilosulae Radix (黨參), Polygoni Cuspidati Rhizoma et Radix (虎杖根), Coptidis Rhizoma (黃連), Zizyphi Fructus (大棗)
Liu29 (2019) Compound Xiexin decoction (複方瀉心湯) Glycyrrhizae Radix et Rhizoma (甘草), Pinelliae Tuber (半夏), Coptidis Rhizoma (黃連), Scutellariae Radix (黃芩), Zingiberis Rhizoma Recens (生薑), Atractylodis Rhizoma Alba (白朮), Notoginseng Radix Et Rhizoma (三七), Bletillae Rhizoma (白芨), Typhae Pollen (蒲黃), Taraxaci Herba (蒲公英), Zizyphi Fructus (大棗)
Cai30 (2018) fire-deposit and hair-raising therapy (火鬱發之論) Rehmanniae Radix (地黃), Angelicae Gigantis Radix (當歸), Moutan Radicis Cortex (牧丹皮), Coptidis Rhizoma (黃連), Cimicifugae Rhizoma (升麻), Glycyrrhizae Radix et Rhizoma (甘草)
Jia31 (2018) Gancao Xiexin decoction (甘草瀉心湯) Glycyrrhizae Radix et Rhizoma (甘草), Pinelliae Tuber (半夏), Coptidis Rhizoma (黃連), Codonopsis Pilosulae Radix (黨參), Zingiberis Rhizoma Recens (生薑), Zizyphi Fructus (大棗), Scutellariae Radix (黃芩)
Liu32 (2018) Gancao Xiexin decoction (甘草瀉心湯) Glycyrrhizae Radix et Rhizoma (甘草), Coptidis Rhizoma (黃連), Scutellariae Radix (黃芩), Zingiberis Rhizoma Recens (生薑), Codonopsis Pilosulae Radix (黨參), Pinelliae Tuber (半夏), Zizyphi Fructus (大棗)
Sun33 (2018) Self-made Stomach Nourishing and Cleansing decoction (自擬養胃清營湯) Dioscoreae Rhizoma (山藥), Poria Sclerotium (茯苓), Lophatheri Herba (淡竹葉), Coicis Semen (薏苡仁), Scrophulariae Radix (玄蔘), Rehmanniae Radix (地黃), Liriopis seu Ophiopogonis Tuber (麥門冬), Bletillae Rhizoma (白芨), Paeoniae Radix (芍藥), Scutellariae Radix (黃芩), Coptidis Rhizoma (黃連), Lonicerae Flos (金銀花), Glycyrrhizae Radix et Rhizoma (甘草), Forsythiae Fructus (連翹)
Wang HB34 (2017) Self-made Heat and Toxin Clearing Formula (自擬清熱解毒方劑) Lonicerae Flos (金銀花), Isatidis Radix (板藍根), Agastachis Herba (藿香), Gypsum Fibrosum (石膏), Saposhnikoviae Radix (防風), Forsythiae Fructus (連翹), Isatidis Folium (大靑葉), Lophatheri Herba (淡竹葉), Hordei Fructus Germinatus (麥芽), Glycyrrhizae Radix et Rhizoma (甘草)
Wang XL35 (2017) Kouyanqing Granules (口炎清顆粒) Moschus (麝香), Bovis Calculus (牛黃), Margarita (珍珠), Bomeolum (氷片), Bufo (蟾酥), Arsenicum (雄黃)
Wang Y 36 (2017) Pipa Qingwei Decoction (枇杷清胃飲) Eriobotryae Folium (枇杷葉), Glycyrrhizae Radix et Rhizoma (甘草), Hordei Fructus Germinatus (麥芽), Oryzae Fructus Germinatus (穀芽), Phyllostachyos Caulis in Taeniam (竹茹), Phragmitis Rhizoma (蘆根), Imperatae Rhizoma (茅根), Tetrapanacis Medulla (通草), Lophatheri Herba (淡竹葉), Artemisiae Capillaris Herba (茵蔯)
Yuan37 (2017) Xiehuang Powder (瀉黃散) Hedyotidis Herba (白花蛇舌草), Taraxaci Herba (蒲公英), Gypsum Fibrosum (石膏), Astragali Radix (黃芪), Atractylodis Rhizoma Alba (白朮), Gardeniae Fructus (梔子), Agastachis Herba (藿香), Saposhnikoviae Radix (防風), Glycyrrhizae Radix et Rhizoma (甘草)
Zhao38 (2017) Modified Qianyang Fengsui Dan (加味潛陽封髓丹) Aconiti Lateralis Radix Preparata (附子), Testudinis Chinemis Plastrum et Carapax (龜板), Phellodendri Cortex (黃柏), Amomi Fructus (砂仁), Glycyrrhizae Radix et Rhizoma (甘草), Platycodonis Radix (桔梗), Asiasari Radix et Rhizoma (細辛), Cinnamomi Cortex (肉桂)
Chen39 (2016) Herbal decoction (中藥湯劑) Gypsum Fibrosum (石膏), Glycyrrhizae Radix et Rhizoma (甘草), Chrysanthmi Flos (菊花), Borax (硼砂)
Qian40 (2016) Gancao Xiexin decoction (甘草瀉心湯) Glycyrrhizae Radix et Rhizoma (甘草), Scutellariae Radix (黃芩), Coptidis Rhizoma (黃連), Phellodendri Cortex (黃柏), Zingiberis Rhizoma Recens (生薑), Pseudostellariae Radix (太子參), Pinelliae Tuber (半夏), Forsythiae Fructus (連翹), Zizyphi Fructus (大棗)
Wang41 (2016) Self-made cooling blood and generating body fluid decoction (自擬涼血生津方) Phragmitis Rhizoma (蘆根), Imperatae Rhizoma (茅根), Sophorae Tonkinensis Radix (山豆根), Belamcandae Rhizoma (射干), Paeoniae Radix (芍藥), Moutan Radicis Cortex (牧丹皮), Rehmanniae Radix (地黃), Liriopis seu Ophiopogonis Tuber (麥門冬), Lonicerae Flos (金銀花), Trichosanthis Radix (天花粉), Prunellae Spica (夏枯草), Dendrobii Caulis (石斛), Glycyrrhizae Radix et Rhizoma (甘草), Nelumbinis Rhizomatis Nodus (藕節)
Yang42 (2016) TCM Mouth Ulcer Gargle (口腔潰瘍含漱液) Astragali Radix (黃芪), Bubalus Bubalis Linne (水牛角), Ficus carica (無花果), Moutan Radicis Cortex (牧丹皮), Sanguisorbae Radix (地楡), Rehmanniae Radix (地黃), Ostreae Testa (牡蠣)
Zou43 (2016) Compound scutellaria gargle (複方黃芩含漱液) Scutellariae Radix (黃芩), Syzygii Flos (丁香), Menthae Herba (薄荷), Panax quinquefolium (西洋蔘), Magnoliae Cortex (厚朴), Persicae Semen (桃仁), Phellodendri Cortex (黃柏), Corydalis Tuber (玄胡索), Moutan Radicis Cortex (牧丹皮)
He44 (2014) Chinese herbal medicine (中藥) Scrophulariae Radix (玄蔘), Rehmanniae Radix (地黃), Liriopis seu Ophiopogonis Tuber (麥門冬), Lonicerae Flos (金銀花), Isatidis Radix (板藍根), Sophorae Tonkinensis Radix (山豆根), Coptidis Rhizoma (黃連), Phellodendri Cortex (黃柏), Astragali Radix (黃芪), Galla Rhois (五倍子), Bomeolum (氷片)
Su45 (2014) Gancao Xiexin decoction (甘草瀉心湯) Glycyrrhizae Radix et Rhizoma (甘草), Scutellariae Radix (黃芩), Codonopsis Pilosulae Radix (黨參), Zizyphi Fructus (大棗), Coptidis Rhizoma (黃連), Zingiberis Rhizoma Recens (生薑), Pinelliae Tuber (半夏), Sanguisorbae Radix (地楡), Lithospermi Radix (紫草)
Wang46 (2014) Yingyuan-gancao Decoction (銀花甘草湯) Lonicerae Flos (金銀花), Glycyrrhizae Radix et Rhizoma (甘草)
Zhang47 (2014) Kougan Formula (口疳方) Lonicerae Flos (金銀花), Coptidis Rhizoma (黃連), Cinnamomi Cortex (肉桂), Asiasari Radix et Rhizoma (細辛), Glycyrrhizae Radix et Rhizoma (甘草), Rehmanniae Radix (地黃), Sargentodoxae Caulis (大血藤)
Duan48 (2013) Yingyuan juhua Compound (複方銀菊合劑) Lonicerae Flos (金銀花), Chrysanthmi Flos (菊花), Trichosanthis Radix (天花粉), Glycyrrhizae Radix et Rhizoma (甘草)
Liao49 (2013) Self-made Yuyang Decoction (自擬愈瘍湯) Rehmanniae Radix (地黃), Lonicerae Flos (金銀花), Scrophulariae Radix (玄蔘), Adenophorae Radix (沙蔘), Forsythiae Fructus (連翹), Coptidis Rhizoma (黃連), Lophatheri Herba (淡竹葉), Gardeniae Fructus (梔子), Moutan Radicis Cortex (牧丹皮), Cimicifugae Rhizoma (升麻), Achyranthis Radix (牛膝), Akebiae Caulis (木通)
Luo50 (2013) Chrysanthemum solution (銀菊花液) Lonicerae Flos (金銀花), Chrysanthmi Flos (菊花)
Xu51 (2013) Yinxuan Tang (銀玄湯) Lonicerae Flos (金銀花), Scrophulariae Radix (玄蔘), Chrysanthmi Flos (菊花), Liriopis seu Ophiopogonis Tuber (麥門冬)
Zhang52 (2013) Gancao Xiexin decoction (甘草瀉心湯) Glycyrrhizae Radix et Rhizoma (甘草), Scutellariae Radix (黃芩), Coptidis Rhizoma (黃連), Zingiberis Rhizoma Recens (生薑), Codonopsis Pilosulae Radix (黨參), Pinelliae Tuber (半夏), Zizyphi Fructus (大棗), Sanguisorbae Radix (地楡), Lithospermi Radix (紫草)
Zou53 (2013) Easy-convenient Gargle with Traditional Chinese Medicine (簡便中藥漱口防) Rhei Radix et Rhizoma (大黃), Carthami Flos (紅花), Lithospermi Radix (紫草)
Duan54 (2012) combined Chinese and Western medicine (中西醫結合) Coptidis Rhizoma (黃連), Forsythiae Fructus (連翹), Lophatheri Herba (淡竹葉), Scutellariae Radix (黃芩), Rhei Radix et Rhizoma (大黃), Polygoni Cuspidati Rhizoma et Radix (虎杖根), Paeoniae Radix (芍藥), Glycyrrhizae Radix et Rhizoma (甘草), Dioscoreae Rhizoma (山藥), Asparagi Tuber (天門冬), Rehmanniae Radix (地黃), Anemarrhenae Rhizoma (知母), Juncus effusus L. (灯芯草)
Hu55 (2012) Gancao Xiexin decoction (甘草瀉心湯) Glycyrrhizae Radix et Rhizoma (甘草), Lycii Fructus (枸杞子), Pseudostellariae Radix (太子參), Rehmanniae Radix (地黃), Achyranthis Radix (牛膝), Scrophulariae Radix (玄蔘), Forsythiae Fructus (連翹), Scutellariae Radix (黃芩), Pinelliae Tuber (半夏), Phellodendri Cortex (黃柏), Coptidis Rhizoma (黃連), Zingiberis Rhizoma Recens (生薑), Zizyphi Fructus (大棗)
Li56 (2012) Sancai Fengsui tang (三才封髓湯) Rehmanniae Radix (地黃), Asparagi Tuber (天門冬), Ginseng Radix (人蔘), Phellodendri Cortex (黃柏), Amomi Fructus (砂仁), Glycyrrhizae Radix et Rhizoma (甘草)
Zhang YX57 (2012) Compound scutellaria gargle (複方黃芩含漱液) Scutellariae Radix (黃芩), Phellodendri Cortex (黃柏), Menthae Herba (薄荷), Moutan Radicis Cortex (牧丹皮), Corydalis Tuber (玄胡索), Carthami Flos (紅花), Persicae Semen (桃仁)
Zhou58 (2012) nourishing yin and clearing heat gargle (養陰清熱漱口方) Lycii Fructus (枸杞子), Lonicerae Flos (金銀花), Flos Chrysanthemi (杭白菊), Oroxyli Semen (木蝴蝶)
Wang CL59 (2011) compound goji berry and chrysanthemum soup (複方杞菊湯) Lycii Fructus (枸杞子), Lonicerae Flos (金銀花), Oroxyli Semen (木蝴蝶), Flos Chrysanthemi (杭白菊)
Wang P60 (2011) Sha Shen Maidong Tang (沙蔘麥冬湯) Adenophorae Radix (沙蔘), Liriopis seu Ophiopogonis Tuber (麥門冬), Polygonati Odorati Rhizoma (玉竹), Glycyrrhizae Radix et Rhizoma (甘草), Folium Mori (桑葉), Dolichoris Semen (白扁豆), Trichosanthis Radix (天花粉), Sarcandra glabra (肿节风), Hedyotidis Herba (白花蛇舌草), Scutellariae Barbatae Herba (半枝蓮)
Wu61 (2010) Qinggong San (清胃散) Cimicifugae Rhizoma (升麻), Coptidis Rhizoma (黃連), Rehmanniae Radix (地黃), Angelicae Gigantis Radix (當歸), Moutan Radicis Cortex (牧丹皮), Ranunculus ternatus Radix (猫爪草), Forsythiae Fructus (連翹), Fritillariae Thunbergii Bulbus (浙貝母), Cnidii Rhizoma (川芎), Puerariae Radix (葛根)
Jin62 (2009) Shuizhongcao Decoction (水中草湯) Bubalus Bubalis Linne (水牛角), Human Urine Sediment (人中白), Lithospermi Radix (紫草)
Bao63 (2008) Self-made Gargle Solution (自制中藥漱口液防) Astragali Radix (黃芪), Lonicerae Flos (金銀花), Glycyrrhizae Radix et Rhizoma (甘草)
Sun64 (2007) Xiehuang Powder (瀉黃散) Gypsum Fibrosum (石膏), Saposhnikoviae Radix (防風), Gardeniae Fructus (梔子), Agastachis Herba (藿香), Glycyrrhizae Radix et Rhizoma (甘草), Astragali Radix (黃芪), Atractylodis Rhizoma Alba (白朮), Dendrobii Caulis (石斛), Lophatheri Herba (淡竹葉), Hedyotidis Herba (白花蛇舌草), Taraxaci Herba (蒲公英), Coptidis Rhizoma (黃連), Ginseng Radix (人蔘)
Qin65 (2007) Self-made Clearing Heat and Dampness decoction (自擬清熱祛溼湯) Polygonati Rhizoma (黃精), Scutellariae Radix (黃芩), Coptidis Rhizoma (黃連), Coicis Semen (薏苡仁), Phellodendri Cortex (黃柏), Sophorae Radix (苦蔘), Glycyrrhizae Radix et Rhizoma (甘草)
Zeng66 (2005) Yingyuan-gancao Decoction (銀花甘草湯) Lonicerae Flos (金銀花), Glycyrrhizae Radix et Rhizoma (甘草)
Zhou67 (2005) Herbal decoction Bomeolum (氷片), Cinnabaris (朱砂), Indigo Pulverata Levis (靑黛), Rehmanniae Radix (地黃), Liriopis seu Ophiopogonis Tuber (麥門冬), Polygonati Odorati Rhizoma (玉竹), Chrysanthmi Flos (菊花), Scrophulariae Radix (玄蔘), Forsythiae Fructus (連翹), Sophorae Tonkinensis Radix (山豆根), Gardeniae Fructus (梔子), Sterculiae Lychnophorae Semen (胖大海)
Ning68 (2002) Shenjinyuye Mixture (生津玉液合劑) Panax quinquefolium (西洋蔘), Lonicerae Flos (金銀花), Notoginseng Radix Et Rhizoma (三七), Adenophorae Radix (沙蔘), Liriopis seu Ophiopogonis Tuber (麥門冬), Polygonati Odorati Rhizoma (玉竹), Trichosanthis Radix (天花粉), Lophatheri Herba (淡竹葉), Forsythiae Fructus (連翹), Mori Radicis Cortex (桑白皮), Sophorae Tonkinensis Radix (山豆根), Chrysanthmi Flos (菊花), Menthae Herba (薄荷), Imperatae Rhizoma (茅根), Lithospermi Radix (紫草), Rehmanniae Radix (地黃)
Wang JY69 (2002) Chinese herbs decoction (中藥煎劑) Phellodendri Cortex (黃柏), Galla Rhois (五倍子), Verbena officinalis (马鞭草), Catechu (儿茶), Forsythiae Fructus (連翹), Bomeolum (氷片)
Zhang70 (2000) self-made film-containing herbal gargle (自擬愈膜含漱液) Notoginseng Radix Et Rhizoma (三七), Bomeolum (氷片), 용담, Rhei Radix et Rhizoma (大黃), Phellodendri Cortex (黃柏), Scutellariae Radix (黃芩), Asiasari Radix et Rhizoma (細辛), Eupatorii Herba (佩蘭), Menthae Herba (薄荷)
Liu71 (1999) Qiji Decoction (七及湯) Notoginseng Radix Et Rhizoma (三七), Bletillae Rhizoma (白芨), Astragali Radix (黃芪), Phellodendri Cortex (黃柏), Trichosanthis Radix (天花粉), Forsythiae Fructus (連翹), Glycyrrhizae Radix et Rhizoma (甘草)
Qiao72 (1997) Self-made mouth healing decoction (自擬口愈湯) Astragali Radix (黃芪), Angelicae Gigantis Radix (當歸), Rehmanniae Radix (地黃), Paeoniae Radix (芍藥), Atractylodis Rhizoma Alba (白朮), Caesalpinia decapetala (云令), Adenophorae Radix (沙蔘), Lycii Fructus (枸杞子), Cyperi Rhizoma (香附子), Forsythiae Fructus (連翹), Scutellariae Radix (黃芩), Coptidis Rhizoma (黃連)
OhOka73 (2018) Hangeshashinto (半夏瀉心湯) Pinelliae Tuber (半夏), Scutellariae Radix (黃芩), Glycyrrhizae Radix et Rhizoma (甘草), Zizyphi Fructus (大棗), Ginseng Radix (人蔘), Coptidis Rhizoma (黃連), Zingiberis Rhizoma Recens (生薑)
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