Efficacy and safety of spleen-strengthening and phlegm-resolving herbal therapy for residual dizziness after repositioning of benign paroxysmal positional vertigo: a systematic review and meta-analysis of randomized controlled trials
- 1Dongzhimen Hospital, Beijing University of Chinese Medicine , ,
Abstract
Introduction: Spleen-strengthening and phlegm-resolving (SSPR) herbal therapy, a classical core approach in traditional Chinese medicine (TCM) has been widely applied to treat residual dizziness (RD) after canalith repositioning procedures for benign paroxysmal positional vertigo. This systematic review aims to comprehensively evaluate its clinical efficacy and safety.
Methods: We searched eight electronic databases for randomized controlled trials (RCTs) investigating SSPR therapy for RD from database inception to 5 May 2026. The quality of methodology was evaluated by the Cochrane Risk of Bias tool (ROB 2.0). Meta-analysis was conducted using RevMan 5.4 and Stata 18.0.
Results: Thirty-seven RCTs (2,794 participants) were included. Compared with standard of care (SOC) alone, SSPR therapy significantly reduced dizziness handicap inventory (DHI) scores [MD = −9.24, 95% CI: (−10.98, −7.50), p < 0.00001], visual analogue scale (VAS) scores [MD = −1.32, 95% CI: (−1.71, −0.93), p < 0.00001], and TCM syndrome scores [SMD = −1.84, 95% CI: (−2.49, −1.20), p < 0.00001], while achieving higher dizziness resolution rate and clinical effective rate. Furthermore, SSPR therapy plus SOC combination compared with SOC, yielded greater reductions in DHI scores [MD = −9.33, 95% CI: (−11.45, −7.21), p < 0.00001], VAS scores [MD = −1.39, 95% CI: (−2.20, −0.58), p = 0.0008], TCM syndrome scores [SMD = −1.39, 95% CI: (−1.97, −0.81), p < 0.00001], and recurrence rate, while elevating dizziness resolution rate and clinical effective rate. No severe adverse events were reported in the studies that reported safety outcomes.
Conclusion: SSPR therapy appears effective in improving RD symptoms and may reduce recurrence rates. However, its safety remains uncertain due to incomplete reporting of adverse events across the included studies. Given the limitations of the included studies, high-quality, large-sample RCTs are still required for rigorous verification.
Systematic Review Registration: http://www.crd.york.ac.uk/PROSPERO/, identifier CRD420251024692.
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BibTeX
@article{zhang2026efficacy,
title = {{Efficacy and safety of spleen-strengthening and phlegm-resolving herbal therapy for residual dizziness after repositioning of benign paroxysmal positional vertigo: a systematic review and meta-analysis of randomized controlled trials}},
author = {Yuqi Zhang and Yingqiu Sun and Qingxiao Li and Quanzhi Li and Yawei Du and Bingrui Zhang and Shengxian Wu},
journal = {Frontiers in medicine},
year = {2026},
month = oct,
doi = {10.3389/fmed.2026.1949948},
url = {https://europepmc.org/article/PMC/PMC13724474},
note = {CC BY},
}
RIS
TY - JOUR
TI - Efficacy and safety of spleen-strengthening and phlegm-resolving herbal therapy for residual dizziness after repositioning of benign paroxysmal positional vertigo: a systematic review and meta-analysis of randomized controlled trials
AU - Yuqi Zhang
AU - Yingqiu Sun
AU - Qingxiao Li
AU - Quanzhi Li
AU - Yawei Du
AU - Bingrui Zhang
AU - Shengxian Wu
PY - 2026
DA - 2026/10/19
JO - Frontiers in medicine
DO - 10.3389/fmed.2026.1949948
UR - https://europepmc.org/article/PMC/PMC13724474
AB - Introduction: Spleen-strengthening and phlegm-resolving (SSPR) herbal therapy, a classical core approach in traditional Chinese medicine (TCM) has been widely applied to treat residual dizziness (RD) after canalith repositioning procedures for benign paroxysmal positional vertigo. This systematic review aims to comprehensively evaluate its clinical efficacy and safety. Methods: We searched eight electronic databases for randomized controlled trials (RCTs) investigating SSPR therapy for RD from database inception to 5 May 2026. The quality of methodology was evaluated by the Cochrane Risk of Bias tool (ROB 2.0). Meta-analysis was conducted using RevMan 5.4 and Stata 18.0. Results: Thirty-seven RCTs (2,794 participants) were included. Compared with standard of care (SOC) alone, SSPR therapy significantly reduced dizziness handicap inventory (DHI) scores [MD = −9.24, 95% CI: (−10.98, −7.50), p < 0.00001], visual analogue scale (VAS) scores [MD = −1.32, 95% CI: (−1.71, −0.93), p < 0.00001], and TCM syndrome scores [SMD = −1.84, 95% CI: (−2.49, −1.20), p < 0.00001], while achieving higher dizziness resolution rate and clinical effective rate. Furthermore, SSPR therapy plus SOC combination compared with SOC, yielded greater reductions in DHI scores [MD = −9.33, 95% CI: (−11.45, −7.21), p < 0.00001], VAS scores [MD = −1.39, 95% CI: (−2.20, −0.58), p = 0.0008], TCM syndrome scores [SMD = −1.39, 95% CI: (−1.97, −0.81), p < 0.00001], and recurrence rate, while elevating dizziness resolution rate and clinical effective rate. No severe adverse events were reported in the studies that reported safety outcomes. Conclusion: SSPR therapy appears effective in improving RD symptoms and may reduce recurrence rates. However, its safety remains uncertain due to incomplete reporting of adverse events across the included studies. Given the limitations of the included studies, high-quality, large-sample RCTs are still required for rigorous verification. Systematic Review Registration: http://www.crd.york.ac.uk/PROSPERO/, identifier CRD420251024692.
SN - 2296-858X
ER -