# Cangfu Daotan decoction with Diane-35 in phlegm-dampness polycystic ovary syndrome: a meta-analysis and systematic review

## TL;DR

Combining Cangfu Daotan decoction with Diane-35 may improve symptoms and hormone levels in women with phlegm-dampness PCOS, but more high-quality studies are needed.

## Contribution

A meta-analysis and systematic review evaluating the combined use of Cangfu Daotan and Diane-35 for phlegm-dampness PCOS.

## Key findings

- Combination therapy improved total effective rate and reduced testosterone, LH, FSH, and BMI.
- Meta-analysis showed significant improvement in hormonal and metabolic outcomes.
- Publication bias was not evident, but methodological weaknesses were noted in included studies.

## Abstract

To systematically evaluate the efficacy of Cangfu Daotan decoction combined with Diane-35 in treating phlegm-dampness polycystic ovary syndrome (PCOS) and its effects on endocrine- and metabolism-related outcomes.

Major English and Chinese databases (PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang, CQVIP, and SinoMed) were searched. Randomized controlled trials comparing Cangfu Daotan-based therapy plus Diane-35 versus Diane-35-based regimens were included. Two reviewers independently screened studies, extracted data, and assessed the risk of bias via the Cochrane tool. The meta-analysis was conducted with RevMan 5.4. The relative risk (RR) with 95% confidence intervals (CIs) was used for dichotomous outcomes, and the mean difference (MD) with 95% CIs was used for continuous outcomes. Fixed- or random-effects models were applied according to heterogeneity (I2 threshold of 50%). Publication bias was assessed via funnel plots.

Sixteen trials were included. Compared with the controls, the combination therapy significantly improved the total effective rate (RR = 1.24, 95% CI 1.18–1.31, p < 0.00001). It also significantly reduced serum testosterone (MD = −0.26, 95% CI –0.37 to −0.15, p < 0.00001), luteinizing hormone (MD = −1.64, 95% CI –2.46 to −0.82, p < 0.0001), follicle-stimulating hormone (MD = −0.62, 95% CI –1.11 to −0.13, p = 0.01), and the LH/FSH ratio (MD = −0.27, 95% CI –0.43 to −0.12, p = 0.0006). BMI also decreased (MD = −1.55, 95% CI –3.06 to −0.04, p = 0.04). Funnel plots suggested no obvious publication bias. Overall risk-of-bias assessment indicated insufficient reporting or implementation of blinding and unclear allocation concealment.

Cangfu Daotan decoction combined with Diane-35 may enhance clinical efficacy and improve key hormonal indicators and BMI in patients with phlegm-dampness-related PCOS. However, the evidence is limited by methodological weaknesses and heterogeneity across studies; well-designed, large-scale RCTs are needed to confirm these findings.