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JKM > Volume 44(2); 2023 > Article
Kim and Han: Effects of Bojungikgi-tang and its modifications for Anemia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials



This study aimed to evaluate the efficacy and safety of Bojungikgi-tang (BJIG) and its modifications for patients with anemia.


The subject of analysis of this study was a parallel design randomized controlled trial in which BJIG or its modifications was administered orally to patients who met the World Health Organization’s anemia criteria and the efficacy and safety were prospectively measured. Electronic databases were searched to retrieve eligible literature published from 1 January 2000 to 12 February 2023. A meta-analysis was conducted, and the risk of bias (RoB) and level of evidence of the included studies was assessed using the Cochrane RoB 2 tool and GRADE method, respectively.


Five studies were included in the meta-analysis. When BJIG or its modifications was administered to anemia patients receiving conventional treatment, additional benefits compared to the non-administered group were found in terms of an increase in red blood cell count (mean difference (MD) 0.46 x 1012/L, 95% confidence interval (CI) 0.17 to 0.74), hemoglobin concentration (MD 9.28 g/L, 95% CI 6.06 to 12.51), hematocrit (MD 2.57%, 95% CI 1.76 to 3.38), total effective rate (odds ratio 5.29, 95% CI 2.05 to 13.68), and traditional Chinese medicine symptom scores (standardized MD −1.51, 95% CI −2.79 to −0.24).


This study demonstrated the clinical potential of BJIG and its modifications to provide additional benefits to patients with anemia receiving conventional treatment.

Fig. 1
Flowchart of study selection process
Fig. 2
Forest Plots (Bojungikgi-tang Plus Conventional Treatment Versus Conventional Treatment)
(A) Red blood cell count (x 1012/L)
(B) Hemoglobin concentration (g/L)
(C) Hematocrit (%)
(D) Total effective rate
(E) Traditional Chinese Medicine symptom score
Fig. 3
Risk of Bias Summary
Table 1
Characteristics of Included Studies
Study ID Age No. of patients Target patients Intervention Control Formulation Dose Frequency Duration
TG/CG TG(M)/CG(M) Type of anemia (+ PI) Baseline Hb (g/L) Anemia severity
He 201318) 47.5±13.6/ 45.3±10.96 91(59)/57(34) Renal anemia TG: 63.23±3.17
CG: 64.31±3.02
Severe mBJIG+Conv for anemia Conv for anemia decoction 1/2 pack* 2 8 wks
Li 200519) 25.6±13.2/ 27.33±11.8 60(49)/40(31) Post op. hemorrhagic anemia + PI TG: 73.4±4.3
CG: 74.6±3.8
Severe mBJIG+Conv for op. Conv for op. decoction 1/2 pack 2 2 wks
Xu 202120) 74.57±6.6/ 75.68±8.58 30(13)/31(14) Post op. hemorrhagic anemia TG: 110.95±22.36
CG: 116.27±25.84
Mild mBJIG+Conv for op. Conv for op. decoction 1/3 pack 3 Over 1 wk
Chen 202121) 35.53±7.84/ 35.67±9.29 30(15)/30(13) Anemia with hemorrhoids+ PI TG: 86.03 ± 11.36
CG: 85.83 ± 9.61
Moderate BJIG+mox Mox decoction 1/2 pack 2 1 mns
Zhou 201922) 28.6±6.4/ 29.2±6.1 60(0)/60(0) Pregnant women with iron deficiency anemia TG: 73.3±9.6
CG: 74.5±9.8
Moderate BJIG+iron capsule iron capsule Granule 3 gram 3 4 wks

* Pack=貼,

PI: qi deficiency and blood stasis (氣虛血瘀),

PI: spleen deficiency and sinking of qi (脾虛氣陷)

Abbrebiations: TG, treatment group; CG, control group; No., number; M, male; PI, pattern identification; Hb, hemoglobin; mBJIG, modified Bojungikgi-tang; Conv, conventional treatment; wks, weeks; op., operation; BJIG, Bojuingikgi-tang; mox, moxibustion; mns, months

Table 2
Prescription Composition of Bojungikgi-tang Used in Included Studies
Study ID/ingredients Astragali Radix (黃芪) Glycyrrhizae Radix (甘草) Ginseng Radix (人蔘) Angelicae Gigantis Radix (當歸) Citri Pericarpium (陳皮) Cimicifugae Rhizoma (升麻) Bupleuri Radix (柴胡) Atractylodis Macrocephalae Rhizoma (白朮) Other ingredients
He 201318) 30 15* 10 12 Jujubae Fructus 15, Lycii Fructus (枸杞子) 15, Rhei Radix Et Rhizoma (大黃) 9, Poria (茯苓) 15, Dioscoreae Rhizoma (山藥) 15, Mori Fructus (桑椹子) 15, Oryzae Semen (生米仁) 30, Leonuri Herba (益母草) 30
Li 200519) 30 6 30* 6 6 6 10 15 Jujubae Fructus 30, Salviae Miltiorrhizae Radix (丹蔘) 30, Lonicerae Flos (金銀花) 30, Agrimoniae Herba (仙鶴草) 30, Notoginseng Radix (三七根) 15, Eupolyphaga (土鱉蟲) 15
Xu 202120) 30 10 10 15 10 10 10 10 Paeoniae Radix Alba (白芍藥) 15, Paeoniae Radix Rubra (赤芍藥) 10, Cinnamomi Ramulus (桂枝) 10, Cnidii Rhizoma (川芎) 10, Moutan Cortex (牧丹皮) 10
Chen 202121) 30 10 15 10 10 10 10 10 -
Zhou 201922) DNR DNR DNR* DNR DNR DNR DNR DNR Jujubae Fructus (大棗), Zingiberis Rhizoma Crudus (生薑), dextrin

The number in the table represents the daily dose of each ingredient.

* Codonopsis Pilosulae Radix (黨參) was used instead of Panax ginseng C.A. Meyer. Abbreviation:DNR, dosage not reported.

Table 3
Summary of Findings
Outcome measures No. of studies No. of participants Certainty of evidence
RBC 4 428 ⊝⊝○○
Hb 5 489 ⊝⊝○○
HCT 3 269 ⊝⊝○○
TER 4 341 ⊝○○○
Very Lowbef
TCM 2 121 ⊝○○○
Very Lowbdef

Superscripts: a, serious RoB; b, very serious RoB; c, serious inconsistency; d, very serious inconsistency; e, serious indirectness; f, serious imprecision Abbreviations: No, number; RBC, red blood cell; Hb, hemoglobin; HCT, hematocrit; TER, total effective rate; TCM, traditional Chinese medicine symptoms score


Appendix I

Anemia Diagnosis and Severity Criteria

Population Non-Anemia Anemia

Mild Moderate Severe
Men* ≥ 130 110–129 80–109 < 80
Women ≥ 120 110–119 80–109 < 80
Pregnant women ≥ 110 100–119 70–99 < 70

Numbers in the table are hemoglobin concentrations (grams per liter)

* 15 years of age and above,

† non-pregnant women 15 years of age and above

Excerpts from: WHO. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Vitamin and Mineral Nutrition Information System. Geneva, World Health Organization, 2011 (WHO/NMH/NHD/MNM/11.1) (http://www.who.int/vmnis/indicators/haemoglobin.pdf).


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