Table 1_Traditional Chinese medicine for non-alcoholic fatty liver disease: an overview of systematic reviews with evidence mapping and metabolic outcome assessment.docx

The paradigm shift from non-alcoholic fatty liver disease (NAFLD) to metabolic dysfunction-associated fatty liver disease (MAFLD) emphasizes metabolic pathogenesis, yet the efficacy of Traditional Chinese Medicine (TCM) under this framework remains unevaluated. Prior reviews focused on NAFLD with outdated data (<2020), lacking clinical translation tools and methodological standards for TCM systematic reviews and meta-analyses (SRs/MAs). This overview integrates NAFLD criteria, visualizes TCM efficacy via evidence mapping, proposes a methodological framework to standardize TCM SRs/MAs, and focuses on evaluating metabolism-related indicators. Nine databases were searched (from database inception to December 30, 2024) for TCM SRs/MAs in NAFLD. Methodological quality was assessed via AMSTAR-2, PRISMA/PRISMA-CHM, and GRADE. Evidence mapping visualized outcomes (liver enzymes, metabolism) to identify clinical priorities. Standardized reporting guidelines for TCM preparations were adhered to, and a ConPhYMP tool assessment evaluated botanical drugs composition and processing disclosure. Thirty-seven SRs/MAs (35 low/critically low quality) reported trends of reduced ALT (−8.2 U/L, 95% CI: −10.1 to −6.3), improved metabolic parameters (e.g., TG: −0.5 mmol/L), and enhanced B-ultrasound resolution (RR: 1.62), though these findings are limited by methodological flaws and low-quality evidence. Evidence mapping highlighted Xiaoyao Powder and Danning Tablet as top-performing formulas. A methodological framework addressing TCM heterogeneity (formula standardization, dosage) and reporting biases was proposed. This is the first overview integrating NAFLD criteria to visualize TCM-related evidence, offering preliminary observations on potential associations between TCM interventions and metabolic outcomes in NAFLD (interpreted with caution due to low evidence quality). The evidence map and methodological guidelines provide a foundation for standardized future TCM research, while clinical translation of current findings is not recommended due to insufficient high-quality evidence.

从非酒精性脂肪性肝病（non-alcoholic fatty liver disease, NAFLD）到代谢功能异常相关脂肪性肝病（metabolic dysfunction-associated fatty liver disease, MAFLD）的范式转变，强调了该病的代谢发病机制，但在此框架下中医药（Traditional Chinese Medicine, TCM）的疗效仍未得到评估。既往相关综述多聚焦NAFLD且数据过时（早于2020年），缺乏中医药系统评价与Meta分析（systematic reviews and meta-analyses, SRs/MAs）所需的临床转化工具及方法学标准。本研究概述整合NAFLD诊断标准，通过证据图谱可视化中医药疗效，提出标准化中医药SRs/MAs的方法学框架，并聚焦代谢相关指标的评估。研究检索了9个数据库（建库至2024年12月30日）中有关中医药治疗NAFLD的SRs/MAs。采用AMSTAR-2、PRISMA/PRISMA-CHM及GRADE工具对纳入研究的方法学质量进行评价。通过证据图谱可视化结局指标（肝酶、代谢指标）以明确临床研究优先级。研究遵循中医药制剂标准化报告指南，并采用ConPhYMP工具评估植物药的组方及炮制披露情况。共纳入37项SRs/MAs（其中35项为低质量/极低质量研究），结果显示中医药干预可降低谷丙转氨酶（alanine aminotransferase, ALT：-8.2 U/L，95%CI：-10.1~-6.3）、改善代谢参数（如甘油三酯（triglyceride, TG）：-0.5 mmol/L），并提高B超分辨率（相对危险度RR：1.62），但上述结论受方法学缺陷及低质量证据限制。证据图谱显示逍遥散（Xiaoyao Powder）与胆宁片（Danning Tablet）为表现最优的方剂。研究提出了针对中医药异质性（方剂标准化、给药剂量）及报告偏倚的方法学框架。本研究是首个整合NAFLD诊断标准以可视化中医药相关证据的概述，初步观察了中医药干预与NAFLD患者代谢结局间的潜在关联（因证据质量较低，解读需谨慎）。本研究构建的证据图谱及方法学指南可为未来中医药标准化研究奠定基础，但鉴于高质量证据不足，暂不建议将当前研究结果应用于临床转化。