Medicinal Plant Research 2025, Vol.15, No.4, 188-196 http://hortherbpublisher.com/index.php/mpr 193 6.2 Sources of heterogeneity and subgroup analyses Heterogeneity—variation across results between studies—may result from differences in treatment duration, dose, patient groups, and whether Astragalus is given alone or with other treatments given together. Subgroup analyses and meta-regression detect such sources. For example, stratification by dose or treatment length may reveal that longer treatment lengths or higher doses offer greater benefit. Meta-regression is most robust when ten or more studies are available for each covariate (Andrade, 2020). Dealing with heterogeneity is important for meaningful interpretation and for making recommendations applicable to individual patient groups. 6.3 Efficacy and safety of Astragalus combined with conventional treatments Astragalus incorporation into standard therapies will enhance efficacy without incorporating significant side effects, as has been suggested by pooled analyses. Evidence assurance such as this is contingent upon trial consistency and high-quality trials incorporated. Underlying the use of GRADE technique and trial sequential analysis, one can ascertain reliability and strength of evidence so as to formulate recommendations based on strong evidence (Sheng et al., 2025). 7 Limitations and Challenges in Clinical Translation 7.1 Limitations of clinical trial design and small sample sizes The majority of Astragalus membranaceus clinical trials are marred by low sample sizes, inadequate randomization, and lack of blinding, which limit the validity and generalizability of their findings. The quality and quantity of trials included undermine the strength of evidence and do not allow for firm conclusions to be drawn about clinical efficacy. Future research must prioritize larger, multi-center, and well-designed randomized controlled trials to enhance the validity of findings (Zhang et al., 2019; Zheng et al., 2020). 7.2 Variability in interventions and treatment duration High variability exists in Astragalus membranaceus preparation types utilized (e.g., injections, polysaccharide extracts, granules), dosing, and treatment courses among studies. Non-standardization of this sort compels difficulty in comparison of results and establishment of best therapeutic regimens. Additionally, treatment durations in the majority of studies are brief, and it remains unclear how Astragalus membranaceus influences long-term utilization (Sheng et al., 2025). 7.3 Insufficient reporting on safety and adverse effects Safety reporting and adverse effect reporting is often incomplete or inconsistent. While some reports suggest Astragalus membranaceus to be largely well-tolerated, poor overall adverse event data and insufficient long-term safety monitoring lower confidence in its use clinically. Enhanced rigorous and transparent safety assessment should be conducted in future trials (Zhang et al., 2019; Zheng et al., 2020). 7.4 Methodological limitations of meta-analyses Meta-analyses are constrained by the quality and heterogeneity of studies included. Excessive heterogeneity, publication bias, and no standardized outcome measures can invalidate the pooled estimates' validity. The predominance of low-quality trials and the scarcity of subgroup analyses also endanger the interpretation and clinical interpretation of results. Future meta-analyses require improved methodological rigor and standardized reporting (Tian et al., 2024; Sheng et al., 2025). 8 Concluding Remarks Current clinical evidence recommends the potential therapeutic effects of Astragalus membranaceus on many cardiovascular and metabolic disorders like chronic heart failure, coronary heart disease, hypertension, type 2 diabetes mellitus, and hyperlipidemia. Result from systematic reviews and meta-analyses of the aforementioned specified clinical trials suggests that Astragalus may enhance cardiac function, normalize blood sugar and lipid, alleviate clinical symptoms, and enhance quality of life. Interestingly, such impacts are invariably combined with a favorable safety profile, rendering it a desirable adjunct therapeutic agent.
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