Medicinal Plant Research 2025, Vol.15, No.5, 224-232 http://hortherbpublisher.com/index.php/mpr 228 Figure 2 Mechanistic insights into the inhibitory effects of Astragalus membranaceus on pulmonary fibrosis (Adopted from Sun et al., 2024) 5.2 Clinical studies combining Astragalus with Western medicines for respiratory disorders A number of clinical trials and meta-analyses are evaluating the efficacy of Astragalus-based Chinese herbal medicine in addition to Western treatment for respiratory disease, especially in oncology and chronic lung disease. In non-small-cell lung cancer, addition of Astragalus-based TCM to platinum-based chemotherapy improves overall survival, tumor response rates and performance status, and reduces the incidence of chemotherapy-induced adverse effects. Subgroup analysis indicates that individualized herbal decoctions based on syndrome differentiation are superior to standardized preparations given orally or through injection. Similarly, in chronic obstructive pulmonary disease (COPD), the combination of Astragalus injection with ambroxol hydrochloride as adjuvant therapy has been shown to increase clinical efficacy, lung function, and blood gas analysis compared to routine treatment. These findings supplement the pairing of Astragalus with Western medicine for enhancing therapeutic effects and reducing toxicity in respiratory illness (Wang et al., 2016; Zhou et al., 2023). 5.3 Applications of Astragalus injections and modern formulations These Astragalus development into contemporary drug form such as injections and granules are intended for improving bioavailability and clinical convenience. Astragalus injection is now standardized drugs in China used as adjjuvant treatment of respiratory and cardiovascular disease, and the use of the combination with traditional medicine has been proved to be superior in efficacy and safety. For example, Astragalus injection of ambroxol hydrochloride in patients with COPD induces dramatic arterial blood gas and lung function improvements. Furthermore, novel delivery systems such as spatiotemporal pellets, which combine Astragalus with other herbal components, are being explored to enhance release and absorption of active ingredients, yet further boosting therapeutic efficacy. These new formulants represent an important milestone towards the therapeutic application of Astragalus in respiratory diseases (Zhu et al., 2022; Zhou et al., 2023; Sun et al., 2024; Zhang et al., 2024). 6 Clinical Evidence and Efficacy Evaluation 6.1 Results from randomized controlled trials and systematic reviews Systematic reviews and randomised controlled trials (RCTs) are the gold standard for determining the efficacy of intervention, for example, Astragalus membranaceus in respiratory illness. RCTs provide greater internal validity through measurement of the effect of Astragalus under controlled conditions, while systematic reviews aggregate the evidence from many studies to conduct a comprehensive efficacy and safety assessment. However, in even conventional Chinese medicine and herbal treatment environments, heterogeneity problems with study design, patient populations, and outcomes measures typically limit the quality of the findings. Emerging methodological
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