Whether Chinese Medicine Have Effect on Halitosis: A Systematic Review and Meta-Analysis

Abstract

Object:
Halitosis has great adverse impact on personal and social life. There is no strong evidence for the effect of Chinese medicine (CM) and combined Chinese and western medicine (CWM) on halitosis. The aim of the present study is to evaluate the effective rate of CM and CWM on halitosis.

Materials and methods:
Literature search in English and Chinese was conducted in PubMed, Embase, CNKI, CBM, and Wanfang database. Study selection and data collection were conducted. Risks of bias were assessed by the Cochrane tool. Synthesis of results was done by RevMan 5.3. p<0.05 was considered significant difference. Subgroup analysis by classification of halitosis and sensitivity analysis were also conducted.

Results:
Seventeen studies were included. The follow-up length ranged from five days to eight weeks. CM had significantly better effect than WM on intraoral halitosis (I2 =24%; RR=1.21 (95% CI, 1.04, 1.40), P=0.01) and extraoral halitosis (I2 =0; RR=1.39 (95% CI, 1.19, 1.63), P<0.0001). CWM had significantly better effect than WM on intraoral halitosis (I2 =0; RR=1.25 (95% CI, 1.16, 1.35), P<0.00001) and extraoral halitosis (I2 =0; RR=1.19 (95% CI, 1.08, 1.31), P=0.0004). Subgroup analysis and sensitivity analysis showed insignificant results.

Conclusion:
With the limitation of our study, both CM and CWM have significantly better effect on halitosis than WM. More effort should be made to explore long-term effect of CM and CWM on halitosis. This study was registered with the PROSPERO (ID: CRD42018107229).

Full text

Review Article
Whether Chinese Medicine Have Effect on Halitosis:
A Systematic Review and Meta-Analysis
Xinyu Wu, Jie Zhang, Yikun Zhou, Ze He, Qiaoyi Cai, and Min Nie
e State Key Laboratory Breeding Base of Basic Science of Stomatology, Hubei Province & Key Laboratory of
Oral Biomedicine (Wuhan University), Ministry of Education, School and Hospital of Stomatology, Wuhan University,
Luoyu Road 237, Wuhan 430079, Hubei, China
Correspondence should be addressed to Min Nie; niemin@whu.edu.cn
Received 3 September 2018; Revised 16 October 2018; Accepted 31 October 2018; Published 26 November 2018
Academic Editor : Chang G. Son
Copyright ©  Xinyu Wu et al. is is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Object. Halitosis has great adverse impact on personal and social life. ere is no strong evidence for the eect of Chinese medicine
(CM) and combined Chinese and western medicine (CWM) on halitosis. e aim of the present study is to evaluate the eective
rate of CM and CWM on halitosis. Materials and Methods. Literature search in English and Chinese was conducted in PubMed,
Embase, CNKI, CBM, and Wanfang database. Study selection and data collection were conducted. Risks of bias were assessed by
the Cochrane tool. Synthesis of results was done by RevMan .. p<. was considered signicant dierence. Subgroup analysis
by classication of halitosis and sensitivity analysis were also conducted. Results. Seventeen studies were included. e follow-up
length ranged from ve days to eight weeks. CM had signicantly better eect than WM on intraoral halitosis (I2=%; RR=.
(% CI, ., .), P=.) and extraoral halitosis (I2=; RR=. (% CI, ., .), P<.). CWM had signicantly better
eect than WM on intraoral halitosis (I2=; RR=. (% CI, ., .), P<.) and extraoral halitosis (I2=; RR=. (%
CI, ., .), P=.). Subgroup analysis and sensitivity analysis showed insignicant results. Conclusion. With the limitation
of our study, both CM and CWM have signicantly better eect on halitosis than WM. More eort should be made to explore
long-term eect of CM and CWM on halitosis. is study was registered with the PROSPERO (ID: CRD).
1. Introduction
Halitosis is dened as oensive odor exhaling from oral
cavity, the main component of which is volatile sulphur com-
pounds (VSCs) including hydrogen sulde, dimethyl sulde,
and methyl mercaptan []. Halitosis, with a world-wide
prevalence rate ranging from % to % [–], is considered
as the most disfavoring aspect in personal and social life [].
Halitosis is classied as genuine halitosis, pseudo-
halitosis, and halitophobia []. Eighty to ninety percent of
genuine halitosis has intraoral sources, including gingivitis,
periodontitis, and tongue coating in favor of microorganism
[]. Halitosis with extraoral sources comes from systematic
diseases such as nasal inammation, diabetes mellitus, respi-
ratory, and digestive diseases or medication []. Current west-
ern medicine (WM) for halitosis mainly includes mechanical
methods (periodontal initial treatment, oral prophylaxis,
tooth brushing, ossing, and tongue cleaning) and chemi-
cal methods (chlorhexidine, essential oil, menthol, chlorine
dioxide, and two-phase oil-water rinse) []. However, WM
mainly diminish the level of VSCs or related anaerobic
bacteria thus having drug resistance and side eect on the
existing oral microbial ecology []. In cases of extraoral
health, WM discussed above has little eect on the systematic
sources, resulting in relatively high recurrence rate and low
patient satisfaction []. Besides, there is no way to treat
halitosis with unknown sources [].
Research in halitosis in traditional Chinese medicine
(CM) dates back to thousands of years ago. According to
ancient books in China, halitosis is dened as rotting smell
from mouth and has been treated with acupuncture, moxi-
bustion, and decoction of Chinese herbs. Recently, a number
of randomized controlled clinical trials in China reported
that orally administrated CM and combined Chinese and
Hindawi
Evidence-Based Complementary and Alternative Medicine
Volume 2018, Article ID 4347378, 9 pages
https://doi.org/10.1155/2018/4347378

 Evidence-Based Complementary and Alternative Medicine
western medicine (CWM) have superior eects on halitosis
than WM alone. But no synthesis of those results has been
made. Accumulating evidence has aroused interest in CM
and CWM as alternative methods for halitosis.
e aim of the present study is to evaluate eective rate
of CM and CWM versus WM on intraoral and extraoral
halitosis. We review randomized controlled clinical trials, of
which the intervention is CM or CWM and the control is
WM.
2. Materials and Methods
2.1. Study Design and Registration. is systematic review
was written according to the PRISMA list []. e protocol
has registered in the PROSPERO (ID: CRD).
2.2. Eligible Criteria. Only randomized controlled clinical
trials were included in this systematic review. e inter-
vention should be Chinese herbs for mouth rinse or taken
orally, combined with western therapy or not. e control
should be western therapy. Subjects have either intraoral
halitosis or extraoral halitosis. To be diagnosed as intraoral
halitosis, subjects should not have systematic disease that
could induce oral malodor. Outcome measurements should
include eective rate.
Studies were excluded if halitosis was a syndrome of
disease and not specially estimated. RCTs in which control
group is blank or placebo were also excluded.
2.3. Search Strategy. Two individual researchers (XY Wu
and J. Zhang) conducted literature search independently and
in duplicate. A third researcher (M Nie) was consulted if
disagreements occurred. We searched articles in English or
Chinese, from database including CNKI, CBM, Wanfang,
PubMed, and Embase from . to ..
InCNKI,CBM,andWanfang,searchstrategieswere
(“kouchou” OR “kouqiangyiwei”) AND (“zhongyi” OR
“zhongxiyijiehe” OR “zhongyao”). In PubMed and Embase,
search strategies were (“halitosis ” OR “bad breath” OR “oral
malodor” OR “breath ordor”) AND (“Chinese medicine” OR
“combined traditional and Western medicine” OR “chinese
herb∗”)
2.4. Study Selection and Data Collection. Study selection
and data collection were conducted by two researchers (XY
Wu and J. Zhang), independently and in duplicate. Any
disagreement was solved by discussion with a third researcher
(M. Nie).
Study selection procedure was conducted according to
the inclusion and exclusion criteria. Firstly, all the results in
the databases above were gathered together and duplications
were discarded. Secondly, Titles and abstracts were scanned.
Full-texts were accessed if they might meet our criteria
or they were needed for further conrmation. irdly, we
assessed full-texts and determined the included studies. In
this step, reasons for excluding studies were recorded. We
also conducted a manual search in the references and citation
database of included studies.
Aer study selection, data for all included studies were
extracted. Key information included rst author, country,
publication year, the number of subjects, criteria for halitosis
diagnosis and treatment eect assessment, treatment meth-
ods, follow-up length, and outcome measurements. Authors
were contacted for missing data if necessary.
2.5. Risks of Bias Assessment. e Cochrane tool [] was
used to evaluate risks of bias. According to the tool, selection
bias, performance bias, detection bias, attrition bias, and
reporting bias were evaluated according to the sequence
generation, allocation concealment, blinding, incomplete
outcome data, and other potential risks. In this systematic
review, risks of bias induced by dierent halitosis diagnosis
criteria included studies were reected in “Other bias”.
Judgements were classied as “high risk of bias”, “unclear risk
of bias”, and “low risk of bias”.
2.6. Synthesis of Results. Review Manager . was used to
synthesize data. We used dichotomous outcome measures to
evaluate eective with % CI. p<. was considered statis-
tically signicant. e xed eect model was used when less
than four studies were included in a meta-analysis while the
random-eects model was used when four studies or more
were included. Statistical heterogeneity among the studies
was evaluated with the Cochrane Q test and I2statistic.
2.7. Subgroup Analysis and Sensitivity Analysis. Subgroup
analysis by classication of halitosis was conducted. Sensi-
tivity analysis was conducted by excluding studies in which
no criteria for halitosis diagnosis were mentioned. When
studies in one group had ten studies or more, we evaluated
the possibility of publication bias by a funnel plot of the mean
dierences for asymmetry.
3. Results
3.1. Study Selection. Wegot,,,,andresults
from PubMed, Embase, CNKI, Wanfang, and CBM, respec-
tively. Aer discarding duplications,  results remained.
Titles and abstracts were scanned and  articles were
excluded. For the remaining  articles, we assessed full-texts
and excluded  articles. Reasons for exclusion are listed in
Figure . Besides, one study [] was excluded from meta-
analysis for longer follow-up length (one year) than others.
Seventeen studies were included in the nal quantitative
synthesis. Details are listed in Figure .
3.2. Study Characteristics. All the  articles were randomized
controlled clinical trials in Chinese. Intervention includes
CM and CWM. For the eect of CM on halitosis, six studies
were included [–] with a follow-up length ranging from
ve days to eight weeks. For the eect of CWM on halitosis,
 studies were included [–], with a follow-up length
ranging from one week to one month. Intraoral halitosis
mainly originated from gingivitis, periodontitis, and poor
oral care. Extraoral halitosis mainly originated from sys-
tematic diseases such as gastritis, constipation, and children
amygdalitis. Criteria for halitosis diagnosis and treatment

Evidence-Based Complementary and Alternative Medicine 
68 of records
identified
through
database
searching
PubMed and
Embase
1252 of records
identified
through
database
searching CBM,
CNKI and
wanfang
manual search in citation
database of included studies
n=0
822 of records
excluded
56 of full–text articles excluded, with reasons
no intervention or placebo as control group
n=10
no research for halitosis independently n=14
no detail data on changes of cases aer
intervention n=28
intervention method doesn’t meet inclusion
criteria n=1
subject selection doesn’t meet inclusion
criteria n=1
no clear baseline condition for halitosis n=2
long follow up time induce
bias n=1
17 of studies
included in
quantitative
synthesis
(meta–analysis)
896 of records aer
duplicates removed
74 of records
screened
18 of full–text
articles assessed
for eligibility
18 of studies
included in
qualitative
synthesis
F : Flow diagram for study selection.
eect assessment were dierent among studies. Details are
listed in Table .
3.3. Risks of Bias Assessment. For randomization, three stud-
ies described the method and were considered appropriate.
irteen studies were described as randomized without
describing the methods. And three studies did not men-
tion method of randomization. Only one study described
methods of allocation concealment and double blinding
appropriately. All studies fully reported outcomes described
in methods. No withdrawal or dropout was reported. Other
risks of bias were assessed regarding dierent halitosis diag-
nosis criteria. Four studies did not mention any method for
halitosis diagnosis, considered as high risks of bias. Two
studies mentioned an organoleptic test without describing
evaluation scale, considered as unclear risks of bias. All
included studies showed high risks of bias in at least one
domain. (Figures  and )
3.4. Results of Individual Studies. For eective rate of CM on
halitosis (Figure ), CM had signicantly better eect than
WM on intraoral halitosis (I2=%; RR=. (% CI, .,

 Evidence-Based Complementary and Alternative Medicine
Cao.QMG 2015
Chang.YS 2017
Du.HZ 2017
Lai.JZ 2013
Jia.L 2011
Liang.YL 2013
Li.XF 2009
Ren.XJ 2015
Ma.DL 2017
Shi.WB 2013
Sun.SM 2014
Wu.GR 2009
Wang.SC 2015
Xiao.CH 2009
Yang.JX 2015
Zhan.L 2009
Zhao.Y 2012
Random sequence generation (selection bias)
Allocation concealment (selection bias)
Incomplete outcome data (attrition bias)
Blinding of participants and personnel (performance bias)
Blinding of outcome assessment (detection bias)
Selective reporting (reporting bias)
Other bias
F : Risk of bias item in each included study.
Random sequence generation (selection bias)
Allocation concealment (selection bias)
Incomplete outcome data (attrition bias)
Blinding of participants and personnel (performance bias)
Blinding of outcome assessment (detection bias)
Selective reporting (reporting bias)
Other bias
Low risk of bias High risk of biasUnclear risk of bias
0% 25% 50% 75% 100%
F : Risk of bias item among included studies.

Evidence-Based Complementary and Alternative Medicine 
T : Study characteristics for included studies.
Subjects (INT/CON) Halitosis Intervention Control Follow-up length Diagnosis∗Treatment eect∗∗
Xiao et al.()[] / intra-oral CM taken orally PIT d A E
Ren et al.()[] / intra-oral CM mouth rinse
.% sodium
bicarbonate solution
mouth rinse
d C F
Jia et al.()[] / intra-oral CM mouth rinse PIT m D F
Zhao et al.()[] / extra-oral CM taken orally WM taken orally w B E
Chang et al()[] / extra-oral CM taken orally WM taken orally m D E
Du et al ()[] / extra-oral CM taken orally WM taken orally d B E
Liang et al.()[] / intra-oral CM taken orally, PIT PIT d A E
Wu et al.()[] / intra-oral CM taken orally, PIT PIT w A E
Wang et al.()[] / intra-oral CM taken orally, PIT PIT d A E
Ma et al.()[] / intra-oral CM taken orally, PIT PIT d A E
Li et al.()[] / intra-oral CM taken orally, PIT PIT d A E
Sun et al.()[] / intra-oral CM taken orally, PIT PIT d A F
Cao et al.()[] / intra-oral CM taken orally, PIT PIT w C F
Zhan et al.()[] / extra-oral CM taken orally, WM
taken orally WM taken orally m A E
Yang et al.()[] / extra-oral
CM taken orally,
surgery plus WM
taken orally
Surgery, WM taken
orally w D F
Shi et al.()[] / extra-oral CM taken orally, WM
taken orally WM taken orally w D F
Lai et al.()[] / extra-oral CM taken orally, WM
taken orally WM taken orally m A E
INT/CON=intervention group/control group; PIT=periodontal initial therapy.
∗Criteria for halitosis diagnosis. A, organoleptic measurement and Rosenberg scale. In an organoleptic test, the patient takes deep breath by nose, hold it for a while, and exhale by mouth. An examiner standing
cm away from the patient assess and classify the severity of bad odor as  to  points (Rosenberg scale, : no odor, : barely noticeable, : slight but clearly noticeable, : moderate, : strong, and : extremely
strong). Halitosis was diagnosed if a patient scored  points or higher. B, CM symptom rating scale (: no odor, : self-sensed odor, : others could smell bad odor, and : sever odor that keeps others away from
patient). C, olfaction diagnosis but no specic method was described. D, not mentioned. Halitosis was diagnosed if a patient scored  point or higher.
∗∗ Criteria for treatment eect. E, bad odor alleviated and scores reduced by no less than one point aer treatment. F. bad odor alleviated or disappeared aer treatment.

 Evidence-Based Complementary and Alternative Medicine
F : Forest plot for CM on halitosis.
F : Forest plot for CWM on halitosis.
.), P=.) and extraoral halitosis (I2=; RR=. (% CI,
., .), P<.). Subgroup analysis showed insignicant
result (P=., I2=.%).
For eective rate of CWM on halitosis (Figure ), CWM
had signicantly better eect than WM on intraoral halitosis
(I2=; RR=. (% CI, ., .), P<.) and extraoral
halitosis (I2=; RR=. (% CI, ., .), P=.).
Subgroup analysis showed insignicant result (P=., I2=).
3.5. Additional Analysis. For sensitivity analysis, four studies
were excluded in which no criteria for halitosis diagnosis were
mentioned. e eect of CM on intraoral halitosis (I2=%;

Evidence-Based Complementary and Alternative Medicine 
CWM for intra-oral halitosis
CWM for extra-oral halitosis
0.2
0.15
0.1
0.05
0SE(log[RR])
Subgroups
0.05 0.2 1 5 20
RR
F : Funnel plot of included studies on CWM.
RR=. (% CI, ., .), P=.) and extraoral halitosis
(I2=; RR=. (% CI, ., .), P=.) was signicantly
better than that of WM. e eect of CWM on intraoral
halitosis (I2=; RR=. (% CI, ., .), P<.) and
extraoral halitosis (I2=; RR=. (% CI, ., .), P=.)
was signicantly better than that of WM. Sensitivity analysis
presented robust results. A funnel plot was made for included
studies on CWM on halitosis versus WM (Figure ).
4. Discussion
To the best of our knowledge, this is the rst study to syn-
thesize the results of the eect of CM and CWM on halitosis.
With the limitation of follow-up length, both CM and CWM
have signicantly better eect on halitosis than WM.
Better eect of both CM and CWM on halitosis was
in accordance with previous studies. An in vivo study []
reported that chlorhexidine mouth rinse, containing pericarp
extract of Garcinia mangostana L., signicantly reduced VSCs
level in gingivitis patients. Li MY et al. [] reported that
toothpaste mixed with Chinese herb extract showed better
in vitro inhibition eect on VSCs genesis anaerobic bacteria
than most other toothpaste on market. A four-week-period
RCT [] reported that Chinese herb Hyangsa-Pyeongwi
san could alleviate halitosis and increase quality of life in
functional dyspepsia patients and the eect only lasted for
four weeks.
In CM theory, halitosis originates from retention of damp,
heatorreinmouth,stomach,liver,orspleen,allofwhichare
interconnective as an entirety. So, CM treatment concentrates
on a balance of the whole body rather than a certain organ.
For example, Chinese herbs with “cold” properties, such as
Coptis chinensis,Scutellaria baicalensis,Lonicera japonica,the
root of red-rooted salvia, and rhizoma zingiberis, could clear
away the damp, heat, and re in body and cure halitosis
[]. Modern pharmacology explained the mechanisms of
these herbs. Coptis chinensis haspropertiesincludinganti-
bacterial, antitoxin, antiulcer, and reducing gastric acid [].
It decreased level of inammatory cytokines such as VEGF
and TNF in arthritis mouse serum and regulated the cell pro-
liferation, dierentiation, and apoptosis related genes to alle-
viate inammation [, ]. e extraction of Coptis chinensis
could also inhibit urease to anti-H. pylori, the main inducer
of gastritis-related halitosis [–]. Scutellaria baicalen-
sis has eects on iNOS, COX, NF𝜅B, and inammatory
cytokines like IL-𝛽, IL-, IL-, IL-, and TNF-𝛼[–].
Lonicera japonica hadstrongeectsonVSCsandbacteriosta-
sis functions on halitosis related anaerobic bacteria [, ].
In this study, CM shows better eect on extraoral hali-
tosis while CWM shows better eect on intraoral halitosis,
although the dierence was not signicant. According to the
CM theory of “entirety”, Chinese herbs should be admitted
orally to be absorbed by body to exert inuence. On the
contrary, periodontal treatment in WM could reduce oral
VSCs and related anaerobic bacteria immediately. So, the
eect by CM was limited by a short follow-up length in this
study. Better eect of CWM on intraoral halitosis suggested
that CM could strengthen the eect of WM and, in turn,
CM acted better on the basis of WM. CM and WM benet
from each other and combining them together lead to even
superior results.
Dierent criteria for halitosis diagnosis and treatment
eect assessment were used among included studies. How-
ever, sensitivity analysis showed no signicant result. e
gold standard for diagnosis of halitosis is organoleptic
measurement [], which is subjective and inconsistent.
Furthermore, it is hard to grade the severity of halitosis with
clear boundaries. is partly explains the low inheterogeneity
among included studies despite dierent evaluation scales
being used. Future studies should use quantiable outcome
measures, such as component in breath or saliva, to make
their results reproducible and objective.
e protocol of this study has registered in the PROS-
PERO to ensure a qualied methodology. e whole proce-
dure was conducted according to the PRISMA list. We have
done comprehensive literature search and covered nearly

 Evidence-Based Complementary and Alternative Medicine
all available studies. Subgroup and sensitivity analysis was
made to ensure the reliability of results. However, all studies
included were in Chinese and scored high risks of bias in at
least one domain. In one study [] CM mouth rinse was used
in treating intraoral halitosis while in others CM was taken
orally. Only studies with short follow-up length (no longer
than  weeks) were included. Till now evidence was still
insucient for long-term eect of CM and CWM on halitosis.
5. Conclusion
With the limitation of our study, both CM and CWM have
signicantly better eect on halitosis versus WM. Combining
Chinese medicine and western medicine has quicker and
stronger eect on halitosis in short term. More eort should
be made on long-term eect of CM and CWM on halitosis.
Data Availability
No additional data is available.
Conflicts of Interest
No conicts of interest are declared.
Authors’ Contributions
Min Nie and Xinyu Wu contributed to conception and design
and manuscript revision. Xinyu Wu, Jie Zhang, and Min
Nie contributed to database search, study selection, and data
collection. Xinyu Wu and Yikun Zhou contributed to risks
of bias assessment. Ze He was involved in statistical analysis.
Qiaoyi Cai was involved in writing of the paper.
References
[] C. Scully and J. Greenman, “Halitosis (breath odor),” Periodon-
tology 2000,vol.,no.,pp.–,.
[] A. V. D. Broek, L. Feenstra, and C. D. Baat, “A review of the cur-
rent literature on management of halitosis,” Oral Diseases,vol.
,no.,pp.–,.
[] S. Corrao, “Halitosis: New insight into a millennial old prob-
lem,” Internal and Emergency Medicine,vol.,no.,pp.-,
.
[] N.A.A.Van,E.C.Veerman,L.Abraham-Inpijn,T.J.vanSteen-
bergen, and A. J. van Winkelho, “van Winkelho, [Halitosis
(fetor ex ore). A review], Nederlands tijdschri voor tand-
heelkunde,” () ().
[] G.Campisi,A.Musciotto,O.D.Fede,V.D.Marco,andA.Crax`ı,
“Halitosis: Could it be more than mere bad breath?” Internal
and Emergency Medicine,vol.,no.,pp.–,.
[]A.deJongh,C.deBaat,andM.Horstman,“[Psychosocial
aspects of halitosis].,” Nederlands Tijdschri voor Tandheel-
kunde,vol.,no.,pp.–,.
[]F.Romano,E.Pigella,N.Guzzi,andM.Aimetti,“Patients’
self-assessment of oral malodour and its relationship with
organoleptic scores and oral conditions.,” International Journal
of Dental Hygiene,vol.,no.,pp.–,.
[] A.DeJongh,A.J.VanWijk,M.Horstman,andC.DeBaat,
“Attitudes towards individuals with halitosis: An online cross
sectional survey of the Dutch general population,” British Den-
tal Journal,vol.,no.,p.E,.
[] B. U. Aylikci and H. C¸ olak, “Halitosis: From diagnosis to man-
agement,” Journal of Natural Science Biology &amp; Medicine,
vol. , no. , pp. –, .
[] J. M. Moran, “Home-use oral hygiene products: Mouthrinses,”
Periodontology 2000,vol.,no.,pp.–,.
[] P. D. Marsh, “e signicance of maintaining the stability of the
natural microora of the mouth,” British Dental Journal,vol.,
no. , pp. –, .
[] X. Cuihua, “Observation on the ecacy of integrated traditional
Chinese and Western medicine in treating halitosis caused by
periodontitis,” Chinese Medical Innovation,vol.,p.,.
[] R. Xuejuan, X. Guihua, and Z. Yuqin, “Application of self-made
Chinese medicine in oral care of patients with tracheotomy
aer cerebral hemorrhage operation,” Journal of Changchun
University of Traditional Chinese Medicine,vol.,pp.–,
.
[] J.Li,L.Fu,andH.Yiyu,“Clinicalobservationontreatingperio-
dontitis with traditional Chinese medicine periodontal mix-
ture,” Journal of Changchun University of Traditional Chinese
Medicine, vol. , .
[] Z. Yan, Clinical research on treatment of immature Verrucous
Gastritis (damp heat stasis type) by removing dampness and
eliminating war ts Decoction, ShandongUniversity of Traditional
Chinese Medicine, .
[] C. Yushuang, “Clinical observation on treating chronic func-
tional constipation in children with pock kernel pill,” Pediatrics
of Integrated Traditional Chinese and Western Medicine,vol.,
pp. –, .
[] D. Hongzhe, H. Siyuan, Z. Chengliang, and L. Xinmin, “Mul-
ticenter Clinical Study of Pudilan Xiaoyan Oral Liquid in
Dierent Doses in Treating Acute Pharyngeal Tonsillitis with
Pneumogastric Hyperthermia Syndrome in Children,” Chinese
Herbs,vol.,pp.–,.
[] L. Yulin, “Observation on the ecacy of combined treatment
of traditional Chinese medicine and Western medicine for
halitosis caused by periodontitis,” Chinese Disability Medicine,
vol. , pp. -, .
[] W. Guorong, “Clinical observation on treating halitosis with
integrated traditional Chinese and Western Medicine,” Journal
of Liaoning University of Traditional Chinese Medicine,vol.,pp.
-, .
[] W. Shenchuan, “Treatment of  cases of halitosis caused by
periodontitis with integrated traditional Chinese and Western
Medicine,” Henan Journal of Traditional Chinese Medicine,vol.
, pp. -, .
[]M. Dongling, “Clinical eect of integrated traditional Chinese
and Western Medicine on halitosis caused by periodontitis,”
Chinese Health Care Nutrition,vol.,pp.-,.
[] L. Xuefeng, “Treatment of halitosis with periodontal disease
by Integrated Traditional Chinese and Western Medicine,” Nei
Mongol Journal of Traditional Chinese Medicine,vol.,pp.-
, .
[] S. Shimei, “Clinical observation of Banxia Xiexin Decoction in
treating Helicobacter pylori related halitosis,” Inner Mongolia
Medical Journal,vol.,no.,pp.-,.
[] C. QM, “Clinical observation of Mongolian medicine combined
with western medicine in treating halitosis,” Inner Mongolia
Medical Journal,vol.,p.,.

Evidence-Based Complementary and Alternative Medicine 
[] Z. Lin, Clinical observation on treating Hp related halitosis with
integrated traditional Chinese and Western Medicine,Fujian
University of Traditional Chinese Medicine, .
[]Y.Junxiong,L.Zhaojiong,L.Fujian,andG.Hang,“Clinical
observation on treating gastric stones with integrated tradi-
tional Chinese and Western Medicine,” Modern Journal of Inte-
grated Traditional Chinese and Western Medicine,vol.,pp.–
, .
[] S. Wenbin, S. Hong, C. Jing et al., “Clinical study on treatment
of chronic gastritis with erosion, spleen stomach damp heat
syndrome by modied Lian Pu Yin,” in 25th national congress
of Integrated traditional Chinese and Western medicine digestive
system diseases, Nanchang, pp. -, .
[] R. H. Hunt and G. N. Tytgat, Helicobacter pylori,Springer
Netherlands, Dordrecht, .
[] A.Liberati,D.G.Altman,J.Tetzlaetal.,“ePRISMAstate-
ment for reporting systematic reviews and meta-analyses of
studies that evaluate healthcare interventions: explanation and
elaboration,” Epidemiology Biostatistics Public Health,vol.,no.
, pp. e–e, .
[] G. S. Higgins JPT, “CochraneHandbook for Systematic Revie ws
of Interventions version .. (updated March ),” e
Cochrane Collaboration, .
[] P. Lin, Clinical study on treating chronic hepatitis B with
spleen stomach damp heat syndrome and liver depression and
spleen defic iency syndrome by Integrated Traditional Chinese and
Western Medicine, Chengdu University of TCM, .
[] S. Rassameemasmaung, A. Sirikulsathean, C. Amornchat, K.
Hirunrat, P. Rojanapanthu, and W. Gritsanapan, “Eects of
herbal mouthwash containing the pericarp extract of Garcinia
mangostana L on halitosis, plaque and papillary bleeding
index.,” Journal of the International Academy of Periodontology,
vol. , no. , pp. –, .
[] M.-Y. Li, J. Wang, and Z.-T. Xu, “Eect of a variety of Chinese
herbs and an herb-containing dentifrice on volatile sulfur com-
pounds associated with halitosis: An in vitro analysis,” Current
erapeutic Research - Clinical and Experimental,vol.,no.,
pp. –, .
[] J.-B. Kim, J.-W. Shin, J.-Y. Kang et al., “A traditional herbal
formula, Hyangsa-Pyeongwi san (HPS), improves quality of life
(QoL) of the patient with functional dyspepsia (FD): Random-
ized double-blinded controlled trial,” Journal of Ethnopharma-
cology,vol.,no.,pp.–,.
[]F.Guan,W.Lam,R.Hu,Y.K.Kim,H.Han,andY.Cheng,
“Majority of Chinese Medicine Herb Category “Qing Re Yao”
Have Multiple Mechanisms of Anti-inammatory Activity,”
Scientific Reports,vol.,no.,.
[] E. J. Doh, M. Y. Lee, B. S. Ko, and S.-E. Oh, “Dierentiating
Coptis chinensisfromCoptis japonica and other Coptis species
used in Coptidis Rhizoma based on partial trnL-F intergenic
spacer sequences,” Genes & Genomics,vol.,no.,pp.–
, .
[] L. Zhu, B. Huang, X. Ban et al., “Coptis chinensis inorescence
extract protection against ultraviolet-B-induced phototoxicity,
and HPLC-MS analysis of its chemical composition,” Food and
Chemical Toxicology,vol.,no.,pp.–,.
[] J.Yang,Z.Liu,B.Liu,andQ.Zhu,“Determinationofcoptis
chinensis’ quality by FT-NIR spectroscopy,” Health,vol.,no.
, pp. –, .
[] M.Zhao,L.Gao,andX.M.Peng,“EectofCoptisChinensis
extract on proliferation of keratinocytes,” Chinese Journal of
Information on Traditional Chinese Medicine, .
[] J.S.Lu,Y.Q.Liu,M.Li,B.S.Li,andY.Xu,“[Protectiveeects
and its mechanisms of total alkaloids from rhizoma Coptis
chinensis on Helicobacter pylori LPS induced gastric lesion in
rats],” China Journal of Chinese Materia Medica,vol.,no.,
pp. –, .
[] J. Jung, J. S. Choi, and C.-S. Jeong, “Inhibitory activities of
palmatine from Coptis chinensis against Helicobactor pylori and
gastric damage,” Toxicological Research,vol.,no.,pp.–,
.
[] B. P. Burnett, Q. Jia, Y. Zhao, R. M. Levy, and S. Chen, “A medi-
cinal extract of Scutellaria baicalensis and Acacia catechu acts as
a dual inhibit or of cyclooxygena se and -lipoxygenase to reduce
inammation,” Journal of Medicinal Food,vol.,no.,pp.–
, .
[]Q.Wang,H.Kuang,Y.Suetal.,“Naturallyderivedanti-
inammatory compounds from Chinese medicinal plants,”
Journal of Ethnopharmacology,vol.,no.,pp.–,.
[] L. Zhou and B.-Y. Zhou, “[Inuence of baicalin on TNF-alpha
and soluble intercellular adhesion molecule- in rats infected
with Pneumocystis carinii].,” Zhongguo ji sheng chong xue yu
ji sheng chong bing za zhi = Chinese journal of parasitology &
parasitic diseases,vol.,no.,pp.–,.
[] K. H. Rhee, “Antimicrobial Eects of Lonicera japonica against
Gram Positive and Gram Negative Anaerobic Bacteria,” in cof
Korea, pp. –, Kongju National University, Yesan, .
[] J. Han, Q.-Y. Lv, S.-Y. Jin et al., “Comparison of anti-bacterial
activity of three types of di-O-caeoylquinic acids in Lonicera
japonica owers based on microcalorimetry,” Chinese Journal of
Natural Medicines,vol.,no.,pp.–,.
[] S. Erovic Ademovski, P. Lingstr ¨om,E.Winkel,A.Tangerman,
G. R. Persson, and S. Renvert, “Comparison of dierent treat-
ment modalities for oral halitosis,” Acta Odontologica Scandi-
navica,vol.,no.,pp.–,.