Herbal Medicine for Metabolic Dysfunction-Associated Steatotic Liver Disease: Clinical Effectiveness and Research Trends - A Systematic Review and Meta-Analysis

Objective: This study systematically reviewed the effects of herbal medicine for metabolic dysfunction-associated steatotic liver disease (MASLD).Methods: Fifteen randomized controlled trials involving patients with MASLD or non-alcoholic fatty liver disease (NAFLD) accompanied by cardiometabolic risk factors (CMRFs), published between January 2015 and June 2025, were identified from 10 databases. Meta-analysis focused primarily on clinical biochemical markers.Results: Type 2 diabetes mellitus (T2DM) and body mass index were the only factors of CMRFs that appeared during the search. T2DM studies showed a predominance of phlegm-blood stasis patterns. Herbal interventions targeting phlegm-blood stasis patterns increased in addition to existing traditional dampness-heat therapies. Meta-analysis of the studies reporting phlegm-blood stasis patterns in T2DM demonstrated significant improvements in biochemical markers and total effective rate with herbal medicine in combination with standard care.Conclusion: With the transition from NAFLD to MASLD, the Traditional Korean Medicine pathogenesis has expanded to include phlegm-blood stasis, suggesting broader therapeutic potential. Future research should involve rigorous MASLD-based criteria to improve homogeneity and reduce bias.