A systematic review and meta-analysis of traditional Chinese medicine in Parkinsonism

Parkinsonism, commonly caused by idiopathic Parkinson's disease, is a progressive neurodegenerative syndrome presenting with bradykinesia, tremor, rigidity, and postural instability. Non-motor symptoms such as depression, sleep disturbance, dysphagia, and constipation significantly impair quality of life. Standard pharmacotherapy, including levodopa and dopaminergic drugs, provides symptomatic relief but fails to prevent progression and often leads to complications. Traditional Chinese Medicine (TCM), including acupuncture, Chinese herbal Medicine, Tai Chi, Qigong, and moxibustion, has been increasingly used as adjunctive therapy worldwide. To systematically evaluate the efficacy, safety, and underlying mechanisms of TCM in Parkinsonism. Following PRISMA 2020 guidelines, we searched PubMed, Embase, Cochrane CENTRAL, Web of Science, CNKI, Wanfang, VIP, and CBM (2010-2025). Eligible studies included RCTs, NRCTs, and cohort studies involving adults with idiopathic Parkinsonism. Primary outcome was motor function (UPDRS-III); secondary outcomes included depression (HAMD), sleep (PDSS), dysphagia (VFSS/SSA), constipation, quality of life (PDQ-39), and adverse events. Random-effects models were applied for the meta-analysis, and the risk of bias was assessed using RoB2/ROBINS-I, and NOS. Certainty was graded using GRADE. Twenty-two studies (n≈1,650) were included. Pooled estimates showed improvements in motor function (UPDRS-III MD -4.70, 95% CI: -6.10 to -3.30), depression (HAMD MD-3.90), sleep (PDSS +11.5), swallowing (VFSS MD +1.50), quality of life (PDQ-39 MD -7.2), and lower adverse events (RR 0.68). Subgroup analysis suggested acupuncture was most effective for motor and swallowing, Chinese herbal medicine for mood and sleep, and Tai Chi/Qigong for balance. TCM offers safe and effective adjunctive therapy for Parkinsonism, addressing motor and non-motor symptoms. High-quality, multicenter international trials are required to strengthen evidence.