Abstract
To the Editor,
We sincerely thank the authors for their thoughtful and constructive comments on our systematic review and meta-analysis evaluating Fuzheng-Based Qi and Yin Therapy (FBQYT) combined with chemotherapy in advanced non-small cell lung cancer. 1 We appreciate their recognition of the scope of our work and their insightful discussion of the methodological challenges inherent in synthesizing evidence for complex herbal interventions.
We agree that the definition and classification of herbal medicine interventions represent a fundamental methodological issue in integrative oncology research. In our review, FBQYT was defined primarily according to the therapeutic intent and traditional diagnostic framework reported by the original trials—specifically, explicit reference to a “Fuzheng” strategy or the treatment of Qi and/or Yin deficiency patterns. This approach was intentionally chosen to align with how these interventions are conceptualized, prescribed, and evaluated within Traditional Asian Medicine (TAM) clinical practice, where treatment strategy is guided foremost by pattern differentiation rather than by fixed formula composition.
As the correspondents appropriately point out, reliance on author-reported intent may introduce an additional layer of interpretive heterogeneity, distinct from clinical or methodological heterogeneity. We acknowledge that identical or highly similar herbal formulas may be described under different therapeutic rationales, while conversely, interventions labeled as “Fuzheng” may vary considerably in composition. This limitation was implicit in our discussion of heterogeneity and reflects a broader challenge in evidence synthesis for individualized, principle-based medical systems.
At the same time, our frequency and network analyses revealed a convergence toward a core group of commonly used herbs across included studies, suggesting an underlying compositional coherence within the FBQYT framework. We agree with the authors that the partial disconnect between intent-based eligibility criteria and post hoc compositional analyses highlights an important opportunity for methodological refinement.
We strongly concur with the proposal for a dual-anchored classification framework in future systematic reviews—one that integrates both traditional therapeutic principles and standardized, ontology-driven coding of herbal formula composition. Such an approach would allow complementary analyses examining whether clinical effects are more closely associated with documented TAM pattern diagnoses, specific herbal components, or their interaction. This would substantially enhance reproducibility, interpretability, and translational relevance.
Furthermore, we echo the call for improved reporting standards in primary randomized controlled trials. Comprehensive reporting of both pattern diagnosis and complete formula composition with dosages, in accordance with the CONSORT extension for Chinese Herbal Medicine Formulas, is essential. Future studies incorporating objective biomarkers linked to Qi or Yin deficiency patterns may also help bridge traditional diagnostic constructs with modern pathophysiological mechanisms.
We appreciate the authors’ collegial engagement and believe that continued methodological dialogue of this kind will strengthen the evidence base for integrative oncology and facilitate the development of clearer, clinically actionable guidelines.
Footnotes
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.