Table 1_Evidence mapping of Zhenwu decoction for chronic heart failure.xlsx

All included clinical studies were conducted in China and were generally single-center, small-sample, and short-duration trials with limited follow-up. Commonly reported outcomes included left ventricular ejection fraction, New York Heart Association functional class, and natriuretic peptide levels. The most frequently reported traditional Chinese medicine syndrome patterns were heart-kidney yang deficiency and yang deficiency with water retention.

Important limitations included incomplete reporting of randomization, allocation concealment, blinding, protocol registration, follow-up, and adverse events. All included systematic reviews/meta-analyses were rated as critically low quality by AMSTAR-2.</p>Conclusion<p>Current evidence suggests potential adjunctive signals for ZWD in CHF, but the certainty of evidence remains low. Future studies should use prospectively registered, adequately powered, multicenter RCTs with standardized syndrome differentiation, longer follow-up, clinically meaningful endpoints, and rigorous safety monitoring.</p>