*3.3. Herbal Medicine*

3.3.1. Herbal Medicine vs. Active Control Treatment

The level of evidence and recommendations were derived based on seven RCTs [76–82] comparing herbal medicine and active control treatment for LHIVD in terms of pain, function, and overall symptom improvement.

The results of the meta-analysis showed that herbal medicine was more effective in improving the overall symptoms (RR: 1.19, 95% CI: 1.11–1.28, *p* < 0.001), pain (MD, −0.55, 95% CI: −0.70–−0.40, *p* < 0.001), and function (ODI: MD, −3.86, 95% CI: −4.71–−3.10, *p* < 0.001; JOA: MD, 1.46, 95% CI: 0.95–1.97, *p* < 0.001) than active control treatments, such as Western medicine and traction treatment.

Although the level of evidence was high in terms of overall symptom improvement, inconsistency and imprecision were observed in terms of pain and function improvement (VAS, I2 = 78%; ODI, I2 = 85%); therefore, the level of evidence was lowered by two grades.

In conclusion, herbal medicine should be considered to improve the overall symptoms of LHIVD (B/Moderate).
