Evidence for the medicinal value of Squama Manitis (pangolin scale): A systematic review

BackgroundSquama Manitis (pangolin scale) has been used in traditional Chinese medicine for thousands of years. However, its efficacy has not been systematically reviewed. This review aims to fill the gat.MethodsWe searched six electronic databases including PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure Database (CNKI), WanFang Database and SinoMed from inception to May 1, 2020. Search terms included “pangolin”, “Squama Manitis”, “Manis crassicaudata”, “Manis javanica”, “Malayan pangolins”, “Manis pentadactyla”, “Ling Li”, “Chuan Shan Jia”, “Shan Jia”, “Pao Jia Zhu”, “Jia Pian” and “Pao Shan Jia”. The Cochrane Risk of Bias (RoB) assessment tool and Newcastle-Ottawa Scale (NOS) were used to evaluate the risk of bias of the included randomized controlled trials (RCTs) and case control studies (CCSs).ResultsAfter screening, 15 articles that met the inclusion criteria were finally included. There were 4 randomized controlled trials, 1 case control study, 3 case series and 7 case reports. A total of 15 different diseases were reported in these studies, thus the data could not be merged and descriptive analysis was carried out. Included RCTs of this review have shown that Squama Manitis combined with herbal decoction was superior to herbal decoction alone in the treatment of postpartum hypogalactia (RR 1.21, 95% CI1.11 to 1.32, P<0.00001) and breast hyperplasia (RR 1.07, 95% CI 0.96 to 1.19, P=0.24), and the clinical efficacy of Squama Manitis combined with antibiotics was better than antibiotics alone for acute mastitis (RR 1.13, 95% CI 0.95 to 1.35, P=0.16) and mesenteric lymphadenitis (RR 1.51, 95% CI 1.09 to 2.09, P=0.01). The methodological quality was generally low in all included reports.ConclusionThere is no reliable evidence that Squama Manitis has special medicinal value. The removal of Squama Manitis from Pharmacopoeia is rational.