Clinical efficacy and mechanistic insights of Xuebijing in hand, foot, and mouth disease: a meta-analysis with integrated pharmacological approaches

Background: Hand, foot, and mouth disease (HFMD) is a viral infection, primarily caused by gastrointestinal viruses. Xuebijing (XBJ) injection, widely used in China for treating inflammatory conditions like sepsis, may offer therapeutic benefits for HFMD. This study aimed to evaluate the efficacy and safety of adjunctive XBJ therapy for HFMD. Materials and methods: Databases were systematically searched until February 2024. Meta-analysis used random or fixed-effect models, with outcomes reported as standardized mean differences (SMD) or relative risks (RR) and 95% confidence intervals (CI). Heterogeneity was assessed via Cochran’s Q test and I 2 index. Network pharmacology, molecular docking, and molecular dynamics simulations identified active XBJ components and their targets in HFMD. Results: Six randomized controlled trials (RCTs) involving 786 participants were included. XBJ significantly improved the total effective rate (RR = 1.19, P < 0.01), shortened fever duration (SMD = − 1.78, P < 0.01), reduced rash resolution time (SMD = − 1.13, P < 0.01), and decreased hospital stay (SMD = − 1.20, P < 0.01). Pharmacological analysis identified four active XBJ components targeting IFN-γ, TLR4, and TNF-α in HFMD. Conclusions: XBJ as adjunctive therapy improves outcomes in HFMD and is safe, with specific molecular targets identified for its therapeutic effects.