A herbal granule beat placebo 64.5% to 15.8% in a 152-person eczema trial

If you have moderate eczema, you have almost certainly been offered a herbal remedy by someone, and almost as certainly found no real trial data behind it. That is what makes this one worth reading: a genuine double-blind, placebo-controlled randomized trial in 152 adults, running 12 weeks, with stool and blood samples collected alongside the skin scores. The clinical result is large. The gut microbiome result is smaller and more ambiguous, and the honest version of this story keeps the two apart.

Key Takeaways

• 64.5% of adults on the herbal granule formula reached EASI-50 (a halving of eczema severity) at 12 weeks, versus 15.8% on placebo.
• Itch and quality-of-life scores improved significantly too, and side effects were mild and not significantly more common than placebo.
• Gut bacteria and blood metabolites shifted in the treatment group, but the overall community change was very small (R² = 0.016) and attempts to show the microbiome mediated the skin benefit failed.
• The trial was not prospectively registered, ran at a single Chinese hospital, and this formula is not an established treatment. Do not read it as a recommendation.

Qing-Re-Qu-Shi granules quadrupled EASI-50 response versus placebo

A fixed herbal granule formula produced a large, statistically robust improvement in eczema severity compared with placebo over 12 weeks. In the randomized placebo-controlled multi-omics trial published in Frontiers in Medicine, 49 of 76 adults taking the Qing-Re-Qu-Shi formula (64.5%) reached EASI-50, meaning at least a 50% reduction in the Eczema Area and Severity Index, compared with 12 of 76 (15.8%) on placebo, a risk ratio of 4.08 (95% CI 2.37 to 7.04, p < 0.001). The stricter EASI-75 threshold was met by 19.7% versus 2.6% (risk ratio 7.50, p = 0.001). Raw EASI scores fell by 9.1 points on the formula against 5.3 on placebo, an adjusted difference of 3.78 points (p < 0.001). Secondary measures moved the same way: SCORAD, another standard severity scale, showed an adjusted difference of 9.73 points, itch on a numerical rating scale improved by an adjusted 0.94 points, and the Dermatology Life Quality Index by 2.86 points, all at p < 0.001.

Adults with moderate atopic dermatitis rarely get placebo-controlled herbal data

If you have atopic dermatitis, this is the kind of study that has been missing from a field flooded with testimonials. Atopic dermatitis, the most common form of eczema, affects a large share of adults who cycle through topical steroids, emollients and, increasingly, expensive biologics, and many look for something in between. Chinese herbal formulas have been tested for eczema before, including a 1992 report of traditional Chinese herbal therapy in adult atopic dermatitis, but rigorous placebo-controlled trials with modern endpoints remain scarce. EASI is a validated instrument whose reliability in atopic dermatitis has been formally assessed, so the primary outcome here is a real measure rather than a bespoke one. What the trial cannot do is tell an eczema sufferer what product to buy: the formula's manufacturer is not named anywhere in the paper, and its exact herbal constituents sit in a supplementary table.

Double-blind randomization plus paired stool and serum sampling in 152 adults

The design is the strongest part of the study. A total of 152 adults aged 18 to 65 with moderate active disease, defined as an EASI between 7.1 and 21.0 and a SCORAD between 25 and 50, were randomized 1:1 to the formula or matched placebo, 76 per arm, at a single hospital affiliated with Shanghai University of Traditional Chinese Medicine, with both patients and investigators blinded. Granules were taken as 10 g sachets twice daily for 12 weeks, with emollient use and rescue topical therapy standardized across groups. Sixty-four participants completed in the treatment arm and 60 on placebo, and the primary analysis was intention-to-treat, meaning all 152 randomized participants were counted regardless of dropout. Stool was profiled by 16S rRNA gene sequencing (a method that identifies bacteria by a single marker gene, giving genus-level rather than strain-level detail) and blood by targeted mass spectrometry for short-chain fatty acids and tryptophan-pathway metabolites. Notably, the authors state that no financial support was received for the work, which is unusual in a space where trials are often run by the product's maker.

Blautia, butyrate and indoles shifted alongside the skin improvement, not because of it

The gut microbiome changed in the treatment group, but the change was modest and the study cannot show it drove the skin benefit. Diversity within each person barely moved: Shannon diversity showed no significant group effect (p = 0.742) or interaction with time (p = 0.086). The between-group difference in overall community composition was statistically detectable but tiny, with PERMANOVA (a test of whether whole microbial communities differ between groups) returning p = 0.001 but an R² of just 0.016, meaning the treatment explained under 2% of the variation between people's gut communities. Within that small shift, specific genera moved consistently: Blautia, Bifidobacterium, Lactobacillus and Agathobacter increased, while Escherichia/Shigella, Enterococcus, Prevotella and Collinsella decreased, all surviving false-discovery-rate correction. In blood, butyrate, propionate and acetate rose, as did three indole metabolites, while kynurenine and the kynurenine-to-tryptophan ratio fell. Among the 102 participants with complete paired data, indole-3-aldehyde (ρ = 0.60) and butyrate (ρ = 0.54) correlated most strongly with skin improvement. That direction is plausible given evidence that gut-derived short-chain fatty acids modulate skin barrier integrity, but plausibility is not proof, and the authors write that their data support "an associative link between clinical improvement and gut ecosystem remodeling rather than proving causality."

What eczema sufferers should and should not do with this result

Do not treat this as a treatment recommendation, because it is not one. The formula has no named manufacturer in the paper and one trial behind it, in one regional population with moderate disease; nothing here establishes it as safe or effective for mild eczema, severe eczema, children, or anyone on biologics or JAK inhibitors, all of whom were outside the study. What the result justifies is a conversation rather than a purchase. If you are managing moderate atopic dermatitis and are curious about herbal approaches, this is a reasonable paper to bring to a dermatologist, who can weigh it against the real risks of unregulated herbal products, including adulteration and liver toxicity. It is equally worth resisting the inverse error: the microbiome findings do not mean that taking Bifidobacterium or Lactobacillus probiotics, or a butyrate supplement, will reproduce the skin benefit. The trial tested a herbal formula, not those supplements, and could not show the bacterial changes were doing the work. On safety it was reassuring but limited: gastrointestinal side effects occurred in 15.8% of the formula group versus 7.9% on placebo, a non-significant difference (p = 0.209), and nobody withdrew because of an adverse event.

No prospective registration and unstable mediation leave the causal story open

The trial's most serious weakness is that it was not registered before it began. Prospective registration, required under ICMJE clinical trial registration policy, is what stops researchers from quietly changing their primary outcome after seeing the data; the authors state the trial was not prospectively registered and that the protocol is available on request. That does not make the result wrong, but it removes the main safeguard against selective reporting, and it is why this should be treated as a strong signal awaiting independent replication rather than as settled.

The mechanistic side is weaker still. The authors ran exploratory mediation analyses to test whether the microbiome changes explained the clinical benefit, and the indirect-effect confidence intervals crossed zero; they describe the results as unstable and interpret them only as diagnostic. They also acknowledge that 16S sequencing limits taxonomic resolution, that the metabolomics panel was targeted rather than untargeted, that omics data existed for only a subset of participants, that rescue topical therapy was standardized but not quantitatively tracked, and that diet was not measured at all despite being a dominant influence on both gut bacteria and blood metabolites. As they put it, the observed changes may be causal contributors, secondary consequences of less inflammation and less scratching, or simply parallel effects.

Common Questions

Does this mean a herbal formula can treat eczema? It means one 152-person trial found a large benefit over placebo across 12 weeks. That is meaningful evidence but not established treatment, particularly since the trial was not prospectively registered and has not been independently replicated.

Did the gut microbiome changes cause the skin to improve? No, and the authors say so explicitly. The overall community shift was small, the mediation analyses that would have tested causation were unstable, and the changes may equally be a downstream consequence of less inflammation.

Can I buy the Qing-Re-Qu-Shi formula, or get the same effect from probiotics? The paper names no manufacturer and no commercial product, and the exact herbal composition sits in a supplementary table, so products sold as equivalents are not the tested preparation. Nor is there evidence that probiotics or butyrate supplements reproduce the benefit: those were measured outcomes here, not interventions.

References

Yi Xiong, Peiyan Huang, Jihong Wang, et al. (2026). Qing-Re-Qu-Shi formula improves clinical outcomes and is accompanied by gut microbiota and microbial metabolite remodeling in adults with moderate atopic dermatitis: a randomized placebo-controlled multi-omics trial. Frontiers in Medicine. https://doi.org/10.3389/fmed.2026.1847003