Can AP outcomes be improved by adding herbal formulas?

April 8, 2004

, " " <@e...>

wrote:

>

> Acupuncture + placebo capsules effectively improved seasonal

> allergic rhinitis in 81% of patients. Addition of capsules of a herbal

> formula to the AP treatment gave improvement in 73% of patients

> (not significantly better than acupuncture + placebo).

actually unless I am misreading, does this not say that acupuncture and

placebo was better than herbs and acu? I wonder if pattern discrimination

was done. There is no doubt in my mind that doing the wrong thing is worse

than doing nothing at all. Perhaps that is the issue here. for example, if the

rx was for lung depressive heat, but some patients had spleen/stomach

dampheat, then the rx might worsen the condition in theory.

>

> PS: I know that many will raise eyebrows at the need for 16

> sessions of AP [sessions twice/week for 8 weeks] in rhinitis!

Actually, that seems quite reasonable.

April 8, 2004

Hi All,

Below, see abstract [Effect of adding a Chinese herbal preparation

to acupuncture for seasonal allergic rhinitis: randomised

doubleblind controlled trial. Hong Kong Med J 2003;9:427-434].

Acupuncture + placebo capsules effectively improved seasonal

allergic rhinitis in 81% of patients. Addition of capsules of a herbal

formula to the AP treatment gave improvement in 73% of patients

(not significantly better than acupuncture + placebo).

The research team is examining the very sensitive issue of whether

or not addition of herbal formulae significantly improves the clinical

outcome of acupuncture Tx in many diseases.

I have emailed Dr CCL Xue (the main author) to invite the research

team to join the lists. IMO, their inputs would be very valuable to

our discussions on TCM.

Best regards,

Phil

PS: I know that many will raise eyebrows at the need for 16

sessions of AP [sessions twice/week for 8 weeks] in rhinitis!

However, this is a clinical research paper and we can discuss more

realistic Tx protocols with the authors if they join the discussion

Lists.

>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

Effect of adding a Chinese herbal preparation to acupuncture for

seasonal allergic rhinitis: randomised doubleblind controlled trial.

Hong Kong Med J 2003;9:427-434. CCL Xue, FCK Thien, JJS

Zhang, W Yang, C Da Costa, CG Li; RMIT University, Bundoora

West Campus, Bundoora, Victoria 3083, Australia: RMIT Chinese

Medicine Research Group (CCL Xue, PhD, CG Li, PhD); Chinese

Medicine Unit (JJS Zhang, PhD); Department of Mathematics and

Statistics (C Da Costa, PhD); Department of Allergy, Asthma and

Clinical Immunology, Monash University, Alfred Hospital,

Melbourne, Victoria 3004, Australia (FCK Thien, MD); School of

Engineering and Science, Swinburne University of Technology,

Howthorn, Victoria 3122, Australia (W Yang, MEng);

Correspondence to: Dr CCL Xue (e-mail: charlie.xue).

Objective. To assess whether the addition of a Chinese herbal

medicine formula to acupuncture affects the severity of symptoms

and quality-of-life scores among patients with seasonal allergic

rhinitis. Design. Randomised double-blind placebo-controlled trial.

Setting. University teaching and research clinic, Australia.

Participants. 65 patients with seasonal allergic rhinitis, who were

recruited through public media. Intervention. Between July and

December 1999, patients received acupuncture twice a week for 8

weeks plus either a Chinese herbal drug formula (n=33) or placebo

(n=32) at a dosage of four capsules, three times daily.

[Acupuncture: All patients: yintang (Z_03), LI20, and GB20. Other

points for different syndromes were BL13 + LU09 for lung qi

deficiency; BL20 + ST36 for spleen qi deficiency; BL23 + CV06 for

kidney qi deficiency syndrome. Herbal formula (% of each

ingredient): Danggui 3.81, Xixin 2.25, Huangqi 13.87, Baizhu 7.11,

Chaihu 3.81, Shengma 4.68, Dangshen 14.21, Gancao 9.36,

Chuanxiong 4.68, Xinyi 4.68, Bohe 3.81, Chenpi 2.25, Cheqianzi

4.68, Wuweizi 4.51, Jingjie 4.68, Fangfeng 4.68, Hezi 4.68,

Cangerzi 2.25]. Main outcome measures. The severity of nasal and

non-nasal symptoms on a five-point scale, as assessed by both

patients and an ear, nose, and throat specialist, and quality-of-life

scores as measured by the Rhinoconjunctivitis and Rhinitis Quality

of Life Questionnaire. Results. 61 patients completed the study (31

in the intervention group and 30 in the control group). After 8

weeks, no significant difference was found between the two groups

in the severity of nasal and non-nasal symptoms and in the

Rhinoconjunctivitis and Rhinitis Quality of Life Questionnaire

scores. Intention-to-treat analysis of categorical variables showed

moderate-to-marked improvement rates of 72.7% and 81.2% for

intervention and control groups, respectively. 6 patients reported

mild adverse events—3 from each of the study groups. Conclusion.

The Chinese herbal formulation under investigation did not provide

additional symptomatic relief or improvement in quality-of-life

scores among patients with seasonal allergic rhinitis who were

receiving acupuncture.

>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

Best regards,

Email: <

WORK : Teagasc Research Management, Sandymount Ave., Dublin 4, Ireland

Mobile: 353-; [in the Republic: 0]

HOME : 1 Esker Lawns, Lucan, Dublin, Ireland

Tel : 353-; [in the Republic: 0]

WWW : http://homepage.eircom.net/~progers/searchap.htm

April 11, 2004

Hi All, & Hi Marty & Ihor,

I wrote:

>> Acupuncture + placebo capsules effectively improved seasonal

allergic rhinitis in 81% of patients. Addition of capsules of a herbal

formula to the AP treatment gave improvement in 73% of patients

(not significantly better than acupuncture + placebo).

replied:

> unless I am misreading, does this not say that acupuncture and

> placebo was better than herbs and acu?

IMO, no.

In earlier work, the authors had already established that the AP

protocol gives effective control of allergic rhinitis. The purpose of the

recent paper was to see if addition of herbs could enhance the

acupuncture effect. It did not. Although the numerical difference

tended to favour the AP+Placebo group, the difference between the

two group was not significant.

> I wonder if pattern discrimination was done.

The paper suggests that the herb group all got the same herbal

formula. Only the AP points were changed according to pattern

discrimination. All patients got AP at yintang (Z_03), LI20, and

GB20. The only patterns listed were LU Qi Xu, SP Qi Xu and KI Qi

Xu. Points used for those were: BL13 + LU09, or BL20 + ST36, or

BL23 + CV06, respectively.

again:

> There is no doubt in my mind that doing the wrong thing is worse

> than doing nothing at all. Perhaps that is the issue here. For

> example, if the rx was for lung depressive heat, but some patients

> had spleen/stomach dampheat, then the rx might worsen the condition

> in theory.

I had written:

>> The research team is examining the very sensitive issue of whether

or not addition of herbal formulae significantly improves the

clinical outcome of acupuncture Tx in many diseases.

Marty replied:

> Why would they expect to get a better result when they are not

> using correct herbal treatment? A herbal formula is individualized

> depending on the diagnosis. Herbs are added or subtracted from

> standard herbal formulas. A prescription, in general, is only

> used for a short time, say a week. The patient is then examined

> and the formula modified.

Ihor replied:

> They should have initially tried Puerarea Nasal Combination, Major

> or Minor Blue Dragon combination for this with Ma-Huang. Although

> the herbs in these formulas contain sudorific (sweat promoting)

> herbs, they still work well in cats & dogs, who " sweat "

> differently. These herbs tend to bring the " condition " up to the

> surface through sweating, evaporation, and eruptions. Instead of

> sweating, the animals seem to discharge everything out of their

> nose and sinuses with sneezing....for a while....thus eliminating

> the " toxins " such as pollens, and pollutants from the respiratory

> system, and from the superficial blood vessels lining the

> respiratory system and skin. If the congestion is due to dietary

> imbalances, and " liver heat " .....these formulas won't work.

> Ma-Huang is excellent in small doses combined with other herbs.

> Too bad ignorance and inappropriate use of this herb for weight

> reducing formulas, stimulants, and to make crystal-Meth has put it

> on the dangerous herb list. Ihor Basko, DVM

Marty, Ihor & you may be correct. I would like to think that

all the time spent studying different patterns is really necessary.

But do any two herbalists come up with exactly the same formula

for a given set of symptoms?

Also, we must face the fact that, as practised in the East, AP and

herbalism often ignores pattern discrimination and uses " standard

precriptions " , based on the main symptoms. Western practitioners

seem to be more worried about pattern discrimination than many

CM and Kampo practitioners in the East.

>> PS: I know that many will raise eyebrows at the need for 16

sessions of AP [sessions twice/week for 8 weeks] in rhinitis!

> Actually, that seems quite reasonable. Todd

With respect, I must query that.

In circa 40 years of using AP, I cannot remember ever having to

treat a case 16 times in 8 weeks. I usually treat once/week and

expect results within 3-5 sessions. If the result is poor at that

stage, I usually refer the case to someone more expert than I, or

refer the case for different therapy (manipulation, herbs,

homeopathy, etc).

Best regards,

Email: <

WORK : Teagasc Research Management, Sandymount Ave., Dublin 4, Ireland

Mobile: 353-; [in the Republic: 0]

HOME : 1 Esker Lawns, Lucan, Dublin, Ireland

Tel : 353-; [in the Republic: 0]

WWW : http://homepage.eircom.net/~progers/searchap.htm

April 11, 2004

Hi All, & Hi Marty & Ihor,

I wrote:

>> Acupuncture + placebo capsules effectively improved seasonal

allergic rhinitis in 81% of patients. Addition of capsules of a herbal

formula to the AP treatment gave improvement in 73% of patients

(not significantly better than acupuncture + placebo).

replied:

> unless I am misreading, does this not say that acupuncture and

> placebo was better than herbs and acu?

IMO, no.

In earlier work, the authors had already established that the AP

protocol gives effective control of allergic rhinitis. The purpose of the

recent paper was to see if addition of herbs could enhance the

acupuncture effect. It did not. Although the numerical difference

tended to favour the AP+Placebo group, the difference between the

two group was not significant.

> I wonder if pattern discrimination was done.

The paper suggests that the herb group all got the same herbal

formula. Only the AP points were changed according to pattern

discrimination. All patients got AP at yintang (Z_03), LI20, and

GB20. The only patterns listed were LU Qi Xu, SP Qi Xu and KI Qi

Xu. Points used for those were: BL13 + LU09, or BL20 + ST36, or

BL23 + CV06, respectively.

again:

> There is no doubt in my mind that doing the wrong thing is worse

> than doing nothing at all. Perhaps that is the issue here. For

> example, if the rx was for lung depressive heat, but some patients

> had spleen/stomach dampheat, then the rx might worsen the condition

> in theory.

I had written:

>> The research team is examining the very sensitive issue of whether

or not addition of herbal formulae significantly improves the

clinical outcome of acupuncture Tx in many diseases.

Marty replied:

> Why would they expect to get a better result when they are not

> using correct herbal treatment? A herbal formula is individualized

> depending on the diagnosis. Herbs are added or subtracted from

> standard herbal formulas. A prescription, in general, is only

> used for a short time, say a week. The patient is then examined

> and the formula modified.

Ihor replied:

> They should have initially tried Puerarea Nasal Combination, Major

> or Minor Blue Dragon combination for this with Ma-Huang. Although

> the herbs in these formulas contain sudorific (sweat promoting)

> herbs, they still work well in cats & dogs, who " sweat "

> differently. These herbs tend to bring the " condition " up to the

> surface through sweating, evaporation, and eruptions. Instead of

> sweating, the animals seem to discharge everything out of their

> nose and sinuses with sneezing....for a while....thus eliminating

> the " toxins " such as pollens, and pollutants from the respiratory

> system, and from the superficial blood vessels lining the

> respiratory system and skin. If the congestion is due to dietary

> imbalances, and " liver heat " .....these formulas won't work.

> Ma-Huang is excellent in small doses combined with other herbs.

> Too bad ignorance and inappropriate use of this herb for weight

> reducing formulas, stimulants, and to make crystal-Meth has put it

> on the dangerous herb list. Ihor Basko, DVM

Marty, Ihor & you may be correct. I would like to think that

all the time spent studying different patterns is really necessary.

But do any two herbalists come up with exactly the same formula

for a given set of symptoms?

Also, we must face the fact that, as practised in the East, AP and

herbalism often ignores pattern discrimination and uses " standard

precriptions " , based on the main symptoms. Western practitioners

seem to be more worried about pattern discrimination than many

CM and Kampo practitioners in the East.

>> PS: I know that many will raise eyebrows at the need for 16

sessions of AP [sessions twice/week for 8 weeks] in rhinitis!

> Actually, that seems quite reasonable. Todd

With respect, I must query that.

In circa 40 years of using AP, I cannot remember ever having to

treat a case 16 times in 8 weeks. I usually treat once/week and

expect results within 3-5 sessions. If the result is poor at that

stage, I usually refer the case to someone more expert than I, or

refer the case for different therapy (manipulation, herbs,

homeopathy, etc).

Best regards,

Email: <

WORK : Teagasc Research Management, Sandymount Ave., Dublin 4, Ireland

Mobile: 353-; [in the Republic: 0]

HOME : 1 Esker Lawns, Lucan, Dublin, Ireland

Tel : 353-; [in the Republic: 0]

WWW : http://homepage.eircom.net/~progers/searchap.htm

April 12, 2004

Phil,

You are too mild in your response. Statistically there is a pretty big

difference in saying that an herbal formula is not significantly better than

acupuncture plus placebo as compared to saying that acupuncture plus placebo is

better than an herbal formula. I believe the personal to whom you are

responding would do well to have a lab science course under his belt ... or

perhaps resist the temptation to discuss scientific studies or statistics.

Respectfully,

Emmanuel Segmen

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