Medscape Meta analysis Praises Chin Herbal Med for Dysmennorrhea, Diabetes, Gan Mao

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i'm sending a meta analysis from 08Apr medscape which praises chin herbal

med for tx for dysmennorhea, diabetes and ganmao. (scroll down, article

pasted below me signature and attached.

 

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In This Article Introduction

------------------------------

References <http://www.medscape.com/viewarticle/572509_References>

From Medscape Family Medicine <http://www.medscape.com/familymedicine>

Best Evidence

Review<http://www.medscape.com/px/viewindex/more?Bucket=columns & SectionId=3062>

Chinese Herbal Medications for Dysmenorrhea: A Best Evidence Review CME/CE

Posted 04/8/2008

*Charles P. Vega, MD *

Disclosures <http://www.medscape.com/viewprogram/9134_authors>

Introduction

Best Evidence Reference

 

Chinese Herbal Medicine for Primary Dysmenorrhea

 

Zhu X, Proctor M, Bensoussan A, Smith CA, Wu E

 

*Cochrane Database of Systemic Reviews.* 2007; Issue 4. Article No. CD005288

 

Abstract <http://www.medscape.com/medline/abstract/17943847>

 

The study that this review is based on was selected from Medscape Best

Evidence<http://www.medscape.com/pages/features/newsletters/bestevidence/fmpc>,

which uses the McMaster Online Rating of Evidence System. Out of a possible

top score of 7, this study was ranked as 7 for newsworthiness and 6 for

relevance by clinicians who used this system.

Summary

 

Primary dysmenorrhea is a common condition that can have a significant

impact on the lives of women. Although currently available treatments may be

effective for dysmenorrhea, many young women may not seek treatment and are

unaware of treatment options. Chinese herbal medications may be an

attractive treatment alternative for many women, but there are questions

regarding their efficacy. The current review highlights this issue as well

as challenges in applying medical practices across different cultures.

Commentary Background

 

Primary dysmenorrhea may occur in more than half of young women. A

population-based study in Canada found that 60% of respondents met

diagnostic criteria for primary dysmenorrhea.[1] More than half of these

women had moderate or severe pain, and 51% also reported that dysmenorrhea

symptoms limited their activities. Whereas increasing age and smoking

increased the risk for dysmenorrhea, age at menarche and nulliparity status

did not affect the risk for symptoms.

 

Another survey of young women in secondary school demonstrated an even

higher rate of primary dysmenorrhea, with a prevalence of 80%.[2] More than

one third of subjects reported that dysmenorrhea interfered with their

school activities, but only 18% had seen a physician for their symptoms.

Women in this trial were generally naive regarding the treatment of

dysmenorrhea. Medications had been used by 58% of the subjects to treat

their symptoms, but most of these women had used only simple analgesics.

These medications were considered effective in only 53% to 59% of those

using them.

 

Given the lack of knowledge and perceived inefficacy of commonly used

medications for dysmenorrhea, many patients may consider the use of

complementary treatment for their symptoms. This reflects a larger

healthcare trend in Western countries. A survey of medication use in

American households between 1998 and 2004 demonstrated that the rate of use

of natural and herbal supplements was 9.5%, 12%, and 19% among African

Americans, Hispanics, and non-Hispanic white respondents.[3] Hispanics used

the widest variety of different products.

 

Another recent study examined factors associated with the use of herbal

therapy in the United States.[4] These factors included:

 

- Age between 45 and 64 years old;

- Female gender;

- Having a higher education level;

- Being uninsured; and

- Living in the Western United States.

 

Of subjects who used herbal medications, 72% were also receiving

prescription medications. The most popular herbal medications were

echinacea, ginseng, and ginkgo.

Current Review

 

The current systematic review generally supports the use of Chinese herbal

medicine for the treatment of primary dysmenorrhea, but it also highlights

some of the difficulties in applying Western standards of evidence-based

medicine to treatments used for thousands of years in the Far East. The

review considered only trials of treatment of primary dysmenorrhea, and of

interest, focused on trials in which women had previously received

nonsteroidal anti-inflammatory medications (NSAIDs) or hormones for

dysmenorrhea. The main study outcome was the reduction in pain associated

with treatment; others included additional analgesia and quality of life.

 

Thirty-nine trials of Chinese herbal medication for dysmenorrhea were fully

reviewed, but many of these trials had methodologic problems. In particular,

18 trials were not randomized, and 4 other trials failed to mention

randomization.

 

Most research was conducted in mainland China, and the use of traditional

Chinese medicine significantly affected the way the research was conducted.

Chinese medicine emphasizes a different approach to patient symptoms and

diagnosis compared with Western medicine, with a greater emphasis on

clusters of symptoms across different organ systems. The clusters of

symptoms in most of the studies examining the treatment of dysmenorrhea were

consistent with the Western definitions of dysmenorrhea, but 19 studies used

variations in the herbal treatment protocol based on individual

participant's diagnostic patterns.

 

Only 3 studies compared Chinese herbal medications with placebo; most of the

other trials compared herbal treatments with:

 

- NSAIDs;

- Hormonal therapy; or

- Other Chinese herbal treatments.

 

The size of all included studies was small, with only 1 trial involving more

than 100 patients. Most participants in the trials received multiple herbal

treatments, although the dosage ranges of these many different therapies (19

main herbs were investigated) generally conformed to standard Chinese

practice.

 

*Results of The Cochrane Review.* Regardless of these study limitations,

Chinese herbal medications were generally effective against dysmenorrhea.

Herbal medications were approximately twice as likely to improve pain

compared with conventional therapy. In particular, Meiguihua (*Rosa rugosa

Thunb*) was demonstrated to reduce dysmenorrhea-associated symptoms (pain,

stress, and anxiety) over a 6-month time course:

 

Chinese herbal medications can also be rapidly effective against

dysmenorrhea; one trial demonstrated an analgesic effect within 30 minutes.

There was evidence as well that Chinese herbal medications may reduce

patients' use of other analgesic medications for dysmenorrhea.

 

Chinese herbal medications were superior to over-the-counter health

supplements in improving dysmenorrhea. A tailored herbal regimen was more

than twice as likely to improve dysmenorrhea as a routine herbal preparation

available without a prescription. However, the lack of standardization of

herbal preparations and t that there was little confirmatory research to

establish the efficacy of a specific herbal remedy precluded any

recommendation for a particular treatment regimen. Chinese herbal medication

was also found to be superior to acupuncture for dysmenorrhea in 2 trials.

 

Adverse events associated with study therapy were reported in only 8 of the

39 trials. There were no significant events found with either Chinese herbal

medications or the comparator agents.

 

How to apply the results of this meta-analysis in Western medical practice

is a difficult dilemma. First, the methodologic limitations of these studies

must be considered. More practically speaking, it seems clear that some

experience with Chinese herbal medications would be necessary before

effectively prescribing these treatments for dysmenorrhea. Although the

herbal formulas may be generally effective, they involve multiple agents in

each treatment regimen, and this regimen appears to be most effective when

it is individualized to each patient's symptoms.

Context -- Other Research of Chinese Herbal Medication

 

Given the barriers of translating research about Chinese herbal medications

into Western medical practice, healthcare providers would be well-advised to

focus on objective, evidence-based reviews by individuals with some

expertise in the field of Chinese medicine. The *Cochrane Database of

Systematic Reviews* has previously examined the potential role of Chinese

herbal medications for the treatment of type 2 diabetes.[5] This review

examined 66 different trials involving 8302 participants. Similar to the

current review regarding dysmenorrhea, there was significant heterogeneity

between studies in almost every aspect, and the methodologic quality of

studies was generally low. The studies included 69 different treatments, and

the majority of studies compared herbal medications with established

medications for diabetes, usually sulfonylureas.

 

At least 6 different herbal preparations were demonstrated to have

hypoglycemic effects, and 15 herbal preparations were synergistic with

traditional diabetes medications in improving glycemic control. Ginseng,

which is one of the most popular supplements in the United States, was not

effective in improving glucose control. Despite these generally positive

results, the review recommended further study of any of the Chinese herbal

medications prior to their routine use in treating type 2 diabetes.

 

*Chinese Herbs and the Common Cold.* Healthcare providers have multiple

options to effectively treat dysmenorrhea and type 2 diabetes, but there are

no truly effective treatment options for the common cold. Another systematic

review examined the efficacy of Chinese herbal medications for this familiar

malady.[6] Researchers focused on 14 studies involving 2440 participants.

This research was limited because herbal medications were compared with

drugs that were considered to be effective for viral upper respiratory

infections rather than with placebo, which would have been a more effective

means to study this issue. Another overall limitation of these studies was

the poor quality of randomization in the clinical trials.

 

Nonetheless, this review also provides some positive results for Chinese

herbal medications. Five studies demonstrated superior efficacy of herbal

preparations over active control medications in promoting recovery from the

common cold, and another 8 studies demonstrated equivalence of the herbal

medication and active control in this outcome.

Conclusion

 

Traditional Chinese medicine has proven itself through the test of time, and

it has much to offer patients around the world. However, the previous

studies of the efficacy of Chinese herbal medications as well as the current

review of herbal preparations for dysmenorrhea highlight the difficulty of

translating medical treatment across cultures. The currently available

research is not only limited regarding methodology in determining the

efficacy of Chinese herbal medications, but also of importance, many of

these studies do not adequately address concerns regarding tolerability and

safety.

 

More high-quality research focused on Chinese herbal medications is

forthcoming, but until that time, it appears that the most prudent approach

for the incorporation of these medications in clinical practice is to

partner with a practitioner who has significant experience in their use. The

wealth of experience and knowledge accumulated over time is the strength of

traditional Chinese medicine, and healthcare providers should build

relationships and treatment teams with experienced providers to provide the

most complete and effective care for a variety of patient conditions.

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Medscape Family Medicine. 2008; ():. ©2008 Medscape

 

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