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Letters to the Editor Issue 59

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listed in letters to the editor, originally published in issue 59 - December 2000

Thank you

This is to thank Positive Health for the wonderful weekend spent at the Fisher King Centre at Glastonbury.
The food was wonderful and the treatments were refreshing and balancing.
Many thanks

Elaine Saladino
Shiatsu/Reiki Practitioner
Winner therapeutic weekend Issue 53

Chinese Herbal Medicine

by Trina Ward

Rarely is reference made to published research from China. Are we ignoring a valuable source of information without good reason?

The simple most obvious reason why Western reviewers of research do not quote from Chinese research is that they do not read Chinese, and very little is translated. Often this research is criticized without ever being seen. The second important point is that currently such journals are not referenced systematically into a database – no equivalent of Medline is held in China.

In China, Chinese Herbal Medicine (CHM) is a mainstream therapy and receives resources accordingly. Research is commissioned from official sources, either at national or regional level. This contrasts with the poor state of funding of research into herbal medicine in the UK.

European research into CHM herbs focuses on isolating the active principle, then synthesizing it. The latest report of such research is from Phytopharm UK, who have synthesised P58, a drug derived from CHM for Alzheimer's.[l] The practice of CHM is entirely lost in this process.

David Phillipson of the School of Pharmacy, London University, presented his attempts at finding the active principle from a CHM prescription used in eczema trials.[2] He found that none of the ingredients worked on its own.[3] This supports the fundamental principle underlying herbal medicine that the whole is greater than the sum of the parts.

In China this principle is accepted, and therefore research into the complex world of clinical practice is more common. However such environments are difficult to test using the randomized controlled double blind trial design favoured in the west, and many can be justly criticized as being unscientific. It is not uncommon to find for example an outcome category of 'better'. It has been stated that the Chinese believe that using placebo controls is unethical as it deprives some people of treatment.[4] Also those running such research may be practitioners with little training in research methodology, motivated by career development rather than true investigation.[5]

I work as an acupuncturist within the NHS in both GP and hospital outpatient settings, yet neither permit the use of Chinese herbs due to the lack of safety data on CHM. Yet in China, Chinese herbal medicine is considered more appropriate than acupuncture for approximately 70% of patients.

In response to safety worries, the Register of Chinese Herbal Medicine (RCHM) initiated an MPhil research degree to look at the safety aspects of Chinese herbal medicine and a yellow card adverse event reporting system has been put in place. Quality control testing for steroids and heavy metals of suspected products is accessible both to the public and herbalists through the RCHM in conjunction with King's College and the National Poisons Unit.

Potential herb-drug interactions, such as has been seen with Warfarin and Dang Gui[6] are a further source of concern for orthodox practitioners. However the RCHM provides an ongoing alerting service to its members of any such safety worries found in the medical literature. It is in the hands of untrained prescribers that the real dangers lie, as found in an Australian study, where incidence of adverse effects was (inversely) related to the length of training.[7]

Research from China, even when viewed simply as clinical observation, should alert us to the potential of Chinese medicine and prompt further investigation. It is important to bear in mind that lack of evidence of effectiveness is very different from lack of effectiveness. A valuable resource in health care provision may be being ignored.

References:
1. Reuters Health News. September 11 2000.
2. Sheehan MP, Brostoff J, Ostlere OS, Rustin MHA, Atherton DJ, Buckley C, Harris DJ, Dawson A. Efficacy of traditional Chinese herbal therapy in adult atopic dermatitis. The Lancet 340:13-17. 1992.
3. David Phillipson speaker at Royal Pharmaceutical Society Pharmaceutical Sciences Group and School of Health, Biological and Environmental Sciences, Middlesex University Symposium on Traditional Chinese Medicine, October 25-26 1999.
4. Ted J Kaptchuk. Chinese Medicine The Web that has no Weaver. Mackays of Chatham, p28. 1994.
5. Personal experience at Shu Guang Hospital, Shanghai 1992.
6. BMJ 319:623-626. Sep 4 1999.
7. Bensoussan A. Myers SP. Towards a safer choice the practice of Chinese medicine in Australia, Sydney: Faculty of Health, University of Western Sydney. Macarthur 1996.

About the Author

Trina Ward studied Anthropology at UCL, Traditional Chinese Medicine at Sydney College of Traditional Chinese Medicine, Chinese language in Taiwan and spent three months on an internship in China. She is a council member for the Register of Chinese Herbal Medicine and its Research, Safety and Audit group convenor. Trina is currently researching the safety aspects of Chinese herbal medicine at Exeter University as an MPhil student.

Further Information

The Register of Chinese Herbal Medicine. 11-15 Betterton Street, London WC2 9BP. Tel: 07000 790 332.

* This article by Trina Ward was originally published in The CompMed Supplement, Volume 2, Issue 5 of The CompMed Bulletin. The Bulletin summarizes the scientific evidence for and against the use of complementary therapies for specific medical conditions. Available on subscription. Email comp.med@virgin.net or telephone 01789 400295 for more details.

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