Complementary Therapies in Medicine, Engredea News & Analysis

Nov. 30, 2011 12:32am

A meta-analysis published in the journal Complementary Therapies in Medicine found that 60% of infertile women became pregnant after taking Chinese herbs for four months, while only 30% became pregnant after taking drugs or undergoing in vitro fertilization for a year.

“Efficacy of Traditional Chinese Herbal Medicine in the management of female infertility: A Systematic Review” published in Complementary Therapies in Medicine, Volume 19, Issue 6, December 2011. The study was conducted at Discipline of General Practice, School of Population Health & Clinical Practice, The University of Adelaide, South Australia 5005, Australia.

Objectives

To assess the effect of Traditional Chinese Herbal Medicine (CHM) in the management of female infertility and on pregnancy rates compared with Western Medical (WM) treatment.

Methods

We searched the Medline and Cochrane databases and Google Scholar until February 2010 for abstracts in English of studies investigating infertility, menstrual health and Traditional Chinese Medicine (TCM). We undertook meta-analyses of (non-)randomised controlled trials (RCTs) or cohort studies, and compared clinical pregnancy rates achieved with CHM versus WM drug treatment or in vitro fertilisation (IVF). In addition, we collated common TCM pattern diagnosis in infertility in relation to the quality of the menstrual cycle and associated symptoms.

Results

Eight RCTs, 13 cohort studies, 3 case series and 6 case studies involving 1851 women with infertility were included in the systematic review. Meta-analysis of RCTs suggested a 3.5 greater likelihood of achieving a pregnancy with CHM therapy over a 4-month period compared with WM drug therapy alone (odds ratio = 3.5, 95% CI: 2.3, 5.2, p < 0.0001, n = 1005). Mean (SD) pregnancy rates were 60 ± 12.5% for CHM compared with 32 ± 10% using WM drug therapy. Meta-analysis of selected cohort studies (n = 616 women) suggested a mean clinical pregnancy rate of 50% using CHM compared with IVF (30%) (p < 0.0001).

Conclusions

Our review suggests that management of female infertility with Chinese Herbal Medicine can improve pregnancy rates 2-fold within a 4 month period compared with Western Medical fertility drug therapy or IVF. Assessment of the quality of the menstrual cycle, integral to TCM diagnosis, appears to be fundamental to successful treatment of female infertility.

Abstract

OBJECTIVE:

To study the impact of De-qi (, obtaining qi) and psychological factors on the efficacy of acupuncture treatment for primary dysmenorrhea, with an attempt to explore the relationship among De-qi, psychological factors, and clinical efficacy.

METHODS:

The patients with primary dysmenorrhea were randomly assigned to a group of acupuncture with manual manipulation (manipulation group, n=67) and an acupuncture group without manipulation (non-manipulation group, n=64). Pain intensity and pain duration were used as measures for evaluating the therapeutic efficacy of the acupuncture treatment. De-qi, the sensations a patient experienced during the acupuncture treatment, was scored on a 4-point scale by the subjects. In addition, the psychological factors, including belief in acupuncture, the level of nervousness, anxiety, and depression, were quantitatively assessed. The personality of the subject was assessed using the Eysenck personality questionnaire (EPQ) and 16 personality factor questionnaire (16PF).

RESULTS:

Complete data were obtained from 120 patients, 60 patients in each group. There were statistically significant differences in pain intensity (W=2410.0, P<0.01) and pain duration (W=3181.0, P<0.01) between the two groups. The number of De-qi acupoints (W=1150.5, P<0.01) and the average intensity of De-qi (W=1141.0, P<0.01) were significantly higher in the manipulation group as compared with their non-manipulation counterparts. The correlation coefficients between De-qi and therapeutic efficacy of acupuncture were greater than those between psychological factors and therapeutic efficacy.

CONCLUSIONS:

Compared with the psychological factors, De-qi contributed more to the pain-relieving effect of acupuncture in subjects with primary dysmenorrhea. Moreover, manual manipulation is a prerequisite for eliciting and enhancing the De-qi sensations, and De-qi is critical for achieving therapeutic effects.

PMID: 21994026 [PubMed - as supplied by publisher]

Ernst et al. claimed “acupuncture is neither a safe procedure nor superior to placebo.”

One of the last review articles on acupuncture research from Professor Edzard Ernst, prior to the announcement of his retirement, was met with broad dissatisfaction from the acupuncture research community, with concerns raised that he had presented a biased picture of the state of the science. A summary of the published letters rebutting Professor Ernst’s conclusions is presented below. We urge acupuncture researchers and practitioners to read Professor Ernst’s article in Pain (as well as the full complement of letters to the editor published in a subsequent issue of the journal (Witt et al.; Manheimer and Berman; Karst; Baumler; Usichenko; Henke 2011). For the sake of brevity, we summarize the letters to the editors.

A letter by Witt and colleagues found the article “highly misleading” and criticized the authors’ choice of evidence from different levels within the evidence hierarchy for different parts of the paper. In particular, the writers of the letter criticize the use of case studies to determine the safety of acupuncture and cite several larger-scale studies that had different results.

A letter by Manheimer and colleagues criticized Ernst et al.’s methods of data analysis and evaluation as neither systematic, reproducible, nor transparent and found Ernst et al.’s evaluation criteria for assessing the quality and results of systematic reviews to be poorly defined. The writers of the letter also suggest that Ernst et al. succumbed to presentation bias, presenting data in the Discussion section which were not included in the review.

A letter by Matthias Karst notes that the paper misinterprets one of the cited cases, and suggests that the paper’s other conclusions should be suspect, and also warns of a possible “efficacy paradox” which can lead to false positives when testing complex interventions by means of randomized controlled trials.

A letter by Baumler and colleagues pointed out several inconsistencies and accuses the authors of failing to incorporate basic scientific methodology. Specifically, the writers of the letter find the paper’s aim vague, study eligibility criteria absent, and (like Witt et al.) the choice of case reports in the assessment of acupuncture risk questionable. Like Manheimer et al., the letter-writers found Ernst et al.’s methods of determining the quality and outcome of each review unclear. The letter-writers determine that the paper is “not … based on a careful and scientific analysis of the literature.”

A letter by Usichenko and colleagues, like Witt et al. and Baumler et al., criticized the authors’ use of case studies to determine the adverse effects of acupuncture.

A letter by Christian Henke points out the relatively high instance of drug-related adverse events compared to acupuncture-related adverse events and criticizes Ernst et al.’s choice to include the conclusions of various acupuncture experiments in their discussion, despite the fact that conclusions of papers do not reflect statistical outcomes. The letter-writers also note that some important studies were overlooked.

Finally, a letter by James Mooney criticizes the authors’ addressing of the broad spectrum of acupuncture as little more than a single treatment. The letter-writers note that if only the highest-quality reviews are examined, the results are no longer condemning of acupuncture. Mooney also dismisses the authors’ conclusion that acupuncture should be questioned since it reduces pain in “some conditions while failing to work in many others,” noting that the same can be said about acetaminophen.

The authors’ response ran in the same issue of PAIN: Ernst E. Response from Author. Letters to the Editor / PAIN 152 (2011) 2184–2186. As of Oct 13, it is noted this is withdrawn at authors’ request.

Ernst E, Lee MS, Choi TY. Acupuncture: does it alleviate pain and are there serious risks? A review of reviews. Pain. 2011 Apr;152(4):755-64.

Karst M. Comment on ''Acupuncture: does it alleviate pain and are there serious risks? A review of reviews" Ernst et al. [Pain 2011;152:755-764]. Pain. 2011 Sep;152(9):2181

Bäumler P, Irnich D. Pain. 2011 Sep;152(9):2181-2

Henke C. Pain. 2011 Sep;152(9):2183-4.

Manheimer E, Berman BM. Pain. 2011 Sep;152(9):2179-80

Medical acupuncture is acupuncture that has been adapted from traditional sources for use within conventional health practices. Traditional acupuncture practice originates within many of the whole system traditions in Asia such as Chinese medicine and even some evidence suggests historic European sources. Today acupuncture is practiced in both traditional, integrative and CAM related forms in almost every major health care system in the world.

Medical acupuncture is the classification of the acupuncture for use within the conventional medical construct. The foundation of medical acupuncture is the therapeutic insertion of solid needles in various combinations and patterns. The patterns can be based on traditional principles, modern anatomical concepts or both.

While Everspring Health is a full supporter of any therapy that is applied appropriately for the benefit of the individual and the individual's quality of life. It is equally important to note potential challenges of medical acupuncture so that the client can understand how to use this resource most effectively. Medical acupuncture can be used by licensed practitioners (MD, DO, DC) with as little as 100 hours of training, which can make it difficult to qualify the practitioner's full scope of training with this therapy. Compare this training to a fully licensed and nationally board certified acupuncturist where the practitioner has approximately 1000 hours just on acupuncture, plus clinic application experience.

Again this does not discount the opportunity for benefit via medical acupuncture but one must note that if one is not getting results from medical acupuncture or any source of acupuncture no matter the training one should not discount acupuncture therapy as a whole. Like any therapy, any service for that matter, experience does matter and we should seek the appropriate support for our specific needs.

CAM is a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine. Complementary medicine is used together with conventional medicine, and alternative medicine is used in place of conventional medicine. Integrative medicine combines conventional and CAM treatments for which there is evidence of safety and effectiveness.

Barnes PM, Bloom B, Nahin R. CDC National Health Statistics Report #12 - NCCAM/NIH

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Functional medicine focuses on prevention and understanding a person's core clinical imbalances that underlie various disease conditions. Functional medicine seeks prevention as the key component for the cultivation of health especially with regards to chronic disease. By targeting the underlying cause of disease versus focusing on just accommodating symptoms functional medicine seeks to improve outcomes by targeting one objective, the disease, to accomplish multiple benefits, reducing the symptoms. In the cases of chronic disease with the goal of understanding each individual's physiological, environmental, and psychosocial contexts becomes a necessary part of the diagnostic process.

While functional medicine is perspective of more recent terminology the historical systems of healing (e.g. Chinese Medicine, Ayurvedic medicine, Tibetan medicine, etc.) have utilized the holistic view as a means of approaching disease. All of the healing systems mentioned above seek to target the disease to reduce symptoms in concert with constitutional/personal diagnosis all of which Everspring Health embraces and offers as a part of our service offerings.

Integrative medicine is a healthcare resource that combines conventional, complementary and alternative (CAM) treatments for which there is evidence of safety and effectiveness.

In the clinic setting integrated medicine means that all effective medical resources are considered to address the chief complaint, identify the most accessible options to obtain the chief objective and to consider options for preventing concerns that may be predicted to arise in the future. The benefit of integrative medicine where the whole picture is considered we observe and note a more complete picture of one's life thus taking a diagnosis further and extending a healing program as far as possible towards the cultivation of quality of life.

Andrew Weil, M.D. - What is Integrative Medicine? from Andrew Weil, M.D. on Vimeo.