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| Chinese Herbs: How Substantial Is the Evidence?
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Background: Two traditional extractions of Chinese
herbs, elemene and shengmai, have been used in China to treat lung cancer
and heart failure, respectively. Recent Cochrane reviews address their
efficacy.
Elemene for Lung Cancer (Rui et al.)
Design and Participants: In this Cochrane Review, the authors searched the
Cochrane Central Register of Controlled Trials, MEDLINE (1966-June 2006),
EMBASE (1974-2006), OVID (1950-2006), CBMdisc on Chinese Biomedical
Literature (Issue 1, 2004, Chinese Language), and CNKI (Chinese Knowledge
Internet; 1994-2006). Eligible studies were randomized controlled trials (RCTs)
that compared elemene with chemotherapy agents, radiotherapy, surgery,
physical therapy, or other effective Chinese herb therapy, either alone or
in combination. Two investigators telephoned the original trial authors of
potentially eligible RCTs to determine inclusion and exclusion in the
review.
Results: Twenty trials presented as RCTs claimed to use random
allocation;16 study authors were contacted by telephone. All contacted study
authors misunderstood the randomization procedure, hence these 16 trials
were identified as non-RCTs. Four remaining study authors could not be
contacted; these 4 trials were designated as ”studies awaiting assessment.”
Shengmai for Heart Failure (Chen et al.)
Design and Participants:ommentary: In this Cochrane Review, the authors
searched the Cochrane Central Register of Controlled Trials (CENTRAL) of The
Cochrane Library (Issue 2, 2005), MEDLINE (1966-2005), EMBASE (1984-2004),
AMED (1985-2005), Chinese BioMedical Literature Database (1978-2004), DARE
(Issue 2, 2005), and BIOSIS (1997-2004); in addition, 17 Chinese journals
were hand searched. Eligible studies were randomized or quasirandomized
controlled trials, either blinded or unblinded, of shengmai plus usual
treatment vs. usual treatment alone for heart failure. Two reviewers
independently selected trials, assessed methodological quality, and
extracted data. Dichotomous data were calculated as relative risk (RR);
continuous data were calculated as weighted mean differences (WMD).
Metaanalysis was performed using a fixed-effect model.
Results: Nineteen trials were included, but their overall
methodological quality was low. Compared to usual treatment alone, shengmai
plus usual treatment showed significant improvement in New York Heart
Association classification of clinical status (RR, 0.32; 95% CI, 0.25-0.40),
mortality (RR, 0.25; 95% CI, 0.07-0.86), and tumor necrosis factor-alpha (WMD,
0.52; 95% CI, -0.99 to -0.05). Improvements were also seen in hemodynamic
tests (1 trial, 100 participants). No adverse affects occurred in any of the
included trials.
Commentary: These reviews show the limited amount of research in the
classic double-blind placebo-controlled approach for these two herbs. It was
clear from the reviews that concentrations and purity of ingredients, the
locations where the herbs were grown, poor randomization, and other aspects
that could effect a study’s outcome were not taken into account. This does
not mean, however, that no benefit exists or that some component of the herb
might not be tremendously effective. One major problem with studying Chinese
herbal medicine is the contrast in medical philosophies. Chinese herbal
medicine has a very long and successful history. However, how do we apply
herbs or other alternative treatments that are based on contrasting medical
philosophies to a western paradigm? An answer to this question is
forthcoming. We should never be so arrogant to assume we have the final say
in medical truth. However, we also must have some basis from which to treat
our patients. Since we are steeped in a western paradigm, we have no choice
but to approach these reviews from that paradigm.
Bottom Line: At this point, elemene and shengmai cannot be
recommended for use because the limited and poor data currently available.
Reviewer: John F. Peppin, DO FACP, The Pain Treatment Center of the
Bluegrass, Lexington, KY
Sources: Rui D, Xiaoyan C, Taixiang W, Guanjian L. Elemene for the treatment
of lung cancer. Cochrane Database System Review. 2007;17(4):CD006054.To
access the abstract of this article, link to NLM–PubMed here.
Chen J, Wu G, Li S, et al. Shengmai (a traditional Chinese herbal medicine)
for heart failure. Cochrane Database System Review. 2007;17(4):CD005052. To
access the abstract of this article, link to NLM–PubMed here . |
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