Wednesday, November 20, 2019 22:49

Traditional Chinese Medicine for Gynaecological Diseases

Posted by on Thursday, December 2, 2010, 5:53
This news item was posted in G, Gynaecological category and has 0 Comments so far.

Introduction

Traditional Chinese medicine (TCM) is a well defined healthcare profession with its practice of acupuncture and herbal medicine guided by a coherent and an evolving body of knowledge underpinned by its unique philosophy, holism and ongoing scientific endeavour [1]. The development of TCM in countries other than China has been started over one and a half century. For example in Australia, the most rapidly period of development was over the last three decades, and the culmination of the introduction of the national statutory regulation of Chinese Medicine in the Australia from July 2012. Under the principle of Evidence Based Medicine (EBM), all therapies, Traditional or Orthodox, will need to be evaluated by employing the same method to determine if there are any therapeutic benefits to patients.

Gynaecological Diseases
Gynaecological Diseases

Basic knowledge of Chinese medicine includes the philosophy, medical theories, the diagnostic system, therapeutic studies including acupuncture or medicinal substances, and clinical studies. Chinese medical theory includes traditional physiological concepts, the maintenance of health, the processes in the development of disease, and approaches to therapy. Body and mind are viewed as part of a broader ecological system which includes both environmental and socio-emotional factors. The diagnostic system in Chinese medicine involves the identification of the disease state and the underlying symptom pattern ( zheng). This is often referred to as a dual diagnostic system ( bian zheng lun zhi). Accurate diagnosis of both the disease and the symptom pattern type is essential for setting treatment priorities and determining the treatment. Therapeutic studies may include acupuncture, herbal medicine and traditional herbal formulae, massage ( tui na) and manipulative therapies, exercise ( qi gong), dietary intervention, moxa and cupping therapies etc. Clinical studies in specialist areas include internal medicine, external medicine (including dermatology), obstetrics and gynaecology, paediatrics, traumatology and orthopaedics, eye, ear, nose and throat disorders, and others.

There has been ongoing debate within the profession about the appropriateness of using Chinese Medicine in several gynaeoclogical conditions. In general, the trend is towards the integrative use of both Western and Chinese Medicine. A significant number of diseases the treatment options have been influenced by Western medical investigations and diagnosis as well as the results of experimental and clinical studies employing modern research methods. In this article, we shall take several common gynaecological conditions for discussion on the current evidence of using Chinese medicine in those areas.

TCM and Polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is a heterogeneous syndrome characterised by excess androgen secretion manifested by hirsutism, ovarian dysfunction with or without polycystic ovaries. Stein and Leventhal first described it in 1935. Until the late 1950s and early 1960, there has been a controversy on the adrenal or ovarian origin of increased androgen. The knowledge that ovarian oestrogen synthesis pathway includes the production of an androgen (androstenedione) lead to the belief that PCOS is an ovarian disorder [2].

There are two important points on defining PCOS, the first is the aetiology of this syndrome is still largely unknown. Thus, the diagnosis is one of exclusion from other causes of excess androgen secretion like adrenal or ovarian androgen-secreting tumors [3]. PCOS is also associated with insulin resistance, therefore, syndrome like Type C insulin resistance syndrome need exclusion. Further, disorders that may result in ovulatory dysfunction like hypercalcitonaemia and thyroid disorders need to be excluded [4]. The second point is that the disorder is a syndrome (a collection of symptoms and signs) with no single diagnostic test, but rather a heterogeneous disorder characterised by excess androgen, ovulatory dysfunction and polycystic ovaries [5]. Current western medical diagnostic criteria for PCOS include the The 1990 National Health Institute (NIH) Criteria [6], The 2003 Rotterdam Criteria [7], and The 2006 Androgen Excess Society (AES) criteria [8].

Chinese Herbal medicine in women with PCOS

Our searching in the Chinese databases identified 125 clinical trials of using Chinese herbal medicine (CHM) either alone (54 studies) or in combination with conventional drugs (71 studies) for treatment of PCOS (unpublished data). All the trials were conducted and published in Chinese and majority of the studies were randomized clinical trials. The formulation of herbal medicine was mainly based on symptom differentiations, and herbal compounds (mixture of herbs) were typically used. Critical appraisals of 15 trials show the improvement of the methodological quality in terms of randomization, blinding and intention-to-treat during the recent years. Majority of the identified trials reported promising effects for PCOS patients. Potential mechanism of herbal medicine in PCOS may be related to regulation of hormones such as LH, FSH, oestrogen 2 and testosterone [9-11]. However, publication bias could not be excluded, and further analyses of data will provide evidence from these studies in future systematic reviews.

Acupuncture in women with PCOS

Stener-Victorin et al [12] summarized the experimental and clinical evidence suggesting that acupuncture exert long-lasting beneficial effects on metabolic and endocrine systems and ovulation in women with PCOS. The mechanism may relate to the stimulation of needle insertion into the skin and muscle inducing release of ergoreceptors and initiated afferent nerves activity and an increased β-endorphin production or release. Acupuncture may improve the success rate of in vitro infertility induced by PCOS (also see below), and possible mechanisms include neuroendocrinological regulation, increased blood flow to the uterus and ovaries, modulating cytokines, and reducing stress, anxiety and depression [13]. More research and evidence based clinical studies are required before the widespread use of acupuncture in the management of PCOS.

Acupuncture in women with infertility

Manheimer and his colleagues performed a systematic review and meta-analysis of randomised trials to evaluate whether acupuncture improves rates of pregnancy and live birth when used as an adjuvant treatment to embryo transfer in women undergoing in vitro fertilization [14]. The findings from seven trials showed that acupuncture given with embryo transfer improves rates of pregnancy and live birth among women undergoing in vitro fertilization [14]. The mechanism may be related to the effect of acupuncture on increased β-endorphin levels, and the lower levels of β-endorphin were associated with stress evidenced by high levels of sympathetic markers (corticotrophin-releasing factor and endothelin-1) [15,16]. It is suggested that increased β-endorphin level induced by acupuncture affects the HPA axis through promoting the release of ACTH by stimulation of its precursor pro-opiomelanocortin synthesis [17]. Other studies suggested that acupuncture may reduce stress and anxiety thus, decreases the HPA axis activity with subsequent increase in ovarian sympathetic tone to improve reproductive functions [15].

However, there is inconsistent evidence from a systematic review and meta-analysis of acupuncture for in vitro fertilization. EI-Toukhy and colleagues did not confirm that adjuvant acupuncture improves in vitro fertilization through reviewing 13 trials [18], while Manheimer’s study [14] showed the positive findings from acupuncture. As stated by Sterner-Victorin [19], ” Acupuncture may or may not have specific effects and a place within IVF/ET treatment, but there are compelling reasons for the scientific community to elucidate the issue further.”

Chinese herbal medicine for endometriosis

Endometriosis is a condition with the presence of tissue that is morphologically and biologically similar to normal endometrium in locations outside the uterus. The conventional medicine uses surgical and hormonal treatment, but with unpleasant side effects and high rates of relapse. Flower and Liu et al conducted a Cochrane systematic review on CHM for the treatment of endometriosis [20]. The review applied strict inclusion criteria to only include randomized trials with confirmed randomization procedures and laparoscopic diagnosis of endometriosis. The findings from two trials showed that post-surgical administration of herbal medicine may have comparable benefits to gestrinone but with fewer side effects, oral herbal medicine may have a better overall treatment effect than danazol, and it may be more effective in relieving dysmenorrheal and shrinking adnexal masses when used in conjunction with an herbal enema. However, the authors suggested that more rigorous research is required to assess the potential role of CHM in treating endometriosis.

Chinese herbal medicine and acupuncture for primary dysmenorrhoea

Conventional medicine for treatment of primary dysmenorrhoea has an unsuccessful rate of 20% to 25% and may be contraindicated or not tolerated by some women. CHM has been used for long time and a Cochrane review with 39 randomized trials involving 3475 women has been evaluated [21]. The data analyses showed that CHM relieve pain, improve overall symptoms, and use of additional medication when compared to the use of pharmaceutical drugs. CHM also resulted in better pain relief than acupuncture from two trials. The review found promising evidence supporting the use of CHM for primary dysmenorrhoea. However, authors also mentioned the limitations of poor methodological quality of the trials and small sample size.

Another Cochrane review identified nine randomized trials testing high frequency transcutaneous electrical nerve stimulation (TENS) or acupuncture for primary dysmenorrhoea [22] and the review found that high frequency TENS was more effective for pain relief than placebo, while low frequency TENS was not different from the placebo. One small trial with sound methodology showed acupuncture to be significantly more effective for pain relief than placebo or no treatment.

Chinese herbal medicine for uterine fibroids

Uterine fibroids are the most common non-malignant growths in women of childbearing age. The disease is associated with heavy menstrual bleeding and subfertility. CHM is used as alternatives to surgical procedures. Liu and Cardini et al published a Cochrane review with inclusion of two randomized trials of confirmed randomization and concluded with insufficient evidence to support or refute the use of herbal medicines for treatment of uterine fibroids due to limited number of trials and varied quality of the included trials [23].

Chinese herbal medicine for premenstrual syndrome

One Cochrane review with two randomized trials concluded with insufficient evidence to support the use of CHM in the treatment of premenstrual syndrome [24]. It suggests more well designed trials needed in this area.

Conclusion s

A significant portion of the general public chooses to use one or more forms of Chinese medicine (including herbal medicine and acupuncture) to manage gynecological diseases. Clinical evidence from systematic reviews and meta-analyses show promising benefits for some conditions, but inconsistent evidence for some other conditions. It is important for a consumer to consult a well trained practitioner and consumes herbal medicines according to instructions provided by the practitioner, given that the herbal products are properly manufactured or dispensed and contain herbs that are accurately identified, of good quality and free from contamination, the risks from using Chinese medicine could be reduced to the possible minimal level. However, when proper processes and controls are not in place, the risk of harm to the consumer is significant and unmanageable.

Introduction

Traditional Chinese medicine (TCM) is a well defined healthcare profession with its practice of acupuncture and herbal medicine guided by a coherent and an evolving body of knowledge underpinned by its unique philosophy, holism and ongoing scientific endeavour [1]. The development of TCM in countries other than China has been started over one and a half century. For example in Australia, the most rapidly period of development was over the last three decades, and the culmination of the introduction of the national statutory regulation of Chinese Medicine in the Australia from July 2012. Under the principle of Evidence Based Medicine (EBM), all therapies, Traditional or Orthodox, will need to be evaluated by employing the same method to determine if there are any therapeutic benefits to patients.

Basic knowledge of Chinese medicine includes the philosophy, medical theories, the diagnostic system, therapeutic studies including acupuncture or medicinal substances, and clinical studies. Chinese medical theory includes traditional physiological concepts, the maintenance of health, the processes in the development of disease, and approaches to therapy. Body and mind are viewed as part of a broader ecological system which includes both environmental and socio-emotional factors. The diagnostic system in Chinese medicine involves the identification of the disease state and the underlying symptom pattern ( zheng). This is often referred to as a dual diagnostic system ( bian zheng lun zhi). Accurate diagnosis of both the disease and the symptom pattern type is essential for setting treatment priorities and determining the treatment. Therapeutic studies may include acupuncture, herbal medicine and traditional herbal formulae, massage ( tui na) and manipulative therapies, exercise ( qi gong), dietary intervention, moxa and cupping therapies etc. Clinical studies in specialist areas include internal medicine, external medicine (including dermatology), obstetrics and gynaecology, paediatrics, traumatology and orthopaedics, eye, ear, nose and throat disorders, and others.

There has been ongoing debate within the profession about the appropriateness of using Chinese Medicine in several gynaeoclogical conditions. In general, the trend is towards the integrative use of both Western and Chinese Medicine. A significant number of diseases the treatment options have been influenced by Western medical investigations and diagnosis as well as the results of experimental and clinical studies employing modern research methods. In this article, we shall take several common gynaecological conditions for discussion on the current evidence of using Chinese medicine in those areas.

TCM and Polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is a heterogeneous syndrome characterised by excess androgen secretion manifested by hirsutism, ovarian dysfunction with or without polycystic ovaries. Stein and Leventhal first described it in 1935. Until the late 1950s and early 1960, there has been a controversy on the adrenal or ovarian origin of increased androgen. The knowledge that ovarian oestrogen synthesis pathway includes the production of an androgen (androstenedione) lead to the belief that PCOS is an ovarian disorder [2].

There are two important points on defining PCOS, the first is the aetiology of this syndrome is still largely unknown. Thus, the diagnosis is one of exclusion from other causes of excess androgen secretion like adrenal or ovarian androgen-secreting tumors [3]. PCOS is also associated with insulin resistance, therefore, syndrome like Type C insulin resistance syndrome need exclusion. Further, disorders that may result in ovulatory dysfunction like hypercalcitonaemia and thyroid disorders need to be excluded [4]. The second point is that the disorder is a syndrome (a collection of symptoms and signs) with no single diagnostic test, but rather a heterogeneous disorder characterised by excess androgen, ovulatory dysfunction and polycystic ovaries [5]. Current western medical diagnostic criteria for PCOS include the The 1990 National Health Institute (NIH) Criteria [6], The 2003 Rotterdam Criteria [7], and The 2006 Androgen Excess Society (AES) criteria [8].

Chinese Herbal medicine in women with PCOS

Our searching in the Chinese databases identified 125 clinical trials of using Chinese herbal medicine (CHM) either alone (54 studies) or in combination with conventional drugs (71 studies) for treatment of PCOS (unpublished data). All the trials were conducted and published in Chinese and majority of the studies were randomized clinical trials. The formulation of herbal medicine was mainly based on symptom differentiations, and herbal compounds (mixture of herbs) were typically used. Critical appraisals of 15 trials show the improvement of the methodological quality in terms of randomization, blinding and intention-to-treat during the recent years. Majority of the identified trials reported promising effects for PCOS patients. Potential mechanism of herbal medicine in PCOS may be related to regulation of hormones such as LH, FSH, oestrogen 2 and testosterone [9-11]. However, publication bias could not be excluded, and further analyses of data will provide evidence from these studies in future systematic reviews.

Acupuncture in women with PCOS

Stener-Victorin et al [12] summarized the experimental and clinical evidence suggesting that acupuncture exert long-lasting beneficial effects on metabolic and endocrine systems and ovulation in women with PCOS. The mechanism may relate to the stimulation of needle insertion into the skin and muscle inducing release of ergoreceptors and initiated afferent nerves activity and an increased β-endorphin production or release. Acupuncture may improve the success rate of in vitro infertility induced by PCOS (also see below), and possible mechanisms include neuroendocrinological regulation, increased blood flow to the uterus and ovaries, modulating cytokines, and reducing stress, anxiety and depression [13]. More research and evidence based clinical studies are required before the widespread use of acupuncture in the management of PCOS.

Acupuncture in women with infertility

Manheimer and his colleagues performed a systematic review and meta-analysis of randomised trials to evaluate whether acupuncture improves rates of pregnancy and live birth when used as an adjuvant treatment to embryo transfer in women undergoing in vitro fertilization [14]. The findings from seven trials showed that acupuncture given with embryo transfer improves rates of pregnancy and live birth among women undergoing in vitro fertilization [14]. The mechanism may be related to the effect of acupuncture on increased β-endorphin levels, and the lower levels of β-endorphin were associated with stress evidenced by high levels of sympathetic markers (corticotrophin-releasing factor and endothelin-1) [15,16]. It is suggested that increased β-endorphin level induced by acupuncture affects the HPA axis through promoting the release of ACTH by stimulation of its precursor pro-opiomelanocortin synthesis [17]. Other studies suggested that acupuncture may reduce stress and anxiety thus, decreases the HPA axis activity with subsequent increase in ovarian sympathetic tone to improve reproductive functions [15].

However, there is inconsistent evidence from a systematic review and meta-analysis of acupuncture for in vitro fertilization. EI-Toukhy and colleagues did not confirm that adjuvant acupuncture improves in vitro fertilization through reviewing 13 trials [18], while Manheimer’s study [14] showed the positive findings from acupuncture. As stated by Sterner-Victorin [19], ” Acupuncture may or may not have specific effects and a place within IVF/ET treatment, but there are compelling reasons for the scientific community to elucidate the issue further.”

Chinese herbal medicine for endometriosis

Endometriosis is a condition with the presence of tissue that is morphologically and biologically similar to normal endometrium in locations outside the uterus. The conventional medicine uses surgical and hormonal treatment, but with unpleasant side effects and high rates of relapse. Flower and Liu et al conducted a Cochrane systematic review on CHM for the treatment of endometriosis [20]. The review applied strict inclusion criteria to only include randomized trials with confirmed randomization procedures and laparoscopic diagnosis of endometriosis. The findings from two trials showed that post-surgical administration of herbal medicine may have comparable benefits to gestrinone but with fewer side effects, oral herbal medicine may have a better overall treatment effect than danazol, and it may be more effective in relieving dysmenorrheal and shrinking adnexal masses when used in conjunction with an herbal enema. However, the authors suggested that more rigorous research is required to assess the potential role of CHM in treating endometriosis.

Chinese herbal medicine and acupuncture for primary dysmenorrhoea

Conventional medicine for treatment of primary dysmenorrhoea has an unsuccessful rate of 20% to 25% and may be contraindicated or not tolerated by some women. CHM has been used for long time and a Cochrane review with 39 randomized trials involving 3475 women has been evaluated [21]. The data analyses showed that CHM relieve pain, improve overall symptoms, and use of additional medication when compared to the use of pharmaceutical drugs. CHM also resulted in better pain relief than acupuncture from two trials. The review found promising evidence supporting the use of CHM for primary dysmenorrhoea. However, authors also mentioned the limitations of poor methodological quality of the trials and small sample size.

Another Cochrane review identified nine randomized trials testing high frequency transcutaneous electrical nerve stimulation (TENS) or acupuncture for primary dysmenorrhoea [22] and the review found that high frequency TENS was more effective for pain relief than placebo, while low frequency TENS was not different from the placebo. One small trial with sound methodology showed acupuncture to be significantly more effective for pain relief than placebo or no treatment.

Chinese herbal medicine for uterine fibroids

Uterine fibroids are the most common non-malignant growths in women of childbearing age. The disease is associated with heavy menstrual bleeding and subfertility. CHM is used as alternatives to surgical procedures. Liu and Cardini et al published a Cochrane review with inclusion of two randomized trials of confirmed randomization and concluded with insufficient evidence to support or refute the use of herbal medicines for treatment of uterine fibroids due to limited number of trials and varied quality of the included trials [23].

Chinese herbal medicine for premenstrual syndrome

One Cochrane review with two randomized trials concluded with insufficient evidence to support the use of CHM in the treatment of premenstrual syndrome [24]. It suggests more well designed trials needed in this area.

Conclusion s

A significant portion of the general public chooses to use one or more forms of Chinese medicine (including herbal medicine and acupuncture) to manage gynecological diseases. Clinical evidence from systematic reviews and meta-analyses show promising benefits for some conditions, but inconsistent evidence for some other conditions. It is important for a consumer to consult a well trained practitioner and consumes herbal medicines according to instructions provided by the practitioner, given that the herbal products are properly manufactured or dispensed and contain herbs that are accurately identified, of good quality and free from contamination, the risks from using Chinese medicine could be reduced to the possible minimal level. However, when proper processes and controls are not in place, the risk of harm to the consumer is significant and unmanageable.

Random Diseases

You can leave a response, or trackback from your own site.

No Responses to “Traditional Chinese Medicine for Gynaecological Diseases”

Leave a Reply