An Alternative Approach to Atopic Dermatitis: Part I-Case-Series Presentation

Atopic dermatitis (AD) is a complex disease of obscure pathogenesis.A substantial portion of AD patients treated with conventionaltherapy become intractable after several cycles of recurrence.Over the last 20 years we have developed an alternative approachto treat many of these patients by diet and Kampo herbal medicine.However, as our approach is highly individualized and the Kampoformulae sometimes complicated, it is not easy to provide evidenceto establish usefulness of this approach. In this Review, todemonstrate the effectiveness of the method of individualizedKampo therapy, results are presented for a series of patientswho had failed with conventional therapy but were treated afterwardsin our institution. Based on these data, we contend that thereexist a definite subgroup of AD patients in whom conventionaltherapy fails, but the ‘Diet and Kampo’ approachsucceeds, to heal. Therefore, this approach should be consideredseriously as a second-line treatment for AD patients. In theDiscussion, we review the evidential status of the current conventionalstrategies for AD treatment in general, and then specificallydiscuss the possibility of integrating Kampo regimens into it,taking our case-series presented here as evidential basis. Weemphasize that Kampo therapy for AD is more ‘art’than technology, for which expertise is an essential pre-requisite.     

Efficacy and Safety of a Traditional Herbal Medicine, Hochu-ekki-to in the Long-term Management of Kikyo (Delicate Constitution) Patients with Atopic Dermatitis: A 6-month, Multicenter, Double-blind, Randomized, Placebo-controlled Study

Hochu-ekki-to is a traditional herbal (Kampo) medicine that has been shown to be effective for patients with Kikyo (delicate, easily fatigable, or hypersensitive) constitution. Previous case reports have suggested that this herbal drug was effective for a certain subgroup of patients with atopic dermatitis (AD). We aimed to evaluate the efficacy and safety of Hochu-ekki-to in the long-term management of Kikyo patients with AD. In this multicenter, double blind, randomized, placebo-controlled study, 91 Kikyo patients with AD were enrolled. Kikyo condition was evaluated by a questionnaire scoring system. All patients continued their ordinary treatments (topical steroids, topical tacrolimus, emollients or oral antihistamines) before and after their protocol entry. Hochu-ekki-to or placebo was orally administered twice daily for 24 weeks. The skin severity scores, total equivalent amount (TEA) of topical agents used for AD treatment, prominent efficacy (cases with skin severity score = 0 at the end of the study) rate and aggravated rate (more than 50% increase of TEA of topical agents from the beginning of the study) were monitored and evaluated. Seventy-seven out of 91 enrolled patients completed the 24-week treatment course (Hochu-ekki-to: n = 37, placebo: n = 40). The TEA of topical agents (steroids and/or tacrolimus) was significantly (P < 0.05) lower in the Hochu-ekki-to group than in the placebo group, although the overall skin severity scores were not statistically different. The prominent efficacy rate was 19% (7 of 37) in the Hochu-ekki-to group and 5% (2 of 40) in the placebo group (P = 0.06). The aggravated rate was significantly (P < 0.05) lower in the Hochu-ekki-to group (3%; 1 of 37) than in the placebo group (18%; 7 of 39). Only mild adverse events such as nausea and diarrhea were noted in both groups without statistical difference. This placebo-controlled study demonstrates that Hochu-ekki-to is a useful adjunct to conventional treatments for AD patients with Kikyo constitution. Use of Hochu-ekki-to significantly reduces the dose of topical steroids and/or tacrolimus used for AD treatment without aggravating AD.     

Estimation of Health Utilities Based on the Response to Treatment in Atopic Dermatitis: a Population-based Study

Purpose

This study estimated utility weights based on the response to treatment for atopic dermatitis in the general population.

An Overview of Traditional Chinese Herbal Formulae and a Proposal of a New Code System for Expressing the Formula Titles

Traditional Chinese herbal therapy can be characterized by theuse of a large number of multi-herb formulae. To provide modernand Western scientists without knowledge of Chinese literatureand cultural background easy access to information, a databasewith a total of 11 810 traditional Chinese herbal formulae wasconstructed. All the information was then translated into understandablescientific terms in English. While coining the formula titlesin English, we discovered some principles governing the namingof titles by using computer analysis. In addition, we observedthat about 92% of the formulae are in the range of single-herbformulae to thirteen-herb formulae. Most large number-herb formulaeare formulated by combining pre-existing smaller number-herbformulae. The King herbs ()with major therapeutic activity in a multi-herb formula wereidentified by the formulation concept using two parameters:the herbal dose and the herbal drug property (the degree oftoxicity). Based on such analytical data, we established anEnglish code system representing all formula titles writtenin ideographic Chinese characters: an array of important keywords such as ‘Herbal name in Latin + Efficacy (Targetorgans) + Preparation form + Number of herbs.’ By searchingthe English version of the database with any of the above keywords, a variety of information on the status of traditionalChinese herbal therapy can be accessed.     

Complementary and Alternative Medicine Approaches for Pediatric Pain: A Review of the State-of-the-science

In recent years, the use of complementary and alternative medicine(CAM) in pediatric populations has increased considerably, especiallyfor chronic conditions such as cancer, rheumatoid arthritisand cystic fibrosis in which pain may be a significant problem.Despite the growing popularity of CAM approaches for pediatricpain, questions regarding the efficacy of these interventionsremain. This review critically evaluates the existing empiricalevidence for the efficacy of CAM interventions for pain symptomsin children. CAM modalities that possess a published literature,including controlled trials and/or multiple baseline studies,that focused on either chronic or acute, procedural pain wereincluded in this review. The efficacy of the CAM interventionswas evaluated according to the framework developed by the AmericanPsychological Association (APA) Division 12 Task Force on Promotionand Dissemination of Psychological Procedures. According tothese criteria, only one CAM approach reviewed herein (self-hypnosis/guidedimagery/relaxation for recurrent pediatric headache) qualifiedas an empirically supported therapy (EST), although many maybe considered possibly efficacious or promising treatments forpediatric pain. Several methodological limitations of the existingliterature on CAM interventions for pain problems in childrenare highlighted and future avenues for research are outlined.     

Single-blind and Double-blind Randomized Controlled Trials of Palmtherapy(R), an Alternative Medical Approach, for Anxiety before Cardiac Catheterization

Alternative medicine is widely used, but lacks consensus regarding its amenability to scientific investigation. Anxiety increases morbidity and mortality in ischemic heart disease. We performed two studies of Palmtherapy(R), an alternative treatment, for anxiety before cardiac catheterization. In the first study, patients were randomized to receive pressure at particular points on the palm, or at incorrect locations, for about 50 min, while the therapist conversed with them. In the second study, the conversation was conducted by a second, 'blind' investigator. In both studies, patients and nurses, all blind to treatment assignment, completed visual analog scale and National Institute of Mental Health measures of anxiety, respectively. Twenty-three subjects completed study 1, and 17 completed study 2. In study 1, palm therapy was superior to sham therapy for both outcome measures. In study 2, palm therapy was superior for self-reported anxiety, but not for nurses' assessments of anxiety. Future studies should attempt to separate possible mechanistic effects of Palmtherapy(R) from therapist-related variables. Whether alternative medicine deserves to be studied at all remains controversial. Palmtherapy(R) may offer anxiolytic benefit without the harm attributable to drugs.     

Blood-nourishing and hard-softening capsule costs less in the management of osteoarthritic knee pain: a randomized controlled trial

The blood-nourishing and hard-softening (BNHS) capsule is a traditional Chinese formula used in the symptomatic treatment of inflammation and pain. We conducted this randomized controlled trial to compare the efficacy of BNHS with other commonly prescribed drugs. We recruited 120 patients from two teaching hospitals; 30 patients in each hospital were randomly assigned to receive BNHS. In one hospital, the 30 controls were given another traditional Chinese drug; whereas a Western medicine (chondroprotection drug/Viartril-s) was used as the control in the other hospital. Intervention was carried out over a period of 4 weeks. Primary outcome measures included self-reported pain level, and changes in stiffness and functional ability as measured by the Western Ontario McMaster Universities Osteoarthritis (WOMAC) index. Mixed models were used for statistical analysis. Substantial improvements in disease-specific symptoms were observed, after 4 weeks of treatment, in patients taking BNHS capsules. As assessed by the WOMAC index, pain level of the BNHS group decreased by 57% [95% confidence interval (CI) = 50, 63], stiffness by 63% (95% CI = 55, 71) and functional ability increased by 56% (95% CI = 50, 63). No significant differences were found in any of the outcome measures between the BNHS group and either of the comparison groups. No severe adverse effects were reported. However, this study lacked a placebo group; therefore, we conclude that BNHS appears to be as effective as commonly prescribed medicines for the relief of pain and dysfunction in knee osteoarthritis patients, but costs a lot less than other Western and herbal drugs in the study.     

Adaptogenic potential of a polyherbal natural health product: report on a longitudinal clinical trial

Stress is a risk factor for a number of diseases and is an important predictor of health in general. Herbal medicines have been used as adaptogens to regulate and improve the stress response and there is evidence to support the use of herbal medicines for this purpose. We conducted an open-label longitudinal study on the natural health product, OCTA(c), a compound mixture of eight herbs, to determine its effects on perceptions of stress. Eighteen participants were enrolled in the study and were followed over a period of 3 months. Primary endpoints included scores from four validated questionnaires (SF-36v2, PSS, STAI and BDI-II), serum DHEA, ALT, AST and creatinine all measured at 12 weeks. Seventeen patients completed the study. Except for the physical summary score of the SF36 questionnaire, all the subjective scores indicated a highly significant (P < 0.0001) improvement in the participants' ability to cope with stress. No adverse effects were reported and there was no evidence of damage to the liver or kidney based on serum markers. Initial evidence for this polyherbal compound supports its potential as an effective 'adaptogenic' aid in dealing with stress. Further research using a randomized controlled design is necessary to confirm the findings from this pilot study.     

The Systemic Theory of Living Systems and Relevance to CAM: The Theory (Part II)

This theory stems from observing the universe's ‘omniscient’nature, manifested in flows of energy and information of itslife plethora. A notorious example is the living cell's intelligentnature, which guides its basic goal: to maximize survival. Thislast motivated me to address the living system's intelligence,which constitutes a vital and controversial topic, its relationshipwith ‘incurable’ disease in general, including cancer,and to propose golden rules for therapeutics, as well as a definitionof ideal medicine. The scientific confirmation of these findingsis embedded in discoveries in cybernetics, biological theoryof information and modern thermodynamic concepts, concerningenergy and information exchange, within a living system. Thisapproach's practical application, denominated Systemic Medicine,has been substantiated by treatment and results obtained in>300 000 patients suffering from chronic degenerative diseases.     

Evidence-Based Research in Complementary and Alternative Medicine III: Treatment of Patients with Alzheimer's Disease

This paper presents the novel domain of evidence-based research (EBR) in the treatment of patients with Alzheimer's disease (AD) from the perspective of traditional medicine and of complementary and alternative medicine. In earlier lectures we have described the process of evidence-based medicine as a methodological approach to clinical practice that is directed to aid clinical decision-making. Here, we present a practical example of this approach with respect to traditional pharmacological interventions and to complementary and alternative treatments for patients with AD.     

Spatial Distribution of QT Intervals: An Alternative Approach to QT Dispersion

QT dispersion (QTd) describes the heterogeneity of ventricular repolarization on the basis of the temporal range of QT intervals as measured in the 12-lead ECG. We examined the spatial distribution of QTd using multichannel magnetocardiograms (MCGs), which noninvasivety register changes in magnetic field strength at 37 sites over the heart. As in ECG, the MCG signal in each channel may be used to measure QT interval. By calculating QT deviation from QT_min at each site, one can reconstruct the spatial distribution of QTd. Analysis of spatial QTd in ten healthy subjects and ten patients after acute myocardial infarction (MI) showed clear differences in spatial distribution. The healthy subjects generally displayed shorter QT intervals along a line corresponding to the approximate position of the septum with longer intervals in plateaus in the upper right and lower left. Spatial QTd of the post-MI patients deviated from this pattern, often displaying a sharp rise in QT duration over specific areas, which could be related to functional and morphological disturbances. The quantification of local irregularities as well as the overall pattern on the basis of a smoothness index allowed better discrimination between healthy subjects and post- MI patients than QTd. Distribution patterns of QTd which reflect local repolarization alterations may thus represent a more differentiated marker for pathology and risk.     

An Alternative Approach to the Training of Residential Treatment Counsellors

This article describes the development and conduct of an actual training program for residential counsellors. The concepts of levels of experience and stages of group process are discussed as the principles guiding the design of the program. The elements of the course: skills, knowledge, information, and team building, are discussed in detail. The composition of the trainee group is analyzed and the roles of the trainers are described.     

Finding the Words to Say It: The Healing Power of Poetry

My purpose in this paper is to help you experience for yourselfthe potential of poetry to heal by feeling its power throughyour own voice. Many people have an intuitive sense that voicein general and poetry in particular can be healing. We haveall experienced the comfort of soothing words. Finding the wordsto articulate a traumatic experience can bring relief. A letterbetween friends who are fighting can heal a relational wound.People are frequently moved to write a poem in times of extremity.In mainstream culture there are subjects that are not talkedabout. They are taboo. For example, each of us is going to die,but we do not talk about dying. We are all in the dialogue ofillness, death and dying, whether or not we are talking aboutit. Poetry gives us ways to talk about it. Multiple ways ofutilizing poetry for healing, growth and transformation willbe presented including the Poetry and Brain Cancer project atUCLA. Particular attention will be given to issues of Palliativecare. The reader will be directed to the scientific evidenceof the efficacy of utilizing expressive writing. The developingprofessional field of Poetry Therapy, and The National Associationfor Poetry Therapy will be discussed.     

Traditional and Modern Biomedical Prospecting: Part I-the History: Sustainable Exploitation of Biodiversity (Sponges and Invertebrates) in the Adriatic Sea in Rovinj (Croatia)

Nature, especially the marine environment, provides the mosteffective drugs used in human therapy. Among the metazoans,the marine sponges (phylum Porifera), which are sessile filterfeeders, produce the most potent and highly selective bioactivesecondary metabolites. These animals (or their associated symbioticmicroorganisms) synthesize secondary metabolites whose activityand selectivity has developed during their long evolutionaryhistory (evochemistry). The exploitation of these resourceshas become possible due to the progress in molecular and cellbiology. BIOTECmarin, the German Center of Excellence followsthis rationale. In the past, these animals have been successfullyand extensively utilized to isolate bioactive compounds andbiomaterials for human benefit. Pharmaceuticals prepared frommarine animals, primarily sponges, have been applied since ancienttimes (Hippocrates, Aristotle and later Plinius). It has beenreported that extracts and/or components from sponges can beused for the treatment of specific diseases. For a systematicand applied-oriented exploitation, the successful developmentof effective compounds largely depends on quality of the institutionalinfrastructure of marine stations and more so on the biodiversity.The Center for Marine Research in Rovinj (Croatia) fulfils theseprerequisites. Founded in 1891, this institute has to its creditmajor discoveries related to exploitation of secondary metabolites/biomaterialsfrom sponges for therapeutical application and to obtain biomaterialsfor general wellbeing. This is the first part of a review focusing on biomedical prospecting.Here, we have mainly described the historic background. Thedetails of techniques, substances, approaches and outlooks willbe discussed in the second part.     

CT检查在脾损伤治疗中的价值探讨(附198例分析)

目的:探讨脾损伤治疗中CT扫描的价值。材料与方法:198例脾损伤按时间分为二组:第一组为未行CT检查组77例,第二组为CT组121例,将两组的保脾治愈率与脾切除治愈率进行比较和分析。结果:行CT检查组保脾治愈率为64.47％,尤其是非手术治愈率为59.50％,而未行CT检查组保脾治愈率仅为36.36％,非手术治愈率为15.58％,两组间有显著差异(P值<0.01)。结论:CT是脾损伤诊断分级和制定治疗方案的重要依据。     

Salvia officinalis extract in the treatment of patients with mild to moderate Alzheimer's disease: a double blind,randomized and placebo-controlled trial

BACKGROUND: Alzheimer's disease is characterized by a slow, progressive decline in cognitive function and behaviour. Acetylcholine esterase inhibitors are the only agents approved by the Food and Drug Administration for the treatment of Alzheimer's disease. All other agents prescribed for the treatment of Alzheimer's disease are used on an off-label basis. Current research into new drugs is focused on agents that will prevent, slow down and/or halt the progress of the disease process. Salvia officinalis has been used in herbal medicine for many centuries. It has been suggested, on the basis of traditional medicine, its in vitro cholinergic binding properties and modulation of mood and cognitive performance in humans, that Salvia officinalis might potentially provide a novel natural treatment for Alzheimer's disease. The objective of this study was to assess the efficacy and safety of Salvia officinalis extract using a fixed dose (60 drops/day), in patients with mild to moderate Alzheimer's disease, over a 4-month period. METHODS: This was a 4-month, parallel group, placebo-controlled trial undertaken in three centres in Tehran, Iran. Patients with mild to moderate Alzheimer's disease aged between 65 and 80 years (n = 42, 18 women) with a score of > or = 12 on the cognitive subscale of Alzheimer's Disease Assessment Scale (ADAS-cog) and < or = 2 on the Clinical Dementia Rating (CDR) were randomized to placebo or fixed dose of S. officinalis extract. Over the 16 weeks, the main efficacy measures were the change in the ADAS-cog and CDR-Sum of Boxes scores compared with baseline. In addition, side-effects were systematically recorded throughout the study using a checklist. RESULTS: At 4 months, S. officinalis extract produced a significant better outcome on cognitive functions than placebo (ADAS-cog: F = 4.77, d.f. = 1, P = 0.03) (CDR-SB: F = 10.84, d.f. = 1, P < 0.003). There were no significant differences in the two groups in terms of observed side-effects except agitation that appears to be more frequent in the placebo group (P = 0.09). CONCLUSIONS: The results of this study indicate the efficacy of S. officinalis extract in the management of mild to moderate Alzheimer's disease. Moreover, S. officinalis may well reduce agitation of patients but this needs to be confirmed.     

The systemic theory of living systems and relevance to CAM: the theory (Part III)

Western medical science lacks a solid philosophical and theoretical approach to disease cognition and therapeutics. My first two articles provided a framework for a humane medicine based on Modern Biophysics. Its precepts encompass modern therapeutics and CAM. Modern Biophysics and its concepts are presently missing in medicine, whether orthodox or CAM, albeit they probably provide the long sought explanation that bridges the abyss between East and West. Key points that differentiate Systemic from other systems' approaches are 'Intelligence', 'Energy' and the objective 'to survive'. The General System Theory (GST) took a forward step by proposing a departure from the mechanistic biological concept-of analyzing parts and processes in isolation-and brought us towards an organismic model. GST examines the system's components and results of their interaction. However, GST still does not go far enough. GST assumes 'Self-Organization' as a spontaneous phenomenon, ignoring a causative entity or central controller to all systems: Intelligence. It also neglects 'Survive' as the directional motivation common to any living system, and scarcely assigns 'Energy' its true inherent value. These three parameters, Intelligence, Energy and Survive, are vital variables to be considered, in our human quest, if we are to achieve a unified theory of life.