bian zheng

June 30, 2007

Consider:

Ginger (Zingiber officinale) in rheumatism and musculoskeletal

disorders.

Srivastava KC, Mustafa T.

Department of Environmental Medicine, Odense University, Denmark.

One of the features of inflammation is increased oxygenation of

arachidonic acid which is metabolized by two enzymic pathways--the

cyclooxygenase (CO) and the 5-lipoxygenase (5-LO)--leading to the

production of prostaglandins and leukotrienes respectively. Amongst

the CO products, PGE2 and amongst the 5-LO products, LTB4 are

considered important mediators of inflammation. More than 200

potential drugs ranging from non-steroidal anti-inflammatory drugs,

corticosteroids, gold salts, disease modifying anti-rheumatic drugs,

methotrexate, cyclosporine are being tested. None of the drugs has

been found safe; all are known to produce from mild to serious side-

effects. Ginger is described in Ayurvedic and Tibb systems of

medicine to be useful in inflammation and rheumatism. In all 56

patients (28 with rheumatoid arthritis, 18 with osteoarthritis and 10

with muscular discomfort) used powdered ginger against their

afflictions. Amongst the arthritis patients more than three-quarters

experienced, to varying degrees, relief in pain and swelling. All the

patients with muscular discomfort experienced relief in pain. None of

the patients reported adverse effects during the period of ginger

consumption which ranged from 3 months to 2.5 years. It is suggested

that at least one of the mechanisms by which ginger shows its

ameliorative effects could be related to inhibition of prostaglandin

and leukotriene biosynthesis, i.e. it works as a dual inhibitor of

eicosanoid biosynthesis.

Question: if the TCM concept of assigning herbs properties such as

temperature is therapeutically valid, how is it explained that in

this study all 56 patients experienced relief and none had adverse

effects. (BTW, dried ginger, gan jiang, was used at a dosage of 500 –

1000 mg per day. ) This result is adequately explained by the modern

scientific model. However, according to TCM theory, at least some of

these patients should have had a HEAT condition, perhaps the majority

of RA patients. Shouldn't the therapy have ben useless at best for

these patients or even have had negative effects (increasing HEAT,

thus increasing symptoms). As I have noted many times, most clinical

studies in China do not use pattern differentiation as a basis for

determining treatment, yet a very high percentage of success is

typically reported. This is the case even when the researchers use

completely different hypotheses of the pathomechanisms of the disease

as the basis for their formulations. In all such cases, biochemistry

can explain why differing therapies are effective. For example, in

the case above, ginger is anti-inflammatory. The validity of TCM

theory depends on demonstrating that one approach is superior to

another because one better addresses the most typical so-called

pathomechanisms of a given disease. However, in reality, many doctors

have completely different ideas about the pathomechanisms of a given

disease and yet the research on their formulas is all reportedly

equally successful. This seriously calls into question the validity

of bian zheng as a important clinical tool, IMO. As Paul Unschuld has

pointed out, the ascendancy of the status of this mode of practice in

ancient China had far more to due with cultural factors such as class

elitism and simple competition for patients than it did with any

demonstrated differences in efficacy, so this is hardly surprising.

June 30, 2007

Todd-

Without having read the study, several thing jump out at me. First

of all the dosage. It seems unlikely that such a small dosage of

herbal material would increase the heat in a patients with diagnoses

of hot patterns. Also, you just never know about the sample of

patients. 28 RA, 18 OA, and 10 with varying degrees of muscular

discomfort might not have presented with severe heat signs and

symptoms in the first place. You just don't know until you look at

the patients from a TCM perspective, and I do not see that this was

done in the study. Another question to ask is, if they did have

heat, where was it? If it was not located in the digestive tract,

that might account for the lack of adverse effects. Also, how were

they measuring adverse effects? Were they sensitive to changes in

hot signs and symptoms that might be relevant to TCM? Or were they

looking for changes that were more gross in nature?

I agree with you that pattern differentiation needs to be tested.

The first hurdles to doing that are looking at ways of reliably

distributing patients into syndrome groups. Until a method is

devised to do that, the question is difficult to get at. Rosa

Schnyer et al over at NESA are working on these questions, but there

needs to be more effort put into it if we are to get at the bottom of

this question. While the study you cite is interesting, I do not

think that it helps answer this question. Studies need to be

designed specifically for this question.

-Steve

On Jun 30, 2007, at 4:37 PM, wrote:

> Consider:

>

> Ginger (Zingiber officinale) in rheumatism and musculoskeletal

> disorders.

>

> Srivastava KC, Mustafa T.

>

> Department of Environmental Medicine, Odense University, Denmark.

>

> One of the features of inflammation is increased oxygenation of

> arachidonic acid which is metabolized by two enzymic pathways--the

> cyclooxygenase (CO) and the 5-lipoxygenase (5-LO)--leading to the

> production of prostaglandins and leukotrienes respectively. Amongst

> the CO products, PGE2 and amongst the 5-LO products, LTB4 are

> considered important mediators of inflammation. More than 200

> potential drugs ranging from non-steroidal anti-inflammatory drugs,

> corticosteroids, gold salts, disease modifying anti-rheumatic drugs,

> methotrexate, cyclosporine are being tested. None of the drugs has

> been found safe; all are known to produce from mild to serious side-

> effects. Ginger is described in Ayurvedic and Tibb systems of

> medicine to be useful in inflammation and rheumatism. In all 56

> patients (28 with rheumatoid arthritis, 18 with osteoarthritis and 10

> with muscular discomfort) used powdered ginger against their

> afflictions. Amongst the arthritis patients more than three-quarters

> experienced, to varying degrees, relief in pain and swelling. All the

> patients with muscular discomfort experienced relief in pain. None of

> the patients reported adverse effects during the period of ginger

> consumption which ranged from 3 months to 2.5 years. It is suggested

> that at least one of the mechanisms by which ginger shows its

> ameliorative effects could be related to inhibition of prostaglandin

> and leukotriene biosynthesis, i.e. it works as a dual inhibitor of

> eicosanoid biosynthesis.

>

> Question: if the TCM concept of assigning herbs properties such as

> temperature is therapeutically valid, how is it explained that in

> this study all 56 patients experienced relief and none had adverse

> effects. (BTW, dried ginger, gan jiang, was used at a dosage of 500 –

> 1000 mg per day. ) This result is adequately explained by the modern

> scientific model. However, according to TCM theory, at least some of

> these patients should have had a HEAT condition, perhaps the majority

> of RA patients. Shouldn't the therapy have ben useless at best for

> these patients or even have had negative effects (increasing HEAT,

> thus increasing symptoms). As I have noted many times, most clinical

> studies in China do not use pattern differentiation as a basis for

> determining treatment, yet a very high percentage of success is

> typically reported. This is the case even when the researchers use

> completely different hypotheses of the pathomechanisms of the disease

> as the basis for their formulations. In all such cases, biochemistry

> can explain why differing therapies are effective. For example, in

> the case above, ginger is anti-inflammatory. The validity of TCM

> theory depends on demonstrating that one approach is superior to

> another because one better addresses the most typical so-called

> pathomechanisms of a given disease. However, in reality, many doctors

> have completely different ideas about the pathomechanisms of a given

> disease and yet the research on their formulas is all reportedly

> equally successful. This seriously calls into question the validity

> of bian zheng as a important clinical tool, IMO. As Paul Unschuld has

> pointed out, the ascendancy of the status of this mode of practice in

> ancient China had far more to due with cultural factors such as class

> elitism and simple competition for patients than it did with any

> demonstrated differences in efficacy, so this is hardly surprising.

>

July 3, 2007

Claude Bernard, the famous physiologist, addressed a French medical

academy in the late 19th century with the following:

" Ladies and gentlemen, the medicine I am about to teach you does not

exist " .

I recently inquired of Paul Unschuld on a similar point to the one

you make below. He answered the following:

" It presents a rather controversial thesis to the effect that neither

in the history of European/Western medicine nor in the history of

Chinese medicine the most fundamental theories on physiology and

pathology can claim to have been stimulated by experience or the

expressiveness of the human body. Rather, they have arisen either as

projections of certain notions of social order and crisis, or because

of strategic considerations, including " competition for patients " .

In his seminar in San Diego a few years back, Paul pointed out that

the body is basically 'mute' in its expressiveness, and that the

human mind interprets and explains its phenomena in accordance with

the patterns of thought that arise in different eras.

We use the theories developed by the human mind to interpret,

explain, and ultimately develop medicine.

You seem to think these days that somehow biomedicine is more 'real'

than Chinese medicine, because it is based on anatomical and

physiological data, rather than a systematic approach based on

process and patterns of change.

It is only a change of bias.

On Jun 30, 2007, at 2:37 PM, wrote:

> However, in reality, many doctors