Alternative Perspectives: How Chinese Medicine Understands Hypercholesterolemia

Treatment of cardiovascular disease, albeit under the auspices of other clinical descriptors to those described in western biomedicine, has a long history in China. Chinese Medicine (CM) is guided by unique philosophical underpinnings and theories. There are differences in how the heart is conceptualised traditionally in CM compared to biomedicine. This paper focusses on how hypercholesterolemia is understood from within the Chinese medical paradigm, including its aetiology, pathogenesis, and treatment. A brief overview of the key characteristics and theories of CM is given to provide context. Modern science has demonstrated that many Chinese herbs have cholesterol-lowering properties. Examples of research into individual herbs and medicinal formulae, combinations of herbs are presented. At a more sophisticated level, some researchers are challenging some of the very assumptions upon which CM is based, including applicability of CM theory to modern clinical entities such as hypercholesterolemia, and are seeking intersections of knowledge between CM and biomedicine that may extend CM theory

A Chinese Herbal Preparation Containing Radix Salviae Miltiorrhizae, Radix Notoginseng and Borneolum Syntheticum Reduces Circulating Adhesion Molecules

Circulating adhesion molecules (CAMs), surface proteins expressed in the vascular endothelium, have emerged as risk factors for cardiovascular disease (CVD). CAMs are involved in intercellular communication that are believed to play a role in atherosclerosis. A Chinese medicine, the “Dantonic Pill” (DP) (also known as the “Cardiotonic Pill”), containing three Chinese herbal material medica, Radix Salviae Miltiorrhizae, Radix Notoginseng and Borneolum Syntheticum, has been used in China for the prevention and management of CVD. Previous laboratory and animal studies have suggested that this preparation reduces both atherogenesis and adhesion molecule expression. A parallel double blind randomized placebo-controlled study was conducted to assess the effects of the DP on three species of CAM (intercellular cell adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 and endothelial cell selectin (E-selectin)) in participants with mild-moderate hypercholesterolemia. Secondary endpoints included biochemical and hematological variables and clinical effects. Forty participants were randomized to either treatment or control for 12 weeks. Treatment with DP was associated with a statistically significant decrease in ICAM-1 (9% decrease, P = .03) and E-Selectin (15% decrease, P = .004). There was no significant change in renal function tests, liver function tests, glucose, lipids or C-reactive protein levels and clinical adverse effects did not differ between the active and the control groups. There were no relevant changes in participants receiving placebo. These results suggest that this herbal medicine may contribute to the development of a novel approach to cardiovascular risk reduction

Hepatic stellate cells:central modulators of hepatic carcinogenesis

Hepatocellular carcinoma (HCC) represents the second most common cause of cancer-related death worldwide, and is increasing in incidence. Currently, our therapeutic repertoire for the treatment of HCC is severely limited, and therefore effective new therapies are urgently required. Recently, there has been increasing interest focusing on the cellular and molecular interactions between cancer cells and their microenvironment. HCC represents a unique opportunity to study the relationship between a diseased stroma and promotion of carcinogenesis, as 90 % of HCCs arise in a cirrhotic liver. Hepatic stellate cells (HSC) are the major source of extracellular proteins during fibrogenesis, and may directly, or via secreted products, contribute to tumour initiation and progression. In this review we explore the complex cellular and molecular interplay between HSC biology and hepatocarcinogenesis. We focus on the molecular mechanisms by which HSC modulate HCC growth, immune cell evasion and angiogenesis. This is followed by a discussion of recent progress in the field in understanding the mechanistic crosstalk between HSC and HCC, and the pathways that are potentially amenable to therapeutic intervention. Furthermore, we summarise the exciting recent developments in strategies to target HSC specifically, and novel techniques to deliver pharmaceutical agents directly to HSC, potentially allowing tailored, cell-specific therapy for HCC

Regulation of Chinese Herbs in Australia and Legislative Changes Impacting on Access to Potentially Toxic Chinese Herbs

This article describes the regulatory context of Chinese herbal medicines in Australia with a particular focus on the legislative mechanisms in Victoria that will enable practitioners to have access to potentially toxic Chinese herbs. It also seeks to provoke thought on factors that can contribute to the legitimation of Chinese medicine, which may eventually equip the profession with the power and means to effect positive change

Chinese Medicine Education in Victoria, Australia - the Impact of Statutory Regulation

This article will discuss the impact of statutory regulation on these four areas, with a focus on the requirements for approval of undergraduate or entry-level courses

Medicinal cannabis : issues of evidence

Introduction: Medicinal cannabis has been used for over 6000 years. It may be accessed legally in many western countries, yet in Australia, access is very difficult. It is treated as a pharmaceutical and an ‘unapproved therapeutic good’, and is subsequently subject to a complex regulatory system around prescribing. There have been calls by authoritative bodies in Australia for more evidence in relation to its efficacy and safety, suggesting that this is inadequate. The adoption of the evidence-based medicine (EBM) approach as the basis of decision-making in the healthcare sector positions systematic reviews and randomised controlled trials (RCTs) at the top of the hierarchy of evidence. It is largely this form of evidence that has been used to argue for or against the efficacy and safety of cannabis and to substantiate the current regulatory system in Australia. It is therefore important to understand the EBM approach and factors that need to be considered when examining scientific research into cannabis, in order to decide whether there is sufficient evidence or not. It is argued that regulation of cannabis is inappropriate, based on a limited understanding of evidence, and continues to limit access to medicinal cannabis by patients. Methods: This paper examines the notion of evidence in medicine, points of consideration in scrutinizing research methodology, what the actual evidence is in relation to safety and efficacy of medicinal cannabis, the implications of evidence and whether it supports the current regulatory framework around medicinal cannabis in Australia. It poses an alternative regulatory approach. Results: A robust definition of EBM goes beyond the notion of simply scientific evidence in the form of RCTs and systematic reviews. Rigorous scrutiny of the evidence about cannabis is required, since evidence is being used to control access. Scientific evidence including reports from authoritative bodies indicates there is much evidence to support the safety and efficacy of medicinal cannabis. CBD has been found to be relatively safe, non-addictive and efficacious. Access to medicines that alleviate suffering in a timely manner is a human right and a medical responsibility. There is enough evidence to justify regulatory changes to significantly increase access to medicinal cannabis in Australia. Conclusion: We need to bring back the human element when considering what evidence we use and how we use it in medicine. Cannabis has the potential to alleviate much suffering, and patient (human) rights must be central in public policy. There is already much scientific evidence in relation to safety and efficacy of cannabis and cannabinoids such as CBD and THC. In Australia, the current regulatory system needs to be disbanded, cannabis products treated as ‘approved goods’ and regulated as complementary medicines (for products containing CBD and low THC) or in the case of high THC-containing products, regulated under the SUSMP as an S4 (rather than S8) medicine

Chinese Medicine Perspectives on Myocardial Ischaemia

Chinese medicine (CM) has treated cardiovascular disease (CVD) for hundreds of years, albeit under the auspices of very different clinical descriptors. CM is based on very different metaphysics to that of biomedicine, viewing the body and health in a vastly different manner, and its medical system has developed around this unique understanding. One could describe CM as an energetic model of the human, since CM views that body and indeed the world as being based on ‗qi‘, a fundamental substance akin to ‗energy‘. It is necessary to understand the underpinning philosophies and theories that guide CM in order to appreciate how the cardiovascular system is understood and how it is treated with major modalities such as Chinese herbal medicine and acupuncture. CM has its own unique diagnostic techniques that are used to detect pathology in the body. A feature of diagnosis is the recognition of underlying patterns of disharmony (or CM syndromes) for diseases or disorders or symptoms. Treatment, typically with Chinese herbal medicine or acupuncture, is aimed at not only the disease but its underlying pattern of disharmony

A Review of the Reliability of Traditional East Asian Medicine Diagnoses

Background: In the practice of forms of traditional East Asian medicine (TEAM) such as Traditional Chinese Medicine and Japanese meridian therapy, treatment follows identification of underlying “patterns of disharmony.” However, little is known in an objective sense of the consistency or reliability of diagnosis within TEAM. This is important: If diagnosis is not reliable, there can be less confidence that optimal treatment is received. TEAM systems have their own diagnostic endpoints that are used as evidence of change. If these are to be incorporated into clinical studies, a prerequisite is that they are reliable. Few studies have assessed the reliability of diagnostic data collected during a TEAM examination. The majority have investigated reliability of pulse diagnosis, with results ranging from low to a very good level of agreement. Studies of reliability of tongue diagnosis and other diagnostic data collected in a Chinese Medicine examination suggest considerable variability. In general, studies of reliability of pattern diagnosis and treatment in a range of disorders have not found a high level of reliability. A range of factors may affect reliability. Objectives: This paper reviews the current knowledge of reliability of TEAM diagnoses, including limitations of studies, and discusses the implications for practice and research and how to improve the current situation

Confidence in Clinical Practice of Chinese Medicine Degree Graduates 1 Year After Graduation: A Pilot Study

Background: The issue of transition from student to practitioner of Chinese medicine (CM) in Australia and other Western countries has received little formal attention. Workforce studies, while not up to date nationally in Australia, suggest that the majority of CM practitioners practice as sole practitioners or in small practices. Data from the state of Victoria suggest that a significant proportion of the CM workforce is relatively new to the profession. It is not known how many graduates successfully enter the workforce and importantly, remain in it. Objectives: An initial survey of final-year bachelor degree CM students in Australian education institutions in 2008 suggested that students felt “somewhat” prepared for clinical practice in eight dimensions of clinical practice. The authors conducted a follow-up study to this initial one, seeking to investigate perceptions of confidence in CM graduates in various aspects of clinical practice within the first year of completing their degree. Methods: A content-validated survey based on the previous study was distributed to a subset of 30 graduates from the original study cohort who had indicated a willingness to participate in this follow-up survey. Results: There were a small number of responses (n=12), limiting the usefulness of the quantitative questions. However, some interesting qualitative outcomes from the long-answer part of the survey support findings from the previous study that recent practitioners would like more clinical experience, as well as support in developing their business and interpersonal skills, and the option to participate in a professional mentoring arrangement. Conclusions: Results of this study suggest that both education providers and professional associations may be able to play important and complementary roles in assisting CM students to successfully transition into the workforce. If CM is to continue to develop as a profession in Australia, it will be important that more attention be given to how to assist new graduates to successfully transition into and remain in clinical practice