Panax ginseng for Chronic Obstructive Pulmonary Disease (COPD)

Chronic obstructive pulmonary disease (COPD) is characterised by shortness of breath, cough and excess sputum production. The most common conditions included in COPD are chronic bronchitis (inflammation in the airway) and emphysema (destruction of lung tissue) resulting in irreversible airflow restriction. COPD is a major cause of morbidity and mortality and predicted to be the third leading cause of death by 2030. The causes of COPD are the long-term exposure to toxic substances and gases such as cigarette smoke, which induce an amplified inflammatory response in the lung, particularly in the small airway. Due to the irreversible nature of the condition, available treatments only provide symptomatic relief and management of exacerbations. These treatments are limited in their effectiveness and are associated with a range of adverse events. Patients with COPD have increasingly used complementary and alternative medicines (CAM). In Australia, 17.3% or nearly one in five COPD sufferers have used some form of CAM therapy. Panax ginseng is one herb, which shows promise for a number of health conditions including COPD. However, existing Panax ginseng studies have produced inconsistent evidence on efficacy due to a range of methodological issues. The research presented in the thesis achieved the objectives, which include: 1) search and analysis of the classical literature on Chinese herbal medicine for symptoms associated with COPD; 2) review extant systematic reviews of Panax ginseng; 3) systematically review the English and Chinese literature of Panax ginseng in randomised controlled trials (RCTs) ; 4) review the potential mechanisms of Panax ginseng on reducing inflammation and oxidative stress; and 5) design and implement an RCT that addresses the methodological short falls identified in the literature and evaluate the efficacy and safety of Panax ginseng for patients with moderate COPD. A stepwise approach was developed to identify candidate herbal medicines for COPD through systematic reviews on classical and modern literature, and then prioritise the key herb for further investigation with respect to its efficacy, potential mechanisms of action and evaluation of its efficacy and safety through an RCT. Although there is extensive literature, methodological flaws often limit the acceptance and applicability of results. This highlights the importance of improving standards and reporting in future research. The clinical trial presented here will provide critical clinical data and build on previous RCTs and systematic reviews. Given the increasing prevalence and burden associated with COPD, particularly in the elderly, this research is timely to explore alternatives that may help patients to improve their quality of life and lung function. This thesis applies a systematic “whole evidence” approach in investigating a herb for the management of a major health condition. There is no cure in modern medicine for COPD, and thus an investigation such as this is of significant value. This thesis revealed promising benefits of Panax ginseng for the treatment of COPD. Our multi-centre RCT will provide a conclusive answer to this well-characterised Ginseng product for the management of moderate level COPD patients

Panax ginseng C.A Meyer root extract for moderate Chronic Obstructive Pulmonary Disease (COPD): study protocol for a randomised controlled trial

Chronic obstructive pulmonary disease (COPD) impairs quality of life and leads to premature mortality. COPD sufferers experience progressive deterioration of lung function and decreased ability to undertake day-to-day activities. Ginseng has been used for thousands of years in Chinese medicine for respiratory symptoms. Several controlled clinical trials using ginseng for COPD have shown promising clinical effect, however these studies were generally small and with some potential bias, prompting the need for rigorously designed studies

Updated clinical evidence of Chinese herbal medicine for insomnia: A systematic review and meta-analysis of randomized controlled trials

This systematic review is to evaluate the efficacy and safety of Chinese herbal medicine (CHM) for people with insomnia. Randomized controlled trials (RCTs) investigating oral CHM alone or in combination with conventional therapies for primary insomnia were identified by searching English and Chinese publications and databases of clinical trial registration. Risk of bias was assessed according to the Cochrane Handbook 5.1. Meta-analysis was conducted using RevMan 5.2.4. Seventy-nine trials (7886 participants) were finally included in the review, and 76 were included in the meta-analysis. Twenty-seven trials reported the methods of random sequence generation, and five of them used the allocation concealment. Blinding of participants and personnel were used in 10 studies. The main meta-analysis showed that CHM alone was more effective than placebo by reducing scores of Pittsburgh Sleep Quality Index (mean difference, MD: -3.06, 95% confidence interval, CI: -5.14 to -0.98, I2 = 97%) and benzodiazepine drugs (BZDs) (MD: -1.94, 95% CI: -2.45 to -1.43, I2 = 96%). The effect was also seen when CHM was combined with BZDs compared with placebo plus BZDs (MD: -1.88, 95% CI: -2.78 to -0.97, I2 = 0%) or cognitive and behavioral therapy (MD: -3.80, 95% CI: -4.91 to -2.68, I2 = 68%) alone. There was no significant difference between CHM and placebo regarding the frequency of adverse events (relative risk, RR: 1.65, 95% CI: 0.67-4.10, I2 = 0). Overall, oral CHM used as a monotherapy or as an adjunct to conventional therapies appears safe, and it may improve subjective sleep in people with insomnia. However, the typical effect of CHM for insomnia cannot be determined due to heterogeneity. Further study focusing on individual CHM formula for insomnia is needed. The development of a comparable placebo is also needed to improve the successful blinding in RCTs

Evidence-Based Clinical Chinese Medicine - Volume 7: Insomnia

Currently, Chinese medicine practitioners who develop a special interest in a particular health condition such as insomnia have to consult a variety of sources to further their knowledge. Typically, they use the contemporary clinical literature to understand the theory, aetiology, pathogenesis and obtain expert opinions on the Chinese medicine management of insomnia. They search the electronic literature to identify systematic reviews of clinical trials, if any exist, to obtain assessments of the current state of the clinical evidence for particular interventions. If they have the skills and resources, they may search the classical Chinese medicine literature for an historical perspective on treatments that have stood the test of time

Panax ginseng in randomised controlled trials: a systematic review

Panax ginseng C.A. Meyer is a common herb with many purported health benefits. However, there is no conclusive evidence supporting its use in the treatment of any particular disease. We conducted a systematic review to evaluate randomised controlled trials. Four English databases were searched with no publication date restriction. Included studies evaluated P.ginseng in patients with any type of disease or in healthy individuals. We assessed the quality of studies using the Cochrane risk of bias tool. Of the 475 potentially relevant studies, 65 met the inclusion criteria. These studies examined P.ginseng's effects on psychomotor performance (17 studies), physical performance (ten), circulatory system (eight), glucose metabolism (six), the respiratory system (five), erectile dysfunction (four), immunomodulation (four), quality of life/mood (four), antioxidant function (two), cancer (two), menopausal symptoms (two) and dry mouth (one). The risk of bias was unclear in most studies. Authors evaluated adverse events in 40 studies, with 135 minor events and no serious adverse events reported. P.ginseng shows promising results for improving glucose metabolism and moderating the immune response. This may have implications for several diseases including type 2 diabetes and chronic respiratory conditions. Further studies are needed to explore P.ginseng's potential as an effective treatment for these and other health condition

Quality and risk of bias in panax ginseng randomized controlled trials: A review

Panax ginseng is one of the most frequently used herbs in the world. Numerous trials have evaluated its clinical benefits. However, the quality of these studies has not been comprehensively and systematically assessed. We reviewed randomized controlled trials (RCTs) of Panax ginseng to evaluate their quality and risk of bias. We searched four English databases, without publication date restriction. Two reviewers extracted details about the studies' methodological quality, guided by the Consolidated Standards of Reporting Trials (CONSORT) checklist and its extension for herbal interventions. Risk of bias was determined using the Cochrane Risk of Bias tool. Of 475 potentially relevant studies, 58 met our inclusion criteria. In these 58 studies, 48.3% of the suggested CONSORT checklist items and 35.9% of the extended herbal items were reported. The quality of RCTs published after the CONSORT checklist improved. Until 1995 (before CONSORT) (n = 4), 32.8% of the items were reported in studies. From 1996-2006 (CONSORT published and revised) (n = 30), 46.1% were reported, and from 2007 (n - 24), 53.5% were reported (p - 0.005). After the CONSORT extension for herbal interventions was published in 2006, RCT quality also improved, although not significantly. Until 2005 (n = 34), 35.2% of the extended herbal items were reported in studies; and from 2006 onwards (n = 24), 37.3% were reported (p = 0.64). Most studies classified risk of bias as "unclear". Overall, the quality of Panax ginseng RCT methodology has improved since the CONSORT checklist was introduced. However, more can be done to improve the methodological quality of, and reporting in, RCTs

Herbal medicine for adults with asthma: a systematic review

Background: Many people with asthma use herbal medicines to help reduce symptoms and improve asthma control. Objective: To update the systematic review and meta-analysis of randomised controlled trials of herbal medicine for adult asthma. Data Sources: Nine English and Chinese databases were searched (PubMed, Embase, CINAHL, CENTRAL, AMED, CBM, CNKI, CQVIP, Wanfang). Study Selections: Herbal medicines combined with routine pharmacotherapies compared with the same pharmacotherapies alone or placebo. Cochrane Risk of Bias Tool and GRADE Summary of Findings tables were used to evaluate methodological quality. Results: Twenty-nine (29) studies involving 3,001 participants were included. Herbal interventions used multi-ingredients such as licorice root, crow-dipper, astragali, and angelica. Compared with routine pharmacotherapies alone, herbal medicines as add-on therapy improved lung function (FEV1: MD 7.81%, 95% CI 5.79, 9.83, I 2 = 63%; PEFR: MD 65.14 L/min, 95% CI 58.87, 71.41, I 2 = 21%); asthma control (MD 2.47 points, 95% CI 1.64, 3.29, I 2 = 55%); reduced salbutamol usage (MD -1.14 puffs/day, 95% CI -2.20, -0.09, I 2 = 92%); and reduced acute asthma exacerbations over one year (MD -1.20, 95% CI -1.82, -0.58, one study). Compared with placebo plus pharmacotherapies herbal medicines as add-on therapy improved lung function (FEV1: MD 15.83%, 95% CI 13.54, 18.12 and PEFR: MD 55.20 L/min, 95% CI 33.41, 76.99). Other outcomes were not reported in these placebo studies. Included studies were low to moderate quality. Adverse events were rare. Conclusions: Herbal medicines combined with routine pharmacotherapies improved asthma outcomes greater than pharmacotherapies alone. Included studies did not blind participants therefore more studies that address such weaknesses are warranted