Background: The potential benefit of silymarin (special extract from the fruits of Silybum marianum) in the treatment of liver diseases remains a controversial issue. Methods:For this systematic review electronic databases identified 65 papers for the search terms silymarin, silibinin, silicristin or milk thistle and clinical trial. Only 19 complied with the criteria‘double-’ or ‘single-blind’. These publications were analysed from a clinical point of view and meta-analytic calculations were performed. Results: The clinical evidence of a therapeutic effect of silymarin in toxic liver diseases is scarce. There is no evidence of a favourable influence on the evolution of viral hepatitis, particularly hepatitis C. In alcoholic liver disease, comparing with placebo, aspartate aminotransferase was reduced in the silymarin-treated groups (p = 0.01) while alkaline phosphatase was not. In liver cirrhosis, mostly alcoholic, total mortality was 16.1%with silymarin vs. 20.5% with placebo (n.s.); liver-related mortality was 10.0% with silymarin vs. 17.3% with placebo(p = 0.01). Conclusions: Based on the available clinical evidence it can be concluded - concerning possible risks /probable benefits - that it is reasonable to employ silymarin as a supportive element in the therapy of Amanita phalloides poisoning but also (alcoholic and grade Child ‘A’)liver cirrhosis. A consistent research programme, consolidating existing evidence and exploring new potential uses,would be very welcome.
We describe the case of a 28-year-old woman, who had been suffering for more than 5 years from severe fatigue, myofascial pain, obstipation, obesity of trunk, abdominal striae, oedema, tinnitus, folliculitis, and facial swelling. The patient also showed a secondary adrenocortical insufficiency. From the anamnesis we assumed that environmental factors could account for the symptoms. The therapy consisted of dietary advise, chelating agents, supplements, and acupuncture. Under this therapy the patient became completely symptom-free. No such case has ever been reported before. We report mainly on the CAM diagnostic and therapeutic procedures, which are discussed together with the assumed pathogenetic factors.
Objective: To explore the effects of acupuncture on perimenopausal symptoms in women who underwent oophorectomy. Methods: 67 women who had undergone oophorectomy were divided into an acupuncture group (n = 36) and a comparison group ( n = 31) according to their wishes. The first group was treated by acupuncture and the latter group by Livial. Clinical symptoms were assessed by the modified Kupperman index. The levels of venous blood serum beta-endorphin (beta-EP), follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E-2) and the maturation index (MI) of vaginal epithelial cells were assessed. Results: There were no significant group differences for the MI of vaginal exfoliative cells nor for the levels of FSH, LH and E-2 after treatment (p > 0.05), but Kupperman scoring and the levels of beta-EP differed significantly between the acupuncture and the Livial group (p < 0.05). No side-effects were reported in either group. Conclusion: Acupuncture results in a significant improvement in perimenopausal symptoms in women who have had an oophorectomy. Acupuncture performs as well or better than Livial. Yet, this result may have been influenced by a potential bias and the small sample size.
Recently, the European Medicines Agency (EMEA) and the Committee on Herbal Medicinal Products (HMPC) have released a public statement to draw the attention of European health authorities to 42 cases (34 directly reported from European national competent authorities and 8 published) of suspected hepatotoxic reactions to Cimicifugae racemosae rhizoma (black cohosh, root) in patients, probably all of them women, who were treated for menopause-related disorders. Following a review of all data available, this statement assumes a connection between herbal medicinal products that contain Cimicifugae racemosae rhizoma and human hepatotoxic adverse reactions. Nevertheless, this highly authoritative review of such an impressive number of cases concludes in its summary that ‘Overall, all discussed cases of literature and pharmacovigilance reports are poorly documented,’ and only ‘two can be considered as possible’ and ‘two can be classified as probable’ [1, p 9]: (1) In case 28, according to the numeration in the EMEA statement, RUCAM score 4, the only case directly collected from European national competent authorities, the adverse reaction was considered possible, but information on differential diagnostic assessment was not available. The patient consumed 80 mg of an unknown extract daily and for an unknown period. (2) In another case report [2] (RUCAM score 3) the patient was a 54-year-old woman suffering from hypothyroidism, fibromyalgia, osteoarthritis and depression. She had taken 1,000 mg black cohosh (unclear, if a type of extract or crude drug) daily for several months. The patient was on fluoxetine, propoxyphene and paracetamol (a well known hepatotoxic substance) concomitantly and used to drink 2 glasses of wine in the evenings. The statement claims ‘that since there is no further information on the herbal preparation, the case report is not of great relevance in the assessment of cimicifuga-related hepatotoxicity’ [1]. (3) A 57-year-old multimorbid Afro-American woman [3] (RUCAM score 7) with a history of polymyositis had developed an autoimmune hepatitis about 3 weeks after the first intake of Cimicifugae racemosae rhizoma (brand and dose unknown; no information if it was a combination product). After discontinuation of Cimicifugae racemosae rhizoma intake and starting a therapy with steroids and azathioprine, the patient recovered. Here, autoimmune hepatitis may as well have been a manifestation of a multisystem autoimmune disease. According to the draft recommendations of the Scientific Advisory Panel Subgroups on Hepatotoxicity, the case could be classified as idiosyncratic liver necrosis. Inititally, the causal relationship to black cohosh in this case was assessed ‘unclassifiable’, as information concerning the reaction was considered incomplete and inconsistent, and the follow-up publication includes more (although to some extent still inconsistent) information about the therapy [1]). (4) In another well-documented case [4] (RUCAM score 6) the dose administered was 500 mg/day. The reaction was described as hepatocellular, other causes of acute hepatitis were excluded. The provisional clinical diagnosis was autoimmune hepatitis. Therapy started with 60 mg prednisone / day for 5 weeks. Liver enzymes improved, but due to an aggravation of coagulopathy and encephalopathy, the patient underwent orthotopic liver transplantation. In the explanted organ, histological features of acute hepatitis, fibrous linkage of portal tracts and cholestasis were observed after 5 weeks on corticosteroids. Yet, in this case, too, the exact content of the remedy based on black cohosh is unclear, and it is not reported if it was an extract or crude drug, and if it contained other toxic substances, i.e. heavy metals. Later, Levitsky [4] reported that the patient neither drank, nor used drugs, nor took any other medication. However, in a US District Court proceeding the woman admitted that she regularly consumed alcohol, and used large doses of ibuprofen, a non-steroidal anti-inflamma-
Background: Major surgery suppresses natural killer (NK) cell cytotoxic activity which is potentially harmful for cancer patients by favouring haematogenic tumour cell dissemination. The influence of a perioperative infusion of a standardized mistletoe extract ( Iscador) on immune functions was tested in a prospective, sequential, randomized clinical trial. Patients and Methods: Colorectal cancer patients undergoing open tumour resection were randomly assigned to either mistletoe infusion or no additional therapy. We hypothesized that mistletoe infusion improves NK cell activity and increases expression of MHC class II antigen HLA-DR on monocytes 24 h and 7 days after surgery, respectively. For statistical analysis we used a sequential study design. The decision boundaries for the two triangular tests were calculated for altogether 62 patients. Results: The sequential study design allowed stopping the recruitment prematurely. NK cell activity differed significantly between the therapy groups 24 h after surgery (p = 0.027). The absolute number of HLA-DR molecules on monocytes did not differ 7 days after surgery. NK cell activity of patients treated with mistletoe extract did not change significantly during the course of the study (-7.9% 24 h after surgery), whereas HLA-DR expression changed significantly (-38.5% at day 7 after surgery). For control patients both parameters decreased significantly after surgery ( NK cell activity: -44.4% at 24 h; HLA-DR expression: -32.9% at day 7 after surgery). Conclusion: Perioperative infusion of mistletoe extracts can prevent a suppression of NK cell activity in cancer patients. The impact of this therapy on relapse and survival should be tested in further studies.
Background: The health status of an individual in adulthood is proposed to be determined by events occurring in the prenatal and early postnatal period. A common early life event proven to have long lasting effects on the developing fetus is stress, including pain. Exposure of fetal and neonatal infants to repetitive psychological ( e. g., maternal stress) or physiological ( e. g., pain, infection, and noise) stress during this period is proposed to alter mechanisms involved in the regulation of stress, immunological maturation, pain perception, and cognition. Such changes, which persist into adulthood, may occur via alterations in the development of the hypothalamic-pituitary-adrenal ( HPA) axis. This process is typically referred to as 'perinatal programming'. Ontogenic alterations in the development of the HPA-axis have been related to a number of adult pathologies such as cardiovascular disease, type 2 diabetes, asthma, as well as psychopathologies such as anxiety and depression. Objective: In this review, the effectiveness of complementary and alternative medicine ( CAM), such as music, dietary supplements, massage and aromatherapy, in reducing perinatal stress in mothers and infants is examined. An emphasis is placed on these therapies as preventative measures which may be of value to individuals at risk of developing disease profiles associated with the consequences of adverse perinatal programming. The widening interest in perinatal programming and CAM suggests the potential for CAM to become a valuable tool in offsetting negative adult health outcomes resulting from perinatal programming associated with adverse gestational early life environments.
Vinzenz Priessnitz (1799-1851) did not only carry out water treatments within the scope of his cure, but also movement therapy, aerial and solar baths, natural lifestyle and, above all, diet therapy. According to the literature Priessnitz only seldom allowed starvation within his cure because this would break his preferred principle of restoration. Nevertheless, the widely unknown 'Vinzenz Priessnitz family water book' which he dictated to his daughter Sophie in 1847, includes 13 orders of starvation for a series of indications (breast inflammations, pneumonia, pulmonary embolism, cholera, intestines inflammation, tapeworm) and symptoms (diarrhoea and vomiting, heart cramp, head woe, faint, stone pains, feeling of sickness). Furthermore, it comprises diet recommendations on cold water drinking, milk and cold confection of pastry, compote and buttermilk, vegetables, fruit and strawberries, fruit and frozen food, no meat, little meat and cold food. In the view of the literature, these diet principles and means as well as their applications then and now are discussed. As for those days the Priessnitz diet was quite modern, manifold, logic and 'natural'.
Wissenschaft folgt nicht festen Regeln wie Auto fahren, wo man nur die allgemeine Strasenverkehrsordnung befolgen und moglichst nuchtern und wach bleiben muss, damit man irgendwie ans Ziel kommt. Sie funktioniert auch nicht wie Klempnerei, wo man lediglich das rechte Material dabei haben muss, um mit ein bisschen Geschick und Ausbildung alles richtig zu machen. Und komplementarmedizinische Forschung ist auch nicht wie englische Klempnerei, also nur etwas schlampiger als normale, so dass sie nur richtig organisiert gehorte und alles ware in Ordnung. Nein, Wissenschaft ist ein lebendiger, organismischer Prozess. Das Subjekt der Wissenschaft sind all jene, die Forschung betreiben und Wissen publizieren. Aber was ist das Objekt? Naiverweise wurde man antworten: die Natur, das, was uns gegeben ist. Aber so einfach ist es nicht. Die Natur ist etwas, was wir Menschen dauernd verandern, herstellen, ja uns selber erst zurichten, damit wir es als Natur verstehen. Kultur – die geschaffene Wirklichkeit – und Natur – die vorgefundene Wirklichkeit – sind nicht voneinander zu trennen. Kultur fruherer Generationen wird Natur fur die kunftigen, die daraus wieder ihre eigene Kultur schaffen. So schafft sich auch Wissenschaft immer wieder selber die Wirklichkeit, die sie beforscht. Sie hat nicht nur eine abbildende Funktion, sondern ist eminent schopferisch. Aus diesem Grund ist es auch straflich naiv zu glauben, man musse nur ein guter, gesetzestreuer Fahrer im wissenschaftlichen Strasenverkehr sein, und schon ist man ein Mitspieler. Wissenschaft ist eher wie ein Strasenverkehr, in dem sich Verkehrsmittel, Verkehrsregeln, Ziel und Stil der Bewegung wahrend des Fahrens fortlaufend andern. Oder, um ein etwas organischeres Bild zu verwenden, Wissenschaft ist wie ein Tanz, bei dem die Tanzenden durch ihre Bewegung die Musik, nach der sie tanzen, mitgestalten, verandern, zu neuen Rhythmen und Melodien inspirieren und damit gleichzeitig zu Musikern werden. Wie der Tanz hat die Wissenschaft einige implizite Ordnungsund Organisationsformen, und auch diese andern sich im Laufe der Zeit. Neuankommlinge versuchen sich erst etwas zurechtzufinden, indem sie moglichst regelgetreu mithupfen und die Erfahreneren imitieren. Spater versuchen sie, auch ein bisschen den Ton anzugeben. Aber erst wenn sie richtig gut integriert sind im Gesamtkonzert, wird es ihnen gelingen, Einfluss auf die Musik zu nehmen, nach der im Moment alle tanzen. Die komplementarmedizinische Forschung ist eine solche neue Mittanzerin auf einem vergleichsweise alten Parkett. Zwar hat es in der Medizin Tradition, dass sich neue Gebiete etablieren, zum Teil unter heftigen Gefechten. Meistens aber sind die verbindenden Elemente zwischen neuen Teilgebieten und alten Disziplinen stark genug. So haben sich etwa die neuen bildgebenden Verfahren nahtlos in die etablierten Disziplinen integriert. Andere Gebiete, wie die Palliativmedizin, haben es vielleicht etwas schwerer gehabt oder kampfen immer noch um Gehor, aber die Gemeinsamkeit mit den Herkunftsdisziplinen ist immer noch groser als das Trennende. Die komplementarmedizinische Forschung ist mit radikaleren Klangen angetreten. Sie hat nicht einen neuen, langsam innerhalb der Schulmeinung wachsenden Zweig zum Bluhen gebracht und allmahlich zu einem Baum gemacht, sondern gleichsam einen vollig anderen, neuartigen Baum, der bereits gepflanzt war, ins Zentrum des Interesses gestellt. So etwas ist immer schwieriger, als lediglich organisches Wachsen zu befordern. Man verlangt den anderen nicht nur ab, dass sie etwas neu Entstehendes als eigenstandig wahrnehmen, sondern dass sie etwas ganz anderes, fur das sie bislang gar keinen Blick hatten, ernst nehmen. Es ist schon in normalen Familien nicht leicht, die langsam heranwachsenden Kinder in ihrer Selbstandigkeit zu unterstutzen und ihre oftmals anderen Meinungen, Ziele und Verhaltensweisen zu akzeptieren. Noch schwieriger ist es, Kinder, die schon mit relativ selbstandiger Personlichkeit zu einem spateren Zeitpunkt in die Familie kommen, zu integrieren.
Background: Some studies have shown beneficial effects of needle acupuncture on physical performance. Objective: To evaluate immediate effects of a standardized acupuncture treatment on vertical jumping performance. Subjects and Methods: 12 healthy sport students participated in the study. A randomized crossover design was used to investigate specific effects of real acupuncture, sham acupuncture and a no-acupuncture waiting list condition on myoelectric activity and kinematic parameters ( duration of ground contact, maximum jumping height) in one-legged drop jumps. Results: The results of the present study do not demonstrate significant treatment effects on myoelectric and kinematic parameters. However, real acupuncture tends to result in a relative decrease in the duration of ground contact accompanied by increased muscular innervation. Conclusion: Acupuncture treatment had no significant impact on muscular performance of lower leg in stretch-shortening cycle under the present conditions. As to further research, the potential efficacy of acupuncture for improving reactive strength should be investigated in terms of controlled trials with stratified randomization according to physical performance capacity.
Objective: The present paper examines the experience of establishing a center for evidence-based complementary and alternative medicine (EBCAM) practice. It examines both the difficulties and the challenges of doing research to establish EBCAM. The paper also examines the political context of the demand for evidence-based practice (EBP) for CAM. Implementation: A center for EBCAM was funded for 3 years within the Southern California Evidence-Based Practice Center by the National Center for CAM and administered by the Agency for Health Research Quality. This experience provides the basis for this paper. Results: While the experience of creating an EBM Center for CAM has shown that much work can be accomplished by applying standard methods of EBP medicine, it also highlights the weaknesses of such an agenda. Many standard research methods are simply not applicable to CAM, and even where they are, effectiveness is a much more important means of assessing CAM than simply efficacy. Researchers however, must be conscious of the political motivations behind much of the demand for EBCAM. Where such demands are coming from allopathic medicine, they clearly form a continuing part of medical opposition to CAM and may be intended to perpetuate the dominance of the biomedical paradigm in healthcare. The challenge for CAM is to recognize the limitations of EBP but not to throw the 'baby out with the bathwater'. There is much in EBP that clearly should be emulated by the CAM community but only where it is appropriate.
Background: The present study examines the efficacy of breathing and body therapy (according to the organization of breathing therapists, BVA) on bronchial asthma. This psychophysical therapy procedure has never before been studied for its efficacy on asthma, much in contrast to breathing exercises, which have been extensively examined. Patients and Methods: This uncontrolled observational study is of preliminary character. It examines the influence of psychophysical breathing and body exercises practiced in short-term intervention groups on quality of life (S-36) as well as subjective discomfort (discomfort diary) in patients with bronchial asthma. As there are no prior studies on the breathing and body therapy (BVA) method, it was hypothesized, based on experience, that it would improve ventilation, lower anxiety, and perhaps even allow for a reduction of medication. Results: An anti-obstructive effect could not be addressed here, as the study only included patients who were free of clinically relevant obstructions through conventional treatment. However, a tendency for an anxiety-relieving effect could be observed in the SF-36. Subjective reports of respiratory discomfort, obtained through assessment of the patients' diaries, did not show any tendencies or even significant changes over the course of the therapy. Conclusion: The suggested anxiety-relieving effect of breathing therapy should be examined in future studies with more patients and stricter inclusion criteria.
Objective: We aimed to investigate whether the Prognos (R) device might be a useful tool in the diagnosis of disorders suspected to be due to dental amalgam fillings. Participants and Methods: A diagnostic case-control study was performed in 27 patients who complained about health problems attributed to amalgam ( cases), 27 healthy volunteers with amalgam fillings ( controls I), and 27 healthy amalgam-free volunteers ( controls II). All participants were tested before and after application of 300 mg DMPS (2.3-dimercapto-1-propanesulfonic acid) with Prognos, a diagnostic device for the energetic measurement of Traditional Chinese Medicine meridians. In addition, mercury was measured in blood, urine, and saliva, and a lymphocyte transformation test (LTT) was performed. Results: Diagnoses derived from the first and second Prognos testing did not agree above chance (Cohen's Kappa = -0.11, 95% confidence interval -0.33 to 0.10; p = 0.30). Agreement for secondary outcome measures was poor, too. Prognos measurements did not differ between cases and controls. Correlations with measurements in urine, blood and saliva were low. Conclusion: In this study Prognos could not be shown to be a useful tool in the diagnosis of disorders suspected to be due to dental amalgam fillings.
