CHINESE HERBS TRUMP WESTERN MEDICINE?

I hate to be skeptical of the study below. Where I grew up, if you were sick, you went to the doctor but if you were really sick you went to the Chinese herbalist. So I am not prejudiced against Chinese herbalism. I once used a Chinese herbal medicine to apparent good effect myself. And the study below is a Cochrane product so deserves some respect for that.

But having said all that, the reasoning below is peculiar. We are asked to believe that something of unknown and probably quite variable composition is more therapeutically efficient and side-effect-free in the given application than any known molecule. Even if true, that does not tell us much, as far as I can see. That users of Chinese medicines exhibit a particularly strong placebo effect would be my provisional interpretation of the results below. That would also explain the low rate of side-effects. I hope I will not be abused for suggesting that menstrual discomfort (which is what was studied) could be quite susceptible to placebo effects. I could only check my interpretation by re-doing the whole Cochrane study, however.

Since the authors themselves acknowledge "the poor methodological quality of the included trials", however, I doubt that anyone needs to do that. Not much to hang your hat on there at all. Rather surprising to see it under the Cochrane aegis. Even the Cochrane project is not immune from Leftist fantasies about the wonders of non-Western cultures, it would seem. Abstract follows:


Chinese herbal medicine for primary dysmenorrhoea

By X Zhu et al.

Background: Conventional treatment for primary dysmenorrhoea (PD) has a failure rate of 20% to 25% and may be contraindicated or not tolerated by some women. Chinese herbal medicine (CHM) may be a suitable alternative.

Objectives: To determine the efficacy and safety of CHM for PD when compared with placebo, no treatment, and other treatment.

Search strategy: The Cochrane Menstrual Disorders and Subfertility Group Trials Register (to 2006), MEDLINE (1950 to January 2007), EMBASE (1980 to January 2007), CINAHL (1982 to January 2007), AMED (1985 to January 2007), CENTRAL (The Cochrane Library issue 4, 2006), China National Knowledge Infrastructure (CNKI, 1990 to January 2007), Traditional Chinese Medicine Database System (TCMDS, 1990 to Dec 2006), and the Chinese BioMedicine Database (CBM, 1990 to Dec 2006) were searched. Citation lists of included trials were also reviewed.

Selection criteria: Any randomised controlled trials (RCTs) involving CHM versus placebo, no treatment, conventional therapy, heat compression, another type of CHM, acupuncture or massage. Exclusion criteria were identifiable pelvic pathology and dysmenorrhoea resulting from the use of an intra-uterine contraceptive device (IUD).

Data collection and analysis: Quality assessment, data extraction and data translation were performed independently by two review authors. Attempts were made to contact study authors for additional information and data. Data were combined for meta-analysis using either Peto odds ratios or relative risk (RR) for dichotomous data or weighted mean difference for continuous data. A fixed-effect statistical model was used, where suitable. If data were not suitable for meta-analysis, any available data from the trial were extracted and presented as descriptive data.

Main results: Thirty-nine RCTs involving a total of 3475 women were included in the review. A number of the trials were of small sample size and poor methodological quality. Results for CHM compared to placebo were unclear as data could not be combined (3 RCTs). CHM resulted in significant improvements in pain relief (14 RCTs; RR 1.99, 95% CI 1.52 to 2.60), overall symptoms (6 RCTs; RR 2.17, 95% CI 1.73 to 2.73) and use of additional medication (2 RCTs; RR 1.58, 95% CI 1.30 to 1.93) when compared to use of pharmaceutical drugs. Self-designed CHM resulted in significant improvements in pain relief (18 RCTs; RR 2.06, 95% CI 1.80 to 2.36), overall symptoms (14 RCTs; RR 1.99, 95% CI 1.65 to 2.40) and use of additional medication (5 RCTs; RR 1.58, 95% CI 1.34 to 1.87) after up to three months follow up when compared to commonly used Chinese herbal health products. CHM also resulted in better pain relief than acupuncture (2 RCTs; RR 1.75, 95% CI 1.09 to 2.82) and heat compression (1 RCT; RR 2.08, 95% CI 2.06 to 499.18).

Authors' conclusions: The review found promising evidence supporting the use of CHM for primary dysmenorrhoea; however, results are limited by the poor methodological quality of the included trials.

Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD005288

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