Archive for October, 2009

Doubts Raised on Efficacy of Moxibustion for Breech Pregnancy

Acupuncture, News, Research | Posted by Philip
Oct 30 2009

Breech births are difficult.  Instead of the baby’s head at the bottom, ready to charge through at the proper time, it is the feet which are “presented” to the doctor.  A viewing of the movie “Red Cliff” showed Zhuge Liang (played by Takeshi Kaneshiro) successfully solve the problem of breech birth in a horse.  However, traditionally the use of moxibustion on acupoint Zhiyin (BL-67, or the 67th point of the Bladder channel).  However, a recent article <http://www.reuters.com/article/healthNews/idUSTRE59S41C20091029?pageNumber=1&virtualBrandChannel=10522> says that the “Chinese Medicine Tactic doesn’t turn breech babies”

Before I examine the article in depth, I’d like to point out how this “tactic” is supposed to work.

Using a Moxibustion "cigar"

Using a Moxibustion "cigar"

Peter Deadman describes the procedure as such:

The principal application of Zhiyin BL-67 is the treatment of malposition of the foetus, for which it is renowned.  For this purpose it is treated by stick moxibustion for fifteen to twenty minutes bilaterally, or by moxa cones (five to ten cones at each point) once or twice a day.  the woman should loosen her clothes and sit in a comfortable semi-reclining position.  It is common practice in China to demonstrate this method to the pregnant woman who is then supplied with moxa sticks for self-treatment at home.  Best results are achieved if this treatment is started in the 34th week.

That’s what Peter Deadman says in his encyclopedic work, A Manual of Acupuncture which is actually more huge textbook than manual.  Other texts describe the procedure differently:

Chinese Therapeutic Methods of Acupoints published by Hunan Science and Technology Press elaborates:

Let the patient loosen her clothing and evacuate the urine from her bladder.  She should lie supine in bed.  then, hold two moxa sticks respectively 2-3 cm bilaterally to Zhiyin (BL-47).  Ignite them for moxibustion for 15-20 minutes causing local congestion.  The treatment is given once a day.

What strikes me in this description is the need to perform moxibustion on both sides (two points, both BL-67) simultaneously.

So how did the study do it?  You know the drill by know, folks: we quote the study and critique it.

NEW YORK (Reuters Health) – A traditional Chinese therapy used for turning babies out of the breech position before birth may not be effective, a new study finds.

The study, reported in the journal Obstetrics & Gynecology, tested a tactic known as moxibustion, which uses heat to stimulate a particular acupuncture point in an effort to turn a breech fetus to the head-down position before birth.

Moxibustion is MORE than just heat.  It is also exposing the acupoint to the essential oils released when the mugwort plant (mogusa in Japanese, hence the name “moxa”) is burned.

Some research has suggested moxibustion might be effective; a trial in China, for example, found that the method increased the chances of the fetus turning to the head-down position.

However, some other studies have been unable to replicate that success, and moxibustion remains “controversial” outside of Chinese medicine, according to the researchers on the new study, led by Marie-Julia Guittier of the Geneva University Hospitals in Switzerland.

Uh… I love it when people seem to imply that only Chinese studies prove efficacy.  What about the following:

Acupuncture plus moxibustion to resolve breech presentation: a randomized controlled study.  – Neri I – J Matern Fetal Neonatal Med – 01-APR-2004; 15(4): 247-52

OBJECTIVE: In many Western countries breech presentation is an indication for elective Cesarean section. In order to correct fetal presentation, the stimulation of the acupoint BL67 by moxibustion, acupuncture or both has been proposed. Since no studies had previously been carried out on Western populations, pregnant Italian women at 33-35 weeks gestational age carrying a fetus in breech presentation were enrolled in a randomized, controlled trial involving an active BL67 point stimulation and an observation group. METHODS: A total of 240 women at 33-35 weeks of gestation carrying a fetus in breech presentation were randomized to receive active treatment (acupuncture plus moxibustion) or to be assigned to the observation group. Bilateral acupuncture plus moxibustion was applied at the BL67 acupoint (Zhiyin). The primary outcome of the study was fetal presentation at delivery. RESULTS: Fourteen cases dropped out. The final analysis was thus made on 226 cases, 114 randomized to observation and 112 to acupuncture plus moxibustion. At delivery, the proportion of cephalic version was lower in the observation group (36.7%) than in the active-treatment group (53.6 %) (p = 0.01). Hence, the proportion of Cesarean sections indicated for breech presentation was significantly lower in the treatment group than in the observation group (52.3% vs. 66.7%, p = 0.03). CONCLUSIONS: Acupuncture plus moxibustion is more effective than observation in revolving fetuses in breech presentation. Such a method appears to be a valid option for women willing to experience a natural birth.

That was not just moxibustion however: it was acupuncture AND moxibustion.

Effectiveness of acupuncture-type interventions versus expectant management to correct breech presentation: A systematic review – van der Berg et al, Complementary Therapies in Medicine Volume 16, Issue 2, April 2008, Pages 92-100 Online March 18, 2008 Accessed 30 october 2009 (http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WCS-4S0356K-1&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&_docanchor=&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=c619612fbda948f84d4d532350dfd306>

Objective

A systematic review of studies assessing the effectiveness of acupuncture-type interventions (moxibustion, acupuncture, or electro-acupuncture) on acupuncture point BL 67 to correct breech presentation compared to expectant management, based on controlled trials.

Data sources

Articles published from 1980 to May 2007 in databases of Medline, EMBASE, the Cochrane Central Register of Controlled Trials, AMED, NCCAM, Midirs and reference lists.

Study selection

Studies included were original articles; randomised controlled trials (RCT) or controlled cohort studies; acupuncture-type intervention on BL 67 compared with expectant management; ultrasound confirmed breech presentation and position of the fetus after treatment confirmed with ultrasound, position at delivery, and/or the proportion of caesarean sections reported.

Data extraction

Three reviewers independently extracted data. Disagreements were resolved by consensus.

Data synthesis

Of 65 retrieved citations, six RCT’s and three cohort studies fulfilled the inclusion criteria. Data were pooled using random-effects models. In the RCT’s the pooled proportion of breech presentations was 34% (95% CI: 20–49%) following treatment versus 66% (95% CI: 55–77%) in the control group (OR 0.25 95% CI: 0.11–0.58). The pooled proportion in the cohort studies was 15% (95% CI: 1–28%) versus 36% (95% CI: 14–58%), (OR 0.29, 95% CI: 0.19–0.43). Including all studies the pooled proportion was 28% (95% CI: 16–40%) versus 56% (95% CI: 43–70%) (OR 0.27, 95% CI: 0.15–0.46).

Conclusions

Our results suggest that acupuncture-type interventions on BL 67 are effective in correcting breech presentation compared to expectant management. Some studies were of inferior quality to others and further RCT’s of improved quality are necessary to adequately answer the research question.

Breech Pregnancies - treated by moxibustion?

Breech Pregnancies - treated by moxibustion?

Habek D, Habek J and Jagust. “Acupuncture Conversion of Fetal Breech Presentation” Fetal Diagn Ther 2003;18:418-421 (DOI: 10.1159/000073135)  Accessed 30 October 2009<http://content.karger.com/ProdukteDB/produkte.asp?Doi=73135>

Abstract

Aim: The aim of this study was to assess the value of acupuncture (AP) in the conversion of fetal breech presentation into vertex presentation. Patients and Methods: A randomized prospective controlled clinical study included 67 pregnant women with fetal breech presentation: 34 women with singleton pregnancies treated with manual AP (urinary bladder 67, Zhiyin) and a control group which included 33 women with singleton pregnancies without AP treatment. The AP treatment lasted 30 min a day, and was conducted during and after 34 weeks of pregnancy with simultaneous cardiotocography. Results: The success rate of the AP correction of fetal breech presentation is 76.4% (26 women), and spontaneous conversion without AP in vertex presentation is observed in 15 women (45.4%; p < 0.001). Conclusions: We believe that AP correction of fetal malpresentation is a relatively simple, efficacious and inexpensive method associated with a lower percentage of operatively completed deliveries, which definitely reflects in improved parameters of vital and perinatal statistics.

So… a study in Croatia suggests that not only is it effective, but that it improves fetal health as well.

But anyway back to our article of the day:

For their study, the researchers followed 212 women who had a fetus in the breech position between the 34th and 36th week of pregnancy.

Half of the women were randomly assigned to have moxibustion therapy; a midwife trained in acupuncture performed it three times weekly in the hospital, and the women were encouraged to do it at home on all other days. The rest of the women received no therapy and served as control group.

All study participants, however, had the option of undergoing an ECV at the 37th week of pregnancy.

In the end, Guittier’s team found, 18 percent of fetuses in the moxibustion group had turned to the head-down position by the time of delivery or a scheduled ECV. In the control group, 16 percent of fetuses had spontaneously turned — a difference that was not statistically significant.

I am very much looking forward to obtaining a copy of this study because I want to see the following answered:

a) what BRAND of moxibustion was used? (some brands are great, some suck big time… like comparing cheap china watches to rolexes)

b) how COMPLIANT were the mothers-to-be in terms of using the moxa at home?

c) what MANIPULATION was used? You don’t just wave the stick at the toe, there are various techniques to it.

Also, the study was done with MIDWIVES TRAINED IN ACUPUNCTURE.  Note, MIDWIVES TRAINED IN ACUPUNCTURE.  Not fully trained acupuncturists.  Maybe they think this is simple enough, waving weed on a toe.

“To say the least, moxibustion was not as effective as suggested in (the) earlier trial that was conducted in China,” co-researcher Dr. Michel Boulvain, also with the Geneva University Hospitals, told Reuters Health in an email. The reasons for the differences in the trials, he added, are unclear.

Yes, the study says it was not as effective as the earlier trial conducted in China AND the one in Italy AND the one in Croatia AND the one… etc.

It’s also unclear whether moxibustion has any physiological effects that would help turn a breech fetus.

Boulvain said that some researchers have reported increases in fetal movement during moxibustion sessions, which in theory could be beneficial. But he added that there are no known reasons, based on “traditional physiology,” for why moxibustion would work in this context.

Based on the existing evidence, Boulvain said, “the decision in our hospital is to not implement or recommend moxibustion for these women.

I agree, conventional physiology cannot explain acupuncture 100%, which is why I cringe when some MDs try to force acupuncture to fit into western concepts.  Acupuncture and Moxibustion developed using CHINESE philosophy, CHINESE experience and CHINESE vocabulary.

And he has the guts to say “based on the existing evidence…” Well based on YOUR evidence maybe, not based on the kaboodles of others, “…the decision in our hospital is not to implement or recommend moxibustion for these women.” I agree, especially if the treatment is not done by professionals.

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HPV Vaccine Near-Useless: Diane Harper

News, Western Medicine | Posted by Philip
Oct 30 2009

Diane Harper is THE leading researcher in the development of cervical cancer “vaccines”.  In a recent conference she had this to say, and I quote from this article <http://thebulletin.us/articles/2009/10/25/top_stories/doc4ae4b76d07e16766677720.txt>

Dr. Diane Harper, lead researcher in the development of two human papilloma virus vaccines, Gardasil and Cervarix, said the controversial drugs will do little to reduce cervical cancer rates and, even though they’re being recommended for girls as young as nine, there have been no efficacy trials in children under the age of 15.

Dr. Harper, director of the Gynecologic Cancer Prevention Research Group at the University of Missouri, made these remarks during an address at the 4th International Public Conference on Vaccination which took place in Reston, Virginia on Oct. 2-4. Although her talk was intended to promote the vaccine, participants said they came away convinced the vaccine should not be received.

“I came away from the talk with the perception that the risk of adverse side effects is so much greater than the risk of cervical cancer, I couldn’t help but question why we need the vaccine at all,” said Joan Robinson, Assistant Editor at the Population Research Institute.

So it boils down to risk assessment!

Dr. Harper began her remarks by explaining that 70 percent of all HPV infections resolve themselves without treatment within a year. Within two years, the number climbs to 90 percent. Of the remaining 10 percent of HPV infections, only half will develop into cervical cancer, which leaves little need for the vaccine.

She went on to surprise the audience by stating that the incidence of cervical cancer in the U.S. is already so low that “even if we get the vaccine and continue PAP screening, we will not lower the rate of cervical cancer in the US.”

There will be no decrease in cervical cancer until at least 70 percent of the population is vaccinated, and even then, the decrease will be minimal.

Those are very strong words, Diane!

Apparently, conventional treatment and preventative measures are already cutting the cervical cancer rate by four percent a year. At this rate, in 60 years, there will be a 91.4 percent decline just with current treatment. Even if 70 percent of women get the shot and required boosters over the same time period, which is highly unlikely, Harper says Gardasil still could not claim to do as much as traditional care is already doing.

Dr. Harper, who also serves as a consultant to the World Health Organization, further undercut the case for mass vaccination by saying that “four out of five women with cervical cancer are in developing countries.”

Would that mean that an increase in hygenic practices and/or better diet would be better than an untested vaccine?  Also, even in developing countries, only those who live in first world conditions can afford the expensive vaccine… so what’s the point?

Dr. Diane Harper

Dr. Diane Harper

Ms. Robinson said she could not help but wonder, “If this is the case, then why vaccinate at all? But from the murmurs of the doctors in the audience, it was apparent that the same thought was occurring to them.”

However, at this point, Dr. Harper dropped an even bigger bombshell on the audience when she announced that, “There have been no efficacy trials in girls under 15 years.”

Merck, the manufacturer of Gardasil, studied only a small group of girls under 16 who had been vaccinated, but did not follow them long enough to conclude sufficient presence of effective HPV antibodies.

This is not the first time Dr. Harper revealed the fact that Merck never tested Gardasil for safety in young girls. During a 2007 interview with KPC News.com, she said giving the vaccine to girls as young as 11 years-old “is a great big public health experiment.”

At the time, which was at the height of Merck’s controversial drive to have the vaccine mandated in schools, Dr. Harper remained steadfastly opposed to the idea and said she had been trying for months to convince major television and print media about her concerns, “but no one will print it.”

“It is silly to mandate vaccination of 11 to 12 year old girls,” she said at the time. “There also is not enough evidence gathered on side effects to know that safety is not an issue.”

When asked why she was speaking out, she said: “I want to be able to sleep with myself when I go to bed at night.”

Since the drug’s introduction in 2006, the public has been learning many of these facts the hard way. To date, 15,037 girls have officially reported adverse side effects from Gardasil to the Vaccine Adverse Event Reporting System (VAERS). These adverse reactions include Guilliane Barre, lupus, seizures, paralysis, blood clots, brain inflammation and many others. The CDC acknowledges that there have been 44 reported deaths.

Hmmm, in my very first blog article (http://qi-spot.com/2009/10/03/british-girl-dies-after-cervical-cancer-jab/) it was said that there were 32 deaths.  Now there are 44?


Dr. Harper also participated in the research on Glaxo-Smith-Kline’s version of the drug, Cervarix, currently in use in the UK but not yet approved here. Since the government began administering the vaccine to school-aged girls last year, more than 2,000 patients reported some kind of adverse reaction including nausea, dizziness, blurred vision, convulsions, seizures and hyperventilation. Several reported multiple reactions, with 4,602 suspected side-effects recorded in total. The most tragic case involved a 14 year-old girl who dropped dead in the corridor of her school an hour after receiving the vaccination.

The outspoken researcher also weighed in last month on a report published in the Journal of the American Medical Association that raised questions about the safety of the vaccine, saying bluntly: “The rate of serious adverse events is greater than the incidence rate of cervical cancer.”

Ms. Robinson said she respects Dr. Harper’s candor. “I think she’s a scientist, a researcher, and she’s genuine enough a scientist to be open about the risks. I respect that in her.”

However, she failed to make the case for Gardasil. “For me, it was hard to resist the conclusion that Gardasil does almost nothing for the health of American women.”

Again, nothing that we Chinese docs don’t already know – taking care of your own health is priority! Vaccines can work and I would recommend them if properly tested and not politically or profit motivated.

Dr. Harper’s photo from colleenhammond.com.

Source Article:

Brinkman, Susan.  “Gardasil Researcher Drops a Bombshell” The Bulletin.  25 October 2009.  Retrieved 31 October 2009. <http://thebulletin.us/articles/2009/10/25/top_stories/doc4ae4b76d07e16766677720.txt>

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More Evidence for Red Yeast Rice!

Dietary Therapy, Herbal Medicine, News, Research | Posted by Philip
Oct 29 2009

Three days ago, I wrote an article about red yeast rice and it’s popular derivative drug Xue Zhi Kang. <http://qi-spot.com/2009/10/27/red-yeast-rice-for-cholesterol-fermented-fun/>.  Now, Medscape has put online a study about it.  Here it is with the usual highlights and commentary:

Red Yeast Rice and Hyperlipidemia: How Strong Is the Evidence?

3-Hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors, or statins, have proven to be effective in reducing lipid levels and improving the risk for cardiovascular disease. However, many patients may not tolerate statins over time, partly due to statin-associated myopathy. Does red yeast rice present a valid alternative treatment for patients with this adverse event? The randomized trial discussed in this review examined the efficacy, safety, and tolerability of red yeast rice among a cohort of patients with a history of statin-associated myopathy.

The significant benefits of statins are hard to refute. These are being reported even among patients at a low risk for cardiovascular disease. For example, in a 2009 study, within 12 months of the initiation of treatment, rosuvastatin was associated with significant regression of carotid intima-media thickness — a strong surrogate marker for cardiovascular events.[1] Moreover, statin treatment among low-risk patients is associated with a reduction in the risk for cardiovascular events. The Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS) examined treatment with lovastatin vs placebo among patients without a history of cardiovascular events.[2] Researchers found that lovastatin reduced the risk for first coronary heart disease events by nearly half over an average follow-up time of 5.2 years. This included a 40% reduction in the risk for myocardial infarction. There was also no significant difference in the rate of severe adverse events when comparing the lovastatin and placebo groups.

In English:  Statins work.  Statins also harm muscles sometimes.  Can Red Yest Rice work for those who can’t take statins?

Sigh, gotta love it.  The question is not “can we use herbal medicine/diet instead of statins” but “can we use them when patient’s can’t tolerate statins”.

The next few paragraphs deal with explaining the very rare side effects of statins.  We’ll leave it to the curious reader to follow the link later on.  Now we focus on red yeast rice!

One strategy in the management of patients with statin-associated myopathy could involve the use of red yeast rice, the fermented product of the yeast species Monascus purpureus grown on rice. It has been used for medicinal and nonmedicinal purposes in China since 900 A.D., and it is promoted there as a means to improve circulation. Red yeast rice contains several compounds collectively known as monacolins, one of which is monacolin K, a powerful HMG-CoA reductase inhibitor and the same chemical as lovastatin. Because of this, red yeast rice has received increased attention in Western countries as a means to treat hyperlipidemia, and there is good research to support its efficacy. In one placebo-controlled trial of 83 individuals with hyperlipidemia, red yeast rice was associated with mean reductions in the concentrations of total and LDL cholesterol of 18% and 22%, respectively, over 12 weeks of treatment.[7] Red yeast rice also reduced serum triglyceride levels by 7% but did not significantly alter high-density lipoprotein (HDL) cholesterol levels. In another placebo-controlled trial, red yeast rice reduced total and LDL cholesterol levels by 27.7% and 21.5%, respectively, and red yeast rice decreased apolipoprotein B levels by 26%.[8]

In English, again – Red Yeast rice was proven to reduce bad cholesterol but not good cholesterol!

To help determine whether red yeast rice may be useful among patients with hyperlipidemia who do not tolerate a statin, the study under discussion in this review compared red yeast rice and placebo among patients with statin-associated myopathy. Patients from one cardiology practice in the United States were eligible for study participation if they were between 21 and 80 years old and had discontinued a statin because of myalgia. Participants’ LDL cholesterol levels were between 100 and 210 mg/dL at baseline, and patients with a serum triglyceride level of 400 mg/dL or more were excluded from study participation, as were those with a history of coronary heart disease.

Sixty-two patients underwent randomization to treatment with 3 red yeast rice 600-mg capsules twice daily, or matching placebo capsules with the same dosing schedule. The treatment period was 24 weeks. All study participants had previously been enrolled in a 12-week trial of lifestyle counseling to prevent cardiovascular disease. The mean age of the participants was 61 years, and 65% of the participants were women. The mean patient weight at baseline was 81 kg. The 2 groups were similar at baseline, except for a slightly higher mean pain score in the placebo cohort.

The main study outcome was LDL cholesterol level, as measured at baseline, week 12, and week 24. The mean values in the placebo group were 165 mg/dL, 154 mg/dL, and 149.8 mg/dL at baseline, week 12, and week 24. The respective levels of LDL cholesterol in the red yeast rice group were significantly better during the active trial period (163 mg/dL, 120 mg/dL, and 128 mg/dL, respectively). This represented a decrease in the baseline LDL cholesterol level of -27.3% at 12 weeks and -21.3% at 24 weeks in the red yeast rice group. Total cholesterol levels were also improved in the red yeast rice vs placebo groups, but there was no treatment difference in HDL cholesterol or triglyceride levels.

Researchers also examined other lipid values and patient weight, as well as specific surveys for bodily pain and laboratory assessments of creatine phosphokinase levels and liver-associated enzymes. There was no significant difference between the red yeast rice and placebo groups in the rate of adverse events and bodily pain, even when the researchers performed a subgroup analysis that was based on the number of statins that patients had previously tried. Four patients discontinued treatment in the red yeast rice group, compared with 1 patient in the placebo group. Creatine phosphokinase and liver-associated enzyme levels remained similar between the groups. Both treatment groups experienced a weight loss of approximately 3.5 kg from baseline.

Again in English: Red Yeast rice caused “bad cholesterol” to go down.  It did not cause any significant difference in both body pain (known statin side effect) and liver and kidney problems between the two groups.

And for their conclusion!

The collective research suggests that red yeast rice is effective and safe in improving the lipid profile among patients with hyperlipidemia. Some research even has suggested that red yeast rice, along with other nonprescription treatment, may be as or more effective than a statin. Becker and colleagues compared treatment with simvastatin 40 mg daily vs combination therapy consisting of enrollment in an intensive lifestyle intervention, fish oil supplementation, and red yeast rice supplementation.[9] The reduction in LDL cholesterol was approximately 40% in both treatment groups, and patients receiving the combination treatment experienced a greater reduction in body weight and serum triglycerides. Although these results are impressive, it is unclear which of the nonstatin interventions was most effective in improving study outcomes.

Red yeast rice does not have the impressive track record of statins in terms of the prevention of cardiovascular events. However, a trial of 5000 individuals with a history of previous myocardial infarction demonstrated that red yeast rice reduced the risk for nonfatal myocardial infarction by 62% and coronary disease mortality by 31% compared with placebo.[10] Red yeast rice also reduced overall mortality by one third compared with placebo.

More research is required with regard to the clinical outcomes of red yeast rice before this treatment can be recommended as an alternative to statins to treatment-naive patients with hyperlipidemia. Concerns about red yeast rice toxicity have been based on monacolin K, the natural lovastatin. Myopathy and rhabdomyolysis,[11,12] similar to that seen with lovastatin, have been reported in case reports. Hepatotoxicity is the main concern, with reports on red yeast rice’s effects on the liver being variable. Some studies have shown theoretical potential for hepatic damage,[13,14] and others have reported no harm in humans.[15] In some animal studies (rats and mice), high doses were tolerated without liver toxicity.[16-18] Because of this finding, statins themselves and any agents that interact with statins should be avoided by those taking red yeast rice.

There are also common questions associated with any complementary and alternative therapy about standardization of the preparation and reimbursement for long-term treatment. However, among special cohorts of patients, particularly those with statin-associated myopathy, red yeast rice appears to be a viable alternative treatment. Physicians should weigh the potential risks and benefits of statins vs alternative treatments for individual patients on the basis of their history of treatment and cardiovascular risk.

Charles P. Vega, MD “Red Yeast Rice and Hyperlipidemia: How Strong Is the Evidence?”  http://www.medscape.com Published: 10/28/2009, Retrieved 10/29/09<http://www.medscape.com/viewarticle/711114>

Vega cites the following as references:

1.  Bots ML, Palmer MK, Dogan S, et al; METEOR Study Group. Intensive lipid lowering may reduce progression of carotid atherosclerosis within 12 months of the treatment: the METEOR study. J Intern Med. 2009;265:698-707.
2. Downs JR, Clearfield M, Weis S, et al. Primary prevention of acute coronary events with lovastatin in men and women with average cholesterol levels: results of AFCAPS/TexCAPS. Air Force/Texas Coronary Atherosclerosis Prevention Study. JAMA. 1998;279:1615-1622.
3. Law M, Rudnicka AR. Statin safety: a systematic review. Am J Cardiol. 2006;97:52C-60C.
4. Hansen KE, Hildebrand JP, Ferguson EE, Stein JH. Outcomes in 45 patients with statin-associated myopathy. Arch Intern Med. 2005;165:2671-2676.
5. Avorn J, Monette J, Lacour A, et al. Persistence of use of lipid-lowering medications: a cross-national study. JAMA. 1998;279:1458-1462.
6. Young JM, Florkowski CM, Molyneux SL, et al. Effect of coenzyme Q10 supplementation on simvastatin-induced myalgia. Am J Cardiol. 2007;100:1400-1403.
7. Heber D, Yip I, Ashley JM, Elashoff DA, Elashoff RM, Go VL. Cholesterol-lowering effects of a proprietary Chinese red-yeast-rice dietary supplement. Am J Clin Nutr. 1999;69:231-236.
8. Lin CC, Li TC, Lai MM. Efficacy and safety of Monascus purpureus Went rice in subjects with hyperlipidemia. Eur J Endocrinol. 2005;153:679-686.
9. Becker DJ, Gordon RY, Morris PB, et al. Simvastatin vs. therapeutic lifestyle changes and supplements: randomized primary prevention trial. Mayo Clin Proc. 2008;83:758-764.
10. Lu Z, Kou W, Du B, et al; Chinese Coronary Secondary Prevention Study Group. Effect of Xuezhikang, an extract from red yeast rice, on coronary events in a Chinese population with previous myocardial infarction. Am J Cardiol. 2008;101:1689-1693.
11. Smith DJ, Olive KE. Chinese red rice-induced myopathy. South Med J. 2003;96:1265-1267.
12. Rhabdomyolysis linked to Chinese red yeast rice. Prescrire Int. 2008;17:64.
13. Lu ZL, Xu S, Kou WR. The clinical observation of treatment of hyperlipidemia with different dose of Xuezhikang. National Symposium of Clinical Therapies for Cardiovascular Diseases. 1995;1997:53-57.
14. Wang J, Lu Z, Chi J, et al. Multicenter clinical trial of the serum lipid-lowering effects of a Monascus purpureus (red yeast) rice preparation from traditional Chinese medicine. Curr Ther Res. 1997;58:964-978.
15. Kantola T, Kivisto KT, Neuvonen PJ. Grapefruit juice greatly increases serum concentrations of lovastatin and lovastatin acid. Clin Pharmacol Ther. 1998;63:397-402.
16. Changling L, Yafang L, Zhonglin H. Toxicity study for Monascus purpureus (red yeast) extract [abstract]. Chin Pharmacol Soc. 1995;12:12.
17. Li C, Li Y, Hou Z, et al. Experimental studies on toxicology of Xuezhikang. Commun Chin Pharmacol Soc. 1995;12:12.
18. Blanc PJ, Laussac JP, Le Bars J, et al. Characterization of monascidin A from Monascus as citrinin. Int J Food Microbiol. 1995;27:201-213.

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Insomnia: Chinese Medicine Better than Counting Sheep

News | Posted by Philip
Oct 29 2009

Okay, I meant that as a joke.  What isn’t a joke is that so many people have sleep problems and are reliant on western drugs that sometimes counting sheep is the only apparent alternative option.  Just today, after our weekly conference at the University of the Philippines College of Medicine Dept. of Family and Community Medicine, a colleague asked me to treat her with acupuncture for her jet lag.

How fitting, it seems, that I then stumble on this news article a few hours later:

Traditional Chinese Medicine Effectively Treats Insomnia <http://www.naturalnews.com/027348_medicine_insomnia_Chinese.html>

Melissa Sokulski starts:

Acupuncture, which actually treats the person, not the disease, helps to balance the body’s energy, strengthening weak areas and moving energy where it’s stuck…

Insomnia can have many causes; figuring out the cause is an important part of diagnosis and treatment. For instance, pain can cause insomnia because the person is not able to get into a comfortable position for sleeping and the pain wakes them up. In that case acupuncturists treat the pain.

Okay, “balancing body energy” isn’t exactly accurate, but it’s not that far off either.  What she did hit right on the point (pun intended) was the importance of treating the CAUSE and not just the symptom.  Of course, for western medicine, cause means “what biological agent is missing or excessive” whereas for us cause means “what’s causing the imbalance” whether internal or external…

Is Counting Sheep the Gold Standard for Insomnia?

Is Counting Sheep the Gold Standard for Insomnia?

The rest of the article is so good I’ll just reprint it here, but it ends with some points and formulas that can be used and I discourage people from taking these over the counter – it is still best to be evaluated by a professional:

Eating late at night is a common cause of insomnia. When people stop eating after 7 pm, sleep often comes much more easily and is more peaceful. According to the Chinese Clock, digestion is the strongest in the morning, between 7 am and 9 am for the Stomach, and 9 am to 11 am for the Spleen/Pancreas. Twelve hours later (7 pm to 11 pm) digestion is the weakest, and eating at this time will cause gas, bloating and indigestion, making it difficult for one to fall asleep easily. Other causes of insomnia according to Traditional Chinese Medicine are yin deficiency, an imbalance of yin and yang, heart imbalance, spleen deficiency and stagnant liver qi.

In my practice, Spleen Deficiency is the most common cause of insomnia.  It leads to decreased production of Blood and thus, the Mind has no place to rest.  Thus, sleep is inefficient.  EVERYONE these days seemingly has some form of liver qi stagnation.  I believe it affects sleep by affecting Blood as well.  (In TCM, the Liver stores Blood.)

Acupuncturists take a detailed history, which includes questioning, pulse analysis and tongue diagnosis, to give a complete picture of the patient as a whole. Even if it is determined that two different patients have insomnia as a result of yin deficiency, their treatments may still be different, depending on each person’s constitution (strength and type of overall body and health) and other factors.

This is what makes acupuncture so individualized and effective: there is no one prescription for a condition. Each time a patient comes in, they are re-evaluated, and each treatment is specifically selected. This is also why it is so common to see all sorts of symptoms clear up – not just the one someone has come in to treat. Rarely do acupuncturists just work on one symptom alone; in every treatment, the whole person is being addressed and treated.

Again, an emphasis is put on customized treatment for an individual person.  Sure, by picking points and formulas symptomatically, you can treat symptoms.  But that is not the same as effecting a long term solution.  It does sound weird, though when I question an insomniac lady about her menses and poo-poo in great detail…

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Red Yeast Rice for Cholesterol: Fermented Fun!

Dietary Therapy, Herbal Medicine, News, Research | Posted by Philip
Oct 27 2009

The latest “food fad” for health – at least in the media – is fermented red rice.  Known as hong qu mi (what else? red yeast rice), this popular oriental garnish was featured in an article (http://featuresblogs.chicagotribune.com/features_julieshealthclub/2009/10/red-yeast-rice-for-high-cholesterol.html) for (as you can read in the link) high cholesterol.

When Chicago’s Adele Simmons discovered she had high cholesterol and a blocked artery, she chose a drug-free treatment approach that included red yeast rice, the product of yeast grown on white rice.

The powdery yeast-rice mixture, a dietary stable in many parts of Asia that’s used in traditional Chinese medicine, contains monacolin K, the same ingredient as in the prescription cholesterol drug lovastatin (Mevacor).

But while red yeast rice is available over the counter, don’t take it unless you’re under the care of a physician, said Simmons’ doctor, preventive cardiologist Steve Devries, who is on staff at Northwestern Memorial Hospital.

The drug-like supplement can have side effects (though they’re less likely than with prescription statins) and patients need blood tests to monitor safety.

In fact, Devries said that red yeast rice is a good cholesterol-lowering option in only two situations: “in those who are absolutely philosophically opposed to taking a prescription statin, or in those who have tried to take prescription statins but cannot tolerate them.”

Other key points to remember:

Don’t take red yeast rice when you’re pregnant.The same is true for any prescription statin.

Brands vary by dosage and purity. Devries recommends a specific brand that has been tested by an independent lab and asks patients to use only this brand.

Red yeast is only one option. “Prescription statins are an excellent choice for those in need of cholesterol lowering when lifestyle changes have been tried and found to be inadequate to achieve the desired cholesterol result,” Devries said.

Red Yeast Rice

Red Yeast Rice

Now before I go on to cite other studies I’d like to point out that I believe that the process of fermentation does a lot in terms of preserving what I call “digestive energy.”  This is my personal term for Spleen Qi, which in Chinese medicine is in charge of digestion.  (Hmmm, perhaps another time I’ll talk about the Spleen and western pancreas…)

The thing about Chinese dietary theory is that you can’t just eat anything you want.  Well, you can if your Spleen Qi is as strong as a bull on steroids – but you’ll still wear it down.  The key to maintaining long term health is to make things easier on the Spleen.  This is why raw foods is a no-no in oriental medicine because it takes more fuel to light the fire to burn it down (or is the proper term burn it up?)

Hmmm, another future article idea – Spleen health.

Anyway fermentation is seen as a precursor to digestion.  In fact, the classical chinese words for digestion can be literally translated as “rotting” and “ripening”.  Of course, that doesn’t mean that you should go ahead and ferment everything you eat – Chinese medicine never encourages excessive consumption of one type of flavor or taste.  Variety is the spice of life, as the old saying goes.

So what we have here is a fermented foodstuff, making it easier to digest food, and thus, maintaining Spleen Qi.  I think.

But on to the modern studies.  There is a prepared Chinese medicine made from Red Yeast Rice, known as Xue Zhi Kang:

Xue Zhi Kang

Xue Zhi Kang

Derived from red yeast rice, Xue Zhi Kang has been the subject of many a study.  Here are some sample excerpts:

Liu ZG and Yu XY. “Effects of Xuezhikang capsule on blood lipids, platelet activation and coagulation-fibrinolysis activity in patients with hyperlipidemia” Chinese Journal of Integrative Medicine Volume 10, Number 4 / December, 2004 pp. 259-262. 27 October 2009 <http://www.springerlink.com/content/d474443332748t6v/>

Abstract    Objective: To investigate the effects of Xuezhikang capsule (XZK) on blood lipids level, platelet activation and coagulation-fibrinolysis activity in patients with hyerlipidemia.Methods: Seventy-six patients of hyperlipidemia were randomly divided into two groups, the XZK group (n = 38) treated with XZK 600mg, taken two times per day and the Simvastatin (SIM) group (n = 38) treated with SIM 20mg per day, with the treatment lasting 8 weeks for both groups. Levels of fasting serum lipids, including total cholesterol (TC), triglyceride (TG), high and low density lipoprotein cholesterol (HDL-C and LDL-C), plasma GMP-140, fibrinogen (FIB), tissue plasminogen activator (t-PA), plasminogen activator inhibitor type-1 (PAI-) and prothrombin time (PT) were all measured before and 8 weeks after treatment. Data were compared before and after treatment and also compared with those measured in 20 healthy subjects of control.Results: Before treantment the levels of TC, TG and LDL-C were obviously higher and HDL-C level was significantly lower in hyperlipidemia patients than those in healthy subjects (P<0.05 orP<0.01). After 4–8 weeks of XZK treatment, the levels of TC, TG, LDL-C and FIB and activities of GMP-140 and PAI-1 were obviously lowered (P<0.05 orP<0.01). But in the SIM group there was no obvious change in FIB (P>0.05), instead it showed obvious increase of HDL-C and decrease of TC and LDL-C after treatment (P<0.05 orP<0.01).Conclusion: XZK could inhibit platelet activity and improve coagulation-fibrinolysis function, besides its lipids lowering effect. (emphasis mine)

This shows that Xuezhikang works by preventing formation of atherosclerotic plaques, as also seen in this study published in the American Journal of Cardiology:

Lu et al. “Effect of Xuezhikang, an extract from red yeast Chinese rice, on coronary events in a Chinese population with previous myocardial infarction.” Am J Cardiol. 2008 Jun 15;101(12):1689-93. Epub 2008 Apr 11.  accessed 27 October 2009 (http://www.ncbi.nlm.nih.gov/pubmed/18549841)

Results of well-controlled prospective clinical trials showed the efficacy of lipid-lowering therapies in the reduction of cardiovascular (CV) events in western populations, but they were not reported with a Chinese population. This multicenter study was conducted to determine the effects of Xuezhikang (XZK), a partially purified extract of red yeast rice, on lipoprotein and CV end points in Chinese patients who experienced a previous myocardial infarction. Nearly 5,000 of these patients with average low-density lipoprotein cholesterol levels at baseline were randomly assigned either to placebo or to XZK daily for an average of 4.5 years. The primary end point was a major coronary event that included nonfatal myocardial infarction and death from coronary heart disease. Frequencies of the primary end point were 10.4% in the placebo group and 5.7% in the XZK-treated group, with absolute and relative decreases of 4.7% and 45%, respectively. Treatment with XZK also significantly decreased CV and total mortality by 30% and 33%, the need for coronary revascularization by 1/3, and lowered total and low-density lipoprotein cholesterol and triglycerides, but raised high-density lipoprotein cholesterol levels. In conclusion, long-term therapy with XZK significantly decreased the recurrence of coronary events and the occurrence of new CV events and deaths, improved lipoprotein regulation, and was safe and well tolerated. (emphasis mine)

Some news articles report similar side effects as statins.  This makes me wonder if there are any differences in side effect profile if taken in raw form as opposed to processed with alcohol into pill form.

Sources:

Deardorff, Julie.  “Red yeast rice: A natural approach to high cholesterol” Chicago Tribune.  26 October 2009.  Accessed 27 October 2009 <http://featuresblogs.chicagotribune.com/features_julieshealthclub/2009/10/red-yeast-rice-for-high-cholesterol.html>

Liu ZG and Yu XY. “Effects of Xuezhikang capsule on blood lipids, platelet activation and coagulation-fibrinolysis activity in patients with hyperlipidemia” Chinese Journal of Integrative MedicineVolume 10, Number 4 / December, 2004 pp. 259-262. 27 October 2009 < http://www.springerlink.com/content/d474443332748t6v/>

Lu et al. “Effect of Xuezhikang, an extract from red yeast Chinese rice, on coronary events in a Chinese population with previous myocardial infarction.” Am J Cardiol. 2008 Jun 15;101(12):1689-93. Epub 2008 Apr 11.  accessed 27 October 2009 (http://www.ncbi.nlm.nih.gov/pubmed/18549841)

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