Tuesday, June 20, 2006

Alternative Medicine - Homeopathy

The founder and developer of homeopathy was Samuel Hahnemann, (1755-1843). He was a German physician and some of his concepts seem to appear early in medical history. He developed homeopathy after becoming dissatisfied with the medicine of the time. Treatments at that time included bleeding, purging, cupping and excessive doses of mercury. He stopped practicing medicine in about 1782 and began to seriously question the mechanisms his cohorts were using.

He viewed disease as a matter of vital force or spirit. One of the earliest speculations of recorded medical history is the concept of the vital spirit and similar forces form the probable basis for any number of metaphysical health practices. It was thought to be a nonmaterial "force" that maintains life and for which there is no objective evidence. "The cause of our maladies cannot be material, since the least foreign material substance, however mild it may appear to us, if introduced into our blood-vessels, is promptly ejected by the vital force, as though it were a poison. no disease, in a word, is caused by any material substance, but that every one is only and always a peculiar, virtual, dynamic derangement of the health", according to Hahnemann.

Paying attention to the symptoms rather than to the external causes of a disease is believed to be more important. If one knew the specific symptoms of an illness, then all one had to do was find a substance or substances that induced the same symptoms in a healthy individual. This is referred to as, "Hahnemann's Principle of Similars". At one time there were experiments that supported this notion, such as the work of Pasteur and Koch on inoculations, where very tiny amounts of weakened disease-causing microbes were used.

To test this notion Hahnemann and his followers tested the effects of almost 100 substances on themselves. This is a process known as "proving". The usual procedure was for a healthy person to ingest a small amount of a particular substance and then attempt to cautiously note any type of reaction or symptom which included emotional or mental reactions that might occur. By using this method, he "proved" that some substances were effective for treatment for a particular symptom. In one controlled study, healthy people reported similar symptoms whether given a homeopathic dilution of belladonna or a placebo.

Hahnemann believed that homeopathic remedies must be right for each individual person and prescribed them according to body type and personalities, which was based on the ancient humoral theories of Galen. The theories stated that there were four body types and personalities, based on which body "humor" predominated: blood (sanguine, warm-hearted and volatile,) black bile (melancholic, sad), yellow bile (choleric, quick to anger and to action) and phlegm (phlegmatic, sluggish and apathetic). He also said there were a few corresponding primary causes of acute and chronic illnesses, which he called "miasms". The first miasm is known as "psora" (itch) refers to a general susceptibility to disease and may be considered the source of all chronic diseases. The other two miasms are venereal diseases syphilis and sycosis (gonorrhea). These three conditions were thought to be the causes of at least 80 percent of all chronic diseases.

One good thing most definitely did come from homeopathy and that was an end to some of the ridiculous treatments. Some of the treatments were more dangerous than the diseases. Homeopathy may have helped speed the demise of such treatments and it provided the ideas and source for more useful drugs and treatments. Some early scientists stated that homeopathy led them to important pharmacological discoveries.

Michael Russell Your Independent Alternative guide.

Sunday, October 02, 2005

What Is Complementary and Alternative Medicine (CAM)?

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What Is Complementary and Alternative Medicine (CAM)?


What is complementary and alternative medicine?
Are complementary medicine and alternative medicine different from each other?
What is integrative medicine?
What are the major types of complementary and alternative medicine?
What is NCCAM's role in the field of CAM?
Definitions
For More Information
There are many terms used to describe approaches to health care that are outside the realm of conventional medicine as practiced in the United States. This fact sheet explains how the National Center for Complementary and Alternative Medicine (NCCAM), a component of the National Institutes of Health, defines some of the key terms used in the field of complementary and alternative medicine (CAM). Terms that are underlined in the text are defined at the end of this fact sheet.

What is complementary and alternative medicine?
Complementary and alternative medicine, as defined by NCCAM, is a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine.1,2 While some scientific evidence exists regarding some CAM therapies, for most there are key questions that are yet to be answered through well-designed scientific studies--questions such as whether these therapies are safe and whether they work for the diseases or medical conditions for which they are used.

The list of what is considered to be CAM changes continually, as those therapies that are proven to be safe and effective become adopted into conventional health care and as new approaches to health care emerge.



Are complementary medicine and alternative medicine different from each other?
Yes, they are different.

Complementary medicine is used together with conventional medicine. An example of a complementary therapy is using aromatherapy to help lessen a patient's discomfort following surgery.


Alternative medicine is used in place of conventional medicine. An example of an alternative therapy is using a special diet to treat cancer instead of undergoing surgery, radiation, or chemotherapy that has been recommended by a conventional doctor.


What is integrative medicine?
Integrative medicine, as defined by NCCAM, combines mainstream medical therapies and CAM therapies for which there is some high-quality scientific evidence of safety and effectiveness.


What are the major types of complementary and alternative medicine?
NCCAM classifies CAM therapies into five categories, or domains:

1. Alternative Medical Systems

Alternative medical systems are built upon complete systems of theory and practice. Often, these systems have evolved apart from and earlier than the conventional medical approach used in the United States. Examples of alternative medical systems that have developed in Western cultures include homeopathic medicine and naturopathic medicine. Examples of systems that have developed in non-Western cultures include traditional Chinese medicine and Ayurveda.

2. Mind-Body Interventions

Mind-body medicine uses a variety of techniques designed to enhance the mind's capacity to affect bodily function and symptoms. Some techniques that were considered CAM in the past have become mainstream (for example, patient support groups and cognitive-behavioral therapy). Other mind-body techniques are still considered CAM, including meditation, prayer, mental healing, and therapies that use creative outlets such as art, music, or dance.

3. Biologically Based Therapies

Biologically based therapies in CAM use substances found in nature, such as herbs, foods, and vitamins. Some examples include dietary supplements,3 herbal products, and the use of other so-called natural but as yet scientifically unproven therapies (for example, using shark cartilage to treat cancer).

4. Manipulative and Body-Based Methods

Manipulative and body-based methods in CAM are based on manipulation and/or movement of one or more parts of the body. Some examples include chiropractic or osteopathic manipulation, and massage.

5. Energy Therapies

Energy therapies involve the use of energy fields. They are of two types:

Biofield therapies are intended to affect energy fields that purportedly surround and penetrate the human body. The existence of such fields has not yet been scientifically proven. Some forms of energy therapy manipulate biofields by applying pressure and/or manipulating the body by placing the hands in, or through, these fields. Examples include qi gong, Reiki, and Therapeutic Touch.


Bioelectromagnetic-based therapies involve the unconventional use of electromagnetic fields, such as pulsed fields, magnetic fields, or alternating-current or direct-current fields.


What is NCCAM's role in the field of CAM?
NCCAM is the Federal Government's lead agency for scientific research on CAM. NCCAM is dedicated to exploring complementary and alternative healing practices in the context of rigorous science, training CAM researchers, and disseminating authoritative information to the public and professionals.





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Notes

1 Conventional medicine is medicine as practiced by holders of M.D. (medical doctor) or D.O. (doctor of osteopathy) degrees and by their allied health professionals, such as physical therapists, psychologists, and registered nurses. Other terms for conventional medicine include allopathy; Western, mainstream, orthodox, and regular medicine; and biomedicine. Some conventional medical practitioners are also practitioners of CAM.

2 Other terms for complementary and alternative medicine include unconventional, non-conventional, unproven, and irregular medicine or health care.

3 Some uses of dietary supplements have been incorporated into conventional medicine. For example, scientists have found that folic acid prevents certain birth defects and that a regimen of vitamins and zinc can slow the progression of an eye disease called age-related macular degeneration (AMD).



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Definitions
Acupuncture ("AK-yoo-pungk-cher") is a method of healing developed in China at least 2,000 years ago. Today, acupuncture describes a family of procedures involving stimulation of anatomical points on the body by a variety of techniques. American practices of acupuncture incorporate medical traditions from China, Japan, Korea, and other countries. The acupuncture technique that has been most studied scientifically involves penetrating the skin with thin, solid, metallic needles that are manipulated by the hands or by electrical stimulation.

Aromatherapy ("ah-roam-uh-THER-ah-py"): involves the use of essential oils (extracts or essences) from flowers, herbs, and trees to promote health and well-being.

Ayurveda ("ah-yur-VAY-dah") is a CAM alternative medical system that has been practiced primarily in the Indian subcontinent for 5,000 years. Ayurveda includes diet and herbal remedies and emphasizes the use of body, mind, and spirit in disease prevention and treatment.

Chiropractic ("kie-roh-PRAC-tic") is a CAM alternative medical system. It focuses on the relationship between bodily structure (primarily that of the spine) and function, and how that relationship affects the preservation and restoration of health. Chiropractors use manipulative therapy as an integral treatment tool.

Dietary supplements. Congress defined the term "dietary supplement" in the Dietary Supplement Health and Education Act (DSHEA) of 1994. A dietary supplement is a product (other than tobacco) taken by mouth that contains a "dietary ingredient" intended to supplement the diet. Dietary ingredients may include vitamins, minerals, herbs or other botanicals, amino acids, and substances such as enzymes, organ tissues, and metabolites. Dietary supplements come in many forms, including extracts, concentrates, tablets, capsules, gel caps, liquids, and powders. They have special requirements for labeling. Under DSHEA, dietary supplements are considered foods, not drugs.

Electromagnetic fields (EMFs, also called electric and magnetic fields) are invisible lines of force that surround all electrical devices. The Earth also produces EMFs; electric fields are produced when there is thunderstorm activity, and magnetic fields are believed to be produced by electric currents flowing at the Earth's core.

Homeopathic ("home-ee-oh-PATH-ic") medicine is a CAM alternative medical system. In homeopathic medicine, there is a belief that "like cures like," meaning that small, highly diluted quantities of medicinal substances are given to cure symptoms, when the same substances given at higher or more concentrated doses would actually cause those symptoms.

Massage ("muh-SAHJ") therapists manipulate muscle and connective tissue to enhance function of those tissues and promote relaxation and well-being.

Naturopathic ("nay-chur-o-PATH-ic") medicine, or naturopathy, is a CAM alternative medical system. Naturopathic medicine proposes that there is a healing power in the body that establishes, maintains, and restores health. Practitioners work with the patient with a goal of supporting this power, through treatments such as nutrition and lifestyle counseling, dietary supplements, medicinal plants, exercise, homeopathy, and treatments from traditional Chinese medicine.

Osteopathic ("ahs-tee-oh-PATH-ic") medicine is a form of conventional medicine that, in part, emphasizes diseases arising in the musculoskeletal system. There is an underlying belief that all of the body's systems work together, and disturbances in one system may affect function elsewhere in the body. Some osteopathic physicians practice osteopathic manipulation, a full-body system of hands-on techniques to alleviate pain, restore function, and promote health and well-being.

Qi gong ("chee-GUNG") is a component of traditional Chinese medicine that combines movement, meditation, and regulation of breathing to enhance the flow of qi (an ancient term given to what is believed to be vital energy) in the body, improve blood circulation, and enhance immune function.

Reiki ("RAY-kee") is a Japanese word representing Universal Life Energy. Reiki is based on the belief that when spiritual energy is channeled through a Reiki practitioner, the patient's spirit is healed, which in turn heals the physical body.

Therapeutic Touch is derived from an ancient technique called laying-on of hands. It is based on the premise that it is the healing force of the therapist that affects the patient's recovery; healing is promoted when the body's energies are in balance; and, by passing their hands over the patient, healers can identify energy imbalances.

Traditional Chinese medicine (TCM) is the current name for an ancient system of health care from China. TCM is based on a concept of balanced qi (pronounced "chee"), or vital energy, that is believed to flow throughout the body. Qi is proposed to regulate a person's spiritual, emotional, mental, and physical balance and to be influenced by the opposing forces of yin (negative energy) and yang (positive energy). Disease is proposed to result from the flow of qi being disrupted and yin and yang becoming imbalanced. Among the components of TCM are herbal and nutritional therapy, restorative physical exercises, meditation, acupuncture, and remedial massage.



For More Information
Sources of NCCAM Information

NCCAM Clearinghouse

Toll-free in the U.S.: 1-888-644-6226
International: 301-519-3153
TTY (for deaf and hard-of-hearing callers): 1-866-464-3615

E-mail: info@nccam.nih.gov
Web site: nccam.nih.gov
Address: NCCAM Clearinghouse, P.O. Box 7923, Gaithersburg, MD 20898-7923

Fax: 1-866-464-3616
Fax-on-Demand service: 1-888-644-6226

The NCCAM Clearinghouse provides information on CAM and on NCCAM. Servics include fact sheets, other publications, and searches of Federal databases of scientific and medical literature. The Clearinghouse does not provide medical advice, treatment recommendations, or referrals to practitioners.

Sources of Information on Dietary Supplements

Office of Dietary Supplements, NIH
Web site: ods.od.nih.gov
E-mail: ods@nih.gov

ODS supports research and disseminates research results on dietary supplements. It produces the International Bibliographic Information on Dietary Supplements (IBIDS) database on the Web, which contains abstracts of peer-reviewed scientific literature on dietary supplements.

U.S. Food and Drug Administration (FDA)
Center for Food Safety and Applied Nutrition
Web site: www.cfsan.fda.gov
Toll-free in the U.S.: 1-888-723-3366

Information includes "Tips for the Savvy Supplement User: Making Informed Decisions and Evaluating Information" (www.cfsan.fda.gov/~dms/ds-savvy.html) and updated safety information on supplements (www.cfsan.fda.gov/~dms/ds-warn.html). If you have experienced an adverse effect from a supplement, you can report it to the FDA's MedWatch program, which collects and monitors such information (1-800-FDA-1088 or www.fda.gov/medwatch).

This publication is not copyrighted and is in the public domain. Duplication is encouraged.

NCCAM has provided this material for your information. It is not intended to substitute for the medical expertise and advice of your primary health care provider. We encourage you to discuss any decisions about treatment or care with your health care provider. The mention of any product, service, or therapy in this information is not an endorsement by NCCAM.


NCCAM Publication No. D156
May 2002
http://nccam.nih.gov/health/whatiscam/











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Rheumatoid Arthritis and Complementary and Alternative Medicine

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Rheumatoid Arthritis and Complementary and Alternative Medicine


Key Points
What is rheumatoid arthritis (RA)?
How is rheumatoid arthritis treated in conventional medicine?
Why do some people with rheumatoid arthritis use CAM, and what do they use?
What CAM therapies for rheumatoid arthritis are discussed in this report?
What are some important points to keep in mind if I have rheumatoid arthritis and am thinking about using CAM?
What is known from the scientific research about whether these CAM treatments for rheumatoid arthritis are effective and safe?
Is NCCAM funding research on CAM therapies for rheumatoid arthritis?
Definitions
References
For More Information
Acknowledgments
Rheumatoid arthritis (RA) is a chronic disease that affects the joints, often those in a person's wrists, fingers, and feet. (Terms that are underlined are defined "Definitions".) The common symptoms of RA are pain, stiffness, fatigue, sleep disturbances, and fever. There are treatments for RA in conventional medicine, but some people also try complementary and alternative medicine (CAM).a This report answers some frequently asked questions on this topic and suggests sources for more information.

aCAM is a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine. Conventional medicine is medicine as practiced by holders of M.D. (medical doctor) or D.O. (doctor of osteopathy) degrees and by their allied health professionals, such as nurses, physical therapists, and dietitians. Some practitioners of conventional medicine are also practitioners of CAM.

Key Points
It is very important for people with RA to ensure that (1) their RA was diagnosed by a professional with substantial conventional medical training and (2) their condition is being followed by a rheumatologist (a physician who specializes in rheumatic diseases like RA). This is important to minimize damage to the joints and bones, as well as disability.


There are many proven conventional treatments for RA. It is important not to replace them with a CAM treatment that is unproven.


Many CAM therapies for arthritis are heavily advertised and make attractive claims, often based on personal stories (testimonials). However, it is important to find out whether any high-quality scientific research has been done on a CAM therapy.


None of the CAM therapies discussed in this report have been proven to be of benefit for RA. Some--such as thunder god vine (which is not currently available in a safe American-made product), gamma-linolenic acid, fish oil, and mind-body therapies--have shown some possibility of benefit for RA, but further studies are needed to answer this question for sure.


It is important to tell your health care provider(s) about any CAM therapies you are using or considering for RA. This is for your safety and a comprehensive treatment plan.


What is rheumatoid arthritis (RA)?
Rheumatoid arthritis (RA) is what is called an autoimmune disease. In this type of disease, a person's immune system (the system in the body responsible for fighting disease) mistakenly attacks the person's own body. In RA, the parts attacked are the linings of the joints (places in the body where two bones connect). The reasons that this happens are complex and not fully understood. RA causes pain, swelling, and stiffness in a person's joints and problems with functioning. However, RA affects different people in different ways, in terms of the symptoms they have, how serious the symptoms are, and how long the symptoms last. RA is different from other types of arthritis (such as osteoarthritis). For example:

RA usually occurs in a symmetrical pattern; for example, if one hand is affected, usually the other will be, too.
RA often affects the wrists and fingers, though it can affect other parts of the body.
RA is an autoimmune disease affecting the entire body. A person with RA may feel tired and weak, have fevers at times, lose appetite, lose weight, and generally not feel well.
To find out more about RA, contact the National Institute of Arthritis and Musculoskeletal and Skin Diseases (see "For More Information").



How is rheumatoid arthritis treated in conventional medicine?
There are many proven treatments in conventional medicine for RA. They are used to relieve pain, reduce swelling, slow down or stop the damage to joints, help the person function better, and improve the person's sense of well-being. Medications include nonsteroidal anti-inflammatory drugs (NSAIDs), disease-modifying antirheumatic drugs (DMARDs), biological response modifiers, and corticosteroids. Non-drug treatments include physical therapy; modified exercise programs; devices such as canes, special shoes, and splints (rigid supports that keep a part of the body from moving while it heals); and lifestyle changes--such as balancing activity with rest, eating a healthy diet, and reducing stress. Scientific research is advancing in understanding the many complexities of RA and in uncovering new and promising treatments.

It is important for people with RA to have their condition followed by a rheumatologist (a physician who specializes in diseases of the bones, muscles, and joints). This helps prevent or minimize damage to the joints and disability, which can occur if RA is left untreated over time.



Why do some people with rheumatoid arthritis use CAM, and what do they use?
Among the many reasons that some people use CAM for RA are:

Because conventional treatment is not working as well as they would like
A wish for greater relief of symptoms and/or disability
Issues with side effects of drug treatment
A desire to reduce some of the stress that comes from living with a chronic illness and to cope better
A belief that CAM therapies are safer and more "natural"
Widespread advertising and attractive claims for many CAM products


What CAM therapies for rheumatoid arthritis are discussed in this report?
Many types of CAM are tried for RA, such asb:

Preparations made from botanicals (plants and their products, including herbs)
Vitamins and minerals in unconventional amounts
Other products taken by mouth, such as fish oil
Dietary approaches
Preparations applied to the skin, such as balms and liniments
Hydrotherapy
Items that are worn (for example, magnetic clothing or copper bracelets)
Mind-body therapies such as relaxation techniques, meditation, prayer for health purposes, and tai chi
Whole medical systems, such as Ayurveda (a traditional medicine of India), traditional Chinese medicine, homeopathy, and chiropractic
Other therapies delivered by CAM practitioners--for example, acupuncture or massage
It is beyond the scope of this report to discuss the scientific evidence about all CAM therapies used for RA. The therapies listed below were selected because they are among those most frequently discussed in the scientific literature and inquired about at the NCCAM Clearinghouse.c In reading about them, you will also see some general points to consider about similar therapies (for example, other botanicals). You can seek science-based information on any CAM therapy that interests you through some of the resources listed in "For More Information."

b Information on these or any other CAM therapies can be obtained from the NCCAM Clearinghouse (see "For More Information").

cReferences for the discussions on therapies are listed at the end of this report. They consist of recent peer-reviewed literature in English in the National Library of Medicine's PubMed database; two evidence-based databases on natural products; and other Federal Government publications.



Therapies Discussed in This Report

Botanical supplements and other dietary supplements
Thunder god vine
Gamma-linolenic acid (GLA)
Fish oil
Valerian
Four Other Botanicals
Ginger
Curcumin
Boswellia
Feverfew
Glucosamine and chondroitin
Special diets
Acupuncture
Magnets
Hydrotherapy
Homeopathy
Selected mind-body techniques


About Dietary Supplements

Dietary supplements were defined in a law passed by Congress in 1994. A dietary supplement must meet all of the following conditions:

It is a product (other than tobacco) intended to supplement the diet, which contains one or more of the following: vitamins; minerals; herbs or other botanicals; amino acids; or any combination of the above ingredients.
It is intended to be taken in tablet, capsule, powder, softgel, gelcap, or liquid form.
It is not represented for use as a conventional food or as a sole item of a meal or the diet.
It is labeled as being a dietary supplement.
Other important information about dietary supplements:

They are regulated as foods, not drugs, so there could be quality issues in the manufacturing process.
Supplements can interact with prescribed or over-the-counter medicines, and other supplements.
"Natural" does not necessarily mean "safe" or "effective."
Consult your health care provider before starting a supplement, especially if you are pregnant or nursing, or considering giving a supplement to a child.




What are some important points to keep in mind if I have rheumatoid arthritis and am thinking about using CAM?
It is important to make sure you have been diagnosed with RA by a health care provider who has substantial conventional medical training and experience with arthritis patients. RA can be hard to diagnose, there is no single test for it, and its symptoms can be similar to those of other conditions.


Proven conventional treatments for RA should not be replaced with a CAM treatment that is unproven. This is especially important in the early stages of RA, when researchers believe the most damage to joints and bones occurs.


Tell your health care provider(s) about any supplements or medications (prescription or over-the-counter) that you are using or considering. Prescribed medicines may need to be adjusted if you are also using a CAM therapy. Supplements can interact with medications (whether prescription or over-the-counter) and can affect how the body responds to them. Pharmacists can also be a helpful source of information about dietary supplements (though their advice is not a substitute for that of your provider).


If you decide to use supplements, what you see on the label may not reflect what is in the bottle. For example, some botanical supplements have been found to be contaminated with heavy metals or prescription drugs, and some have been found to have much more or much less of the featured ingredient than their label states. NCCAM has publications on these topics (see "For More Information").


The claims for many CAM therapies can be attractive, ranging from enhancing well-being, to helping with difficult chronic conditions, to achieving unbelievable results. It is important to know whether scientific research has proven that a therapy works and, if so, why.


Women who are pregnant or nursing, or people who are thinking of using CAM to treat a child, should use extra caution and be sure to consult their health care provider.


What is known from the scientific research about whether these CAM treatments for rheumatoid arthritis are effective and safe?
1. Botanical Supplements and Other Dietary Supplements

Overall, there is not much rigorous research available on the effectiveness and safety of botanical and other supplements that people try for RA. It is also important to know that while supplements are regulated by the U.S. Food and Drug Administration (FDA) as a category of foods, supplements made from plants and used for medicinal purposes (sometimes referred to as herbal medicines) can have effects as powerful as those of drugs. In fact, many conventional drugs first came from plants, such as digitalis (from the foxglove plant), used to treat heart failure and heart rhythm, and paclitaxel (from the yew tree), a cancer chemotherapy drug.

It is important to be as informed as possible about the safety of any supplement you are considering or using. Some information already exists from a long history of botanical use outside conventional medicine. This knowledge is being strengthened as NCCAM supports rigorous studies on botanicals and other supplements that have shown promise in early studies to find out more about their molecular structure, their safety, how they may work, and for what diseases or conditions.

Thunder God Vine
Thunder god vine (TGV for short; botanical name Tripterygium wilfordii Hook F) is a perennial vine native to China, Japan, and Korea. Preparations made from the skinned root of TGV have been used in traditional Chinese medicine to treat inflammatory and autoimmune diseases. Interestingly, TGV also has a history of use to kill insects in farm fields.

Effectiveness and safety
Some anti-inflammatory and immune-system-suppressing activity for TGV has been seen in laboratory and animal studies. The first clinical trial on TGV in the United States (the earlier ones were done in China) was carried out at the University of Texas Southwestern Medical Center and the National Institutes of Health (NIH). Its results were published in 2002. Twenty-one patients for whom conventional RA treatment had not worked completed the trial. Eighty percent of those who received a high-dose TGV extract and 40 percent of those who received a low-dose TGV extract experienced improvement in RA symptoms and physical functioning. No one in the placebo group improved. Longer and larger studies are needed to confirm these findings and to find out more about TGV.


Parts of the TGV plant are dangerous. The leaves, the flowers, the main stem, and the skin covering the root are poisonous, to a point that they could cause death. People should never try to make TGV medications themselves.


Currently, there are no consistent, high-quality TGV products being manufactured in the United States. Preparations of TGV made outside the United States (for example, in China) can sometimes be obtained, but it is not possible to verify whether they are safe and effective. An expert from the University of Texas/NIH study advises that consumers not use TGV until reliable TGV preparations become available.


If taken for a long time (according to one study, for more than 5 years), TGV may decrease the density of the minerals in women's bones, which would be of special concern for women who have osteoporosis or are at risk for it. If taken at high doses, TGV could suppress the immune system and increase the effects of immune-suppressing drugs.


The TGV extract made for the NIH study discussed above was well tolerated by study participants. However, side effects can occur and may include stomach upset, diarrhea, skin rash, changes in menstrual periods, and hair loss.
Gamma-Linolenic Acid (GLA)
GLA is an omega-6 fatty acid that is found in the oils of some plant seeds, including evening primrose (Oenothera biennis L.), borage (Borago officinalis L.), and black currant (Ribes nigrum L.). GLA can be used by the body to make substances that reduce inflammation.

Effectiveness and safety
A 2000 Cochrane Collaboration review analyzed seven placebo-controlled studies of GLA (from evening primrose, borage, and black currant oils) for RA. The authors noted there were issues with these studies that made it difficult to draw conclusions. However, they thought the better studies indicated potential relief for RA pain, morning stiffness, and joint tenderness.


There are potential side effects and risks to know about with GLA. First, these plant seed oils may affect certain medical conditions and interact with prescription medications. Specifically:
Some borage seed oil preparations contain ingredients called PAs (for pyrrolizidine alkaloids) that can harm the liver or worsen liver disease. Only preparations that are certified and labeled as "PA-free" should be used.
Borage oil and evening primrose oil might increase the risk of bleeding and bruising, especially in people taking blood-thinning drugs, such as aspirin, clopidogrel, NSAIDs, or warfarin.
Evening primrose oil may cause problems for people taking a class of psychiatric drugs called phenothiazines, such as chlorpromazine or prochlorperazine.
Side effects of these oils can include nausea, diarrhea, soft stool, intestinal gas, burping, and stomach bloating.
Fish Oil
Fish oil contains high amounts of two omega-3 fatty acids: EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid). As with GLA, the body can use omega-3s to make substances that reduce inflammation.

Effectiveness and safety
There is some encouraging evidence from a number of laboratory studies, animal studies, and clinical trials about the potential usefulness of fish oil or omega-3 supplementation for various aspects of RA--such as the number of tender joints, morning stiffness, and the need for NSAIDs. However, more research is needed to definitively answer various questions, including what the most effective dosage or length of treatment would be, which patients would benefit most, and whether a placebo effect is at work.


In some people, the high amounts of omega-3s that are present in fish oil can increase the risk of bleeding or affect the time it takes blood to clot. If a person is taking drugs that affect bleeding or is going to have surgery, this is of special concern. Fish oil supplements interact with medicines for high blood pressure, so taking them together might lower a person's blood pressure too much.


Certain species of fish can contain high levels of contaminants, such as mercury, from the environment. Thus, their oils could pose a health risk, especially for pregnant or nursing women and for children. The fish that the Federal Government has found to have the highest levels of mercury are shark, swordfish, king mackerel, and tilefish. People who decide to use fish oil should look for products made from fish with lower mercury levels. Government information on this topic is available.d You may have to contact the manufacturer to find out the type(s) of fish used in a product. Also, it is desirable to find out whether the manufacturer tests the product for contaminating substances and if the results of those tests are available.


Another point to note about safety is that a product called fish liver oil can contain more vitamin A than the recommended daily dosage, which could cause problems.


Generally, for low doses of fish oil supplements, the side effects are mild and can include a fishy aftertaste, belching, stomach disturbances, and nausea.
dTwo Federal publications are "Mercury Levels in Commercial Fish and Shellfish" and "What You Need to Know About Mercury in Fish and Shellfish: Advice for Women Who Might Become Pregnant, Women Who Are Pregnant, Nursing Mothers, and Young Children" are available online. They are copublished by the U.S. Department of Health and Human Services and the U.S. Environmental Protection Agency.

Valerian
The herb valerian has a history of use for sleep problems and anxiety disorders. Disrupted sleep has been called a common and often neglected symptom of arthritis. A large, nationally representative survey of people over 65 with arthritis in 2000 found that disruption of sleep, among all the disruptions of arthritis, was the main reason that people sought a variety of CAM, self-care, and conventional medical treatments. Valerian has also been taken for other reasons, such as the intent to relieve muscle and joint pain. The species of valerian most used in American supplements is Valeriana officinalis.

Effectiveness and safety
The evidence suggests that valerian has at least mild benefits for sleep problems in the general population, including insomnia. It has been theorized that valerian may have benefit for people with sleep problems from RA. However, research on valerian for RA specifically has not been done to answer this question.


There is not much evidence on how long it is safe to take valerian and which dose to use.


There is not enough reliable evidence to declare whether valerian is effective for muscle and joint pain, including pain from RA. There may be some biological basis for the theory that valerian could be beneficial for musculoskeletal pain.


Valerian is considered generally safe. However, it should not be taken with sedative drugs (for example, alcohol, benzodiazepines, or narcotics) or other sedative herbs (such as melatonin, SAMe, or St. John's wort). Valerian will increase sedative effects. People who are taking antifungal drugs, statins, or certain anti-arrhythmia drugs should not take valerian. Valerian may not be safe for people who have a liver disorder or are at risk for one. After taking valerian, caution should be used in driving or using dangerous machinery. Side effects of valerian can include drowsiness in the morning, headache, stomach problems, excitability or anxiety, and sleeplessness.
Four Other Botanicals


Three of the other botanicals marketed with claims to benefit arthritis pain are:

Ginger
Curcumin (a component of the spice turmeric)
Boswellia (also called Indian frankincense, made from the resin of a tree that grows in India)
These three botanicals have a history of use in Ayurveda to treat inflammatory conditions. Based on some early findings that may indicate promise, NCCAM is supporting studies at the University of Arizona on these three botanicals, to increase scientific knowledge about them and determine whether they are helpful for chronic inflammatory conditions such as arthritis and asthma.

A fourth botanical, feverfew, has been used in folk medicine with an intent to treat arthritis, migraine, and other conditions. One small published clinical trial was located for this report. It found no more benefit from feverfew than from the placebo. Overall, feverfew has not been proven to help RA symptoms.

Safety
Ginger's possible side effects include stomach upset, diarrhea, and irritation to the mouth and throat. Ginger is not recommended for people who have a bleeding disorder, a heart condition, or diabetes. Ginger may further slow blood clotting when combined with other herbs and drugs that slow blood clotting; add to the blood-pressure-lowering effects of drugs for high blood pressure and heart disease; and add to the blood-sugar-lowering effects of diabetes drugs.


Curcumin can have side effects of stomach problems, including nausea and diarrhea. Curcumin could add to the effects of other herbs and drugs that slow blood clotting. Curcumin can cause gallbladder contractions and should not be used by people with gallbladder disease or gallstones.


Boswellia can have side effects of stomach pain, stomach upset, nausea, and diarrhea. It is not known whether boswellia interacts with any drugs, supplements, or diseases and conditions.


Feverfew appears to be safe for short-term use, but the safety of long-term use is not known. Feverfew can cause an allergic reaction, especially in people who are allergic to the daisy family. Side effects can include diarrhea and other stomach upsets. Chewing fresh leaves of feverfew may cause mouth irritation and sores. Feverfew might interact with medications broken down by the liver and increase the actions of drugs that slow blood clotting. Pregnant women should not take feverfew.
Glucosamine and Chondroitin
Glucosamine sulfate (glucosamine for short) and chondroitin sulfate (chondroitin) are popular dietary supplements for arthritis. They are sold separately, in combination with each other, and in other combinations.

Glucosamine is a substance found in the fluid around the joints. It can also be obtained from the shells of shrimp, lobster, and crabs, or made in the laboratory. The body uses glucosamine to make and repair cartilage, a firm but flexible tissue that covers the ends of bones, keeps them from rubbing against each other, and absorbs the force of impact.

Chondroitin is a substance found in the cartilage around joints. As a supplement, it is obtained from sources such as sharks and cattle.

Effectiveness and safety
Both glucosamine and chondroitin have shown anti-inflammatory effects in animal studies. In humans, they have been studied only for osteoarthritis so far, not for RA. Osteoarthritis is a different form of arthritis than RA, with different causes, although the symptoms are similar (such as joint pain and problems with function). One cannot assume that if a treatment is helpful for one type of arthritis, it will also be helpful for another type. The studies of glucosamine and chondroitin for osteoarthritis mostly found a modest benefit. However, some design flaws have been noted in those studies. In sum, there is no evidence that glucosamine and chondroitin are helpful for RA.


Glucosamine appears to be safe for most people. However, it might worsen asthma through an allergic reaction. Also, glucosamine might cause higher blood sugar and insulin levels in people with diabetes, and those who decide to use it need to carefully monitor their blood sugar. Glucosamine could possibly decrease the effectiveness of certain medications--acetaminophen, some anticancer drugs, and antidiabetes drugs. Generally, side effects of glucosamine can include mild stomach problems and nausea; less commonly, there can be sleepiness, a skin reaction, or a headache. Some people who are allergic to shellfish are concerned about an allergic reaction to glucosamine. However, most shellfish allergies are to proteins in the meat, not to the shell material from which glucosamine supplements are made.


Chondroitin appears to be safe for most people. However, chondroitin may possibly worsen asthma (through an allergic response), blood clotting disorders, and prostate cancer. The side effects of chondroitin can include stomach pain and nausea; less commonly, diarrhea, constipation, swelling, and problems with heart rate.


Both supplements could affect the action of the drug warfarin, but this is not definite.
2. Special Diets

Many people with RA are interested in whether certain foods can affect their symptoms. Examples of foods that are believed to possibly worsen the symptoms of arthritis (including RA) are the nightshade family of plants (white potatoes, tomatoes, eggplant, and peppers), dairy, citrus fruits, acidic foods, sweets, coffee, and animal protein. There are various theories about how foods may affect RA, including:

The foods one eats and how the digestive system handles them are known to affect the immune system. Because RA is a disease of the immune system, a connection between diet and the disease has been proposed.


Certain fats (mostly from animal sources, but also from corn and sunflower oils) break down in the body into substances that can cause inflammation.


RA and/or medications to treat it may affect the way a person's digestive system handles foods.


RA can affect a person's ability to prepare and eat food, leading to nutritional problems.
Effectiveness and Safety
There is no strong, reproducible evidence that any foods or diets have a specific role in causing or treating RA.


It is important for people who have RA to eat a healthy, balanced diet.


If one or more foods are eliminated from the diet, it is possible to miss key nutrients and not get enough calories. It is important to discuss any major dietary changes with your health care provider or a registered dietitian.


A true food allergy may exist in a small percentage of patients with RA. Many people think they have food allergies when they do not have them or when they have a different condition called food intolerance. To find out more, see the National Institute of Allergy and Infectious Diseases in "For More Information."
3. Acupuncture

Acupuncture is a practice that developed as a part of traditional Chinese medicine. Some people try acupuncture to treat RA pain or to treat the RA itself. For more about acupuncture, see NCCAM's fact sheet "Acupuncture."

Effectiveness and Safety
Good research studies have shown that acupuncture can help relieve pain associated with osteoarthritis. However, not much is known about its effectiveness for symptoms of RA. A handful of small studies have been conducted, and the findings do not clearly answer this question. Issues with the studies have included design problems, a small number of participants, variations in where acupuncture was given on the body, and how many treatments were given and for how long. More and better research is needed.


Acupuncture tends to have minimal side effects, if any. Relatively few complications from acupuncture have been reported to the FDA. If a person decides to use acupuncture, it is important to find a licensed and certified practitioner, as any complications have usually occurred from inadequate practitioner training and experience.
4. Magnets

Magnets are objects that produce a type of energy called magnetic fields. The term "magnets" is also used to refer to consumer products that contain magnets. Examples include shoe insoles, clothing, wraps for parts of the body, and mattress pads. These are of a type called static magnets, because their magnetic fields are unchanging.

Effectiveness and Safety: Static Magnets
The research so far does not firmly support claims that static magnets are effective for treating pain, including pain from RA. In those cases where some benefit was seen, it has not been proven why; many scientists think it may be due to a placebo effect. If someone does experience a benefit from a magnet, it will tend to occur quickly.


Static magnets should not be used by pregnant women; people who have a condition--such as an acute sprain, inflammation, infection, or wound--that could be affected by dilation of the blood vessels; and people who use a device such as a pacemaker, defibrillator, or insulin pump, or who use a medication patch.
The second type of magnets used for health purposes are called electromagnets (EMs), because they produce magnetic fields only when electric current flows through them. EMs are used in conventional medicine to treat bone fractures that have not healed well, and they are being studied in research settings for a number of other conditions (including cancer, epilepsy, RA, and mental disorders). Some consumer products using EMs are available.

Effectiveness and Safety: Electromagnets
EMs are being studied because there have been some encouraging early findings indicating the possibility of benefits for pain, physical function, and stiffness. However, it is too early to know for sure whether EMs are of benefit for patients with RA.


EMs should not be used by pregnant women; people who have a condition--such as an acute sprain, inflammation, infection, or wound--that could be affected by dilation of the blood vessels; and people who use a device such as a pacemaker, defibrillator, or insulin pump, or who use a medication patch. It may be advisable for people who have a history of cancer or seizure disorder to avoid using EMs until more is known about their effects on these medical conditions.
For more about magnets, see the NCCAM fact sheet "Questions and Answers About Using Magnets To Treat Pain."

5. Hydrotherapy

Hydrotherapy is the use of water for therapeutic purposes. A few examples of hydrotherapy include bathing in heated water, as from hot springs or the sea; mineral baths; and water-jet massages. Another term used for hydrotherapy baths is balneotherapy.

Hydrotherapy dates back to ancient Greece and Rome. In recent centuries, it has been a popular treatment in Europe and Israel. Some forms of hydrotherapy are used in conventional medicine in the United States, such as whirlpool baths for athletic injuries and ice for sprains. As CAM, hydrotherapy is often combined with other treatments, such as exercises, massage, diets, herbs, and/or mud packs. It is used with the intent to benefit arthritis, circulation, and various other health issues, and to enhance feelings of relaxation and well-being. Some also claim that hydrotherapy "detoxifies" the body. In this report, the term hydrotherapy refers to external water treatments and not to internal treatments using water, such as colon irrigation or drinking specially treated water.

Effectiveness and Safety
A small number of controlled studies have been done on hydrotherapy for RA, most based on sea-bath treatments given in Israel's Dead Sea area. Most of these studies reported benefit. However, there have been quality issues noted with these studies, and it is not considered proven that the hydrotherapy itself provided the benefits for RA claimed in these studies. Larger and better studies are needed to answer this question. Study authors have noted that there could be other reasons for any benefit, such as traveling to a spa, being removed from one's daily routine, relaxation, socializing, etc.


The safety of hydrotherapy has not been well studied. Overall, it appears to be a low-risk practice for most people if common-sense precautions are taken, such as not exposing the body to too much heat or cold or for too long a time, and being sure to drink enough fluid. However, hydrotherapy is riskier and could even be dangerous for certain people:
Those who have a condition that could be worsened by exposure to extremes of heat or cold (for example, heart disease, lung disease, circulation disorder, Raynaud's phenomenon, or chilblains) or by strong motions from water jets
Those who have difficulty perceiving temperature (for example, from neuropathy, or damage to the nerves)
Women who are pregnant
People who have implanted medical devices such as pacemakers or pumps


Some people may get a skin irritation or infection from hydrotherapy water, either as a reaction to something in the water or if the water is not in sanitary condition.
6. Homeopathy

Homeopathy is a whole medical system that was developed in Germany and brought to the United States in the 19th century. Homeopathy involves giving very small doses of substances called remedies that would produce the same or similar symptoms of illness in healthy people when given in larger doses. This approach is called "like cures like." The remedies are diluted very highly, often to a point where not one molecule of the original substance remains. For more about homeopathy, see NCCAM's fact sheet "Questions and Answers About Homeopathy."

Effectiveness and Safety
Little rigorous research has been done on homeopathy for RA. The results have been mixed. It appears from some studies that homeopathy might be more effective than a placebo for rheumatic diseases and syndromes (including RA), but this evidence is not strong. Larger, better-designed studies are needed to resolve this question.


Homeopathic remedies are considered safe and unlikely to cause severe side effects. The FDA has learned of a few reports of illness associated with the use of these remedies, but determined that the remedies were not likely to be the cause. Homeopathic remedies are not known to interfere with conventional drugs.
7. Selected Mind-Body Techniques

Mind-body techniques draw upon the interactions that exist in health and disease between the mind, the emotions, the body as a whole, and various body systems (such as the immune, nervous, and endocrine systems). Some mind-body techniques are part of ancient healing traditions, others have emerged in recent times. Examples of mind-body techniques include meditation, tai chi, relaxation techniques, and spirituality for health purposes.

Effectiveness and Safety
Mind-body therapies have been applied to and studied for various types of pain. Results from clinical trials indicate that mind-body therapies may be effective additions to the treatment and management of arthritis, including RA and its pain.


One analysis of clinical trials on mind-body therapies for RA has been published. These authors, who evaluated 25 trials and published their findings in 2002 also concluded that mind-body approaches may be effective additions to RA treatment. They noted that mind-body practices led to significant improvements in RA pain, disability, overall psychological state (psychological status), coping, and belief in one's own ability to handle situations (self-efficacy). Mind-body therapies appeared to be more helpful for people who had RA for a shorter period of time, not a longer period.


There are still questions about mind-body therapies and RA that need to be answered by research, such as which among these therapies are most effective and, if they work, how they work.


Spirituality may help people with RA in their quality of life, coping, and how they feel about their health, although the research so far has been limited, and often it has not looked at RA only. A 2003 study at Johns Hopkins University of people with moderate RA found that those who had "spiritual transcendence"e had more happiness, joy, and positive perceptions of their own health. This was regardless of how severe their RA was or how well they could function.


There have been some small studies on tai chi for RA. Tai chi is a practice from traditional Chinese medicine that uses specific postures along with gentle, slow movements; meditation; and coordinated breathing. These studies on RA have had conflicting results; some found improvement in daily functioning and certain symptoms, others did not. NCCAM is co-sponsoring a clinical trial that compares tai chi chih (a type of tai chi) to relaxation therapy for symptoms of RA. An earlier clinical trial by this team found tai chi chih improved physical functioning and immunity in healthy older adults. Other research as well has supported benefit from tai chi to older people on such outcomes as balance, postural stability, frailty, and prevention of falls. Tai chi is a relatively safe practice. It is done slowly and at low impact to the body.


In mind-body therapies, there are relatively few physical and emotional risks, if any. A helpful aspect of most mind-body therapies is that they can be taught to users and practiced by them at times and places of their choice.
e In this study, spirituality was described as something "often viewed as an intrinsic quality of the individual, a desire for personal connectedness with a transcendence reality." This was different from religiousness, "an outward practice of a particular spiritual understanding and/or the framework of beliefs, values, and rituals," although the authors noted that this distinction is difficult. Spirituality was measured using a scale designed to evaluate "the capacity of an individual to stand outside of his/her immediate sense of time and place and to view life from a larger, more detached perspective."



Is NCCAM funding research on CAM therapies for rheumatoid arthritis?
Yes. Examples of recent studies include:

Fish oil, borage seed oil, or a combination of both, to determine if they affect RA symptoms
Mindfulness-based stress reduction (a type of meditation), to determine if it affects RA symptoms
Low-strength electromagnetic fields, to see whether they have an effect on pain, fatigue, sleep quality, mood, and inflammation in postmenopausal women with RA
Recently published NCCAM-supported research on RA has included:

A 2004 review of valerian for sleep disturbances from RA
A 2003 review of studies on selected CAM therapies for arthritis-related pain, including RA pain
A 2002 review of studies on mind-body therapies for RA
These and many other reports on NCCAM-supported research may be located in the CAM on PubMed database (See "For More Information").



Definitions
Acupuncture: A family of procedures that originated in traditional Chinese medicine. Acupuncture is the stimulation of anatomical points on the body by a variety of methods, including the insertion and manipulation of thin steel needles or the use of pressure from the practitioner's hands. It is intended to remove blockages in the flow of qi. American practice of acupuncture incorporates medical traditions from China, Japan, Korea, and other countries.

Botanical: A plant or plant part that is used for its flavor, scent, and/or therapeutic properties. Examples include flowers, leaves, bark, fruits, seeds, stems, and roots; substances produced by plants; and algae.

Chiropractic: A whole medical system based on the concept that the body has a powerful self-healing ability, and its structure (primarily the spine), function, and health are closely related. The goal of therapy is to correct structural alignment problems and allow the body to heal itself.

Chronic disease: A disease that lasts a long period of time or comes back frequently.

Clinical trial: A research study in which a treatment or therapy is tested in people to see whether it is safe and effective. Clinical trials are a key part of the process in finding out which treatments work, which do not, and why. Clinical trial results also contribute new knowledge about diseases and medical conditions.

Herb: A plant or plant part used for its scent, flavor, and/or therapeutic properties. Also called a botanical. Herbal supplements are a type of dietary supplement that contains herbs, either singly or in mixtures.

Inflammation: The body's response to injury or infection. Chemicals are released from white blood cells to increase the blood flow to the area, which results in swelling, redness, and warmth.

Insomnia: A condition in which a person cannot fall asleep, cannot remain asleep, or wakes up not feeling restored or refreshed after sleeping.

Joint: The place where two bones meet.

Mind-body therapies: Practices that focus on the relationships of brain, mind, body, and behavior and how they affect health. Examples include meditation and yoga.

Omega-3 fatty acids: A group of polyunsaturated fatty acids that come from food sources, such as fish, fish oil, some vegetable oils (primarily canola and soybean), walnuts, wheat germ, and certain dietary supplements. Polyunsaturated fatty acids are one of the three types of fatty acids. They contain a chain of carbon atoms and hydrogen and oxygen molecules, with two or more double bonds between the carbon atoms.

Omega-6 fatty acids: A group of essential fatty acids found in cereals, vegetable and seed oils, eggs, and poultry. Essential fatty acids are needed for human health and cannot be made by the body.

Osteoporosis: A condition in which bones become thin and brittle and more likely to break.

Placebo: A placebo is designed to resemble as much as possible the treatment being studied in a clinical trial, except that the placebo is inactive. An example of a placebo is a pill containing sugar instead of the drug or other substance being studied. By giving one group of participants a placebo and the other group the active treatment, the researchers can compare how the two groups respond and get a truer picture of the active treatment's effects. In recent years, the definition of placebo has been expanded to include other things that could have an effect on the results of health care, such as how a patient and a health care provider interact and what the patient expects to happen from the care.

Placebo effect: The physical or psychological benefits that can occur with the use of an inert or sham treatment (a placebo), such as a sugar pill.

Relaxation techniques: Use of methods such as guided imagery to help calm the mind and release the muscles. It is used to reduce physical tension and promote emotional well-being.

Rheumatic disease: A type of disease in which inflammation and loss of function are present in one or more connecting or supporting structures of the body. These diseases especially affect the joints, tendons, ligaments, bones, and muscles. Common symptoms are pain, swelling, and stiffness, and some rheumatic diseases can also involve internal organs.

Rheumatologist: A medical doctor who specializes in treating conditions that affect the joints and muscles, such as rheumatoid arthritis.

Sedative: A substance used for medicinal purposes (such as a drug or herb) that depresses the central nervous system, producing feelings of calmness, relaxation, and drowsiness.

Tai chi: An exercise program that is part of traditional Chinese medicine. The exercises consist of a series of slow, gentle movements coordinated with breathing and meditation.

Traditional Chinese medicine: A whole medical system that was documented in China by the 3rd century B.C. Traditional Chinese medicine is based on a concept of vital energy, or qi, that is believed to flow throughout the body. It is proposed to regulate a person's spiritual, emotional, mental, and physical balance and to be influenced by the opposing forces of yin (negative energy) and yang (positive energy). Disease is proposed to result from the flow of qi being disrupted and yin and yang becoming unbalanced. Among the components of traditional Chinese medicine are herbal and nutritional therapy, restorative physical exercises, meditation, acupuncture, and remedial massage.

Whole medical systems: A general term for medical and health care systems that employ practices from among the following four domains: mind-body medicine, biologically based practices, manipulative and body-based practices, and energy medicine. To find out more, see the NCCAM Web site.



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Strange CJ. Coping with arthritis in its many forms. FDA Consumer. 1996;30(2).

Taibi DM, Bourguignon C. The role of complementary and alternative therapies in managing rheumatoid arthritis.* Family and Community Health. 2003;26(1):41-52.

Taibi, DM, Bourguignon C, Taylor AG. Valerian use for sleep disturbances related to rheumatoid arthritis.* Holistic Nursing Practice. 2004;18(3):120-126.

Tao X, Younger J, Fan FZ, et al. Benefit of an extract of Tripterygium wilfordii Hook F in patients with rheumatoid arthritis: a double-blind, placebo-controlled study.* Arthritis and Rheumatism. 2002;46(7):1735-1743.

Uhlig, T, Larsson C, Hjorth AG, et al. No improvement in a pilot study of tai chi exercise in rheumatoid arthritis.* Annals of the Rheumatic Diseases. 2005;(64):507-509.

Van Tubergen A, van der Linden S. A brief history of spa therapy.* Annals of the Rheumatic Diseases. 2002;61(3):273-275.

Verhagen AP, Bierma-Zeinstra SM, Cardoso JR, et al. Balneotherapy for rheumatoid arthritis. Cochrane Database of Systematic Reviews. 2005;(2):CD00518. Accessed on September 2, 2005.
Wang C, Roubenoff R, Lau J, et al. Effect of tai chi in adults with rheumatoid arthritis.* Rheumatology (Oxford). 2005;44(5):685-687.

Yocum DE, Castro WL, Cornett M. Exercise, education, and behavioral modification as alternative therapy for pain and stress in rheumatic disease.* Rheumatic Disease Clinics of North America. 2000;26(1):146-159.

*Links to a PubMed abstract.


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NCCAM Publication No. D282
September 2005
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Traditional Chinese medicine

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Traditional Chinese medicine

(Redirected from Oriental medicine)
Traditional Chinese medicine (TCM) also known simply as Chinese medicine (Chinese: 中醫學, zhōngyī xué, or 中药学, zhōngyaò xué) is the name commonly given to a range of traditional medical practices used in China that have developed over the course of several thousand years of history. It is also known as oriental medicine, a term which may include other traditional Asian medical systems such as Japanese, Korean, Tibetan, and Mongolian medicine. Chinese medicine principally employs a method of analysis and synthesis, inquiring on a macro-level into the internal systems of the human body and their mutual relationships with the internal and external environment in an attempt to gain an understanding of the fundamental laws which govern the functioning of the human organism, and to apply this understanding to the treatment and prevention of disease, and health maintenance. TCM is rooted in a unique, comprehensive and systematic theoretical structure which includes the Theory of the Five Elements, the human body Meridian system and Yin-yang. Treatment is conducted with reference to this philosophical framework.

Contents [hide]
1 Uses
2 TCM theory
3 TCM diagnostics
3.1 Diagnostic techniques
4 TCM treatment techniques
5 TCM and science
5.1 Does it work?
5.2 How does it work?
6 The relationship between TCM and Western medicine
7 TCM and Animals
8 See also
9 References
10 External links




Uses
In the West, TCM is often considered alternative medicine; however, in mainland China and Taiwan, TCM is widely considered to be an integral part of the health care system. The term TCM is sometimes used specifically within the field of Chinese medicine to refer to the standardized set of theories and practices introduced in the mid-20th century under the government of Mao, as distinguished from related traditional theories and practices preserved by people in Taiwan, Hong Kong and by the overseas Chinese. The more general sense is meant in this article.

TCM developed as a form of noninvasive therapeutic intervention (also described as folk medicine or traditional medicine) rooted in ancient belief systems, including traditional religious concepts. Chinese medical practitioners before the 19th century relied essentially on observation, trial and error. Like their counterparts in the West, they had a very different understanding of infection which predated the discovery of bacteria, viruses (germ theory of disease) or cellular structures and little knowledge of organic chemistry, relying mainly on distinctly personal medical theory describing the nature of infections and remedies. Traditions, and observations based on their theory, along with three millenia of practical experience guided their courses of treatment and instruction in diagnostic principles.

Unlike other forms of traditional medicine which have largely become extinct, traditional Chinese medicine continues as a distinct branch of modern medical practice, and within China, it is an important part of the public health care system. There are thousands of years of empirical knowledge about TCM on its own terms, and in recent decades there has been an effort to place traditional Chinese medicine on a firmer Western scientific empirical and methodological basis as well as efforts to integrate Chinese and Western medical traditions.

That this effort has occurred is surprising to many for a number of reasons. In most of the world, indigenous medical practices have been supplanted by practices brought from the West, while in Chinese societies, this has not occurred and shows no sign of occurring. Furthermore, many have found it peculiar that Chinese medicine remains a distinct branch of medicine separate from Western medicine, while the same has not happened with other intellectual fields. There is, for example, no longer a distinct branch of Chinese physics or Chinese biology.

In the West, TCM is usually regarded as a form of alternative medicine (CAM). TCM is used by some to treat the side effects of chemotherapy, treating the cravings and withdrawal symptoms of drug addicts and treating a variety of chronic conditions that conventional medicine is claimed to be sometimes ineffective in treating. TCM has also been used to treat antibiotic-resistant infections.

In China, practitioners of Chinese medicine tend to perform functions which in the West would be performed by allied health professionals such as nutritionists, pharmacists, nurses, chiropractors, physical therapists and others. Chinese medicine hospitals also perform some emergency medicine such as prevention and treatment of shock and seizure. The general distinction made by Chinese in China is that Western medicine involves cutting or acute care while Chinese medicine involves manipulation or chronic care. Hence medical procedures such as bone setting or chiropractic spinal manipulation would be seen as Chinese, while surgery tends to be seen as Western.


TCM theory
There are many schools of thought on which TCM is based. Because of this, the foundation principles of Chinese medicine are not necessarily uniform. Received TCM can be shown to be most influenced by Taoism, Buddhism, and Neo-Confucianism.

For over 3000 years (1200 BC - present), Chinese academics of various schools have focused on the observable natural laws of the universe and their implications for the practical characterisation of humanity's place in the universe. In the I Ching and other Chinese literary and philosophical classics, they have described some general principles and their applications to health and healing:

There are observable principles of constant phenomenal change by which the Universe is maintained.
Man is part of the universe and cannot be separated from the universal process of change.
As a result of these apparently inescapable primordial principles, the Universe (and every process therein) tends to eventually balance itself.
Optimum health should result from living as harmoniously as possible with the spontaneous process of change tending towards balance. If there is no change (stagnation), or too much change (catastrophism), balance is increasingly lost and illnesses can occur.
Everything is ultimately interconnected.
Always use a systemic approach when addressing imbalances.
TCM is therefore largely based on the philosophical concept that the human body is a small universe with a set of complete and sophisticated interconnected systems. Those systems usually work in balance to maintain the healthy function of the human body. The balance is described as necessarily including qi, blood, jing, bodily fluids, the wu xing, emotions, and spirit (shen). TCM has a unique model of the body, notably concerned with the meridian system. TCM isn't monolithic, however, and there are from minor to significant regional and philosophical differences between practitioners and schools which in turn can lead to differences in practice.


TCM diagnostics
The basics of TCM diagnostics are: observe (望 wàng), hear and smell (聞 wén), ask about background (問 wèn) and read the pulse (切 qiè). Then classify the symptoms into different types:

Yin or Yang (yin-yang 陰陽)
Superficial or internal (li-biao 表裡)
Cold or hot (han-re 寒熱)
Deficient or Replete (xu-shi 虛實)
Because traditional Chinese medicine predates the more invasive medical testing used in conventional Western medicine, TCM requires skill in a range of diagnostic systems not commonly used outside of TCM. Much of this diagnostic skill involves developing the abilities to observe subtle appearances; to observe that which is right in front of us, but escapes the observation of most people.


Diagnostic techniques
Palpation of the patient's radial artery pulse in six positions
Observation of the appearance of the patient's tongue
Observation of the patient's face
Palpation of the patient's body (especially the abdomen) for tenderness
Observation of the sound of the patient's voice
Observation of the surface of the ear
Observation of the vein on the index finger on small children
Comparisons of the relative warmth or coolness of different parts of the body
Anything else that can be observed without instruments and without harming the patient

TCM treatment techniques
The traditional treatment in Chinese medicine consists of five major methods:

Tui na推拿
Acupuncture針疚
Moxibustion艾炙
Herbology
Qigong, T'ai Chi Ch'uan and Chinese martial arts in general. Die-da or Tieh Ta (跌打): practitioners who specialize in healing trauma injury such as bone fractures, sprains, bruises etc. Some of these specialists may also use or recommend other disciplines of Chinese medical therapies (or Western medicine in modern times) if serious injury is involved. These practices are also seen as health maintenance regimes as well as interventions.
Traditional Chinese medicine uses herbs and other drugs as the last resort to fight health problems. This conforms to its basic belief: a human body has a sophisticated system to find illness, allocate resources and energy and heal the problems by itself. The goal of external efforts should carefully focus on assisting the normal self-healing function of human body, not interfering with it. There is a Chinese saying which reflects the same idea: "Any medicine has 30% poison ingredients."

The modern practice of traditional Chinese medicine is increasingly incorporating techniques and theories of Western medicine in its praxis.

Other specialties include:

Nutrition or food therapy
Gua Sha or coin-rubbing 刮痧
Auriculotherapy耳燭療法

TCM and science
There are two questions about TCM which can be investigated scientifically:

Does it work?
How does it work?

Does it work?
Most scientific research in the West about TCM has focused on acupuncture. The National Institutes of Health Consensus Statement on Acupuncture summarizes research on the efficacy of acupuncture as follows:

...promising results have emerged, for example, efficacy of acupuncture in adult post-operative and chemotherapy nausea and vomiting and in postoperative dental pain. There are other situations such as addiction, stroke rehabilitation, headache, menstrual cramps, tennis elbow, fibromyalgia, myofascial pain, osteoarthritis, low back pain, carpal tunnel syndrome, and asthma for which acupuncture may be useful as an adjunct treatment or an acceptable alternative or be included in a comprehensive management program. Further research is likely to uncover additional areas where acupuncture interventions will be useful.

Much less work in the West has been done on Chinese herbal medicines, which comprises much of TCM in China. It is clear, however, that many if not most of these medicines do have powerful biochemical effects. An example is the herb ephedra which was introduced into the West as a stimulant, and later banned in the United States after deaths were attributed to its use. A less controversial example is artemisinin, derived from an herb long-used used in TCM, and now used worldwide to treat multi-drug resistant strains of falciparum malaria. In the West, many Chinese medicines have been marketed as herbal supplements and there has been considerable controversy over the regulatory status of these substances.

TCM practitioners have no philosophical objections to scientific studies on the effectiveness of treatments. The main barrier to the adoption of Chinese herbal medicines into Western practice is economic. It requires a large amount of expertise and money to conduct, for example, a double-blind drug trial, making it a large venture to test even one of the thousands of compounds used by TCM. Because these compounds cannot be patented and owned exclusively, there is a distinct disincentive to sponsor such expensive protocols.

There are also great a priori doubts about the efficacy of many TCM treatments that appear to have their basis in magical thinking, e.g. plants with heart-shaped leaves will help the heart, ground bones of tiger give a person energy because tigers are energetic animals and so on. To researchers, this is a very small base to start serious research on.


How does it work?
The basic mechanism of TCM is akin to treating the body as a black box, recording and classifying changes and observations of the patient using a traditional philosophy. In contrast to many alternative and complementary medicines such as homeopathy, practically all techniques of TCM have explanations for why they may be more effective than a placebo, which Western medicine can find plausible. Most doctors of Western medicine would not find implausible claims that qigong preserves health by encouraging relaxation and movement, that acupuncture relieves pain by stimulating the production of neurotransmitters, or that Chinese herbal medicines may contain powerful biochemical agents. However, the metaphors used in TCM theory often concern areas not readily measured or described by Western science.


The relationship between TCM and Western medicine
Within China, there has been a great deal of cooperation between TCM practitioners and Western medicine, especially in the field of ethnomedicine. Chinese herbal medicine includes many compounds which are unused by Western medicine, and there is great interest in those compounds as well as the theories which TCM practitioners use to determine which compound to prescribe. For their part, advanced TCM practitioners in China are interested in statistical and experimental techniques which can better distinguish medicines that work from those that do not. One result of this collaboration has been the creation of peer reviewed scientific journals and medical databases on traditional Chinese medicine.

The relationship between TCM and Western medicine in the West is more contentious. While more and more medical schools are including classes on alternative medicine in their curricula, older Western doctors and scientists are far more likely than their Chinese counterparts to skeptically view TCM as archaic pseudoscience and superstition. This skepticism can come from a number of sources. For one, TCM in the West tends to be advocated either by Chinese immigrants or by those that have lost faith in conventional medicine. Many people in the West have a stereotype of the East as mystical and unscientific, which attracts those in the West who have lost hope in science and repels those who believe in scientific explanations. There have also been experiences in the West with unscrupulous or well-meaning but improperly-trained "TCM practitioners" who have done people more harm than good in many instances.

As an example of the different roles of TCM in China and the West, a person with a broken bone in the West (i.e. a routine, "straightforward" condition) would almost never see a Chinese medicine practitioner or visit a martial arts school to get the bone set, whereas this is routine in China. As another example, most TCM hospitals in China have electron microscopes and many TCM practitioners know how to use one.

This is not to say that TCM techniques are considered worthless in the West. In fact, Western pharmaceutical companies have recognized the value of traditional medicines and are employing teams of scientists in many parts of the world to gather knowledge from traditional healers and medical practitioners. After all, the active ingredients of most modern medicines were discovered in plants or animals. The particular contribution of Western medicine is that it strictly applies the scientific method to promising traditional treatments, separating those that work from those that do not. As another example, most Western hospitals and increasing numbers of other clinics now offer T'ai Chi Ch'uan or qigong classes as part of their inpatient and community health programs.

Most Chinese in China do not see traditional Chinese medicine and Western medicine as being in conflict. In cases of emergency and crisis situations, there is generally no reluctance in using conventional Western medicine. At the same time, belief in Chinese medicine remains strong in the area of maintaining health. To put it simply, you see a Western doctor if you have acute appendicitis, but you do exercises or take Chinese herbs to keep your body healthy enough to prevent appendicitis, or to recover more quickly from the surgery. Very few practitioners of Western medicine in China reject traditional Chinese medicine, and most doctors in China will use some elements of Chinese medicine in their own practice.

A degree of integration between Chinese and Western medicine also exists in China. For instance, at the Shanghai cancer hospital, a patient may be seen by a multidisciplinary team and be treated concurrently with radiation surgery, Western drugs and a traditional herbal formula.

It is worth noting that the practice of Western medicine in China is somewhat different from that in the West. In contrast to the West, there are relatively few allied health professionals to perform routine medical procedures or to undertake procedures such as massage or physical therapy.

In addition, Chinese practitioners of Western medicine have been less impacted by trends in the West that encourage patient empowerment, to see the patient as an individual rather than a collection of parts, and to do nothing when medically appropriate. Chinese practitioners of Western medicine have been widely criticized for overprescribing drugs such as corticosteroids or antibiotics for common viral infections. It is likely that these medicines, which are generally known to be useless against viral infections, would provide less relief to the patient than traditional Chinese herbal remedies.


TCM and Animals
As animal products are used in Chinese formulas, vegans and vegetarians should inform their practitioner, if their beliefs forbid the ingestion of animals. Often alternative substances can be used.

The animal rights movement notes that a few traditional Chinese medicinal solutions use bear bile. To extract maximum amounts of the bile, the bears are often fitted with a sort of permanent catheter. The treatment itself and especially the extraction of the bile is very painful, causes damage to the intestines of the bear, and often even kills the bears. However, due to international attention on the issues surrounding its harvesting, bile is now rarely used by practioners outside of China.


See also
History of traditional Chinese medicine
Public health in the People's Republic of China
Traditional Japanese medicine (Kampo)
Traditional Korean medicine

References
Chang, Stephen T. The Great Tao; Tao Longevity; ISBN 0942196015 Stephen T. Chang
Kaptchuck, Ted J., The Web That Has No Weaver; Congdon & Weed; ISBN 0809229331Z
Maciocia, Giovanni, The Foundations of Chinese Medicine: A Comprehensive Text for Acupuncturists and Herbalists; Churchill Livingstone; ISBN 0443-039801
Ni, Mao-Shing, The Yellow Emperor's Classic of Medicine : A New Translation of the Neijing Suwen with Commentary; Shambhala, 1995; ISBN 1570620806
Holland, Alex Voices of Qi: An Introductory Guide to Traditional Chinese Medicine; North Atlantic Books, 2000; ISBN 1556433263
Unschuld, Paul U., Medicine in China: A History of Ideas; University of California Press, 1985; ISBN 0520050231
Qu, Jiecheng, When Chinese Medicine Meets Western Medicine - History and Ideas (in Chinese); Joint Publishing (H.K.), 2004; ISBN 9620423364
From Wikipedia, the free encyclopedia.








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