SAN FRANCISCO CHRONICLE

CHINESE MEDICINE GAINING RESPECTABILITY IN WEST

FDA support for testing of botanical drugs helps boost credibility of ancient herbal treatments

Suzanne B. Thompson, Eugenia Chien, Special to The Chronicle

Tuesday, June 27, 2006

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More... Weary and frightened after 10 years of fighting a losing battle against bronchitis, Sheila Cohen turned two years ago to traditional Chinese medicine. A practitioner from the Osher Center for Integrative Medicine at UCSF prescribed herbal pills and teas, as well as deep tissue massage, to boost the 58-year-old's immune system.

Since then, Cohen has been gaining the upper hand on her fight against her chronic problem. Her bronchitis used to flare up at least monthly; now it strikes every eight weeks or so. "That's an accomplishment, and we're going to keep pushing to make (the period between relapses) longer," said Cohen, a San Francisco resident.

Bob Friend, 62, a real estate investor who lives in Marin County, coped with severe colds several times a year most of his adult life. His general physician told him there was no remedy. "I felt lousy," Friend said. "And there was nothing Western medicine could do for that."

Three years ago, he met with Joseph Acquah, a licensed Chinese medicine practitioner at the Osher Center. Acquah diagnosed Friend as having a weak immune system and prescribed herbs and acupuncture. Since then, Friend has taken pills containing eight Chinese herbs three times a day. "I knock on wood as I'm saying this," said Friend, "but I haven't had a cold in three years."

Like Cohen and Friend, more Americans are turning to traditional Chinese medicine after failing to find relief from conventional treatments. Such patients typically have sought out Chinese remedies at the urging of friends or family; now many are doing so on the advice of doctors at prestigious medical institutions, which over the past decade have been cautiously integrating the 5,000-year-old practice. Just as cautiously, the U.S. Food and Drug Administration recently revised its research protocols to support clinical trials of Chinese and other herbal treatments.

UCSF, Kaiser Permanente and Stanford University Medical Center are among a growing number of medical institutions that offer traditional Chinese approaches such as acupuncture, tai chi chuan and meditation as evidence mounts of their effectiveness. Hundreds of studies show clinically significant results with these treatments, including a 2002 review from Harvard Medical School that concluded that acupuncture can safely ease chronic pain as well as nausea caused by chemotherapy and pregnancy. A 2004 Tufts-New England Medical Center review of 47 studies on tai chi found the Chinese discipline of meditative movements promoted cardiovascular fitness in people with chronic conditions.

Studies like these have persuaded medical directors at hospitals to introduce traditional Chinese medicine treatments to their patient services.

"What we have to look at is safety and effectiveness and then integrate it into the system," said Dr. Harley Goldberg, a physician who directs the complementary and alternative medicine program for Kaiser's Northern California division.

One-fifth of the nation's hospitals offered complementary medical services in 2004, more than double the number in 1998, according to the American Hospital Association. Complementary medicine combines the therapies and philosophies of conventional medicine with those of alternative medicines. Influencing this trend is the Consortium of Academic Health Centers for Integrative Medicine, which was founded in 1999 to facilitate the integration of alternative medicine into American institutions and now includes 32 member medical centers, such as Harvard and Columbia universities.

This phenomenon may well signal a gradual acceptance of traditional Chinese medicine by American medical institutions -- if the ancient system can clear at least two more hurdles.

The first involves winning the confidence of U.S. physicians in the effectiveness of Chinese herbs, which rarely have been tested in controlled studies. In 2004 the FDA showed its support for the testing of Chinese and other herbs by releasing its first-ever guideline for clinical trials of plant mixtures. The agency is even allowing researchers to experiment with plant materials in clinical drug trials without first identifying their active ingredients.

"There's a need to adjust our approach if we want to encourage study of these complex mixtures," said Shaw Chen, botanical team leader with the FDA's Center for Drug xxxxuation and Research.

The second hurdle is both psychological and institutional. Many American-trained doctors are skeptical that traditional Chinese medical methods of diagnosis and treatment can be proved as beneficial as Western treatments, let alone able to meet accepted scientific standards.

And Chinese herbal pharmacies, with their unrefined, natural ingredients, do little to inspire confidence in physicians accustomed to prexxxxion drugs.

Inside Superior Trading Co., a 47-year-old herbal shop in San Francisco's Chinatown, for example, a small room is lined with old wooden drawers containing such products as dried insects, ground mollusks, dried berries, bark and corn silk, the latter of which is used to stop itching. Across town in the Potrero district, practitioners at the American College of Traditional Chinese Medicine employ ground turtle shells to ease facial spasms, low-back pain, insomnia and ulcers.

But run those remedies by Wallace Sampson, a clinical professor of medicine at Stanford University, and you'll get an earful. Sampson teaches a class called "Alternative Medicine: A Scientific View," in which he underscores the pitfalls of the Chinese approach.

"(Traditional Chinese medical practitioners) reach in the drawer and pull out dried plants, but they have no idea of the ratio of leaf to branch to root to flower, or the concentration of active ingredients, if there are any," said Sampson.

"The Chinese diagnosis is even funnier," continued Sampson. "They take your pulse and look at your tongue, look out the window and tell you that you have kidney disease. ... The entire system on which they base their claims is false."

If a treatment is followed by recovery, Sampson views it as a random event or that the malady simply ran its natural course.

Practitioners of traditional Chinese medicine are accustomed to doubt and even derision from conventional doctors.

"The cynics say this is all voodoo medicine, and it's placebo," said Dr. Bradly Jacobs, an internist at UCSF's Osher Center. "In my opinion, this is based on empirical experience of what's worked for millennia. There's something to be said for that."

Traditional Chinese medicine first arrived in the United States in the 1860s, carried across the ocean to the West Coast by Chinese immigrants recruited to build the transcontinental railroad. But few outside Chinese American culture paid any attention to the ancient practice, with its exotic remedies and bitter potions. It wasn't until the 1970s, when relations thawed between the United States and China, that mainstream medical practitioners gave it any heed -- and then the focus was primarily on the promise of acupuncture.

But over the past two decades, Americans from across the cultural spectrum have been trying traditional Chinese medical treatments and spreading news of their success stories. No statistics are available for how many Americans have tried these ancient remedies, according to the National Center for Complementary and Alternative Medicine. However, in a 2004 report, the center stated that traditional Chinese medicine is among a range of unconventional treatments that more than one quarter of American adults are turning to when conventional treatments fail. Roughly the same number also are seeking these remedies at the advice of their Western doctors, the report noted. One reason more patients and doctors are embracing traditional Chinese medicine is the reported success rate at treating "multisystemic" maladies, like fibromyalgia, chronic fatigue syndrome and chronic pain, which affect the brain as much as the body. A 2004 study from UCLA noted that new research into the neurological aspects of disease "show striking similarities with concepts used by traditional Chinese medicine." The researchers referenced Western medicine's expanding knowledge of the role of stress as well as physical and emotional trauma in triggering "complex interactions between mind, body and brain" -- a phenomenon long acknowledged in Chinese medicine.

Traditional Chinese medicine also can be more affordable than prexxxxion drugs. For $17 a month, for example, Friend gets a monthly supply of pills to stave off severe colds. And Cohen pays about $13 a month for her bronchitis pills. But the cost of the raw products for making teas sometimes can be higher than prexxxxion medications.

Chinese medicine practitioners in most medical institutions are either doctors or licensed acupuncturists. In 1979, California became the first state to license acupuncturists, who also serve as de facto licensed herbal practitioners, as they're required to complete at least 450 hours of training in the use of Chinese herbs.

Although the FDA is lending its support to these doctors and practitioners, it is doing so carefully -- acknowledging scientists' concerns about Chinese herbal treatments.

"Because these (herbs) have been used by alternative medicine for so long, we want to be able to understand if they're useful," explained the FDA's Chen.

Previously, botanicals could be used in clinical trials only if their active ingredients were identified. But with Chinese medicines, that's difficult if not impossible, as multiple herbs are employed, said Xiu-Min Li, a researcher at the Mount Sinai School of Medicine in New York City.

Later this year, she is beginning a human trial testing nine Chinese herbs, including dried fruit, roots, ginger and Chinese pepper, to prevent anaphylactic shock in children allergic to peanuts. In mice, she says, the treatment proved successful.

Li and her colleagues tested the effect of each herb, but none worked as well individually as the combination. "That's why we say the whole xxxx is so potent," Li said. She's also testing Chinese herbs for preventing asthma attacks.

In experiments using botanicals, the FDA is also allowing anecdotal evidence of the safety of an herbal remedy in lieu of safety tests on animals. This safety xxxxuation phase for Chinese herbs will be "significantly cheaper" than safety testing for conventional new drugs, predicted Li, although she couldn't cite a specific estimate for completing a drug study. Clinical trials for standard drugs cost an estimated $800 million, according to the Journal of Health Economics.

Li thinks the FDA guidelines will foster a new wave of promising research using ancient remedies. Acquah of UCSF agrees. He said the federal agency's support for testing of botanical drugs will "give a stamp of credibility" to traditional Chinese medicine.

"It will offer more therapeutic opportunities for people," said Acquah. "And it makes herbal practitioners more legitimate in the eyes not only of the general public but to our colleagues in the medical profession."

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Treating hay fever the herbal way

Jian He Chen uses these substances to make up a remedy for hay fever in a Chinese medicine pharmacy at the Superior Trading Co. in San Francisco.

Red dates

Citrus peel

Poria cocos

Schizandra berries

Bitter almond

Honey-cured

licorice root slices

Pinellia

Codonopsis

Atractylodes

Ephedra stems

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10 commonly used Chinese herbs
Traditional Chinese medicine uses more than 6,000 species of plants, processed in different ways and prescribed in different combinations depending on the patient's condition. Always consult a licensed practitioner and your general doctor before taking any herbal supplements, many of which may have negative side effects when taken in combination with other medications.

Astragalus (Huang Qi) -- A perennial plant with hairy stems and small leaflets. Its long root is dried and used for colds and flu as well as fatigue and digestive disorders, like diarrhea and bloating. Astragalus is also given to boost the immune system, treat skin disorders and replenish qi (or energy) of the spleen and stomach.

Chinese angelica (Dang Gui) -- A fragrant perennial plant with white flowers and purple stems. The root of this plant is reputed to relieve menstrual disorders, anemia, chronic abdominal and bodily pains, and chronic constipation. It is also used to treat insomnia and fight skin infections.

Chinese yam (Shan Yao) -- A root vegetable that is sliced and dried. It is reputed to strengthen the spleen, lungs and kidneys. It is also given to reduce fatigue, treat chronic cough and wheezing, and stabilize the leakage of fluids in urogenital conditions.

Eucommia bark (Du Zhong) -- A tree bark used in cases of aching back and knees by nourishing the liver and kidney as well as the sinews and bones. Eucommia bark is also used to prevent miscarriages in cases of bleeding during pregnancy.

Fleece flower root (He Shou Wu) -- A root that is used to invigorate the liver and blood and strengthen the kidneys. Fleece flower root is also given to treat constipation and to clear toxins. It is commonly used to maintain both hair color and hair growth.

Ginger (Gan Jiang, dried ginger; or Sheng Jiang, fresh ginger) -- A common root used in its dry xxxx to treat digestive problems, warm the body, promote circulation and transxxxx congested fluid in the lungs. Fresh ginger root is reputed to alleviate the common cold, reduce intestinal inflammation, and reduce nausea and vomiting associated with pregnancy, motion sickness and chemotherapy.

Ginseng (Ren Seng) -- This knotty root has been used as a general tonic to strengthen body functions, recover from illnesses or surgery, improve male infertility and impotence, and enhance the immune system. Ginseng is a particularly potent herb that can raise blood pressure and interact with medications such as blood thinners. It should be avoided during pregnancy. Ginseng's strength increases over time; its age can be determined by the wrinkles that encircle the plant.

Licorice (Gan Cao) -- A sweet-tasting root that is reputed to treat sore throats and coughs, muscle spasms and digestive weakness. Licorice has been used in treatments for liver disease, respiratory ailments like allergies and bronchitis, heart conditions such as irregular pulse or palpitations, and stomach problems like heartburn. Licorice is also commonly used in Chinese herbal xxxxulas to modify the harsh attributes of other herbs and as an antidote to a variety of toxic substances.

Poria (Fu Ling) -- A fungus that grows on pine tree trunks. Poria is a mild diuretic, often used in cases of edema, urinary difficulty and diarrhea. It is said to enhance the immune system, increase the flow of urine and improve the spleen's function of transxxxxing fluids. It is also used as a mild sedative that can relax the mind and reduce insomnia.

Wolfberry fruit (Gou Qi Zi) -- Small red berries that contain large amounts of antioxidants. They are believed to help eyesight, protect the kidney and liver, and improve circulation by nourishing the blood. The berries are sweet and act to enrich yin fluids. (Yin is the darker element in the two opposing forces in traditional Chinese medicine.) Wolfberries are also said to improve the immune system.

This list was compiled with the help of Fiamma Sita Aaron, a licensed acupuncturist with private practices in Manhattan and Basking Ridge, N.J., and Anita Huang, licensed acupuncturist and clinical practitioner at the American College of Traditional Chinese Medicine in San Francisco.