Qi Spot

Chinese Herbs

Ah yes, the sacred double blind study – the holy grail of western medicine.  It’s proponents mean well, and if used properly, it is an essential tool in the research of the effectiveness of interventions.  Again, the key phrase, as always, is “if used properly.”  The article I have cited does not use it properly. Feel free to read the whole article, as I have linked to it below, but let me quote the conclusion as follows:

“Overall the positive evidence in favour of Chinese herbal medicines for the treatment of impaired glucose tolerance is constrained by the following factors: a lack of trials that tested the same medicine, lack of details on co-interventions, unclear methods of randomisation, poor reporting and other risks of bias,”

So here are their “constraints”:

a) a lack of trials that tested the same medicine.

b) a lack of details on co-interventions

c) unclear methods of randomisation

d) poor reporting and other risks of bias

And here are my comments, first for letters b and d.

“lack of details on co-interventions” – I agree that this needs rectification.  Co-interventions are very important in Chinese Medicine as we believe that the human being is a microcosm of the universe.  Everything affects health – diet, lifestyle, work and play level, family relationships, etc.  What I find surprising is that western medicine is using this critique on Chinese medicine, considering how much less an emphasis western medicine puts on it.

“poor reporting and other risks of bias” – Considering that western medical studies are more often than not funded by the very companies that produce the drugs, poor reporting and bias risks is not something that we M.D.s should be throwing at our “alternative” counterparts.

And back to our main program:

Western medicine is heavily influenced by Robert Koch.  His idea was basically one pathogen per disease.  A logical corollary of that is that there is a tendency to go for one solution per problem, hence the comment “lack of trials that tested the same medicine”.  I can assume this means, in plain language, “why are there so many formulas (15 cited in the article) for diabetes? Can’t we just stick to a few and test those repeatedly?”

Also, there is the all powerful “randomisation” (or randomization in American).  Why can’t we give the same drug blindly to a group of randomly selected subjects and give a placebo to the other half?  (The essence of a double-blind study, btw, is that neither drug pusher nor drug addict to be knows they’re pushing/drinking).

The answer to these questions can be summarized in the Chinese medicine axiom: “One disease, many treatments; Many diseases, one treatment” and the idea of treating the root and not the branches of the tree.

I recall explaining this concept to a colleague of mine.  After I mentioned that “western medicine doesn’t care for the causes of migraine in terms of formulating treatment,” she replied, “but western medicine does!” and then she went on to elaborate different mechanisms of action for the pain, mostly elaborating on the dilation of cranial blood vessels.

Countering, I said, “no, what we mean by causes include: is the patient’s head constantly bombarded by wind?  Is the problem emotional? Is the problem mainly dietary?”  In other words, we’re not looking for what physiologic process leads to the pain, but what environmental or lifestyle cause is triggering the physiologic process.  The treatment must then look to treat THAT cause.  Hence, “One disease, many treatments.”

Secondly, the same cause might present as different diseases.  For example, a person who gets exposed to extreme (for that person) cold can present with a headache, or a runny nose, or the flu, or might have an old arthritic pain recur.  Treatment in Chinese medicine should look at the presentation (let’s use headache) and treat the root of that headache.  Acupuncture-wise, we might use points specific for the area of pain combined with points for treating cold.  Those points for treating cold may also be used in the other presentations, such as the runny nose, the flu, etc.  Hence, “many diseases, one treatment”.

How does that apply to our Diabetes studies?

Quite simply, Chinese medicine may recognize many causes for a patient’s high blood sugar.  The Diabetes is the branch – the presentation – which may have many roots.  Treat the root, not just the branch.  This is the essence of treatment customization in Chinese medicine.

As a western doctor, I was trained mainly to look at the blood sugar level.  As a chinese doctor, I’d ask the patient about sleep, appetite, waste management, and customize treatment appropriately.  Hence, if the patient improves after just one week, I might tweak the formula or even change the formula altogether; depending on the patient’s presentation at the time.  At the same time, the physician has in mind the root cause of the disease, so one must have both a long term and short term strategy in mind.

Given that summary, I hope the reader realizes why it is so difficult to study Chinese Medicine using double blind trials – because the very nature of Chinese medicine undermines the double blind study.

Sources:

From Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD006690, as quoted by Endocrinology Update.

Corderoy, Amy. “Evidence Lacking in Chinese Medicine for Diabetes” Endocrinology Update 8 October 2009. 9 October 2009 <http://www.endocrinologyupdate.com.au/article/evidence-lacking-for-chinese-medicine-in-diabetes/501343.aspx>