Traditional Herbal Medicine as Pharmacological Stroke Treatment - Essay Example

Critical Review of Traditional Herbal Medicine as Pharmacological Stroke Treatment to Address Evidence-based Medical Practice Treating stroke is an age-old clinical and pharmacological predicament in the health care and medical profession, coupled with the dearth of ground-breaking and evident-based medicine treatment and approach that resulted in people’s continued search for answers. However, embracing which one to choose as a more viable pharmacological solution in treating stroke has varying degree of contradictory views, particularly in using either both conventional or alternative or complementary medicine. Interest in traditional medicine surged in recent years, backed by an even more accelerating number of observational and anecdotal experience being accumulated over the last 1,000 years.1 Traditional medicine is defined by the World Health Organization (WHO) as “health practices, approaches, knowledge and beliefs incorporating plant, animal and mineral based medicines, spiritual therapies, manual techniques and exercise … to treat diagnose and prevent illnesses or maintain well-being.”2 Traditional forms of medicine make use of herbs and acupuncture (holistic treatment approach) when it gets clues of an internal imbalance to achieve body harmony, which is unlike the Western medicine, which focuses only on the disease. In researches chosen for this report, one of the studies evidenced how herbal or traditional medicines helped improve microcirculation in the brain of a patient; it also helps protect against ischemic reperfusion injury, possess neuroprotective properties and inhibit apoptosis, thus justifying their use in stroke patients.3 Similar yet at times contradictory findings would be revealed in the studies explored, but might be the information needed to resolve and address issues that demand attention. Prospect for Evidence-based medicine treatment, where derive. To understand the concept of evidence-based medicine, it is said it is best to postpone any attempt to define it until we inspect and look into the theories in making clinical judgment and decision-making. In an article published by the Journal of Emergency Primary Health Care (JEPHC) about its survey of theories related to judgment and decision-making, its author Ramon Shaban tried to construct a well-thought out definition of the terms judgment and decision-making in the context of medical practice, but to no avail, citing a universally-accepted definition of judgment or decision-making in this context has not been arrived at.4 One of the criticisms often hurled against clinical judgment and decision-making is the propensity of some practitioners to rely not on scientifically or statistically-based information but on trial and error and unpredictability;5 and medicine which should harbor on exactness were kept on bay as medical practitioners rely on their intuition. Until two decades ago, a new movement, now known as evidence-based emerged, more in response to the floundering of our society’s overburdened medical health and care system, according to “A Study a Day keeps the Doctor Away,” an article written by Leyla Kokmen in the politically-charged Utne Reader magazine (Sept-Oct 2007). As evidence-based movement work aim for a just and responsible practice of the medical profession, specially of pharmacological treatment of disease like stroke, we attempted to look into the issues used in the various theories to make a sound and logical clinical judgment and decision-making. With evidence-based medical movement, regard to patients who are asked more and more to get more responsibility in paying for their solicited health services are put in premium. As should be the case, patients must be informed if they are presented with health care choices that were employed with little or no scientific evidence, so they can opt for more invasive and expensive treatments because more often than not, these remedy do more harm than good.6 Doctors should however not receive all the blame as they often do not realize that their treatment choices are not based on evidence but more on their training in the profession, practice philosophy, and experiences, according to Kokmen. To resolve this bias, evidence-based treatments embraced the “gold standard” in research, which called for randomized controlled trial.7 Surveying existing Patented Traditional Chinese Medicines. In the research work, “Meta-Analysis of Traditional Chinese Patent Medicine for Ischemic Stroke,” authored by Wu and colleagues and published by Stroke, it presented the first ever systematic examination of more than 59 Traditional Chinese Patent Medicine (TCPM) for their efficacy and safety using the Cochrane systematic review. These patented medicines, recorded in the books of the Chinese National Essential Drug list (2004) and commonly used in China for ischemic stroke patients, were scrutinized for bias and errors. Using both published and unpublished Chinese and non-Chinese language literatures, the scope of the literature search span from 1966 to 2005. It was identified by the group of Wu8 that almost all or 97 percent of the clinical trials chosen for the review reflected the poor methodological quality of the same. However, in all, the research sought to highlight the recent great attention and interest among Chinese researchers in studying the efficacy of TCPM drugs in ischemic stroke patients. Wu concluded that there was insufficiency in quality evidence on TCPM’s effects in treating ischemic stroke on primary outcome (death or dependency); his group also noted the that agents were found to be promising in terms of giving benefit and for being nontoxic, random controlled trials would be justified if further pursued. In the final analysis, it is note mentioning how it would benefit the whole industry of traditional medicine if statutory regulations and approval process would be designed for the study of medicines appropriately based on scientifically sound and locally applicable guidelines. Sheng Mai San – One More Score for China. One traditional Chinese herbal medicine, Sheng Mai San or SMS, given an extensive coverage in the Journal of Pharmacological Sciences by the Japanese Pharmacological Society, was recognized for its efficacy in remedying heatstroke of those who suffered from circulatory shock and oxidative damage. Ning-Lu Wang and colleagues studied and documented in their published work, “Chinese Herbal Medicine, Shengmai San, Is Effective for Improving Circulatory Shock and Oxidative Damage in the Brain During Heatstroke,” that a circulatory shock happens when there is not enough blood circulating to support the tissues, especially the brain. Oxidative damage, on the other hand, takes place because of the abundance of free radicals in our systems. As if these weren’t enough, the bad news is that these two unwanted events are heightened when a person suffers from heat stroke.9 An anesthetized rats used in the experiment were placed in a 43˚C environment and found to have a higher risk of experiencing such after the onset of heat stroke, unlike the rats that had normal body temperatures. Increased brain levels of free radicals are found to be one of the pathophysiological (referring to the disturbance in normal processes of the body resulting from a disease or condition) changes responsible for this. However, thanks to the SMS that was administered to the heat-stricken rats. In the tests, the results show that they had significantly lower values of mean arterial pressure, cerebral perfusion pressure, cerebral blood flow, and brain partial pressure of oxygen than the ones under normal conditions. In very short words, SMS works, pre-treatment and post treatment-wise. Although, they have also found out that the protective effects of SMS pretreatment is superior to that of post-treatment; proving once again that prevention is better than cure. Finally, the data culled from the present study showed that SMS as an herbal medicine, an alternative to Western medicine, can be adopted and used in treating circulatory shocks and oxidative ishcemic change in the brain during heatstroke. However, unlike the industrially manufactured drugs used in Western medicine, a herbal medicines’ active (potent) components are often never systematically specified and precisely measured. Although there have been recent attempts to regulate dosages and use of these medicines by some governments.10 Mind-Body Therapies. Another method of treating stroke is the applied approach of Mind-Body Therapy (MBT) or treatment. In the research headed by John Astin titled, “Mind-Body Medicine: State of the Science, Implications for Practice,” published by the Journal of the American Board of Family Medicine (JABFM), there is a scientific proof that can prove the efficacy of such treatment in treating the organic cause of the stroke and its symptoms. Treatments in MBT include relaxation, imagery, meditation, hypnosis, and biofeedback. The treatment on a certain illness can be a combination of any of these methods depending on the certain area where particular treatments needed.11 Organic cause of stroke such as the cardiovascular disease and artery concerns were pointing out to the psychological factors of the disease’s development and progression. A 1996 study of treating the stroke and other related cardiovascular disease stated that the treatment was faster when being treated with psychosocial treatments.12 Psychosocial stress treatment used to treat patients who had stroke for recovery is the biofeedback. The method is to re-educate or learn again the proper activity of the bodily muscles being affected by stroke. The group of researchers conducted a survey of available online resources and references that concerns clinical trials and reviews of literature about mind-body therapies and delimiting the research to items which are not necessarily needed to proving the assumptions developed for the study. In coming out with a reliable and verifiable study, relevant systematic reviews, meta-analyses, and randomized controlled trials were also studied. Research study being conducted has concluded that through the evidence produced in proving the efficacy of the MBT, medical treatment should adopt or include in their medical treatment system the biopsychosocial approach. Study also showed that biologic-genetic treatment approach alone cannot reach the bigger percentage of the treated patients used with MBT. Researchers who conducted the study strongly promoted to prioritize the integration of psychosocial-mind-body approaches in the medicine, citing several valid rationales of such move and body of evidences that prove its effectiveness in treating serious diseases such as stroke, coronary artery and cardiovascular diseases.13 Conclusion. This study is necessary in the light of recent weaning effectiveness or efficacy of using Western and commercially-formulated medicine; whereas, the use of alternative medicine, particularly of traditional herbal medicines and other psycho-social therapy, are making progress in this regard. However, while there are progress being made, contradictory views are evident which must heed the call for a forceful adoption of evidence-based medical treatment. To help understand some of the puzzling concerns in treating stroke by way of evaluating both the complementary and the Western-style medicine through the chosen research works, we look into the discourses of recent practitioners of modern and alternative therapies. More particularly, this study looks into the ways by which embracing unconventional treatment like the Traditional Chinese Patent Medicine (TCPM), and some psychosocial-mind-body intervention therapies in treating stroke may be an intelligent and logical alternative after all. As interest in furthering research in the pharmacological use of traditional medicine continue to rise, the adoption of evidence-based medicine treatment should also achieve high acceptance level from the people. This movement calls for careful use or regard on scientifically and statistically sound evidence, rather than on individual physicians’ judgment or intuition. In sum, the lack of effective and largely applicable pharmacological remedy for stroke until now, makes the shift to traditional approaches treating illness a logical and rational step. Recent researches in the years surveyed, yielded published works that deal with the effect and the promising benefits of traditional medicine for the treatment of stroke. Among the advantages seen in furthering the research is that issues identified as affecting its quality, safety and efficacy can still be corrected and may help in coming up with recommendations appropriate in formulating a system of classifying and measuring its formulation needs, and others. References Astin, J., Shapiro, L. L., Eisenberg, D. M., and Forys, K. L. (2005), Mind-Body Medicine: State of the Science, Implications for Practice, Journal of the American Board of Family Medicine. 16(2) April, Retrieved 17 June 2008, from http://www.jabfm.org/cgi/reprint/16/2/131 Bo Wu, Ming Liu, Hua Liu, Wei Li, Song Tan, Shihong Zhang, Yuan Fang (2007) Meta-Analysis of Traditional Chinese Patent Medicine for Ischemic Stroke. Stroke. Retrieved 17 June 2008, from http://stroke.ahajournals.org/cgi/reprint/38/6/1973.pdf Feigin, Valery L. Herbal Medicine in Stroke: Does It Have a Future? Stroke. Retrieved 17 June 2008, from http://stroke.ahajournals.org/cgi/reprint/38/6/1734.pdf Green, AR. (2008) Pharmacological approaches to acute ischemic stroke: reperfusion certainly, neuroprotection Possibly. British Journal of Pharmacology. Retrieved 17 June 2008, from http://www.nature.com/bjp/journal/v153/n1s/pdf/0707594a.pdf Integration of behavioral and relaxation approaches into the treatment of chronic pain and insomnia. NIH Technology Assessment Panel on Integration of Behavioral and Relaxation Approaches into the Treatment of Chronic Pain and Insomnia. JAMA 1996;276:313– 8. Kokmen, Leyla, (2007), A Study a Day Keeps the Doctor Away. Utne Reader. (143) pp. 72-76. Miller, Leonard (ed.) (1999). Stroke Therapy: Basic, Preclinical, and Clinical Directions, Chichester: John Wiley & Sons Inc. Retrieved 16 June 2008, from http://brain.oxfordjournals.org/cgi/reprint/123/1/193 Ning-Lu, Liou, Yann-Lin, Lin, Mao-Tsun, Lin, Chia-Li, and Chang, Cheng-Kuei. (2005) Chinese Herbal Medicine, Shengmai San, Is Effective for Improving Circulatory Shock and Oxidative Damage in the Brain During Heatstroke. Journal of Pharmacological Sciences, pp. 253 – 265/ Retrieved 17 June 2008, from http://www.jstage.jst.go.jp/article/jphs/97/2/253/_pdf Shaban, Ramon Z. (2005). Theories of clinical judgment and decision-making: A review of the theoretical literature Journal of Emergency Primary Health Care,, 3(Issue 1-2). Retrieved 18 June 2008, from http://www.jephc.com/uploads/RS9901141.pdf World Health Organization, (2003), World Health Organization Fact Sheet. Revised May 2003 ed. Geneva: World Health Organization Read More