August 19, 2010 — Tai chi may be a helpful intervention for patients with fibromyalgia, according to the results of a single-blind, randomized trial reported in the August 19 issue of the New England Journal of Medicine.

"Previous research has suggested that tai chi offers a therapeutic benefit in patients with fibromyalgia," write Chenchen Wang, MD, MPH, from Tufts Medical Center, Tufts University School of Medicine in Boston, Massachusetts, and colleagues. "...[Tai chi] combines meditation with slow, gentle, graceful movements, as well as deep breathing and relaxation, to move vital energy (or qi) throughout the body. It is considered a complex, multicomponent intervention that integrates physical, psychosocial, emotional, spiritual, and behavioral elements."

Fibromyalgia was defined by American College of Rheumatology 1990 criteria. Participants (n = 66) were randomly assigned 1:1 to receive classic Yang-style tai chi or a control intervention consisting of wellness education and stretching. In both groups, participants received 60-minute sessions twice weekly for 12 weeks.

Fibromyalgia Impact Questionnaire (FIQ) score (ranging from 0 - 100) at the end of 12 weeks was the main study outcome, with higher scores indicating more severe symptoms. Secondary outcomes were summary scores on the physical and mental components of the Medical Outcomes Study 36-Item Short-Form Health Survey. To assess durability of the response, these tests were performed again at 24 weeks.

Improvements in the FIQ total score and quality of life in the tai chi group were clinically important. For this group, mean baseline and 12-week FIQ scores were 62.9 ± 15.5 and 35.1 ± 18.8, respectively, vs 68.0 ± 11 and 58.6 ± 17.6, respectively, in the control group. The mean between-group difference from baseline in the tai chi group vs the control group was -18.4 points (P < .001).

The tai chi group also fared better than the wellness intervention group in physical component scores of the Short-Form Health Survey (28.5 ± 8.4 and 37.0 ± 10.5 for the tai chi group vs 28.0 ± 7.8 and 29.4 ± 7.4 for the control group; between-group difference, 7.1 points; P = .001) and mental component scores (42.6 ± 12.2 and 50.3 ± 10.2 vs 37.8 ± 10.5 and 39.4 ± 11.9, respectively; between-group difference, 6.1 points; P = .03).

These improvements were still present at 24 weeks (FIQ score between-group difference, -18.3 points; P < .001), with no reported adverse events.

Limitations of this study include lack of double blinding, lack of generalizability because treatment was delivered by a single tai chi master at a single center, and follow-up limited to 24 weeks.

"In conclusion, our preliminary findings indicate that tai chi may be a useful treatment in the multidisciplinary management of fibromyalgia," the study authors write. "Longer-term studies involving larger clinical samples are warranted to assess the generalizability of our findings and to deepen our understanding of this promising therapeutic approach."

The National Center for Complementary and Alternative Medicine, the American College of Rheumatology Research and Education Foundation Health Professional Investigator Award, and the Boston Claude D. Pepper Older Americans Independence Center Research Career Development Award supported this study. The contents of the journal article are solely the responsibility of the study authors and do not necessarily represent the official views of the National Center for Complementary and Alternative Medicine or the National Institutes of Health. Disclosure forms provided by the study authors are available with the full text of the original article here .

N Engl J Med. 2010;363:743-754.

Coenzyme Q10 and Ageing

Coenzyme Q10 and Ageing

Coenzyme Q10 (CoQ10) is an essential component of healthy mitochondrial function. It is incorporated into cells’ mitochondria throughout the body where it facilitates and regulates the oxidation of fats and sugars into energy. Ageing humans have been found to have over 50% less CoQ10 on average compared to that of young adults. This finding makes CoQ10 one of the most important nutrients for people over 30 to supplement with. About 95% of cellular energy is produced in the mitochondria. The mitochondria are the cells “energy powerhouses” and many maladies have been referred to as “mitochondrial disorders.” (1) A growing body of scientific research links a deficiency of CoQ10 to age-related mitochondrial disorders.

Coenzyme Q10 and Skin Anti Ageing

Intracellular and extracellular oxidative stress initiated by reactive oxygen species (ROS) advance skin ageing, which is characterized by wrinkles and atypical pigmentation. Because UV enhances ROS generation in cells, skin ageing is usually discussed in relation to UV exposure. The use of antioxidants is an effective approach to prevent symptoms related to photo-induced aging of the skin. Coenzyme Q10 has shown potential in this area of anti ageing. (2)

Coenzyme Q10, Chronic Illness and Cardiovascular Health

CoQ10 is found in blood and in all organs and CoQ10 deficiencies are due to autosomal recessive mutations, ageing-related oxidative stress and carcinogenesis processes, and also statin treatment. Many neurodegenerative disorders, diabetes, cancer, muscular and cardiovascular diseases have been associated with low CoQ10 levels, as well as different ataxias and encephalomyopathies. (3)

CoQ10 and Parkinson’s (PD)

Mitochondrial dysfunction has been frequently observed in PD, and several lines of evidence support its causative role in disease pathogenesis. Loss of mitochondrial complex I catalytic activity in the electron transport chain (ETC) is found in multiple tissues from individuals with sporadic Parkinson's disease (PD) For example, in a PD study, a 30% to 40% reduction in complex I activity was observed in sporadic PD(4). CoQ10 is also a potent antioxidant distributed in all membranes throughout the cell. It is able to work in concert with a-tocopherol and participates in the recovery of cells from oxidative stress (5). Levels of coQ10 measured in mitochondria from PD patients were significantly lower than in age-matched controls (6), while at the same time the percentage of oxidized coQ10 was relatively increased (7). CoQ10 is extremely lipophilic, making it easy to cross the blood brain barrier (BBB). Its absorption is improved by the inclusion of lipid in the formulation and by taking it with food.

References
1. Coenzyme Q(10) can prolong C. elegans lifespan by lowering oxidative stress. Ishii, N., et al. 1, s.l. : Mech Ageing Dev., 2004, Vol. 125.
2. Role of antioxidants in the skin: Anti-aging effects. Masaki, H. s.l. : Journal of Dermatological Science, 12 July 2010.
3. The Clinical Application of Metabolic Therapy for Cardiovascular Disease . Hadj, A., Salvatore Pepe, S. and Rosenfeldt, F. 3, s.l. : Heart, Lung and Circulation, 2007, Vol. 16.
4. Mitochondria in the aetiology and pathogenesisof Parkinson's disease. AH, Schapira. 1, s.l. : Lancet Neurol., 2008, Vol. 7.
5. Relations between tocopherol depletion and coenzyme Q during lipid peroxidation in rat liver mitochondria. . Noack H, Kube U, Augustin W. 6, s.l. : Free Radic Res., 1994, Vol. 20.
6. Coenzyme Q10 levels correlate with the activities of complexes I and II/III in mitochondria from parkinsonian and nonparkinsonian subjects. Shults CW, Haas RH, Passov D, Beal MF. 2, s.l. : Ann Neurol., 1997, Vol. 42.
7. Redox status of plasma coenzymeQ10 indicates elevated systemic oxidative stress in Parkinson's disease. M, Sohmiya, et al. 2, s.l. : J Neurol Sci., 2004, Vol. 223.

TCM Research: Present and Future

Traditional Chinese Medicine (TCM) is a term commonly given to a range of traditional medical practices developed over several thousand years in China. TCM is a complete and complex systems of medicine with its own unique diagnostic and treatment principles. To treat and prevent disease TCM incorporates patho-physiology and a range of therapies that includes an extensive and effectual range of medicines and techniques. TCM incorporates practices such as herbalism, Tui Na, acupuncture, cupping, moxibustion (the heating of an acupuncture point or needle with a smoldering herb), Qi Gong, diet therapy and Tai chi. In addition, TCM considers behavioural adjustment fundamental to the therapeutic process.1

Medicinal herbs used in Chinese medicine, are accepted in greater numbers by the general public and research facilities.1 Research scientists are studying TCM and other herbs to evaluate their effectiveness and to establish new potent drugs from some or even a single constituent. For example, many new drugs such as TNP-470, perillyl alcohol, homoharringtonine, flavopiridol and paclitaxel used to treat cancer are derived from either plant or fungi.1

Herbal medicine is able to address several problems simultaneously wheras most chemically-derived drugs address only a single problem. A herbal medicine consists of various constituents, and its pharmacological action can be due to a particular active constituent in it or the complex interactions between the constituents, which work synergistically1.

The biggest advantage of herbal medicine is that it is obtained from plants; its organic nature makes it compatible with our body’s chemistry. It is thus more effective with few toxic side effects. Herbal medicine is thus in compliance with the basic principle of naturopathic medicine: the healing power of nature.

Current Research Development

In western countries, herbal medicines have become more popular amongst both the public and scientific communities 1. With this increasing popularity comes the need to competently monitor and scientifically research various aspects of these medicines using modern analytical and chemical techniques to provide qualitative and quantitative analyses, in order to guarantee its safety and efficacy. Such actions serve to maintain quality control and provide botanical, chemical, manufacturing and biological assurance.

In the United States, herbal medicines are regarded as dietary supplements 1. Pharmaceutical companies have recognized the value of traditional Chinese medicine and are employing teams of scientists to gather knowledge from traditional herbalists and medicine practitioners. The United States National Institutes of Health established the National Center for Complementary and Alternative Medicine in 1999. With a budget of $US 50 million 1, this center is dedicated to exploring complementary and alternative healing practices, including TCM, in the context of rigorous scientific testing, the training of complementary and alternative medicine researchers, and disseminating authoritative information to public and professionals alike.

Modern technologies being used or under development for the quality control of TCM include a wide range of analytical techniques used in western pharmaceutical research such as microscopic analysis, chromatographic methods, mass spectrometry, DNA sequencing methods and bioassays.2 Such modernization is important to the standardization of TCM and the establishment of qualitative and quantitative data on its active ingredients and bioactivity. In addition, evaluation of toxicity and side effects of TCM, and clinical tests such as double-blind clinical trials are conducted to ensure its safety and efficacy.3 Modern analytical and pharmacological methods are currently used to determine the properties of herbal combinations in comparison with their single component.

Role and Future Development

Traditional herbs have been the major sources of many modern single-drug developments 1. In current drug development, a herb or herbal formulation from folk remedies or clinics is investigated. Then extraction of the target herbal medicine results in a promising new active natural product or their synthetic analogues through verified pharmacological testing and bioactivity-directed fractionation and isolation of active ingredients.4 The active ingredients of the target drug are then used for the next stage of its development. In this stage, toxicity and efficacy are determined. Clinical trials are the ultimate goal of these preclinical steps.

While western medicine currently employs pure, single compounds to address human diseases, TCM has long used multiple combinations of medicinal herbs to treat and relieve the symptoms of many different diseases. It is more attractive to consumers as TCM may have fewer and less severe side effects than single pure drugs. Therefore, the multi-component and synergistic nature of TCM should not be ignored in pharmaceutical development. In order to continue the legacy of Chinese medicine, TCM research must continue to identify and improve the efficacy of herbal active principals both singly and in combination from active ingredients, active fractions, and active prescriptions of herbal formulations. See below for an example of research on a TCM formula.

References:

1.Georgiou, H. (2006). Reasons for use and Disclosure of Complementary Medicine by People with Haemoglobinopathy. PhD Thesis Victoria University

2. Jonas WB. (1998). Alternative Medicine - learning from the past, examining the present, advancing to the future. JAMA, 280: 1616-1618.

3. Hsien TC, et al. (2002). Effects of Coriolus Versicolor (I'm Yunity) on Cell-Cycle Progression and Expression of Interleukins-1s -6, and -8 in Promyelocytic HL-60 Leukemic Cells and Mitogenically Stimulated and Nonstimulated Human Lymphocytes. J Altern Complem Med 8: 591-602.

4. Tsang KW, et al. (1997). Coriolus Versicolor Polysaccharide Peptide slows progression of advanced non-small cell lung cancer. Resp Med;97: 618-624.

5. Lee KH, et al.(2000). Research and future trends in the pharmaceutical development of medicinal herbs from Chinese medicine. Public Health Nutr, 3(4A): 515-522.

Yu Ping Feng Wan (Yu Ping Feng Pian, Yu Ping Feng San, Jade Screen Teapills). is an ancient Chinese herbal medicine used for building up the resistance of the body against the invasion of pathogenic influences. Today it is the most recommended herbal remedy for boosting the immune defense to the infection of bacteria and viruses.

What does it do?
In Traditional Chinese Medicine (TCM), our body is vulnerable to attacks of pathogenic influences. Normally our body forms a natural line of defense to ward off the attacks from the mouth, the nose, or the surface. When the defense gets weaker, the body is more susceptible to the bacteria and virus infection and to get cold and flu.

Yu Ping Feng Wan acts to enhance the resistance. Literally the name means Jade Screen, as if it forms a solid screen to protect the body. In many controlled clinical trials, Yu Ping Feng Wan is shown to significantly reduce the frequency of the common cold and bacteria infection in the respiratory tract in people who have chronic bronchitis or children who are susceptible to the cold or flu.1

Modern biomedical researches attribute the defense against the pathogens to the function of the immune system. The immune defense requires immunoglobulins (Ig), T lymphocytes, microphages, cytokines like interferons etc.. Many researches have been conducted to test whether Yu Ping Feng San contributes to the immune function. These studies consistently found that Yu Ping Feng San increases IgG and IgA production, enhances microphage function, and inhibits the growth of influenza virus H3N2.1

Yu Ping Feng Wan is indicated in China Pharmacopoeia2 to invigorate the vital energy to strengthen the body surface resistance and to stop perspiration. It is used for deficiency of the superficies to protect the body against diseased, spontaneous perspiration and aversion to wind, pale complexion or general dibility and susceptibility to wind- pathogen.†

Yu Ping Feng Wan was the basic herbal formula recommended by Chinese health authorities to the public for prevention of SARS two years when SARS occured in China. In the verge of a superflu pandemic, we would recommend its use for strengthening our defense to any possible flu outbreak. (Please see more discussion on Cold, Flu, & Prevention.)

The herbal formula is a mild tonic and acts slowly, results may only be noticeable after 1 month. It is suggested to take 4-6 bottles in full dose as the first regimen. The dose may then be reduced.

References
1. Chen Q. (1998). Renowned Patent Traditional Chinese Medicines: Pharmacology and Clinical Applications
2. China Pharmacopoeia 2000.

Chai Hu Jia Long Gu Mu Li Tang (Bupleurum and Dragon Bone Combination): A formula for stress-induced heart disease.
A quick reference to results of Japanese studies to determine not only its efficacy, but also its mode of action and safety, for the formula Bupleurum and Dragon Bone combination followed with more detail in text. To extend our knowledge, facilitate integrative therapies and stimulate discussion.

Decreases LDL, Reduces hypertension, Reduces vasoconstriction, Reduces tachycardia, Decreases stress - cortisol, Reduces soft tissue calcification, Antioxidant, Blood Lipid Profile

Taking Bupleurum and Dragon Bone significantly lowers LDL cholesterol and total cholesterol levels. There were no changes noted in VLDL or HDL cholesterol levels, though triglycerides decreased slightly.1,2 In addition to this, there was a significant decrease in the atheromatous plaques in the intimal surface area of the thoracic aortae.

The authors conclude the results suggest that Bupleurum and Dragon Bone might protect against hypercholesterolemia and atheromatous lesions by affecting apoE and LDL receptor mRNA gene expression in the liver.2

Blood Pressure
The effects of Bupleurum and Dragon Bone on rats with increases in arterial blood pressure, heart rate and peripheral blood flow induced by the stimulant theophylline were examined. Theophylline stimulates endogenous catecholamine production. Bupleurum and Dragon Bone ameliorated the hypertension in the sympathetic system dominant state.3 That is, it lowered stress-induced blood pressure rises.

It is proposed that the antihypertensive effects of this herbal formula could be related to inhibition of noradrenaline- induced vasoconstriction.4,5

Vascular Effects
A study on the effect of Bupleurum and Dragon Bone on the vasoconstriction of cutaneous arterioles induced by nor-adrenaline was carried out using a rabbit ear chamber. The pretreatment with the TCM formula significantly reduced the changes of the average diameter of NA- induced vasoconstriction and also shortened its duration.5

Heart Rate
In addition to lowering hypertension, Bupleurum and Dragon Bone reduces stress-induced increases in heart rate.3

Another study using theophylline to induce tachycardia in rats and convulsions in mice examined the effect of Bupleurum and Dragon Bone on these reactions. Administration of the herbs prevented the tachycardia, lowered the increase in arterial blood pressure and reduced the increased heart rate of the rats treated with theophylline. In the mice the latency of convulsions was prolonged by treatment with Bupleurum and Dragon Bone and 7 out of 15 mice were saved from death due to convulsions. These results suggest that theophylline- induced tachycardia and Bupleurum and Dragon Bone suppress central nervous stimulation.6

Antistress Effects
The common theme throughout the research findings is the calming effect of Bupleurum and Dragon Bone formula on nervous system-induced cardiovascular pathologies. Specifically this formula seems to be effective in stress involving emotional factors and that the antistress effect of SRBT is dependent strongly on the degree of psychological change compared with physical changes.7, 8, 9

Bupleurum and Dragon Bone has a cortisol-lowering effect under stress. Again this effect occurs on psychological stress models, not physical stress.10

Tissue Calcification
When looking at spontaneous soft tissue mineralisation of the heart and tongue in mice, in only two weeks, administration of Bupleurum and Dragon Bone, reduced heart calcium content by 50% and phosphorous by 35%. At four weeks tongue calcification was reduced by 79% and phosphorous by 32%. These results strongly suggest that this formula may be useful in preventing and curing soft tissue calcification.11

Antioxidant
Studies suggest that the pharmacological action of Chinese herbal medicines used for the reduction of post- ischemic brain damage not only have a free-radical scavenging activity, but also have a suppressive effect on the generation of lipid peroxidation.12,13

Bupleurum and Dragon Bone is a traditional Chinese-Japanese medicine formula clinically used for the treatment of hypertension and/or atherosclerosis concurrent with stress disorders.

1 Nomura S, et al. (May, 2001). Effects of Saiko-ka-ryukotsu-borei-to in patients with hyperlipidemia. Phytomedicine. 8(3):165-73,.
2 Yoshie F, et al. Protective effects of Saiko-ka-ryukotsu-borei-to (Chai-Hu-Jia-Long-Gu-Mu-Li-Tang) against atherosclerosis in Kurosawa and Kusanagihypercholesterolemic (KHC) rabbits. Pharmacological Re search. 43(5):481-8, 2001 May.
3 Sanae F, et al. Effects of 9 Kampo medicines clinically used in hypertension on hemodynamic changes induced by theophylline in rats. Biological & Pharmaceutical Bulletin. 23(6):762-5, 2000 Jun.
4 Wei MJ, et al. Endothelium-dependent and - independent vasoactive actions of a Japanese kampo medicine, Saiko-ka-ryukotsu-borei-to. Biomedicine & Pharmacotherapy. 51(1):38-43, 1997.
5 Okano H et al. (Jul-Aug, 1999). Anti-pressor effect of a Chinese-Japanese herbal medicine, saiko-ka-ryukotsuborei- to on hemodynamics in rabbits. In Vivo. 13(4):333-7.
6 Sanae F, et al. (Mar, 1999). Effects of Saiko-ka-ryukotsu-borei-to, a Japanese Kampo medicine, on tachycardia and central nervous system stimulation induced by theophylline in rats and mice. Japanese Journal of Pharmacology. 79(3):283-8.
7 Sasaki K, et al (1998 Jan-Feb). Increase in monoamine levels caused by emotional stress in mice brain regions is attenuated by Saiko-ka-ryukotsu-borei-to. Methods & Findings in Experimental & Clinical Pharmacology. 20(1):27-30,
8 Iizuka S, et al. (Jan-Feb,1998) . Effects of Saiko-ka-ryukotsu-borei-to on irritable characteristics in El mice. Methods & Findings in Experimental & Clinical Pharmacology, 20(1):19-26.
9 Fukushima M. (1997). [Profiles of effects of traditional oriental herbal medicines on central nervous systems in humans--assessment of saiboku-to and saiko-ka-ryukotsu-borei-to using EEG and pharmacokinetics of herbal medicine-derived ingredients as indices]. [Japanese] Seishin Shinkeigaku Zasshi - Psychiatria et Neurologia Japonica. 99(6):355-69.
10 Sasaki K, et al. (Apr, 1995 ). Effect of saiko-ka-ryukotsu-borei-to on the stress-induced increase of serum corticosterone in mice. Biological & Pharmaceutical Bulletin. 18(4):563-5,
11 Hidaka S, et al. (1996). Inhibitory effects of 1-hydroxyethylidene-1,1-bisphosphonate and Chinese traditional (kampo) medicines on calcification of the heart and tongue in DBA/2NCrj mice. American Journal of Chinese Medicine. 24(1):65-75,
12 Fushitani S, et al. (Aug,1995). [Studies on attenuation of post-ischemic brain injury by kampo medicinesinhibitory effects of free radical production. II]. [Japanese] Yakugaku Zasshi - Journal of the Pharmaceutical Society of Japan. 115(8):611-7 .
13 Fushitani S, et al.(Jun,1994 ) [Studies on attenuation of post-ischemic brain injury by kampo medicinesinhibitory effects of free radical production. I.]. [Japanese] Yakugaku Zasshi - Journal of the Pharmaceutical Society of Japan. 114(6):388- 94.

What is Metabolic Syndrome? Metabolic Syndrome is diagnosed when a patient has three or more of the following five American Heart Association criteria:

• Abdominal obesity (waist circumference = 102 cm in men, and = 88 cm in women)
• Hypertriglyceridaemia (= 1.70 mmol/litre)
• Low HDL (= 1.03 mmol/litre in men and =1.29 mmol/litre in women)
• Hypertension (= 130/85 mmHg)

• Elevated fasting glucose (= 5.6 mmol/litre)

• Metabolic Syndrome seriously increases cardiovascular risk. The components of Metabolic Syndrome are some of the most dangerous cardiovascular risk factors. In combination, they increase a patient’s risk of heart disease by around 500%.1

• The prevalence of Metabolic Syndrome is soaring. There are currently over five million people in Australia, and in excess of one million people in New Zealand, who satisfy the criteria for Metabolic Syndrome.2

• Diabetes is Australia’s fastest growing chronic disease. Every single day, 275 Australians are diagnosed with diabetes, contributing to an estimated 3.2 million Australians who live with diabetes or pre-diabetes. Alarmingly, it is thought that for each person diagnosed, there is another that remains undiagnosed. Diabetes is currently ranked as the sixth leading cause of death in Australia.

• Killing ourselves with excess. Due to our modern diets and lifestyles, cardiovascular disease and type 2 diabetes are epidemic in the Western world, typically afflicting 50-65% of adult populations. These diseases are rare or nonexistent in hunter-gatherers and other less Westernised populations, highlighting the negative impact modern diets and lifestyles are having on our health.1
Modern day life provides all the essential ingredients for the alarming rise of cardiovascular disease, type 2 diabetes and neurological diseases we are currently witnessing in Australia and New Zealand. The long-term effects of chronic stress, poor diet, inactivity and toxicity all combine to contribute to Metabolic Syndrome.

A Vicious Cycle
Metabolic Syndrome aetiology is driven by visceral obesity, insulin resistance, inflammation and increased free fatty acids in the body. These factors serve to perpetuate each other in complex ways to ultimately manifest in cardiovascular disease and other chronic diseases. For example, high circulating insulin promotes visceral fat storage, which in turn releases inflammatory mediators that interfere with insulin activity in the liver and muscle, contributing to altered fat metabolism and poor blood sugar regulation. Breaking the cycle involves directly addressing these key factors.


Address Insulin Resistance with Diet and Lifestyle First and Foremost
Insulin resistance is the core underpinning pathophysiological process driving the progression of Metabolic Syndrome. Therapeutically, therefore, this must be addressed first, through exercise and dietary interventions such as those prescribed by your CM practitioner..

A carbohydrate controlled dietary program incorporating moderate exercise and herbal and or nutritional supplementation encourages the body to use fat as the primary source of fuel by restricting dietary carbohydrates. Studies and clinical experience have demonstrated that it is possible to achieve ½ - 1 kg of fat loss weekly, while maintaining lean muscle to promote the healthiest body composition. Such dietary programs help address the issue of overweight/obesity, as well as helping with other aspects of Metabolic Syndrome, such as insulin resistance and increased free fatty acids.



• References
1 Cordain L et al.(2005 Feb). Origins and evolution of the Western diet: health implications for the 21st century. Am J Clin Nutr. 81(2):341-54.