EDITORAL
Potential
role of traditional Chinese botanical therapeutics
for endometriosis-associated pain
Fritz Wieser MD* and Robert
N. Taylor MD, PhD**
*Division of Gynecological Endocrinology and Reproductive
Medicine, University of Vienna, Austria
** Department of Gynaecology and Obstetrics, Emory
University School of Medicine, Atlanta, Georgia,
USA
Over the past decade,
endometriosis scholars, health-care providers and
women afflicted with this disease all have witnessed
dramatic progress in our understanding of endometriosis
pathophysiology. Our own laboratories have been
actively engaged in defining the cellular, genomic
and molecular underpinnings of endometriotic lesions.
Despite this new knowledge, evidence-based medical
trials and new treatment strategies with high efficacy
and limited side-effects have been frustratingly
slow to reach the clinical arena. In this editorial
we hope to increase awareness that natural herbal
drugs have potent anti-inflammatory and pain-alleviating
properties and should receive more consideration
for the treatment of women with endometriosis-associated
symptoms.
Traditional Chinese
medicine is based on a 3,000 year-old holistic model
of individualised health maintenance using herbs,
acupuncture, and other forms of therapy foreign
to many Western-trained physicians. But in addition
to its overwhelming acceptance in Asia, traditional
Chinese medicine is used today by millions of women
in the Americas, Europe, and Australasia. Surveys
on complementary alternative medicine, conducted
in the USA over the last 15 years, report that more
than 38 million adults in this country use these
modalities, with up to 18.6% of the population relying
on herbal therapy for symptom relief [1].
In spite of their
growing popularity in Western societies, limited
formal data about the pharmacology of herbs exist
because they are categorised by the FDA as traditional
food supplements rather than drugs and are not subject
to the same standards and regulation. While users
of Chinese herbal therapy consider natural products
to be safer and thus more beneficial alternatives
to Western pharmaceuticals. their side effects and
toxicity have not been tested rigorously. Formal
controlled clinical trials to evaluate their toxicity,
efficacy and mechanisms of action are needed [2].
Interestingly,
Chinese herbal treatment also is receiving increasing
attention by Western physicians for the treatment
of certain infectious and inflammatory diseases.
A recent meta-analysis of clinical trials showed
that a six-dose regimen of artemether-lumefantrine
was more effective than antimalarial regimens not
containing the herbal derivate artemisinin [3].
Other Chinese herbs have been used for centuries
for treating pain syndromes typically observed in
women with endometriosis. Examples include Angelica
root, Cinnamon twig, Corydalis rhizome extract,
Frankincense, Myrrh, Salvia root, Licorice root,
Persica, Sparganium, White peony root, and Zedoaria
[2]. These Chinese herbs also are used for treatment
of other chronic inflammatory diseases including
eczema, colitis, rheumatoid arthritis and bronchial
asthma. Clinical evidence for the efficacy of these
botanicals for endometriosis has only been reported
in the Chinese literature to date.
Growing observations
that medicinal Chinese herbs have anti-inflammatory,
sedative and pain-alleviating properties led us
and others to investigate these concoctions using
in vitro models of endometriosis as a proof of principle
for treatment of endometriosis-associated symptoms
with natural compounds.
Examples of relevant
Chinese herbs include Angelica root, which is known
by the Chinese names: Bai Zhi, Dang Gui, and Du
Huo. This root contains various coumarin and furocoumarin
derivatives that are known to inhibit cycloxygenase
(Cox)-2 activity and prostaglandin synthesis [2].
Another herbal compound is curcumin, which Cao et
al. [4] have demonstrated can inhibit NF-kB induction
of a proinflammatory and angiogenic cytokine, macrophage
migration inhibitory factor (MIF). Our group has
reported that extracts from a traditional combination
of Chinese herbs inhibit endometriosis cell proliferation
in vitro [5]
Presently there are no randomised, controlled trials
to assess the safety and efficacy of Chinese herbs
in the treatment of endometriosis symptoms. The
establishment of a new NIH institute for complementary
and alternative medicine (NCCAM) in 1998 is an important
step toward the validation of popular and mechanistically
plausible botanical treatments of endometriosis-associated
pain.
References
[1]
Tindle HA, Davis RB, Phillips RS, Eisenberg DM:
Trends in use of complementary and alternative medicine
by US adults: 1997-2002. Altern Ther Healt. Med.
11, 42-9 (2005).
[2] Burks-Wicks C, Cohen M, Fallbacher J, Taylor
RN and Wieser F. A Western primer of Chinese herbal
therapy in endometriosis and infertility. J Women’s
Health, in press (2005)
[3] Omari A, Gamble C, Garner P, Omari A. Artemether-lumefantrine
(six-dose regimen) for treating uncomplicated falciparum
malaria. Cochrane Database Syst Rev. 4: CD005564
(2005)
[4] Cao WG, Morin M, Sengers V, Metz C, Roger T,
Maheux R, Akoum A. Tumour necrosis factor-a up-regulates
macrophage migration inhibitory factor expression
in endometrial stromal cells via the nuclear transcription
factor NF-kB. Hum Reprod, in press (2005)
[5] Wieser F, Burks-Wicks C, Cohen M, Vigne J-L,
Gaeddert A and Taylor RN. Extracts from a traditional
Chinese herbal remedy inhibit cell proliferation
and induce apoptosis in human endometrial and endometriosis
cells. #P-113. Presented at the 61st Annual Meeting
of the American Society for Reproductive Medicine,
Montréal (October 2005)
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