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The Role of Chinese Herbal Medicine in Modern Health Care Delivery

by Todd Luger, L.Ac.

Modern Research and Traditional Practice both suggest an important place for Chinese Herbal Medicine (CHM) in modern health care delivery.  CHM can decrease patient costs and increase clinical success in a wide range of conditions.  This explains why the National Health Service of Japan reimburses for the use of Chinese Herbal Formulae and why they are mainly prescribed by conventional MD's.  It may also be another another piece in the puzzle of the extreme longevity of the Japanese middle class.  I have identified six general areas where CHM could be put to immediate widespread use with high expectations of success.  Ideally, individualized formulae would be prescribed by fully trained practitioners.  However, until that is possible, it will be possible to train MD's around the country in a more limited, but still highly efficacious approach.

1)  The prevention of disease is an important topic these days.   Most discussions focus around the concept of immunity.  It is now well known that the immune system is interdependent upon the neuroendocrine system and vice-versa, thus impaired immunity can have wide ranging health consequences.  Chronic Fatigue syndrome, rheumatoid arthritis, hay fever and cancer are all partially related to a malfunctioning immunity.  Many Chinese herbs have been studied for their effects on immunity.  This was initially done to determine how to protect the immunity of those taking immunosuppressive therapies for cancer and such things.  Research accelerated during the early years of the AIDS epidemic.

2)  The maintenance of health is related to the prevention of disease, but it is slightly different.  To maintain health, the focus is on digestion and nutrition, rather than immunity.  The Chinese have put considerable emphasis on the condition of the digestive tract and the role impaired digestion plays in the decline of health.  So much so, that all Chinese herbal formula designed for longterm treatment of chronic illness, address the GI function to some degree.  The theory is simple.  We are what we eat or at least what we assimilate.  When digestion fails, two things happen.  First, vital nutrients fail to be incorporated into the tissues, which means organ systems do not work optimally.  Second, waste products accumulate in the tissues instead of being properly excreted.  This toxicity leads to all kinds of tissue damage which may initiate serious illnesses.  All physiologists know our GI tract is the final barrier between self and other.  CHM focuses on maintaining the integrity of that final defense.

3)  Promotion of longevity is accomplished through maintenance of immunity and digestion, but also via another important system.   Hormone regulation is emerging as an important issue related to quality of life, especially in the geriatric community.  Most hormones decline or become aberrant over one's life, including DHEA, testosterone, estrogen, thyroid, melatonin and others less well known.  Hormone therapy is thus popular with Naturopaths and progressive MD's.  It has been commonly used by veterinarians for decades.  Hormones from animal products like placenta have been important revitalization therapies in both ancient China and modern European health spas.  However, the direct administration of hormones is only one method treatment.  Many herbs contain phytosterols, which have weak hormonal effects.  However, it appears that herbs may impact the hormonal system mainly through other methods, such as receptor synthesis or metabolite catabolism (more receptors means less hormone can work just as well in some cases).  What is well documented is that many Chinese herbs affect the functions of hormones and more importantly, relieve the symptoms and affect the course of disease in those with hormone related conditions.

4)  CHM is not just for prevention and health optimization.  In fact, most Chinese medical literature, past and modern, has focused on the treatment of real clinical pathology.  Bridging the gap between maintaining already good health and the appearance of a clinically discrete illness is the no man's land of subclinical pathology.  Many patients present with complaints that cannot be diagnosed according to modern physiology or biochemistry.  In some cases, the patients complaints are dismissed as being psychosomatic, but even more prevalent today is the selection of various antidepressant medications to "treat" a wide range of undiagnosable complaints.  This includes chronic fatigue, fibromyalgia, food sensitivities and more.  CHM can effectively treat much of this subclinical pathology by herbally manipulating the patients physiology according to traditional Chinese concepts of harmony and balance.  Typically, this involves herbs that gently impact immunity, digestion and neuroendocrine regulation in combination with those that relieve specific symptoms, such as pain.

5)  CHM can play a vital role in the primary care of several common chronic illnesses that are not managed satisfactorily by modern medicine.  This includes Diabetes, Autoimmunity, Cardiovascular disease, Liver Disease, Menopause and Prostate hypertrophy.  Modern research in china is very promising regarding the treatment of these conditions.  Reported success is so high that this method would be warranted in most cases prior to utilization of surgery or expensive medications.  If the noninvasive methods fail to work, the conventional methods are available as a safety net.  The conventional methods are so expensive that if they became necessary, the cost  of the alternative therapy would end up being only a minute fraction of the total cost.  If the conventional therapy turned out to be unnecessary, then the cost saving would be tremendous.  It is win-win situation for the payer.

6)  Finally, CHM can play a vital role as supportive therapy in conditions such as cancer, stroke and hypertension.  While CHM cannot cure any of these conditions, it can help in several ways.  For borderline hypertension and when medication at the required dosage is either ineffective or produce undesirable side-effects,  Chinese herbs may allow the use of milder drugs and/or lower dosages to get the desired effect.  They may also increase the effectiveness of diet and exercise in borderline cases.  Cancer patients are often weakened by their conventional therapy.  Chinese studies consistently show increased survival rates when CHM is combined with conventional therapy.  Stroke patients find that their recovery can be speeded and those with frequent TIA's can minimize the likelihood of a full blown CVA.

The only way to prove the longterm efficacy of CHM is to follow a large group of diverse patients and record general outcomes.  For many of these patients, the cost of purchasing CHM out of pocket is prohibitive.  For many potential insurers, the data just doesnít exist to justify reimbursement at this time.  However, the cost of CHM would only be a fraction of conventional costs in all the cases described above.  If the patient eventually had to resort to conventional treatment, little money would have been spent in the interim.  However, the potential savings are immense if conventional care can be avoided or minimized.  Drug companies have no incentive to risk studying this issue, but profit making HMO's do.  It is time that someone step up to the plate and fund a longitudinal study.  HMO's claim the need to raise rates yearly to cover expenses, so there is still much work to be done in cost containment.  The next important piece may be the full utilization of CHM and other CAM methods via newly emerging Managed Service Organizations (MSO).


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