Evidence-based Clinical Chinese Medicine

The following sections are included:

• Contents
• Disclaimer
• Foreword
• Purpose of the Monograph
• Authors and Contributors
• Members of Advisory Committee and Panel
• Professor Charlie Changli Xue, PhD
• Professor Chuanjian Lu, MD
• Acknowledgments
• List of Figures
• List of Tables

Allergic rhinitis is a disorder induced by inflammation of the nasal membranes. It is characterised mainly by nasal symptoms including sneezing, itching, rhinorrhoea, and nasal congestion, as well as a group of non-nasal symptoms involving eyes, ears, throat, or lower respiratory track. Clinically, allergic rhinitis is considered a major chronic respiratory disease due to its high prevalence, impairments on patients’ quality of life, substantial economic impact, and its co-morbidities. This chapter provides a review from the conventional medicine perspective of allergic rhinitis with respect to its definition, epidemiology, classification, diagnosis, and clinical management.

In Chinese medicine, allergic rhinitis is mainly considered a result of a combination of Zang-organ deficiency (Lung, Spleen, and Kidney) and external pathogen attack. This chapter describes the aetiology and pathogenesis, syndrome differentiation, and treatments recommended in clinical textbooks and guidelines.

Classical Chinese medicine literature provides a rich source of information for prevention and management of disease. Many treatments used in contemporary practice date back to classical literature, including current treatments for allergic rhinitis. This chapter describes the findings of a systematic search of the Zhong Hua Yi Dian based on a selection of search terms identified from classical dictionaries and texts. A search of the Zhong Hua Yi Dian located over 700 citations which were analysed to identify the common formula, herbs, and acupuncture points used to treat symptoms of allergic rhinitis.

This chapter describes the methods used to identify and evaluate a range of Chinese medicine interventions for allergic rhinitis in clinical studies. Studies identified through a comprehensive search were assessed against eligibility criteria. A review of the methodological quality of the studies was undertaken using standardised methods. Results from included studies were evaluated to provide an estimate of the effects of a range of Chinese medicine therapies.

This chapter provides an up-to-date synopsis of the clinical study literature and an evaluation of the evidence. Comprehensive searches of nine Chinese and English databases identified 8,952 articles. A total of 185 controlled trials were selected for systematic review, and a series of meta-analyses were conducted to evaluate the efficacy and safety of Chinese herbal medicines for allergic rhinitis. Details from 78 non-controlled studies were extracted to provide an overview of the interventions used and the safety of these Chinese herbal medicines. The evidence for Chinese herbal medicine is promising, particularly for improving nasal symptoms and the total effective rate of treatment. Benefits were evident when Chinese herbal medicine was used alone and when combined with conventional pharmacotherapies.

Formulas and herbs exert functional effects through their active compounds. A selection of the most frequently used herbs in clinical trials were reviewed to determine their pharmacological actions. Many key herbs were found to have anti-allergy and anti-inflammatory effects in vivo and in vitro.

Several acupuncture therapies have a long-standing history of use in the classical Chinese medicine literature and have been recommended in clinical textbooks and guidelines. Many research studies that have been published in Chinese and international journals have sought to evaluate a range of acupuncture therapies. This chapter provides an assessment of the evidence from clinical studies. Comprehensive searches of nine databases identified more than 4,400 citations that were reviewed against rigorous inclusion criteria. A total of 43 studies examining a range of acupuncture therapies were chosen for further analysis and are presented in this chapter. Thirty-five controlled trials were included in systematic review, with meta-analyses conducted where possible to evaluate the efficacy and safety of acupuncture therapies for allergic rhinitis. Eight non-controlled studies were examined to identify the interventions used and explore their safety profiles. Acupuncture and moxibustion therapies were found to improve symptoms of allergic rhinitis, although few studies used validated outcome measures.

Along with Chinese herbal medicine and acupuncture therapies, other Chinese medicine therapies such as traditional Chinese tuina 推 拿 can be used clinically to treat allergic rhinitis. This chapter provides a synopsis of the clinical trial literature and an assessment of the state of evidence. Extensive searches were conducted in nine English and Chinese databases, and identified citations were assessed against inclusion criteria. Two randomised controlled trials that were selected for inclusion in this chapter were subject to a systematic review and evaluation of their efficacy and safety. There is limited evidence available for other Chinese medicine therapies for allergic rhinitis.

Clinical practice of Chinese medicine often sees several therapy types used in combination, such as Chinese herbal medicine plus acupuncture. An extensive search of nine English and Chinese databases was conducted. After assessment against inclusion criteria, 10 randomised controlled trials using combinations of Chinese medicine therapies were selected for inclusion. The most common combinations were Chinese herbal medicine with acupuncture therapies. Results showed that some but not all combinations were beneficial. As it was not possible to conduct meta-analyses for all different combinations, there is insufficient evidence for the effectiveness of these various combinations of Chinese medicine therapies.

Chinese medicine therapies are increasingly used to treat allergic rhinitis and a significant number of clinical studies have been conducted. Current conventional therapies are effective for allergic rhinitis symptoms but usually do not cure the disease and may cause unwanted side effects with long-term use. Therefore, Chinese medicine is of significant value. Findings from clinical evidence reveal promising benefits of oral and topical Chinese herbal medicine, acupuncture therapies, and other Chinese medicine therapies. This chapter provides a ‘whole evidence’ analysis in investigating Chinese medicine for the management of allergic rhinitis.

The following sections are included:

• Appendix 1: References to Included Clinical Studies
• Glossary
• Index