Thursday, 14 January 2016

Most Common Disease of elder: The Clinical trials and Studies of Musculo-Skeletal disorders(MSDs) - Osteoarthritis: Treatment In herbal and traditional Chinese medicine - The Herbal Formulas

Kyle J. Norton (Scholar, Master of Nutrients, All right reserved)
Health article writer and researcher; Over 10.000 articles and research papers have been written and published on line, including world wide health, ezine articles, article base, healthblogs, selfgrowth, best before it's news, the karate GB daily, etc.,.
Named TOP 50 MEDICAL ESSAYS FOR ARTISTS & AUTHORS TO READ by Named 50 of the best health Tweeters Canada - Huffington Post
Nominated for shorty award over last 4 years
Some articles have been used as references in medical research, such as international journal Pharma and Bio science, ISSN 0975-6299.

Musculoskeletal disorders (MSDs) are medical condition mostly caused by work related occupations and working environment, affecting patients’ muscles, joints, tendons, ligaments and nerves and developing over time. A community sample of 73 females and 32 males aged 85 and over underwent a standardised examination at home. Musculoskeletal pain was reported by 57% of those interviewed. A major restriction of joint movement range was frequent in the shoulder but uncommon in other joints(1).

Types of Musculo-Skeletal disorders in elder(2)

1. Osteoarthritis
2. Gout
3. Rheumatoid Arthritis
4. Polymalagia Arthritis
5. Cervical myleopathy and spinal canal stenosis
6. Osteoporosis
7. Low back pain
8. Fibromyalgia


Osteoarthritis (OA), a form of arthritis, is defined as a condition of as a result of aging causes of wear and tear on a joint, affecting over 25 million people in the United States in alone. University of Porto Medical School indicated that one must understand the differences in prevalence and incidence estimates of osteoarthritis (OA), according to case definition, in knee, hip and hand joints(3).
The characteristics of osteoarthritis are aching pain(5), stiffness(6), or difficulty of moving the joint or joints(7). The pain usually gets worse in change of weather, at night and in the advanced diseases, the pain can occur even at rest(8). Today management of osteoarthritis (OA) focuses on pain relief and improved physical function through pharmacological, non pharmacological, and surgical treatments(4).

                                    The Treatment

B. In herbal  and traditional Chinese medicine perspective
B.2.2. Herbal and traditional Chinese medicine formulas
1. Phytodolor (STW 1)
Phytodolor, a fixed herbal formulation containing alcoholic extracts of aspen leaves and bark (Populus tremula), common ash bark (Fraxinus excelsior), and golden rod herb (Solidago virgaurea), has been used for treatment in painful inflammatory or degenerative rheumatic diseases(483), probably due to its antiinflammatory, antioedematous, antioxidative and analgesic properties(483).
According to the University Hospital Zurich, in the review of the data base of randomized controlled trials (RCTs), STW1 can be used as non-steroidal anti-inflammatory drugs (NSAIDs) in relieving pain in patient with musculoskeletal disorders, including osteoarthritis(484). DR. Gundermann KJ and Dr.Müller J. in the study of painful inflammatory or degenerative rheumatic diseases, said" Phytodolor (STW 1) is a reasonable alternative to NSAIDs and to cyclooxygenase(COX)-2-inhibitors such as rofecoxib"(483) and "STW 1 has a high drug safety"(483) with little side effects(486).
The formula although is found to be effective in some extension in treating pain for patient with MD, some research suggested that most popular CAM therapies for pain from arthritis-related conditions, should be gone through additional high quality research, especially for herbals and homeopathy(485).
2. Reumalex 
Reumalex, is a herbal medicine formula containing 100 mg White Willow bark, 40 mg, Guaiacum Resin BHP, 35 mg Black Cohosh, 25 mg Extract of Sarsparilla  and 17 mg  Extract of Poplar Bark.  In a 2 months without cross-over study, in 82 subjects with chronic arthritic pain, Dr. Mills SY and the research team at the University of Exeter showed that Reumalex, the herbal medicine improved the pain symptoms through its mild analgesic effect(487).

3. Gitadyl
 Gitadyl is another herbal medicine formula containing 110 mg feverfew, 90 mg American aspen and 60 mg milfoil(488). According to a double-blind, randomized, cross-over study conducted by Hvidovre Hospital, in comparison of the effectiveness of herbal formula Gitadyl and conventional medicine ibuprofen(490) in patients with osteoarthritis, researchers found that Gitadyl can be used for treatment of such as reduced pain(488) and working ability(488) of patient with osteoarthritis who are prone to bleeding or who develop gastrointestinal (GI) symptoms from NSAIDs(489),

4. SKI306X
SKI306X, is a herbal formula containing Clematis mandshurica (CM), Prunella vulgaris (PV), and Trichosanthes kirilowii (TK),
According to the study by the Hanyang University Hospital for Rheumatic Diseases, SKI3006X, reduced pain and improve physical performance(498) by inhibited degradation of glycosaminoglycan (GAG) through its expression on  anti inflammatory(497)(499) and analgesic(499)properties in interleukin (IL)-1β induced gene expression in human OA(497). In a a double-blind placebo controlled study of 96 patients with classical osteoarthritis of the knee, SKI 306X at 100mm demonstrated its clinical efficacy in comparison to placebo, according to the Chung-Ang University(500).

5. Duhuo Jisheng Wan (DJW)
Duhuo Jisheng Wan (DJW)or Duhuo Jisheng Tang (DJT) is a Chinese herbal formula containing over 18 individual herbs(501) has been used for treatment of knee osteoarthritis with limit scientific evidence(502), according to the Nestlé Research Center(503), but in a randomized, double-blind, double-dummy, controlled trial of a total of 200 patients suffering from OA of the knee, researcher at the Chiang Mai University, showed to improve walking pain, standing pain and stiffness, with approximately 30% of patients in both groups experienced mild adverse events(504).
The Taipei City Hospital study of Duhuo Jisheng Wan(DJW) also supported the effectiveness of the herbal formula in reduced pain, stiffness and improved physical functioning as well as other symptoms of degenerative osteoarthritis of the knee(502).

6. Huo-Luo-Xiao-Ling (HLXL) Dan
Huo-Luo-Xiao-Ling (HLXL) Dan is a Chinese herbal formula containing Ru Xiang (Boswellia carterii Birdw.), Mo Yao (Commiphora myrrha Engl.), Dang Gui (Angelica sinensis (Oliv.) Diels) and Dan Shen (Salvia miltiorrhiza Bge), used over thousands of year in Chinese history for treatment in alleviating pain caused rheumatoid arthritis (RA) and other inflammatory disorders(505)(508). On a Phase II clinical trial at Kernan Hospital of the University of Maryland School of Medicine, the herbal formula moderately inhibited hyperanalgesic (severe pain killing)(508) with no side effect in comparison to placebo(506) in patient with osteoarthritis OA. The phase II clinical trials also showed treatment of HLXL-Dan was not superior to placebo in pain relief or functional improvement in patients with knee OA if use only in 8 weeks(507).

7. Si Miao Fang
SI Miao Fang is a herbal formula comprised of Phellodendri Chines Cortex, Atractylodis rhizoma, Coicis Semen, and Achyranthis bidentatae Radix used in traditional Chinese medicine for pain relief, due to inflammation and and analgesics(509) in patient with gouty arthritis(510) and rheumatoid arthritis(511). In osteoarthritic rat model, according to the China Academy of Chinese Medical Sciences, herbal formula inhibited expression of matrix metalloproteinases (MMPs) -3 and -13 and aggrecanases (ADAMTS) -4 and -5, induced OA causes of cartilage matrix degradation, by increasing proteoglycan and collagen content(512) through its interferes with secretion of pro-inflammatory cytokines and inflammatory mediators(512).

8. Other Chinese herbal prescription for treatment of OA, according to Osteoporosis & Osteoarthritis in TCM Therapy by Chun Yi, Lu O.M.D., LAc. may also include Shu Jing Huo Xue Tang
 Shu Jing Huo Xue Tang can be prescribed for treatment of  patient with osteoarthritis caused by blood stagnation and blood stasis induced chronic pain syndromes, through its effect in suppressed neuropathic pain behaviors(514), including adjuvant arthritis(515). According to the article of Osteoporosis & Osteoarthritis in TCM Therapy by Chun Yi, Lu O.M.D., LAc(513), the formula can also used for treatment of OA patient due to the effects in induced blood downward movement, strengthened the movement of bone, relived pain, improved joint function and inhibited inflammation causes of swollen of the joint lining and (513).

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(1) Prevalence of rheumatic symptoms, rheumatoid arthritis, ankylosing spondylitis, and gout in Shanghai, China: a COPCORD study by Dai SM1, Han XH, Zhao DB, Shi YQ, Liu Y, Meng JM.(PubMed)
(2) Musculoskeletal Disorders in the Elderly by Ramon Gheno, Juan M. Cepparo, Cristina E. Rosca,1 and Anne Cotten(PMC)
(3) The effect of osteoarthritis definition on prevalence and incidence estimates: a systematic review by Pereira D1, Peleteiro B, Araújo J, Branco J, Santos RA, Ramos E.(PubMed)
(4) Effect of therapeutic aquatic exercise on symptoms and function associated with lower limb osteoarthritis: systematic review with meta-analysis by Waller B1, Ogonowska-Slodownik A2, Vitor M3, Lambeck J4, Daly D5, Kujala UM6, Heinonen A7.(PubMed)
(5) Effects of therapeutic ultrasound on pain, physical functions and safety outcomes in patients with kneeosteoarthritis: A systematic review and meta-analysis by Zhang C1, Xie Y2, Luo X3, Ji Q3, Lu C3, He C4, Wang P3.(PubMed)
(6) Oral intake of purple passion fruit peel extract reduces pain and stiffness and improves physical function in adult patients with knee osteoarthritis by Farid R1, Rezaieyazdi Z, Mirfeizi Z, Hatef MR, Mirheidari M, Mansouri H, Esmaelli H, Bentley G, Lu Y, Foo Y, Watson RR.(PubMed)
(7) Functional ability, mobility, and pain before and after knee replacement in patients aged 75 and older: a cross-sectional study by Limnell K1, Jämsen E, Huhtala H, Jäntti P, Puolakka T, Jylhä M.(PubMed)
(8) The symptoms of OA and the genesis of pain by David J. Hunter, MBBS PhD,1,2 Jason J. McDougall, BSc PhD,3 and Francis J. Keefe4(PubMed)
(483) Phytodolor--effects and efficacy of a herbal medicine by Gundermann KJ1, Müller J.(PubMed)
(484) Phytodolor® in musculoskeletal disorders: re-analysis and meta-analysis by Uehleke B1, Brignoli R, Rostock M, Saller R, Melzer J.(PubMed)
(485) Selected CAM therapies for arthritis-related pain: the evidence from systematic reviews.
Soeken KL1.(PubMed)
(487) Effect of a proprietary herbal medicine on the relief of chronic arthritic pain: a double-blind study by Mills SY1, Jacoby RK, Chacksfield M, Willoughby M.(PubMed)
(488) [Gitadyl versus ibuprofen in patients with osteoarthrosis. The result of a double-blind, randomized cross-over study].[Article in Danish]by Ryttig K1, Schlamowitz PV, Warnøe O, Wilstrup F.(PubMed)
(489) Gitadyl versus ibuprofen in patients with osteoarthritis: a double-blind, randomized, cross-over study of clinical efficacy and effects on platelets and PMNs by Mieszczak CI1, Kharazmi A, Rein J, Winther K.(PubMed)
(490) [Gitadyl versus ibuprofen].[Article in Danish] by [No authors listed](PubMed)
(491) Danshen prevents articular cartilage degeneration via antioxidation in rabbits with osteoarthritis by Bai B1, Li Y2.(PubMed)
(492) Veterinary Herbal Medicine By Susan G. Wynn, Barbara Fougère, page 349.
(493) Dan Shen (Salvia miltiorrhiza) in Medicine: Volume 2. Pharmacology ..., Volume 2 edited by Xijun Yan 
(494) [Comparative analysis on composition principles of traditional Chinese medicine prescriptions for osteoporosis and osteoarthritis].[Article in Chinese] by Zheng ZR, Tang SH.(PubMed)
(495) Complementary and Alternative Medicine Use Among Adults and Children: United States, 2007 by Patricia M. Barnes, M.A., and Barbara Bloom, M.P.A., Division of Health Interview Statistics, National Center for Health Statistics; and Richard L. Nahin, Ph.D., M.P.H., National Center for Complementary and Alternative Medicine, National Institutes of Health
(496) Chinese Herbal Bath Therapy for the Treatment of Knee Osteoarthritis: Meta-Analysis of Randomized Controlled Trials by Chen B1, Zhan H1, Chung M2, Lin X1, Zhang M1, Pang J1, Wang C3.(PubMed)
(497) Assessment of comparative pain relief and tolerability of SKI306X compared with celecoxib in patients with rheumatoid arthritis: a 6-week, multicenter, randomized, double-blind, double-dummy, phase III, noninferiority clinical trial by Song YW1, Lee EY, Koh EM, Cha HS, Yoo B, Lee CK, Baek HJ, Kim HA, Suh YI, Kang SW, Lee YJ, Jung HG.(PubMed)
(498) SKI306X inhibition of glycosaminoglycan degradation in human cartilage involves down-regulation of cytokine-induced catabolic genes by Choi CH1, Kim TH2, Sung YK2, Choi CB2, Na YI3, Yoo H4, Jun JB2.(PubMed)
(499) Effects of SKI306X on arachidonate metabolism and other inflammatory mediators by Kim JH1, Ryu KH, Jung KW, Han CK, Kwak WJ, Cho YB.(PubMed)
(500) Effect of SKI 306X, a new herbal anti-arthritic agent, in patients with osteoarthritis of the knee: a double-blind placebo controlled study by Jung YB1, Roh KJ, Jung JA, Jung K, Yoo H, Cho YB, Kwak WJ, Kim DK, Kim KH, Han CK(PubMed)

(501) Du Huo Ji Sheng Tang(American Dragon)
(502) Duhuo Jisheng Tang for treating osteoarthritis of the knee: a prospective clinical observation by Jung-Nien Lai,1 Huey-Jeng Chen,2 Chao-Chung Chen,3 Jer-Huei Lin,4 Jing-Shiang Hwang,5 and Jung-Der Wang(PMC)
(503) Osteoarthritis and nutrition. From nutraceuticals to functional foods: a systematic review of the scientific evidence by Ameye LG1, Chee WS.(PubMed)
(504) Chinese herbal recipe versus diclofenac in symptomatic treatment of osteoarthritis of the knee: a randomized controlled trial [ISRCTN70292892] by Teekachunhatean S1, Kunanusorn P, Rojanasthien N, Sananpanich K, Pojchamarnwiputh S, Lhieochaiphunt S, Pruksakorn S.(PubMed)
(505) Chinese Herbal Formula Huo-Luo-Xiao-Ling Dan Protects against Bone Damage in Adjuvant Arthritis by Modulating the Mediators of Bone Remodeling by Siddaraju M. Nanjundaiah,1 David Y.-W. Lee,2 Brian M. Berman,3 and Kamal D. Moudgil(Hindawi Publishing Corporation)
(506) Dose Escalation Study Of Chinese Herbs In Osteoarthritis Of The Knee (TCM-OAK)(Clinical trial. Gov)
(507) Huo-Luo-Xiao-Ling (HLXL)-Dan, a Traditional Chinese Medicine, for patients with osteoarthritis of the knee: a multi-site, randomized, double-blind, placebo-controlled phase II clinical trial by Lao L1, Hochberg M2, Lee DY3, Gilpin AM4, Fong HH5, Langenberg P6, Chen K7, Li EK8, Tam LS9, Berman B10.(PubMed)
(508) Anti-hyperalgesic and anti-inflammatory effects of the modified Chinese herbal formula Huo Luo Xiao Ling Dan (HLXL) in rats by Lao L1, Fan AY, Zhang RX, Zhou A, Ma ZZ, Lee DY, Ren K, Berman B.(PubMed)
(509) Experimental Study on Anti-Inflammatory Effect and Analgesic Effect of Simiao Powder by Jing Yun, Li weilin
(510) Randomized and controlled clinical study of modified prescriptions of Simiao Pill in the treatment of acute gouty arthritis by Shi XD1, Li GC, Qian ZX, Jin ZQ, Song Y.(PubMed)
(511) [Effects and mechanisms of Simiao pill on adjuvant arthritis rats model].[Article in Chinese]by Wang X1, Zhang X, Zhang L, Li Y.(PubMed)
(512) Treatment with SiMiaoFang, an anti-arthritis chinese herbal formula, inhibits cartilage matrix degradation in osteoarthritis rat model by Xu Y1, Liu Q, Liu ZL, Lim L, Chen WH, Lin N.(PubMed)
(513) Osteoporosis & Osteoarthritis in TCM Therapy by Chun Yi, Lu O.M.D., LAc.
(514) Anti-hypersensitivity effects of Shu-jing-huo-xue-tang, a Chinese herbal medicine, in CCI-neuropathic rats by Shu H1, Arita H, Hayashida M, Zhang L, An K, Huang W, Hanaoka K.(PubMed)
(515) Study of sokei-kakketu-to (shu-jing-huo-xue-tang) in adjuvant arthritis rats by Kanai S1, Taniguchi N, Higashino H.(PubMed)

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