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Reumatologia

#Terapia hormonal poderá combater osteoartrite no joelho na pós-menopausa

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Fonte de imagem: Chicago Health Magazine

A terapia hormonal de substituição poderá ajudar a reduzir a prevalência da osteoartrite do joelho em mulheres na pós-menopausa, indicou um estudo. 

A osteoartrite é a doença músculo-esquelética mais comum nos idosos e a causa principal de incapacidade física e de dores naquele grupo populacional. A doença afeta mais as mulheres e é particularmente prevalente após a menopausa.

O estrogénio possui um efeito anti-inflamatório quando se encontra em concentrações elevadas. Por esse facto, tem-se especulado que as alterações hormonais nas mulheres, especialmente a redução dos níveis de estrogénio, poderão conduzir a uma maior incidência de osteoartrite após a menopausa.

Devido ao facto de os joelhos serem a articulação mais afetada pela doença, foram já conduzidos alguns estudos de pequenas dimensões que demonstraram que a terapia hormonal de substituição reduzia a dor crónica e as alterações histológicas na cartilagem relacionadas com a osteoartrite.

Os tratamentos mais comuns para a osteoartrite no joelho são fármacos anti-inflamatórios não-esteroide e a intervenção cirúrgica. Contudo, ambos os tratamentos podem causar complicações cirúrgicas e gastrointestinais.

Este estudo de grandes dimensões contou com dados de 4.766 mulheres na pós-menopausa, que tinham participado numa sondagem sobre saúde e nutrição na Coreia do Sul.

Os investigadores da Faculdade de Medicina da Universidade da Coreia e do Hospital Universitário Ansan, ambos na Coreia do Sul, observaram que a prevalência da osteoartrite no joelho era significativamente inferior nas mulheres que tinham usado terapia hormonal do que nas que não tinham usado hormonas.

“Este estudo sugere que o estrogénio tomado na menopausa pode inibir a danificação na cartilagem e reduzir a deterioração no joelho observada nos raios-X”, comentou JoAnn Pinkerton, diretora da Sociedade Norte-Americana da Menopausa.

 

NotíciasdaSaúde

Anúncios

#Estatinas diminuem mortalidade em pacientes com doença reumática?

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estatinas

Estatinas diminuem mortalidade em pacientes com doença reumática?

As doenças reumáticas autoimunes são doenças que, em sua maioria, causam inflamação nas articulações e diminuem a qualidade de vida do paciente. Os tipos mais comuns são esclerodermia, síndrome de Sjögren, miosite, artrite reumatoide, lúpus sistêmico erimatoso, doença de Behçet e fibromialgia. Se não tratadas, podem desencadear em outros problemas futuros. As doenças reumáticas autoimunes estão associadas, inclusive, a um maior risco para o desenvolvimento de eventos cardiovasculares, geralmente potencializados por contantes inflamações e uso de corticoides.

Estatinas como prevenção de eventos cardiovasculares

Uma pesquisa realizada recentemente averiguou os efeitos das estatinas na profilaxia de eventos cardiovasculares causados por essas doenças. O estudo de coorte reuniu registros de um banco de dados britânico, coletados de um centro reumatológico entre 2000 e 2014, e os resultados foram publicados em dezembro de 2018 no The Journal of Reumatology. Os pesquisadores compararam os escores dos participantes medicados com estatinas com os que não receberam o fármaco.

Participaram da pesquisa 4610 pacientes diagnosticados com alguma doença reumática autoimune. Estes foram designados aleatoriamente em dois grupos, o primeiro grupo (n=2305) foi medicado com estatinas e o segundo grupo não iniciou tratamento com o medicamento. O tempo de follow up foi de cinco anos e os desfechos primários observados foram mortalidade.

Mortalidade

Ao final da pesquisa, houve 298 mortes entre os indivíduos medicados com estatinas, já no grupo dos participantes que não receberam profilaxia com o fármaco ocorreram 338 óbitos. A taxa de mortalidade foi de 25,4/100 pessoas por ano vs 30,3/1000 pessoas por ano.

Resultados

Os pesquisadores constataram que o uso de estatinas foi associado a um menor risco de eventos cardiovasculares e mortalidade por todas as causas em pacientes com doenças reumatológicas autoimunes. (HR 0,84, IC 95% [0,72–0,98]).

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All about #ankylosing spondylitis

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Resultado de imagem para espondilite anquilosante

Ankylosing spondylitis is a form of arthritis that mainly affects the spine and sacroiliac joints, or the lower back.

An inflammatory disease, symptoms of ankylosing spondylitis (AS) include pain, stiffness, and loss of mobility. The disease involves erosion of bone and increased bone formation in the spine, leading to bone fusion. In advanced cases, this can lead to spinal deformity.

AS most commonly occurs in men in their teens and 20s, but it can affect anyone of any age. It tends to be milder when it does occur in women, making it harder to diagnose.

Drug treatments and physical therapy can help relieve symptoms.

Fast facts on ankylosing spondylitis (AS):

  • Ankylosing spondylitis is a type of arthritis.
  • It mostly affects the lower part of the spine, and where it joins to the hips, known as the sacroiliac joints.
  • Ankylosing spondylitis can be difficult to diagnose but has a particular pattern of pain symptoms, and changes can be seen on X-ray and MRI.
  • There is no cure, but drugs can help manage the pain and inflammation. Physical therapy can also relieve and prevent some of the effects.

Symptoms

One of the common symptoms of ankylosing spondylitis is lower back pain.

The three main symptoms of AS are:

  • pain
  • stiffness
  • loss of mobility

Pain is the main symptom, especially in the lower back and buttock areas during the early stages.

However, inflammation and pain are not confined to the spine. It is a systemic condition, which means it can affect other parts of the body.

These include:

  • other joints
  • the neck
  • the top of the shin bone in the lower leg
  • behind the heel of the foot, in the Achilles tendon
  • under the heel of the foot

AS can cause so-called bony fusion, an overgrowth of bones at the joints. This can make it difficult to carry out everyday tasks. In some cases, it can restrict movement of the chest and make it hard to breathe.

People with AS may also experience fatigue, a feeling of being tired and lacking energy.

AS can also affect the eyes, including the iris and other parts. This inflammation, known as iritis or uveitis, depending on the location, can cause redness and pain. It can impair vision if not treated.

Other systemic signs of the disease may include neurological and cardiovascular changes.

Below is a 3-D model of ankylosing spondylitis, which is fully interactive.

Explore the model using your mouse pad or touchscreen to understand more about ankylosing spondylitis.

Treatment

There is no cure for AS, and the damage cannot be reversed. However, some options can help relieve symptoms and manage progression.

These include:

  • physical therapies and exercises
  • advice
  • drugs
  • surgery, in rare cases

The person will need to see a specialist doctor, known as a rheumatologist. They may need a number of visits, as the disease progresses slowly. Medical care enables better monitoring and treatment.

Two approaches commonly used to manage AS are:

  • drugs to reduce pain and inflammation
  • physical therapy and exercises to maintain movement and posture

Surgery is used only rarely, in severe cases, to correct severe deformity, such as excessive bending of the spine, or to replace a hip or other joint.

Drug treatment

The main drugs used to ease the pain and inflammation of AS are nonsteroidal anti-inflammatory drugs (NSAIDs). Examples include ibuprofen, naproxen, and diclofenac. Acetaminophen and codeine are also options if NSAIDs are unsuitable or insufficient.

Some NSAIDs compromise bone health by reducing the creation of new bone, and NSAIDs are not usually recommended after surgery for people with bone fusion problems.

Other drug options include:

  • locally injected corticosteroids
  • disease-modifying anti-rheumatic drugs (DMARDs), such as sulfasalazine (brand names: Azulfidine or Sulfazine) and methotrexate (Otrexup, Rheumatrex, or Trexall)
  • tumornecrosis factor (TNF) antagonists, such as adalimumab (Humira), certolizumab (Cimzia), etanercept (Enbrel), golimumab (Simponi), or infliximab (Remicade)
  • other biologic treatments, such as secukinumab (Cosentyx)

TNF treatment appears to be effective, but it is expensive and can have adverse effects.

AS can affect the whole body, and patients may meet with a range of specialists, including physical therapists, eye specialists, and gastroenterologists.

Exercises

Physical therapy can help relieve the symptoms of ankylosing spondylitis.

Physical therapy and exercises can help prevent symptoms.

A physical therapist will design a program that can help patients maintain good posture and motion in the joints.

This might include:

  • daily exercises
  • special training
  • therapeutic exercises

Physical therapy exercises are referred to as strengthening exercises and range-of-motion exercises.

Here are two exercises, suggested by the U.K. charity, Arthritis Research:

  1. Stand with your back and heels against a wall, and push your head back to touch the wall. Do not tilt the head back. Hold for 5 seconds, relax, and repeat for up to 10 times.
  2. Stand with the feet apart and hands on hips. Turn to one side, hold for 5 seconds, and relax. Repeat on the other side. Do this five times on each side.

There are different ways to exercise, including water fitness. A doctor can recommend a suitable plan.

Diagnosis

A doctor will ask about symptoms, carry out a physical examination, and arrange for tests where necessary.

If inflammatory back pain is present with certain features, this may indicate AS.

The features include:

  • pain that does not improve with rest
  • pain that causes sleep disturbance
  • back pain that starts gradually, before the age of 40 years, and is not caused by injury
  • symptoms that persist for over 3 months
  • spinal stiffness in the mornings, which improves with exercise and motion

Imaging tests may confirm the diagnosis, but changes may not be immediately visible on such tests. This can delay diagnosis.

Blood tests

No blood test can confirm AS, but tests can help confirm diagnosis and rule out other causes.

The tests for inflammation may include:

  • erythrocyte sedimentation rate (ESR)
  • C-reactive protein (CRP)
  • complete blood count (CBC)
  • genetic test (HLA B27)

If other causes, such as rheumatoid arthritis (RA) are suspected, testing for rheumatoid factor (RF), cyclic citrullinated peptide (CCP), and antinuclear antibodies (ANA) can help rule out these conditions.

Imaging tests

These may include:

  • X-rays, which can reveal both early and more advanced changes to the spine and pelvis
  • MRI, for example, an MRI of sacroiliac (SI) joints can reveal early signs of the condition

Causes

The exact cause of AS remains unclear, but the symptoms result from inflammation in parts of the lower spine.

When new bone grows, this inflammation can lead to damage and fusion. The fusion can happen as a result of the inflammation of the tissues that connect to bones.

However, it is not yet known why this chronic inflammatory process occurs in people with ankylosing spondylitis.

The condition often runs in families and is known to have a genetic component.

Outlook

The prognosis for AS is difficult to predict, as it varies widely between individuals, and the progression is often not constant.

Important factors for measuring outlook include levels of functional ability, spinal mobility, joint damage, and so on. Some people will experience severe functional loss, some hardly notice their symptoms, and around 1 percent experience remission, where symptoms cease to develop.

A few people will have life-threatening complications, affecting the heart, lungs, or intestines.

Males who develop symptoms at a younger age are more likely to have severe damage and loss of mobility, but in women, the impact appears to be less severe.

Smoking has been linked to poorer outcomes.

#Dieta mediterrânea associada a um menor risco de #artrite reumatoide

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De acordo com um estudo publicado on-line em 09 de agosto no Arthritis Research & Therapy, a alta adesão à pontuação da dieta mediterrânea está associada a um menor risco de artrite reumatoide (AR) em algumas populações.

Kari Johansson, Ph.D., do Karolinska Institutet em Estocolmo, e colegas usaram dados da investigação epidemiológica de AR na Suécia para identificar 1.721 pacientes com AR incidental (casos) e 3.667 controles, pareados por idade, sexo e região de residência. A pontuação da dieta mediterrânea foi determinada com base em um questionário sobre a frequência de 124 itens alimentares.

Os pesquisadores observaram que 24,1% dos pacientes e 28,2% dos controles tinham alta adesão à dieta mediterrânea (uma pontuação entre 6 e 9 em uma escala de 9 pontos). A alta adesão à dieta reduziu o risco de desenvolver AR em 21% (razão de chances [odds ratio, OR]: 0,79; intervalo de confiança [IC] de 95%: 0,65 a 0,96) em comparação à baixa adesão (uma pontuação entre 0 e 2), depois de ajustar para o índice de massa corporal, nível educacional, atividade física, uso de suplementos nutricionais, ingestão de calorias e tabagismo. No caso dos homens, a OR foi ainda menor (OR: 0,49; IC de 95%: 0,33 a 0,73), mas não houve associação significativa nas mulheres (OR: 0,94; IC de 95%: 0,74 a 1,18). Houve uma associação entre a pontuação alimentar alta e um baixo risco de AR na presença de fator reumatoide positivo (OR: 0,69; IC de 95%: 0,54 a 0,88), mas não na presença de fator reumatoide negativo (OR: 0,96; IC de 95%: 0,68 a 1,34).

“Precisamos reconhecer que os mecanismos e o impacto de possíveis diretrizes nutricionais podem ser diferentes em diferentes subgrupos de AR”, escreveram os autores.

#Foot and Ankle #Osteoarthritis

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As you age, your chance of developing osteoarthritis, which is caused by wear and tear, increases. The joint damage associated with osteoarthritis causes swelling, pain, and deformity. Here is information about how osteoarthritis affects the foot and ankle and information you can use to help you manage this debilitating condition.

What Is Arthritis?

Arthritis is a general term for a group of more than 100 diseases. The word “arthritis” means “joint inflammation.” Arthritis involves inflammation and swelling in and around the body’s joints and surrounding soft tissue. The inflammation can cause pain and stiffness.

In many kinds of arthritis, progressive joint deterioration occurs and the smooth “cushioning” cartilage in joints is gradually lost. As a result, the bones rub and wear against each other. Soft tissues in the joints also may begin to wear down. Arthritis can be painful and eventually result in limited motion, loss of joint function, and deformities in the joints affected.

What Is Osteoarthritis?

Osteoarthritis, or “wear-and-tear” arthritis, is the most common type of arthritis. Also known as degenerative joint disease or age-related arthritis, osteoarthritis is more likely to develop as people age. Inflammation and injury to the joint cause a breaking down of cartilage tissues, resulting in pain, swelling, and deformity. The changes in osteoarthritis usually occur slowly over many years, though there are occasional exceptions.

How Does Osteoarthritis Affect the Foot and Ankle?

Each foot has 28 bones and more than 30 joints. The following are the most common foot joints affected by osteoarthritis:

  • The three joints of the foot that involve the heel bone, the inner mid-foot bone, and the outer mid-foot bone
  • The joint of the big toe and foot bone
  • The joint where the ankle and shinbone meet

What Are the Symptoms of Foot and Ankle Osteoarthritis?

Symptoms of foot and ankle osteoarthritis often include:

  • Tenderness or pain
  • Reduced ability to move, walk, or bear weight
  • Stiffness in the joint
  • Swelling in the joint

How Is Foot and Ankle Osteoarthritis Diagnosed?

The diagnosis of foot and ankle osteoarthritis most likely will involve:

How Is Foot and Ankle Osteoarthritis Treated?

Foot and ankle osteoarthritis can be treated in many ways. Nonsurgical methods to treat foot and ankle arthritis include:

  • Steroid medicationsinjected into the joints
  • Anti-inflammatory drugs to reduce swelling in the joints
  • Pain relievers
  • Pads or arch supports
  • Canes or braces to support the joints
  • Inserts that support the ankle and foot (orthotics)
  • Physical therapy
  • Custom shoes
  • Weight control

Tips on Foot Care With Osteoarthritis

The most essential element of foot care for people with foot and ankle osteoarthritis is to wear shoes that fit properly and feel comfortable. The following are things to look for in finding a comfortable shoe:

  • Shoes shaped like your foot
  • Shoes that have support — for example, no slip-on shoes
  • Rubber soles to provide more cushioning
  • Flexibility
  • Proper fit — ask the salesperson to help you with this

Exercise can help keep your feet pain-free, strong, and flexible. Exercises that can be good for your feet include:

  • Achilles stretch. With your palms flat on a wall, lean against the wall and place one foot forward and one foot back. Lean forward, leaving your heels on the floor. You can feel the pull in your Achilles tendon and your calf. Repeat this exercise three times, holding for 10 seconds on each repeat.
  • Big-toe stretch. Place a thick rubber band around your big toes. Pull the big toes away from each other and toward the other toes. Hold this position for five seconds and repeat the exercise 10 times.
  • Toe pull. Place a rubber band around the toes of each foot, and then spread your toes. Hold this position for five seconds and repeat the exercise 10 times.
  • Toe curl. Pick up marbles with your toes.

Is Surgery an Option for Foot and Ankle Osteoarthritis?

More than one kind of surgery may be required to treat foot and ankle osteoarthritis. Your doctor can select the kind of surgery that is best for you, depending on the extent of your arthritis. The following are some of the surgical options for foot and ankle osteoarthritis:

  • Fusion surgery. This kind of surgery, also called arthrodesis, involves fusing bones together with the use of rods, pins, screws, or plates. After healing, the bones remain fused together.
  • Joint replacement surgery. This kind of surgery involves replacing the ankle joint with artificial implants and is used only in rare cases.

#Veja as novas recomendações de atividade física para pacientes com artrite

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artrite

Veja as novas recomendações de atividade física para pacientes com artrite

 

A Liga Europeia Contra Reumatismo (EULAR, em inglês) lançou recentemente o trabalho da força-tarefa (FT) sobre as recomendações de atividade física em pacientes com artrites (artrite reumatoide, osteoartrite de quadril/joellho e espondiloartrite) após revisão da literatura médica sobre o assunto. Pontos importantes envolvem o potencial beneficio da prática regular no aspecto de reduzir a “atividade” de doença e ajudar no controle do peso corporal, reduzindo a carga imposta na articulação.

Atualmente, os dados da literatura mostram que os pacientes com tais problemas são mais sedentáriosque a média, talvez por medo de piorar dos sintomas e/ou de lesão. Só que isso pode também refletir que os profissionais de saúde têm que ser informados para melhor encorajar a prática quando indicado. O benefício do exercício não se restringiria a melhorar os “doentes”, atuando também na prevenção.

Vamos aos keypoints dessa FT após análise da literatura:

  • Atividade física é parte integral do cuidado.
  • Todo profissional de saúde deve estar envolvido no processo (abordagem multidisciplinar).
  • Capacitação dos profissionais de saúde para orientar corretamente os pacientes.
  • Definir status (ativo/ não ativo) e nos diferentes domínios (cardiorrespiratório, força muscular, flexibilidade e neuromotor).
  • Contraindicações gerais e específicas para cada doença.
  • Individualizar os alvos da terapia com exercício e avaliação com questionários estabelecidos.
  • Barreiras e facilitadores gerais e específicos de cada doença.
  • Adaptação individualizada após avaliação minuciosa.
  • Aplicar técnicas de mudança de comportamento.
  • Modos de prática (terrestre, água, supervisionada, individual).

A opinião da FT é que a maioria dos pacientes com artrites têm condição de praticar atividade física regular quase como uma pessoa sem tais doenças, de modo a atingir o que é recomendado pela OMS. Os benefícios parecem ser diversos e é preciso implementar um processo de orientação/avaliação/encorajamento para atingir o objetivo e com boa adesão dos pacientes após avaliação multidisciplinar individualizada.

 

Autor:

Cristiano Carvalho de Oliveira

Formado em Medicina pela UFRJ em 2009/2 ⦁ Residência de Clínica Médica no HUCFF (UFRJ 2010 -2012) ⦁ Residência de Cardiologia no HUCFF (UFRJ 2012 – 2014) ⦁ Trabalho na Emergência do H. Pró-cardíaco ⦁ Ergometrista na CardioClin.

Referências:

 

 

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#Traditional Chinese Medicine: In Depth

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jars of Chinese herbs

Introduction

Traditional Chinese medicine (TCM) originated in ancient China and has evolved over thousands of years. TCM practitioners use herbal medicines and various mind and body practices, such as acupuncture and tai chi, to treat or prevent health problems. In the United States, people use TCM primarily as a complementary health approach. This fact sheet provides a general overview of TCM and suggests sources for additional information.

Key Points

Is It Safe?

  • Acupuncture is generally considered safe when performed by an experienced practitioner using sterile needles. Improperly performed acupuncture can cause potentially serious side effects.
  • Tai chi and qi gong, two mind and body practices used in TCM, are generally safe.
  • There have been reports of Chinese herbal products being contaminated with drugs, toxins, or heavy metals or not containing the listed ingredients. Some of the herbs used in Chinese medicine can interact with drugs, have serious side effects, or be unsafe for people with certain medical conditions.

Is It Effective?

  • For most conditions, there is not enough rigorous scientific evidence to know whether TCM methods work for the conditions for which they are used.

Keep in Mind

  • Tell all your health care providers about any complementary health approaches you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.

Background

TCM encompasses many different practices, including acupuncture, moxibustion (burning an herb above the skin to apply heat to acupuncture points), Chinese herbal medicine, tui na (Chinese therapeutic massage), dietary therapy, and tai chi and qi gong (practices that combine specific movements or postures, coordinated breathing, and mental focus). TCM is rooted in the ancient philosophy of Taoism and dates back more than 2,500 years. Traditional systems of medicine also exist in other East and South Asian countries, including Japan (where the traditional herbal medicine is called Kampo) and Korea. Some of these systems have been influenced by TCM and are similar to it in some ways, but each has developed distinctive features of its own.

Although the exact number of people who use TCM in the United States is unknown, it was estimated in 1997 that some 10,000 practitioners served more than 1 million patients each year. According to the 2007 National Health Interview Survey (NHIS), which included a comprehensive survey on the use of complementary health approaches by Americans, an estimated 3.1 million U.S. adults had used acupuncture in the previous year. The number of visits to acupuncturists tripled between 1997 and 2007. According to the 2007 NHIS, about 2.3 million Americans practiced tai chi and 600,000 practiced qi gong in the previous year.

This fact sheet focuses on TCM as a whole. For information about some of the individual practices included in TCM, see the pages on acupuncturetai chi, and qi gong on the National Center for Complementary and Integrative Health (NCCIH) Web site. Some of the individual herbs used in TCM are discussed in NCCIH’s Herbs at a Glance fact sheets.

Side Effects and Risks

  • Herbal medicines used in TCM are sometimes marketed in the United States as dietary supplements. The U.S. Food and Drug Administration (FDA) regulations for dietary supplements are not the same as those for prescription or over-the-counter drugs; in general, the regulations for dietary supplements are less stringent. For example, manufacturers don’t have to prove to the FDA that most claims made for dietary supplements are valid; if the product were a drug, they would have to provide proof.
  • Some Chinese herbal products may be safe, but others may not be. There have been reports of products being contaminated with drugs, toxins, or heavy metals or not containing the listed ingredients. Some of the herbs used in Chinese medicine can interact with drugs, can have serious side effects, or may be unsafe for people with certain medical conditions. For example, the Chinese herb ephedra (ma huang) has been linked to serious health complications, including heart attack and stroke. In 2004, the FDA banned the sale of ephedra-containing dietary supplements, but the ban does not apply to TCM remedies.
  • The FDA regulates acupuncture needles as medical devices and requires that the needles be sterile, nontoxic, and labeled for single use by qualified practitioners only. Relatively few complications from the use of acupuncture have been reported. However, adverse effects—some of them serious—have resulted from the use of nonsterile needles or improper delivery of acupuncture treatments.
  • Tai chi and qi gong are considered to be generally safe practices.
  • Information on the safety of other TCM methods is limited. Reported complications of moxibustion include allergic reactions, burns, and infections, but how often these events occur is not known. Both moxibustion and cupping (applying a heated cup to the skin to create a slight suction) may mark the skin, usually temporarily. The origin of these marks should be explained to health care providers so that they will not be mistaken for signs of disease or physical abuse.

Underlying Concepts

When thinking about ancient medical systems such as TCM, it is important to separate questions about traditional theories and concepts of health and wellness from questions about whether specific interventions might be helpful in the context of modern science-based medicine and health promotion practices.

The ancient beliefs on which TCM is based include the following:

  • The human body is a miniature version of the larger, surrounding universe.
  • Harmony between two opposing yet complementary forces, called yin and yang, supports health, and disease results from an imbalance between these forces.
  • Five elements—fire, earth, wood, metal, and water—symbolically represent all phenomena, including the stages of human life, and explain the functioning of the body and how it changes during disease.
  • Qi, a vital energy that flows through the body, performs multiple functions in maintaining health.

Concepts such as these are of interest in understanding the history of TCM. However, NCCIH-supported research on TCM does not focus on these ideas. Instead, it examines specific TCM practices from a scientific perspective, looking at their effects in the body and whether the practices are helpful in symptom management.

TCM practitioners use a variety of techniques in an effort to promote health and treat disease. In the United States, the most commonly used approaches include Chinese herbal medicine, acupuncture, and tai chi.

  • Chinese herbal medicine. The Chinese Materia Medica (a pharmacological reference book used by TCM practitioners) describes thousands of medicinal substances—primarily plants, but also some minerals and animal products. Different parts of plants, such as the leaves, roots, stems, flowers, and seeds, are used. In TCM, herbs are often combined in formulas and given as teas, capsules, liquid extracts, granules, or powders.
  • Acupuncture. Acupuncture is a family of procedures involving the stimulation of specific points on the body using a variety of techniques. The acupuncture technique that has been most often studied scientifically involves penetrating the skin with thin, solid, metal needles that are manipulated by the hands or by electrical stimulation.
  • Tai chi. Tai chi is a centuries-old mind and body practice. It involves gentle, dance-like body movements with mental focus, breathing, and relaxation.

The Status of TCM Research

In spite of the widespread use of TCM in China and its use in the West, rigorous scientific evidence of its effectiveness is limited. TCM can be difficult for researchers to study because its treatments are often complex and are based on ideas very different from those of modern Western medicine.

Most research studies on TCM have focused on specific techniques, primarily acupuncture and Chinese herbal remedies, and there have been many systematic reviews of studies of TCM approaches for various conditions.

  • An assessment of the research found that 41 of 70 systematic reviews of the scientific evidence (including 19 of 26 reviews on acupuncture for a variety of conditions and 22 of 42 reviews on Chinese herbal medicine) were unable to reach conclusions about whether the technique worked for the condition under investigation because there was not enough good-quality evidence. The other 29 systematic reviews (including 7 of 26 reviews on acupuncture and 20 of 42 reviews on Chinese herbal medicine) suggested possible benefits but could not reach definite conclusions because of the small quantity or poor quality of the studies.
  • In a 2012 analysis that combined data on individual participants in 29 studies of acupuncture for pain, patients who received acupuncture for back or neck pain, osteoarthritis, or chronic headache had better pain relief than those who did not receive acupuncture. However, in the same analysis, when actual acupuncture was compared with simulated acupuncture (a sham procedure that resembles acupuncture but in which the needles do not penetrate the skin or penetrate it only slightly), the difference in pain relief between the two treatments was much smaller—so small that it may not have been meaningful to patients.
  • Tai chi has not been investigated as extensively as acupuncture or Chinese herbal medicine, but recent studies, including some supported by NCCIH, suggest that practicing tai chi may help to improve balance and stability in people with Parkinson’s disease; reduce pain from knee osteoarthritis and fibromyalgia; and promote quality of life and mood in people with heart failure.

If You Are Thinking About Using TCM

  • Do not use TCM to replace effective conventional care or as a reason to postpone seeing a health care provider about a medical problem.
  • Look for published research studies on TCM for the health condition that interests you.
  • It is better to use TCM herbal remedies under the supervision of your health care provider or a professional trained in herbal medicine than to try to treat yourself.
  • Ask about the training and experience of the TCM practitioner you are considering. You can find information about the credentials and licensing of complementary health practitioners on the NCCIH Web site.
  • If you are pregnant or nursing, or are thinking of using TCM to treat a child, you should be especially sure to consult your (or the child’s) health care provider.
  • Tell all your health care providers about any complementary health approaches you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.

For More Information

NCCIH Clearinghouse

The NCCIH Clearinghouse provides information on NCCIH and complementary and integrative health approaches, including publications and searches of Federal databases of scientific and medical literature. The Clearinghouse does not provide medical advice, treatment recommendations, or referrals to practitioners.

Toll-free in the U.S.:
1-888-644-6226
TTY (for deaf and hard-of-hearing callers):
1-866-464-3615

PubMed®

A service of the National Library of Medicine, PubMed® contains publication information and (in most cases) brief summaries of articles from scientific and medical journals. For guidance from NCCIH on using PubMed, see How To Find Information About Complementary Health Approaches on PubMed.

Cochrane Database of Systematic Reviews

The Cochrane Database of Systematic Reviews is a collection of evidence-based reviews produced by the Cochrane Library, an international nonprofit organization. The reviews summarize the results of clinical trials on health care interventions. Summaries are free; full-text reviews are by subscription only.

NIH Clinical Research Trials and You

The National Institutes of Health (NIH) has created a Web site, NIH Clinical Research Trials and You, to help people learn about clinical trials, why they matter, and how to participate. The site includes questions and answers about clinical trials, guidance on how to find clinical trials through ClinicalTrials.gov and other resources, and stories about the personal experiences of clinical trial participants. Clinical trials are necessary to find better ways to prevent, diagnose, and treat diseases.

Research Portfolio Online Reporting Tools Expenditures & Results (RePORTER)

RePORTER is a database of information on federally funded scientific and medical research projects being conducted at research institutions.

Key References

Acknowledgments

NCCIH thanks the following people for their technical expertise and review of the update of this publication: Adam Burke, Ph.D., M.P.H., L.Ac., San Francisco State University; Ted Kaptchuk, O.M.D., Harvard Medical School; Lixing Lao, M.D., Ph.D., L.Ac., University of Maryland Medical Center; and Wendy Weber, N.D., Ph.D., M.P.H., and John (Jack) Killen, Jr., M.D., NCCIH.

This publication is not copyrighted and is in the public domain. Duplication is encouraged.

NCCIH has provided this material for your information. It is not intended to substitute for the medical expertise and advice of your health care provider(s). We encourage you to discuss any decisions about treatment or care with your health care provider. The mention of any product, service, or therapy is not an endorsement by NCCIH.

 

* Note: PDF files require a viewer such as the free Adobe Reader(link is external).

NCCIH Pub No.:
D428
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