Search

Objective Social relationships play an important role in human health and disease processes, and the field of psychosomatic medicine currently integrates social factors in its theoretical models and clinical interventions. This article provides a historical perspective on the field of psychosomatic medicine in the United States and examines the extent to which early American psychosomatic medicine incorporated the impact of social relationships on health and disease outcomes. Methods We searched PubMed across all issues of Psychosomatic Medicine for key words related to emotions versus social processes. Article counts are compared for these key words. We then performed a narrative review to analyze how concepts of associations among emotional, interpersonal, and physiological variables evolved in early publications. Results Of 5023 articles found in Psychosomatic Medicine, 1453 contained an emotional, 936 a social search term, and 447 contained both. In the qualitative review, influences of the social environment on emotional states and physiology were recognized already in the 1930s but they only played a subordinate role in early Psychosomatic Medicine. Publications often lacked a clear working model how interpersonal events exert their impact on physiology. With increasing understanding of developmental and neural mechanisms, a more differentiated view evolved. Conclusions Early publications in psychosomatic medicine mainly focused on associations between emotions and physiology. However, some highlighted the importance of interpersonal and social factors. Later, the understanding of emotions, social relationships, and physiology with their developmental and neurobiological correlates have led to a fuller "biopsychosociocultural" understanding of health and disease, although more research on and within these networks is urgently needed.

Das Spektrum universitärer Forschung in der Naturheilkunde/Komplementärmedizin wird anhand klinischer Phytotherapie bei Patienten mit chronischen Erkrankungen aufgezeigt. Methoden der Evidenzbasierten Medizin (EbM) werden angewandt (Metaanalyse, randomisierte kontrollierte Studie (RCT), Beobachtungsstudie), um sowohl die Wirksamkeit und Sicherheit pflanzlicher Extrakte als auch die Kombinationsbegründung und Konfounder in Studien zu pflanzlichen Arzneimitteln zu untersuchen: Zwei Metaanalysen zeigen - bei der Reanalyse der Rohdaten nach Intention-to-treat-Prinzip - eine signifikante und klinisch relevante Reduktion, zum einen gastrointestinaler Symptome durch das Kombinationspräparat STW5 bei 273 Patienten mit funktioneller Dyspepsie und zum anderen der krankheitsspezifischen Mortalität bei 602 Patienten mit alkoholtoxischer Leberzirrhose durch das Monopräparat Silymarin - jeweils im Vergleich zu Placebo. Zwei RCTs zeigten i) bei 204 Patienten mit Fingergelenkspolyarthrose unter topischer Anwendung eines Arnika-Gels keine signifikante Unterlegenheit im Vergleich zu einem nichtsteroidalen Antirheumatikum bezüglich Schmerz sowie Handfunktion und ii) bei 182 Patienten mit somatoformen Störungen mit der Behandlung durch das Kombinationspräparat Ze 185 (4 Pflanzenextrakte) im Vergleich zur 3er-Kombination und Placebo eine signifikante Reduktion depressiver und ängstlicher Symptome. Eine Beobachtungsstudie mit 1541 ambulanten Patienten mit unipolaren leicht- bis mittelgradigen depressiven Episoden ergab, ähnlich wie bei synthetischen Antidepressiva, eine negative Assoziation zwischen Erkrankungsdauer, Symptomstärke und Erkrankungsalter mit dem Outcome. Je nach klinischer Fragestellung eignen sich verschiedene Methoden der EbM zur Untersuchung pflanzlicher Extrakte hinsichtlich der eingangs erwähnten Aspekte.

Die alternde Bevolkerung stellt die Medizin vor neue Probleme. Es geht weniger um das Kurieren, sondern vielmehr darum, den Alltag gelungen zu meistern. Bei diesem ganzheitlichen Ansatz kommt der Pfle

Ayurveda is playing a growing part in Europe. Questions regarding the role of religion and spirituality within Ayurveda are discussed widely. Yet, there is little data on the influence of religious and spiritual aspects on its European diffusion. Methods. A survey was conducted with a new questionnaire. It was analysed by calculating frequency variables and testing differences in distributions with the chi(2)-Test. Principal Component Analyses with Varimax Rotation were performed. Results. 140 questionnaires were analysed. Researchers found that individual religious and spiritual backgrounds influence attitudes and expectations towards Ayurveda. Statistical relationships were found between religious/spiritual backgrounds and decisions to offer/access Ayurveda. Accessing Ayurveda did not exclude the simultaneous use of modern medicine and CAM. From the majority's perspective Ayurveda is simultaneously a science, medicine, and a spiritual approach. Conclusion. Ayurveda seems to be able to satisfy the individual needs of therapists and patients, despite worldview differences. Ayurvedic concepts are based on anthropologic assumptions including different levels of existence in healing approaches. Thereby, Ayurveda can be seen in accordance with the prerequisites for a Whole Medical System. As a result of this, intimate and individual therapist-patient relationships can emerge. Larger surveys involving bigger participant numbers with fully validated questionnaires are warranted to support these results.

Die Wirkstoffe pflanzlicher Arznei- und Heilmittel sind pleiotrope Vielstoffgemische mit Multi-Target Eigenschaften einschlieβlich antiinflammatorischer Wirkungen. Eine pleiotrope Entzundungshemmung konnte bei tumorkranken Menschen als Versuch der Verhinderung bzw. Verzogerung der Metastasierung eine bedeutsame Rolle spielen. Zahlreiche experimentelle Daten fur europaische wie auch auβereuropaische Pflanzen und verschiedene phytotherapeutische Kombinationen weisen auf eine solche Moglichkeit hin. Trotz der bislang nur geringen Anzahl klinischer Untersuchungen konnten derartige phytotherapeutische Behandlungsversuche vertretbar erscheinen, wenn fur solche Arznei- und Heilpflanzen aus Anwendungsbereichen bei nicht tumorkranken Menschen gesicherte Daten uber Qualitat und Sicherheit dokumentiert sind und eine Ubertragung solcher Daten auf die Situation tumorkranker Menschen unter kritischer Abwagung moglich erscheint. Phytotherapeutika spielen zudem in der Supportivtherapie eine zunehmende Rolle, wobei zahlreiche dieser Phytotherapeutika neben ihrer symptomatischen supportiven Wirksamkeit auch antiinflammatorische Wirkungen zeigen. Die gezielte Auswahl von supportiv wirksamen Phytotherapeutika mit zusatzlichen antiinflammatorischen Effekten konnte fur tumorkranke Menschen neben der Symptomlinderung simultan die Moglichkeit einer antiinflammatorischen antitumoralen Wirksamkeit bieten als eine Art personalisierter Phytotherapie. Zurzeit besteht diesbezuglich noch ein groβer Bedarf an therapeutisch orientierter klinischer Forschung.

Background: Mistletoe is often used as a complementary approach in oncology. Despite experimental anti-tumour effects and several reviews there remains controversy about its clinical role. Patients and Methods: Potentially relevant trials were identified to perform a systematic review (databases: e.g. EMBASE, MEDLINE; hand search: e.g. bibliographies; search terms: e.g. mistletoe). To be included, randomised or comparative clinical trials at least had to examine mistletoe preparations standardized according to manufacturing process and to describe interventions explicitly. Additionally, cohort studies were included for reasons of external validity. Results were summarised in tables. Results: 18 clinical trials (>6,800 participants) were included. Their internal quality was mostly low. Due to heterogeneity between trials a meta-analysis was impossible. Regarding efficacy, findings were inconsistent regarding life expectancy, relation to tumour entity, dosing and treatment duration. Yet, studies indicate that quality of life (QoL) is improved. As these findings do not seem to be limited to one of the different parenteral mistletoe preparations reviewed the treatment may be summarised under the umbrella term ‘mistletoe therapy’. Regarding safety, 1 serious adverse event (AE) related to mistletoe was described; non-serious AEs were local reactions at injection site. Allergic reactions were rare. Conclusion: Supportive ‘mistletoe therapy’ seems safe and beneficial for QoL in adult patients with solid tumours. But there is an urgent need to confirm its efficacy in patient-centred care in a complex oncological setting. This has to be evaluated systematically in prospective observational trials with validated, multidimensional patient-rated QoL questionnaires and comparisons of different preparations and dosages.

HINTERGRUND: Mistelzubereitungen werden in den deutschsprachigen Landern oft supportiv in der Behandlung von Patienten mit Krebserkrankungen eingesetzt. Fragestellung: Lasst sich anhand klinischer Studien und systematischer Reviews ein klinischer Nutzen in der Verbesserung der Lebensqualitat (QoL) der Patienten nachweisen? METHODE: Von den potentiell relevanten klinischen Studien wurden fur einen systematischen Review jene randomisierten, vergleichenden oder Kohortenstudien ausgewahlt, die eine supportive parenterale Mistelbehandlung bei Erwachsenen mit soliden Tumoren untersuchten und als primares oder sekundares Zielkriterium die Lebensqualitat nachvollziehbar analysierten (Datenbanken: z.B. MEDLINE; embase, Suchbegriffe: z.B. Mistel, mistletoe, Viscum album). Die Ergebnisse sind tabellarisch zusammengefasst. ERGEBNISSE: Sechs klinische Studien mit unterschiedlicher methodischer Qualitat wurden eingeschlossen. Aufgrund der Heterogenitat der verwendeten Messinstrumente zur QoL war eine Meta-Analyse nicht moglich. Die Studien geben unabhangig von Tumorentitat oder verwendeter Mistelzubereitung Hinweise auf die Verbesserung der QoL, aber nicht alle Studien erfullen den heutigen Forschungsstandard zur QoL. Hinsichtlich Sicherheit scheint die Vertraglichkeit gut, aber lokale Reaktionen an der Injektionsstelle scheinen haufig. Allergische Reaktionen waren selten. SCHLUSSFOLGERUNG: Die supportive Behandlung mit Mistelpraparaten scheint sicher, um die Lebensqualitat erwachsener Patienten mit soliden Tumoren im Rahmen der onkologischen Standardtherapie zu verbessern. Zukunftige prospektive offene Studien sollten mit validierten, multi-dimensionalen und von Patienten ausgefullten Fragebogen die krankheitsspezifische Verbesserung der QoL mit unterschiedlicher Dosierung sowie Anwendungsdauer phytotherapeutischer und anthroposophischer Mistelpraparate analysieren.

Hintergrund: Bei der vorliegenden Studie handelt es sich um eine Anwendungsbeobachung unter Praxisbedingungen in der Schweiz, durchgefUhrt mit einem Weidenrinden-Spezialextrakt (Assalix®). Ziel der Studie war es, eine bessere EinschAtzung zur HAufigkeit von Nebenwirkungen (und mOglicherweise die Identifizierung bisher nicht bekannter Nebenwirkungen) und zur Wirksamkeit zur erhalten. Methoden: In die Studie aufgenommen wurden Patienten im Erwachsenenalter, die aufgrund ihres Beschwerdebildes fUr eine Behandlung mit dem Extrakt geeignet waren. Die Studiendauer betrug 6–8 Wochen, wobei eine Kontrolle nach 3–4 Wochen erfolgte. Neben den Ublichen demografischen und anamnestischen Daten wurden die Variablen (Intent-to-treat) SchmerzintensitAt, BeeintrAchtigung im tAglichen Leben sowie globale Beurteilung von Wirksamkeit und VertrAglichkeit erhoben. Ergebnisse: Die 204 teilnehmenden Arzte behandelten 877 Patienten mit unterschiedlichen rheumatisch bedingten Schmerzen (Frauen 64,2%, Alter 58,76 ± 15,69); 763 Patienten konnten die Studie abschliessen. In 68% der FAlle betrug die Dauer der Beschwerden mehr als 6 Monate und 81,2% der Patienten hatte bereits eine andere Medikation erhalten. Eine anti-inflammatorische Comedikation erfolgte bei 39,3% der Patienten. Der Schmerz-Score betrug 5,32 ± 1,62 (auf einer Skala von 0–9) zu Studienbeginn und bei der letzten Konsultation 2,51 ± 2,04 (p < 0,001); vOllige Schmerzfreiheit wurde von 14% der Patientinnen berichtet. WAhrend zu Studienbeginn lediglich 0,6% der Patienten Uber keine BeeintrAchtigungen in ihrem tAglichen Leben berichteten, waren dies bei der Schlussvisite 27,4%. 38 Patienten (4,3%) berichteten Uber insgesamt 46 unerwUnschte Wirkungen, die vorwiegend das Verdauungssystem (3,1%) und die Haut (1,6%) betrafen. «Ernsthafte» Nebenwirkungen wurden nicht beobachtet. Nebenwirkungen traten hAufiger unter der anti-inflammatorischen Comedikation auf. Schlussfolgerungen: Der untersuchte Weidenrindenextrakt (Assalix®) wurde gut vertragen, unerwartete Nebenwirkungen traten keine auf. Unter BerUcksichtigung des Studiendesigns kann festgestellt werden, dass der Extrakt eine moderat analgetische Wirksamkeit bei Dorsopathien, Weichteilrheuma, entzUndlichen Polyarthropathien und bei Arthrose besitzt.

The potential benefit of silymarin (special extract from the fruits of Silybum marianum) in the treatment of liver diseases remains a controversial issue.For this systematic review electronic databases identified 65 papers for the search terms silymarin, silibinin, silicristin or milk thistle and clinical trial. Only 19 complied with the criteria'double-' or 'single-blind'. These publications were analysed from a clinical point of view and meta-analytic calculations were performed.The clinical evidence ofa therapeutic effect of silymarin in toxic liver diseases is scarce. There is no evidence of a favourable influence on the evolution of viral hepatitis, particularly hepatitis C. In alcoholic liver disease, comparing with placebo, aspartate aminotransferase was reduced in the silymarin-treated groups (p = 0.01) while alkaline phosphatase was not. In liver cirrhosis, mostly alcoholic, total mortality was 16.1% with silymarin vs. 20.5% with placebo (n.s.); liver-related mortality was 10.0% with silymarin vs. 17.3% with placebo(p = 0.01).Based on the available clinical evidence it can be concluded - concerning possible risks /probable benefits - that it is reasonable to employ silymarin as a supportive element in the therapy of Amanita phalloides poisoning but also (alcoholic and grade Child 'A') liver cirrhosis. A consistent research programme, consolidating existing evidence and exploring new potential uses,would be very welcome.

Based on biographic research on the Swiss Alfred Vogel, this article focusses on some socio-cultural aspects, which form part of the background to his career as a naturopath. Due to socialisation in his family, he became aware of the use of herbs in folk medicine. After business training, he worked as a salesman in a grocer’s shop near Basel which, after becoming its owner, he turned into a health food shop. The success of this business laid the financial ground for a new professional orientation. Vogel popularized life reform ideas by publishing books and his own magazine; he passed training courses in naturopathy, got officially registered as a naturopath and ran a small spa hotel close to St. Gallen. His deep religiosity formed his worldview as well as his therapeutic orientation. In a small laboratory which he gradually enlarged due to increasing demand, he produced extracts from fresh plants. Besides his therapeutic and journalistic activities, he travelled to various countries, sometimes in the manner of ethno-botanic excursions, and brought back new knowledge, plants and fruits which he used for his herbal preparations and products. Finally, from 1963 on, he concentrated on the production of herbal preparations in his own company (Bioforce AG) and he became an important protagonist of herbal medicine in Switzerland.

Recent years have seen an explosion of scientific papers that deal with drugs from the fruits of milk thistle and its active substances silymarin (standardized mixture of flavonolignanes), thus justifying an updated systematic review. Methods: Electronic databases identified silymarin, silibinin, silicristin or milk thistle as descriptors in >700 papers (34% published in last 5 years; 92% dealt with animal pharmacological). Only papers adequately reporting on experimental conditions, dosing, variables tested and statistics were analysed. Results: Silymarin was found to modify specifically the functions related to various transporters and receptors located in the cell membranes; that is, organic anion uptake transporter peptides (OATP), ABC transporters (P-gp), bile salt export pump, as well as TNF-a-dependent and possibly selectin-dependent phenomena. In the cytoplasm, some antioxidant properties and the inhibition of the lipoxygenase pathway seem quite selective and could concur to the antitoxic effects. Some effects like the inhibition of inducible nitric-oxide synthase, of nuclear factor κ B, and reduction of collagen synthesis are indicative of DNA/RNAmediated effects. Several studies using ‘in vitro’ and ‘in vivo’ cancer models suggest a potential of silymarin in such diseases. Topical and systemic silymarin has skin protective properties against UV-induced damage in epidermis and causes an up-regulation of tumour-suppressor genes p53- and p21CIP1. There were no data on hepatic viral replication, viremia or spontaneous tumours in the data examined. Conclusions: Data presented here do not solve the question about the complex mechanism(s) of action of the medicinal herbal drug silymarin. Silymarin may be a natural multi-functional and multi-target drug.

Hintergrund: Das komplexe pflanzliche Arzneimittel Padma 28 basiert auf einer Formel der Tibetischen Medizin und wird seit uber 30 Jahren in der Schweiz zur Behandlung von Durchblutungsstorungen und Symptomen der Claudicatio intermittens (reduzierte Gehstrecke) eingesetzt. Fragestellung: Welche Evidenz liegt zur klinischen Wirksamkeit und Sicherheit dieses Arzneimittels bei Patienten mit peripherer arterieller Verschlusskrankheit (PAVK) vor? Material und Methode: Systematischer Review mit Literaturrecherche in elektronischen Datenbanken (jeweils von deren Beginn bis Herbst 2005) und den Literaturverzeichnissen der gefundenen Arbeiten. Ergebnisse: Es fanden sich 14 Artikel (6 publizierte, 1 unpublizierte und 6 doppelt publizierte Studien sowie 1 Metaanalyse). Sechs Studien untersuchten die maximale Gehstrecke, funf davon zeigten eine signifikante Zunahme derselben. Die gepoolten Daten der Metaanalyse bestatigten eine signifikante und klinisch relevante Verlangerung der Gehstrecke um mehr als 100 m bei knapp einem Funftel der Patienten. Die schwerwiegenden unerwunschten Ereignisse standen nicht im Zusammenhang mit dem Verum, die nicht schwerwiegenden waren gleich haufig wie unter Plazebo. Schlussfolgerungen: Die verfugbare Evidenz zeigt, dass die Multi-Target-Therapie mit Padma 28 eine statistisch signifikante und klinisch relevante Besserung von Symptomen der PAVK, d.h. eine erhohte Gehstrecke, bewirkt.

Background: Practitioners and users of naturopathic therapies claim that one of the assumptions underlying their work is a holistic ‘view of man’. Objective: Does there exist one specific view of man in present naturopathy and what does this mean? Material and Methods: Database and literature research of use and meaning of the term ‘view of man’ and descriptive analysis. Results: The term «view of man» is neither timeless nor related to a specific subject area. Its meaning is connected with the state of knowledge of the respective epoch as well as its reception in science and society. The discourse concerning the term ‘view of man’ in the 2nd half of the 20th century in German literature shows, that in different fields the argumentation about one specific view of man shifts towards a pluralistic understanding of man. This pluralistic view about man exists in medicine as well. On the one hand conventional medicine, a long time under influence of the reductionism of natural science, has widened its worldview due to methods and questions of different disciplines such as psychosomatics, psychotherapy or social medicine towards a more complex perception of man. On the other hand Traditional European Naturopathy (TEN) too, claims to respect aspects of the ‘body-mind-soul-unity’ in its understanding of man; yet, in connection with its hardly ever explained ‘natural forces’. Besides the findings in literature clinical experience with our patients reveals some aspects that are characteristic of today’s pluralistic naturopathic understanding of man and could also be useful for conventional medicine: recognition of patients expectations (e.g. subjective view of illness), participation in the therapy planning (e.g. construction of how to get healthy) and naturopathic modes of therapy (e.g. start of therapy at healthy parts of the body, too). Conclusions: Despite some characteristics in naturopathy one finds variations of views or images of man, which originate from multiple subjective and socio-cultural perspectives of patients and therapists and which require, next to medical knowledge, on both sides openness and communication regarding aspects of health, illness and therapeutic settings.

Neben den sich in den letzten 15 Jahren verAnderten Behandlungsschemata zur Therapie der Herzinsuffizienz mit konventionellen Arzneimitteln gibt es eine lange Tradition fUr phytotherapeutische Zubereitungen aus Weissdorn. Die Evidenz fUr diesen komplementArmedizinischen Behandlungsansatz stellt sich, unterteilt nach den verwendeten Drogen, d.h. Pflanzenteilen, folgendermassen dar: FUr die in der Moderne lAnger bekannten Arzneimittel aus BlUten und BlAttern zeigt eine Meta-Analyse von 8 klinischen Studien die Wirksamkeit, z.B. gemessen an der signifikanten Zunahme der maximalen Arbeitsbelastung um 7 Watt. Die Medikation erfolgte je nach Studie und Indikation im Dosisbereich von 160–1’800 mg Crataegus-Extrakt pro Tag und die Studiendauer erstreckte sich von 3 bis 16 Wochen bei Patienten mit Herzinsuffizienz Grad I – III nach NYHA. FUr Crataegus-FrUchte liegt, neben einigen klinisch-pharmakologischen Studien, bislang eine randomisierte klinische Studie bei Patienten mit Herzinsuffizienz NYHA II vor. Auch hier zeigte sich eine signifikante Zunahme der max. Arbeitsleistung um 8 Watt. Die VertrAglichkeit der Arzneimittel wurde fUr beide Zubereitungsarten als gut eingestuft. Keine Interaktionen zeigten sich in einer pharmakokinetischen Studie mit Digoxin und eine Kombination mit konventionellen Herzmittel ist mOglich.

Summary Background : Despite a long-standing use of herbal drugs with dyspeptic symptoms, little attention has been paid to their clinical evaluation. Aim : To assess efficacy and safety of the herbal drug preparation STW 5 (containing, e.g. Iberis, peppermint, chamomile) in the treatment of functional dyspepsia. Methods : Research in electronic databases, consultation of experts and of the producer identified STW 5 (Iberogast) as descriptor in six randomized-controlled trials. The raw data of three placebo-controlled studies which met the selection criteria, were reanalysed and pooled for meta-analysis; one reference-controlled study supported the safety analysis (STW 5: n = 199, control: n = 198). Results : Pooled data showed verum (n = 138) to be more effective than placebo (n = 135) with regard to the severity of the most bothersome gastrointestinal symptom (P-value: 0.001, odds ratio: 0.22, 95% CI: 0.11–0.47). A fourth randomized-controlled trial showed no significant difference between STW 5 and cisapride. As to safety, adverse events were similar with verum and placebo; no serious adverse events occurred. Discussions : From the point of view of efficacy and safety, the herbal medicinal product STW 5 appears to be a valid therapeutic option for patients seeking phytotherapy for their symptoms of functional dyspepsia.

Development of ‚Ordnungstherapie‚ due to Bircher-Benner in the Naturopathy of the 20th Century Background: The German term ‚Ordnungstherapie‚ is one of the five therapeutics which defines naturopathy in German-speaking countries. Objective: Who formed the term Ordnungstherapie in naturopathy and what does it mean? Material and Methods: Heuristics and criticism of literature of the 20th century as well as database research. Results: Nowadays in German-language medical books Ordnungstherpie belongs to the five therapeutics which define European naturopathy. Yet, the interpretation ranges from health education to body-orientated forms of psychotherapy. The term Ordnungstherapie is often related with the German priest and hydropath Sebastian Kneipp, however, term and definition have been founded by the Swiss physician Maximillian Bircher-Benner. In 1937 he defined Ordnungstherapie as a complex concept of natural healing. It is based upon the rather nosological idea that health is order/harmony in the human body (physically, psychologically), the environment and the daily course. Illness occurs if disorder appears in one of these fields. The therapeutic setting of Ordnungstherapy is defined by 9 rules of conduct to maintain order, which include nutrition, the skin as an organ (exposure to light, air, water), breathing, movement, rhythm of life, and psyche. For all these aspects Bircher-Benner himself uses the terms somatotherapy (dietotherapy, sun and light therapy, hydrotherapy, exercise therapy, breathing technique, order of the rhythm of live) and psychotherapy. He chose these complementary methods subjectively after learning them from 1897 onwards in an eclectic manner and after gaining therapeutic empiricism. Nevertheless his ideas of the Ordnungstherapie correlate with the socio-political context of the 1940ies. Conclusions: The term Ordnungstherapie was introduced by Bircher-Benner as an umbrella term in 1937 to describe a complex concept of naturopathic therapies. It comprises, with certain limitations for phytotherapy, the therapies which nowadays define European naturopathy. Yet, in European naturopathy today Ordnungstherapie is mostly considered as one out of 5 constituents of naturopathy (dietotherapy, hydrotherapy, exercise therapy, phytotherapy, Ordnungstherapie). The classification of Ordnungstherapie as one of the 5 pillars of the Kneipp therapy was only done by Kneipp physicians in the middle of the 20th century and needs to be thought over.

A systematic review referring to efficacy and tolerability of the herbal combination Iberogast (Iberis amara planta totalis, Chelidonii herba, Cardui mariae fructus, Melissae folium, Carvi fructus, Liquiritiae radix, Angelicae radix, Matricariae flos, Menthae piperitae folium) was performed in patients with functional dyspepsia. Three placebo-controlled trials and a reference-controlled trial showed a statistical significant and therapeutical relevant reduction of the gastrointestinal symptom-scores in 595 patients. The therapeutic efficacy was also found in one observational study (2267 patients). In accordance with the available evidence Iberogast seems to be an effective phytotherapeutic preparation to reduce the symptoms of dyspepsia yet, without central nervous side effects.

Bisher gibt es kaum systematisch erhobene Daten über den Gebrauch von Naturheilmitteln während Schwangerschaft und Stillzeit. Ziel dieser Pilotstudie an einem nicht repräsentativen Kollektiv von 139 Frauen, die von Mitte 1997 bis zum 2. Quartal 1998 zur Entbindung in drei geburtshilfliche Einrichtungen kamen, war es, Daten zu den Fragen nach der Häufigkeit und dem Spektrum der angewandten Naturheilmittel während Schwangerschaft und Stillzeit zu erheben. Während der Schwangerschaft nahmen mindestens 96% und in der Stillperiode 84% der Frauen mindestens 1 Naturheilmittel ein, wobei jeweils Phytotherapeutika am häufigsten benutzt wurden. Im Gegensatz zum weit verbreiteten Gebrauch von Naturheilmitteln bei Schwangeren und Stillenden in dieser Studie, und ihren Fragen dazu, existieren wenige nachvollziehbare Daten zur Wirksamkeit und zu einem eventuellen Risiko. Während der Schwangerschaft und Stillzeit benutzte Naturheilmittel sollten dahingehend gesichtet und beurteilt werden.

St. John’s Wort ( Hypericum perforatum ): A Plurivalent Raw Material for Modern and Traditional Therapies St. John’s Wort is one of the oldest and one of the best e

Vor rund 20 Jahren begann mit der Akademisierung von Komplemen­ tarmedizin und Naturheilkunde an Universitaten in Europa ein entschei­ dender wissenschaftlicher Emanzipa­ tions­ und Professionalisierungspro­ zess [1]. War vorher jahrhundertealtes Erfahrungswissen vor allem durch experimentelle und klinische Studien fur die medizinische Alltagspraxis gepruft worden, ging es nun um die wissenschaftliche Integration von Komplementarmedizin und Natur­ heilkunde an Universitatskliniken und Lehrkrankenhausern. Die Phyto­ therapie spielte dabei eine wichtige Rolle, da ihre Forschungen aufgrund der methodischen Nahe zur kli­ nischen Pharmakologie besonders geeignet schienen, traditionsreiche Empirie durch klinische Studien zu analysieren [2, 3]. Zu diesem Prozess trug entschieden die Orientierung vieler komplementarmedizinisch For­ schender an der Methodik der evi­ denzbasierten Medizin (EbM) bei [4]. Durch die in der Folge gewonnene Evidenz entwickelte sich die wissen­ schaftliche Akzeptanz fur viele Inter­ ventionen aus traditionellen Medizin­ systemen. So stellt sich heute – auf der Grund­ lage einer mittlerweile breiten klini­ schen Evidenz, beispielsweise auf dem Gebiet der Phytotherapie – fur unter­ schiedliche medizinische Fachberei­ che (z.B. Innere Medizin, Onkologie, Psychiatrie) die Frage, welche Be­ handlungen in der klinischen Praxis geeignet sind und aufgenommen wer­ den konnen [5, 6]. Schweizerische Zeitschrift fur Ganzheitsmedizin Swiss Journal of Integrative Medicine

Iberogast(r): A Modern Phytotherapeutic Combined Herbal Drug for the Treatment of Functional Disorders of the Gastrointestinal Tract (Dyspepsia, Irritable Bowel Syndrome) – from Phytomedicin

In traditional medicine, especially CAM, the concept of (herbal) tonics has a long history in the different medical systems (TEN -- Traditional European Naturopathy; TCM - Traditional Chinese Medicine). Nevertheless, the ideas concerning the function of a tonic differ, e.g., stimulation of body functions, strengthening of organ function, enhancement of adaption, and well-being. Although no exact pharmacodynamic or pharmacokinetic properties of tonics can be given, the following general definition, even in the transcultural comparison between European and Chinese concepts, seems meaningful: A tonic is an agent that has the capability to restore and/or maintain the physiological functioning of an organ system, leading to the subjective feeling of well-being of the patient treated with it.

Atherosclerosis is a systemic disease. Its association with the metabolic syndrome requires a multimodal therapy setting, to alleviate symptoms and for primary and secondary prevention. In the planning of the therapy, information about evidence of the interventions and a rationale for reasonable combinations are important.For compiling a meta-narrative review (MNR) on the evidence of complementary and conventional pharmaco-therapy in peripheral arterial occlusive disease (PAOD), the literature was searched for meta-analyses of randomized controlled trials (RCTs). These were evaluated taking into account network-pharmacological aspects and research parameters.4 suitable meta-analyses were found. In comparison to placebo, treatments with verum showed a significant improvement of the maximum walking distance of 63.5 m (95% confidence interval (CI) 27.11-99.91 m; Padma 28, Tibetan Formula), 41.3 m (95% CI -7.1-89.7 m; cilostazol, phosphodiesterase IIl inhibitor), 43.8 m (95% CI 14.1-73.6 m; pentoxifylline, rheological drug), and 71.2 m (95% CI 13.3-129.0 m; naftidrofuryl, rheological drug). Only for Padma 28, clinical relevance, defined as an increase of the maximum walking distance by100 m, was analyzed and reached by 18.2% of the verum and 2.1% of the placebo patients (odds ratio 10; 95% CI 3.03-33.33). 1 conventional and 1 complementary drug additionally showed to have significant pleiotropic effects (Padma 28 and cilostazol (e.g. reduction of triglycerides)).According to meta-analytic evidence, naftidrofuryl and Padma 28 show clinically relevant efficacy for the treatment of early stages of PAOD. The extent to which the theoretically possible combination of different drugs contributes to improve the systemic disease under a network-pharmacological rationale remains to be shown in a multi-armed RCT.

In western countries, the 19th century marks a turning point for the beginning of psychiatry as an academic discipline. Since this happened and psychiatry had left the asylums at the boundaries not only of cities but medicine itself, we can find quite a row of examples concerning integration [1]. Psychiatry has integrated many treatments into the therapeutic spectrum, for example, tricyclic antidepressants, SSRI, relaxation techniques like progressive muscle-relaxation or hypnosis, cognitive-behavioural, psychoanalytic, or systemic psychotherapy, even acupuncture according to the protocol of the National Acupuncture Detoxification Association (NADA) [2, 3] or lately mindfulness-based cognitive therapy [4]. However, three aspects seem suitable to understand the openness of psychiatry for new methods: (a) the fact that since decades, professional multidisciplinarity in psychiatry is a crucial basis for the inand outpatient treatment (e.g., psycho-, ergo-, music-, physiotherapists, nutritionists, and social workers), (b) psychiatrists today need to have a double qualification in psychiatry and psychotherapy to be able to work according to (c), Engel’s biopsychosocial model, which had been adopted as a solid basis for the previously mentioned.

Background: Padma 28 is an herbal formula from Tibetan Medicine, which since 35 years has been registered in Switzerland as a drug for the symptoms of circulatory disorders. Over this time, a large body of scientific literature has accumulated. The aim of this article was to give an overview of the clinical studies. Methods: A systematic literature search was done in PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials (CCRCT). The clinical trials found were assessed regarding fields of application, efficacy, and safety, as well as methodological quality and level of evidence. Results: 29 trials (1 meta-analysis, 21 controlled trials, 7 open trials) and 3 retrospective case studies were found. They deal with different indications and include a total of 1,704 verum (of these, 697 children), 333 placebo, and 394 untreated or healthy patients. Dropouts and withdrawals were 2.5 and 3.5 times higher in the placebo than in the verum group, respectively. The highest level of evidence for the use of Padma 28 was found in the indication of intermittent claudication (11 trials). Indications of efficacy were also found in other vascular (6 trials) and different inflammatory diseases (12 trials). Conclusions: The results suggest a favorable safety profile for Padma 28, also in the children examined (41% of the study population). Furthermore, the results show a broad field of applications. According to clinical evidence, Padma 28 has shown to be a safe and effective symptomatic treatment option for atherosclerosis-related diseases such as intermittent claudication. It also seems to have a potential for application in certain chronic inflammatory diseases such as recurrent respiratory tract infections, viral hepatitis, and multiple sclerosis. However, further randomized controlled trials (RCT) are needed to confirm these findings.

In outpatient settings diagnostic classification of depressive symptoms is mostly descriptive based on ICD-10. Depending on clinical experience and consultation time, diagnosis can be verified by validated scales. However, physicians working in primary care are familiar with ICD-10 criteria. Therefore, the aim of the present study was to examine the feasibility of the validation of an ICD-10-derived symptom scale for depression.For this preliminary trial we generated a symptom scale derived 1:1 from the diagnostic criteria for depression given in the ICD-10 with 10 items. The Hamilton Rating Scale for Depression (HAMD-17) was used as reference in a population of 226 outpatients suffering from depressive symptoms. Correlation between scales as well as sensitivity and specificity of the ICD-10 scale were calculated.The generated ICD-10 symptom scale for depression could be analyzed in 219 patients and showed a significant and strong correlation with the HAMD-17 (p0.0001; ρ = 0.75). The best tradeoffs between specificity and sensitivity of the ICD-10 score were found at 10 points for the lower and 14 points for the upper cut-off. Overall sensitivity and specificity was 76.7 and 88.6%. Almost two thirds (i.e. 65.3%) of the patients were correctly classified by the ICD-10 scale.The ICD-10 symptom scale examined in the current population was found to have fair correlation with the HAMD-17 as well as, in face of the limited variance of the patients' condition, acceptable sensitivity and specificity. Therefore, this preliminary study showed that the ICD-10-derived symptom scale seems appropriate to be investigated in a thorough validation trial.

The spreading of Tibetan Buddhism and with it the Tibetan medicine in the region east of Lake Baikal, goes back to the 17th century. At the beginning of the 18th century, German speaking scholars were among the first to undertake scientific expeditions through Siberia. As such they were amongst the first scientists of the modern era who encountered the traditions, concepts, and therapeutic methods of Tibetan medicine. The aim of this article is to describe and analyze these first encounters with Tibetan medicine by the example of selected men of science of the 18th and 19th century. This work is based on extensive studies of sources in archives and libraries in Russia and Switzerland. We found documents related to the following scientists: Daniel Gottlieb Messerschmidt (1685-1735), Johann Georg Gmelin (1709-1755), Erik Laxmann (1737-1796), Friedrich Adelung (1768-1843), and Joseph Rehmann (1779-1831). They mentioned the distribution of Tibetan medicine within Russia, the use of medicinal plants and formulas as well as therapeutic techniques. For the scientific community of the time these first encounters of Europeans with practitioners of Tibetan medicine could not lift Tibetan medicine out of other exotic context in the field of ethnography. For today's researchers, these encounters are an important evidence for more than 300 years of development of Tibetan medicine on the vast territory of Siberia. The practice and the scientific examination of Tibetan medicine in Siberia is an active endeavor until today. The present work shows that it is possible and rewarding to follow up the historic and cultural connections from Europe to Asia via the Siberian link.

Die Verbreitung des tibetischen Buddhismus und mit ihm der tibetischen Medizin in der Gegend ostlich des Baikal-Sees geht auf das 17. Jahrhundert zuruck. Ab dem fruhen 18. Jahrhundert waren deutschsprachige Gelehrte unter den ersten, die Sibirien mit wissenschaftlichem Auftrag bereisten und damit unter den ersten neuzeitlichen Wissenschaftlern, die Kontakt mit Traditionen, Konzepten und Behandlungsverfahren der tibetischen Medizin hatten. Die vorliegende Arbeit hat das Ziel, die ersten Begegnungen mit der tibetischen Medizin in Transbaikalien anhand ausgewahlter Forscherpersonlichkeiten des 18. und 19. Jahrhunderts darzustellen und zu analysieren. Die Arbeit basiert auf intensiven Quellenstudien in Archiven und Bibliotheken Russlands und der Schweiz. Fur unser Thema fanden sich relevante Dokumente zu Daniel Gottlieb Messerschmidt (1685–1735), Johann Georg Gmelin (1709–1755), Erik Laxmann (1737–1796), Friedrich Adelung (1768–1843) und Joseph Rehmann (1779–1831). Sie thematisierten die Verbreitung der tibetischen Medizin auf dem Gebiet Russlands, die Verwendung von Arzneipflanzen, Rezepturen und Therapieformen. Die ersten Begegnungen von Westeuropaern mit Heilkundigen der tibetischen Medizin vermochten nicht, die tibetische Medizin fur die wissenschaftliche Offentlichkeit jener Zeit aus dem Kontext des Exotischen im Bereich der Ethnografie herauszuheben. Fur moderne Forscher jedoch sind diese Begegnungen wichtige Zeugnisse fur die mittlerweile 300 Jahre wahrende Entwicklungsgeschichte der tibetischen Medizin in Sibirien. Die Praxis der tibetischen Medizin und die wissenschaftliche Auseinandersetzung mit diesem Medizinsystem bestehen in Sibirien bis heute fort. Die vorliegende Arbeit zeigt, dass eine Anknupfung an die historischen und kulturellen Verbindungen von Europa zu Asien uber Sibirien moglich und fruchtbar ist.

Padma® 28 ist ein tibetisches Kombinationspraparat, das in der Schweiz nach einer traditionellen Rezeptur hergestellt wird. Es bietet einen wirksamen und klinisch relevanten Behandlungsansatz in den fruhen Stadien der peripheren arteriellen Verschlusskrankheit. Dies zeigt eine Metaanalyse mit 5 klinischen Studien bei Patienten mit Claudicatio intermittens. Die Gehstrecke konnte unter Verumbehandlung signifikant verlangert werden. Lesen Sie, welche weiteren Ergebnisse in der Analyse herausgefunden werden konnten und welche Wirkprinzipien zugrunde liegen.

Treatment of rheumatic or musculoskeletal disorders (MD) is multi-disciplinary and includes herbal analgesics. Although already reviewed, no quantitative evaluation of efficacy and safety of the herbal combination Phytodolor® (STW1) is available.We searched in databases and contacted authors and the manufacturer to identify randomized controlled trials (RCTs) examining STW1 in patients with MD. We made a reanalysis of raw data of eligible published and unpublished RCTs and pooled the results for meta-analysis according to Cochrane guidelines and intention-to-treat. Primary outcome measure was patient global assessment of efficacy, secondary outcome measure was pain at rest and on movement. Results were stratified according to treatment groups.Patient data of 11 RCTs were eligible for pooling. In the entire population, STW1 was significantly superior compared to placebo in patients' global assessment of efficacy (group difference for rating very good/good: 20%; placebo 48.9% and STW1 69.1%; p0.001; OR 0.43; 95% CI 0.28-0.65) and in the subpopulation 'other rheumatic diseases' (placebo 45.4%; STW1 72.3%; p0.001; OR 0.32; 95% CI 0.2-0.52), but not in the subpopulation 'gonarthrosis'. STW1 did not differ significantly compared to non-steroidal anti-inflammatory drugs (NSAIDs), neither in the entire population nor the subpopulations. Similar results were found for pain at rest and on movement. No serious adverse events (AE) but minor AE were reported (placebo 8.1%; STW1 14.2%; NSAIDs 18.9%).According to the analysed data, STW1 showed a better pain reduction than placebo in patients with pain due to MD, probably equivalent to NSAIDs, and was well tolerated.

Mistletoe is often used as a complementary approach in oncology. Despite experimental anti-tumour effects and several reviews there remains controversy about its clinical role.Potentially relevant trials were identified to perform a systematic review (databases: e.g. EMBASE, MEDLINE; hand search: e.g. bibliographies; search terms: e.g. mistletoe). To be included, randomised or comparative clinical trials at least had to examine mistletoe preparations standardized according to manufacturing process and to describe interventions explicitly. Additionally, cohort studies were included for reasons of external validity. Results were summarised in tables.18 clinical trials (6,800 participants) were included. Their internal quality was mostly low. Due to heterogeneity between trials a meta-analysis was impossible. Regarding efficacy, findings were inconsistent regarding life expectancy, relation to tumour entity, dosing and treatment duration. Yet, studies indicate that quality of life (QoL) is improved. As these findings do not seem to be limited to one of the different parenteral mistletoe preparations reviewed the treatment may be summarised under the umbrella term 'mistletoe therapy'. Regarding safety, 1 serious adverse event (AE) related to mistletoe was described; non-serious AEs were local reactions at injection site. Allergic reactions were rare.Supportive 'mistletoe therapy' seems safe and beneficial for QoL in adult patients with solid tumours. But there is an urgent need to confirm its efficacy in patient-centred care in a complex oncological setting. This has to be evaluated systematically in prospective observational trials with validated, multidimensional patient-rated QoL questionnaires and comparisons of different preparations and dosages.