A: In my opinion, you shouldn't "use" anything, but go see a Chinese medicine (CM) practitioner (acupuncturist/herbalist) for appropriate herbs for your condition, which I cannot diagnose over internet. I wonder if you are hoarse because of over counter decongestants? - B

Q: I went to Doctor because I was hoarse. With sinus drainage and him thinking that it could be stomach acid, I did try things like Nexium and Nasonex spray, without any luck. In reading some of your website I thought that I read something about a sinus and spleen connection. I think it was something about wet or dry spleen that herbs could help. If you don't have a spleen, it seems that you would be prone to constant sinus problems, which I think I have. It seems like I always have some mucous at back of my throat. Any ideas? I would appreciate any info you can offer. I will try to locate a Chinese medicine practitioner. Thanks, - Patrick

The Spleen in Western and Chinese Medicine Well, first please note that Spleen of CM is different than anatomical spleen of western medicine. The western spleen organ is mostly involved with blood, whereas Chinese medicine Spleen organ-system is about digestion, assimilation, getting energy to four limbs. In western terms, Spleen qi is probably something like enzymes (though not limited to that), which work with stomach acid (part of Stomach qi or yang) to digest food.

A couple years ago, a study of herbs and other natural remedies for menopause got a lot of press. Particularly of note were its assertions that black cohosh is only herb shown to help in menopause.

We could incorrectly assume then that no herbs help for menopause. However, there are some problems with that conclusion. Let's take a look at them:

1. Most herbs have not been subjected to RCT's (Randomized Controlled Trials, medical science's most advanced study design). 2. RCT's are not only kind of study that provides reliable information. 3. Herbs are hardly ever prescribed alone. Research should be conducted on time-tested herbal formulas for menopause - not single herbs. 4. American researchers tend to ignore or discount research done outside U.S. 5. Researchers' own biases affect their conclusions... no study is perfect. Researchers may have little trouble finding reasons to throw out a study whose conclusions threaten their beliefs.

Ok, then...

1. Which herbs have been subjected to RCT's? A quick search of MedLine for "herb randomized controlled trial" yields only 13 results for 11 herbs and herb formulas (note that searching for just herbs alone yields more than 2300 studies):

St John's Wort, Black Cohosh Bing gan tang, Yi zhu tang, Yi Er Gan Tang (Hep C) Phyllanthus, 'Jianpi Wenshen recipe', Fuzheng Jiedu Tang (Hep B) Polyporus umbellatus polysaccharide Echinacea (Common cold) Ginger (Nausea) 'AM' a Ugandan herb remedy (Malaria) I know this is not full list of well-studied herbs. The groundbreaking 1998 Journal of American Medical Association issue on alternative medicine included first RCT faithful to principles of chinese herbal medicine, a study of herbs for IBS.

In November 2002 review of menopause treatments, only 10 of 29 studies (RCT's) they reviewed studied herbs. Of those, only two - black cohosh (sheng ma) and dang gui - are chinese herbs. There are many chinese herbs and herbal formulas for menopause that have not been studied in RCT's.

2. RCT's aren't only kind of study. Without a doubt, they are best, gold standard… they eliminate placebo effect as much as possible, etc. They're good. But most herbs haven't had their RCT day in sun. Why not? Because it costs a lot of money!

Drug companies spend hundreds of thousands of dollars on each drug to prove its safety (not necessarily its effectiveness) in RCT's. No single company has a motivation to study an herb which they cannot patent, own, and have exclusive right to sell. They may take course of isolating one part of an herb and patenting that, but then we've taken herb out of its traditional framework. Applying it like a drug puts it in biomedical treatment framework- same one that assumes side effects are unavoidable. We'd like to avoid that!

There are plenty of other kinds of studies- from smaller scale clinical retrospectives (analyzing data from treatment records) to in-vitro (in a glass tube) lab studies of herbs' effects on micro-organisms. In-vitro studies can show how a substance works, but don't tell us how it works in humans.

A search of MedLine for "Chinese Herb" yields 879 results. We get everything from effect of herbs on rats in space (yes, really) to drug-herb interactions. And we find a lot of studies from outside U.S. I don't have time right now to survey all 626 - sorry!

But point is that there are a lot of studies out there that tell us positive things about herbs even though they haven't yet been awarded adequate funding for an RCT.