akupunktur .

Acupuncture
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Acupuncture
Medicine:
CAM

NCCAM:
Alternative Medical Systems[1]

NCCAM:
Energy Medicine[2]

Modality:
Professionalized

Culture:
East/West



Acupuncture chart from Hua Shou (fl. 1340s, Ming Dynasty). This image from Shi si jing fa hui (Expression of the Fourteen Meridians). (Tokyo : Suharaya Heisuke kanko, Kyoho gan 1716).
Acupuncture is the procedure of inserting and manipulating filiform needles into various points on the body to relieve pain or for therapeutic purposes.[3] The word acupuncture comes from the Latin acus, "needle", and pungere, "to prick". In Standard Chinese, acupuncture is called 针砭 (zhēnbiān), or a related word, 针灸 (zhēnjiǔ), which refers to acupuncture together with moxibustion.[4] According to traditional Chinese medicine, acupuncture points are situated on meridians along which qi (a "life energy"), flows. Modern acupuncture texts present them as ideas that are useful in clinical practice and continue to inform the practice of acupuncture,[5][6] but there is no evidence to support their existence and they have not been reconciled with contemporary knowledge about biology, physics or chemistry.[7][8]
The earliest written record of acupuncture is the Chinese text Shiji (史記, English: Records of the Grand Historian) with elaboration of its history in the second century BCE medical text Huangdi Neijing (黃帝內經, English: Yellow Emperor's Inner Canon).[9] Different variations of acupuncture are practiced and taught throughout the world. Acupuncture has been the subject of active scientific research since the late 20th century[10] but it remains controversial among conventional medical researchers and clinicians.[10] Due to the invasive nature of acupuncture treatments, it is difficult to create studies that use proper scientific controls.[10][11][12][13][14] Many scholarly reviews have concluded that the effectiveness of acupuncture as a treatment can be explained largely through the placebo effect,[15][16] while other studies have suggested some efficacy in the treatment of specific conditions.[10][17][18] The World Health Organization published a review of controlled trials using acupuncture and concluded it was effective for the treatment of 28 conditions and there was evidence to suggest it may be effective for several dozen more,[19] though this review has been criticized by several scientists for bias and a focus on studies with a poor methodology.[20][21] Reports from the National Center for Complementary and Alternative Medicine (NCCAM), the American Medical Association (AMA) and various government reports have studied and commented on the efficacy (or lack thereof) of acupuncture. There is general agreement that acupuncture is safe when administered by well-trained practitioners using sterile needles, and that further research is appropriate.[11][22][23][24]
Contents
[hide]
• 1 History
o 1.1 Antiquity
o 1.2 Middle history
o 1.3 Modern era
• 2 Traditional theory
o 2.1 Traditional Chinese medicine
o 2.2 Acupuncture points and meridians
o 2.3 Traditional diagnosis
o 2.4 Traditional Chinese medicine perspective
o 2.5 Criticism of traditional Chinese medicine theory
• 3 Clinical practice
o 3.1 An example of acupuncture treatment
o 3.2 Infertility and acupuncture
o 3.3 Indications according to acupuncturists in the West
• 4 Scientific theories and mechanisms of action
o 4.1 Gate-control theory of pain
o 4.2 Neurohormonal theory
• 5 Scientific research into efficacy
o 5.1 Issues in study design
o 5.2 Evidence-based medicine
o 5.3 Evidence from neuroimaging studies
o 5.4 NIH consensus statement
o 5.5 World Health Organization statement
o 5.6 American Medical Association statement
• 6 Safety and risks
o 6.1 Adverse events
o 6.2 Other injury
o 6.3 Risks from omitting orthodox medical care
o 6.4 Safety compared with other treatments
• 7 Legal and political status
• 8 See also
• 9 Footnotes
• 10 References
• 11 Further reading
• 12 External links

[edit] History
[edit] Antiquity
Acupuncture's origins in China are uncertain. One explanation is that some soldiers wounded in battle by arrows were cured of chronic afflictions that were otherwise untreated,[25] and there are variations on this idea.[26] In China, the practice of acupuncture can perhaps be traced as far back as the Stone Age, with the Bian shi, or sharpened stones.[27] In 1963 a bian stone was found in Duolon County, Mongolia, pushing the origins of acupuncture into the Neolithic age.[28] Hieroglyphs and pictographs have been found dating from the Shang Dynasty (1600-1100 BCE) which suggest that acupuncture was practiced along with moxibustion.[29] Despite improvements in metallurgy over centuries, it was not until the 2nd century BCE during the Han Dynasty that stone and bone needles were replaced with metal.[28] The earliest records of acupuncture is in the Shiji (史記, in English, Records of the Grand Historian) with references in later medical texts that are equivocal, but could be interpreted as discussing acupuncture. The earliest Chinese medical text to describe acupuncture is the Huangdi Neijing, the legendary Yellow Emperor's Classic of Internal Medicine (History of Acupuncture) which was compiled around 305–204 B.C. The Huangdi Neijing does not distinguish between acupuncture and moxibustion and gives the same indication for both treatments. The Mawangdui texts, which also date from the second century BC though antedating both the Shiji and Huangdi Neijing, mentions the use of pointed stones to open abscesses and moxibustion but not acupuncture, but by the second century BCE, acupuncture replaced moxibustion as the primary treatment of systemic conditions.[9]
In Europe, examinations of the 5,000-year-old mummified body of Ötzi the Iceman have identified 15 groups of tattoos on his body, some of which are located on what are now seen as contemporary acupuncture points. This has been cited as evidence that practices similar to acupuncture may have been practiced elsewhere in Eurasia during the early Bronze Age.[30]
[edit] Middle history
Acupuncture spread from China to Korea, Japan and Vietnam and elsewhere in East Asia.
Around ninety works on acupuncture were written in China between the Han Dynasty and the Song Dynasty, and the Emperor Renzong of Song, in 1023, ordered the production of a bronze statuette depicting the meridians and acupuncture points then in use. However, after the end of the Song Dynasty, acupuncture and its practitioners began to be seen as a technical rather than scholarly profession. It became more rare in the succeeding centuries, supplanted by medications and became associated with the less prestigious practices of shamanism, midwifery and moxibustion.[31] Portuguese missionaries in the 16th century were among the first to bring reports of acupuncture to the West.[32] Jacob de Bondt, a Danish surgeon travelling in Asia, described the practice in both Japan and Java. However, in China itself the practice was increasingly associated with the lower-classes and illiterate practitioners.[33] The first European text on acupuncture was written by Willem ten Rhijne, a Dutch physician who studied the practice for two years in Japan. It consisted of an essay in a 1683 medical text on arthritis; Europeans were also at the time becoming more interested in moxibustion, which ten Rhijne also wrote about.[34] In 1757 the physician Xu Daqun described the further decline of acupuncture, saying it was a lost art, with few experts to instruct; its decline was attributed in part to the popularity of prescriptions and medications, as well as its association with the lower classes.[35]
In 1822, an edict from the Chinese Emperor banned the practice and teaching of acupuncture within the Imperial Academy of Medicine outright, as unfit for practice by gentlemen-scholars. At this point, acupuncture was still cited in Europe with both skepticism and praise, with little study and only a small amount of experimentation.[36]
[edit] Modern era
In the 1970s, acupuncture became better known in the United States after an article appeared in The New York Times by James Reston, who underwent an emergency appendectomy while visiting China. While standard anesthesia was used for the actual surgery, Mr. Reston was treated with acupuncture for post-operative discomfort.[37] The National Acupuncture Association (NAA), the first national association of acupuncture in the US, introduced acupuncture to the West through seminars and research presentations. The NAA created and staffed the UCLA Acupuncture Pain clinic in 1972. This was the first legal clinic in a medical school setting in the US.[citation needed] The first acupuncture clinic in the United States is claimed to have been opened by Dr. Yao Wu Lee in Washington, D.C. on July 9, 1972.[38][unreliable source?] The Internal Revenue Service allowed acupuncture to be deducted as a medical expense beginning in 1973.[39]
In 2006, a BBC documentary Alternative Medicine filmed a patient undergoing open heart surgery allegedly under acupuncture-induced anaesthesia. It was later revealed that the patient had been given a cocktail of weak anaesthetics that in combination could have a much more powerful effect. The program was also criticised for its fanciful interpretation of the results of a brain scanning experiment.[40][41][42]
Cosmetic acupuncture is also being increasingly used in attempts to reduce wrinkles and age-lines.[43][44]
[edit] Traditional theory


Needles being inserted into a patient's skin.
[edit] Traditional Chinese medicine

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Main article: Traditional Chinese medicine
TCM is based on a pre-scientific paradigm of medicine that developed over several thousand years and involves concepts that have no counterpart within contemporary medicine.[11] In TCM, the body is treated as a whole that is composed of several "systems of function" known as the zang-fu (脏腑). These systems are named after specific organs, though the systems and organs are not directly associated. The zang systems are associated with the solid, yin organs such as the liver while the fu systems are associated with the hollow yang organs such as the intestines. Health is explained as a state of balance between the yin and yang, with disease ascribed to either of these forces being unbalanced, blocked or stagnant. The yang force is the immaterial qi, a concept that is roughly translated as "vital energy". The yin counterpart is Blood, which is linked to but not identical with physical blood, and capitalized to distinguish the two. TCM uses a variety of interventions, including pressure, heat and acupuncture applied to the body's acupuncture points (in Chinese 穴 or xue meaning "cavities") to modify the activity of the zang-fu.
[edit] Acupuncture points and meridians
See also: Acupuncture point and Meridian (Chinese medicine)
Classical texts describe most[dubious – discuss] of the main acupuncture points as existing on the twelve main and two of eight extra meridians (also referred to as mai) for a total of fourteen "channels" through which qi and Blood flow. Other points not on the fourteen channels are also needled. Local pain is treated by needling the tender "ashi" points where qi or Blood is believed to have stagnated. The zang-fu of the twelve main channels are Lung, Large Intestine, Stomach, Spleen, Heart, Small Intestine, Bladder, Kidney, Pericardium, Gall Bladder, Liver and the intangible San Jiao. The eight other pathways, referred to collectively as the qi jing ba mai, include the Luo Vessels, Divergents, Sinew Channels, ren mai and du mai though only the latter two (corresponding to the anterior and posterior sagittal plane of the torso respectively) are needled. The remaining six qi jing ba mai are manipulated by needling points on the twelve main meridians.
Normally qi is described as flowing through each channel in a continuous circuit. In addition, each channel has a specific aspect and occupies two hours of the "Chinese clock".
Flow of qi through the meridians
Zang-fu Aspect Hours
Lung taiyin 0300-0500
Large Intestine yangming 0500-0700
Stomach yangming 0700-0900
Spleen taiyin 0900-1100
Heart shaoyin 1100-1300
Small Intestine taiyang 1300-1500
Bladder taiyang 1500-1700
Kidney shaoyin 1700-1900
Pericardium jueyin 1900-2100
San Jiao shaoyang 2100-2300
Gallbladder shaoyang 2300-0100
Liver jueyin 0100-0300
Lung (repeats cycle)
The zang-fu are divided into yin and yang channels, with three of each type located on each limb. Qi is believed to move in a circuit through the body, travelling both superficially and deeply. The external pathways correspond to the acupuncture points shown on an acupuncture chart while the deep pathways correspond to where a channel enters the bodily cavity related to each organ. The three yin channels of the hand (Lung, Pericardium, and Heart) begin on the chest and travel along the inner surface of the arm to the hand. The three yang channels of the hand (Large Intestine, San Jiao, and Small Intestine) begin on the hand and travel along the outer surface of the arm to the head. The three yin channels of the foot (Spleen, Liver, and Kidney) begin on the foot and travel along the inner surface of the leg to the chest or flank. The three yang channels of the foot (Stomach, Gallbladder, and Urinary Bladder) begin on the face, in the region of the eye, and travel down the body and along the outer surface of the leg to the foot. Each channel is also associated with a yin or yang aspect, either "absolute" (jue-), "lesser" (shao-), "greater" (tai-) or "brightness" (-ming).
A standard teaching text comments on the nature and relationship of meridians (or channels) and the Zang Fu organs:
The theory of the channels is interrelated with the theory of the Organs. Traditionally, the internal Organs have never been regarded as independent anatomical entities. Rather, attention has centered upon the functional and pathological interrelationships between the channel network and the Organs. So close is this identification that each of the twelve traditional Primary channels bears the name of one or another of the vital Organs. In the clinic, the entire framework of diagnostics, therapeutics and point selection is based upon the theoretical framework of the channels. "It is because of the twelve Primary channels that people live, that disease is formed, that people are treated and disease arises." [(Spiritual Axis, chapter 12)]. From the beginning, however, we should recognize that, like other aspects of traditional medicine, channel theory reflects the limitations in the level of scientific development at the time of its formation, and is therefore tainted with the philosophical idealism and metaphysics of its day. That which has continuing clinical value needs to be reexamined through practice and research to determine its true nature.[5]
The meridians are part of the controversy in the efforts to reconcile acupuncture with conventional medicine. The National Institutes of Health 1997 consensus development statement on acupuncture stated that acupuncture points, Qi, the meridian system and related theories play an important role in the use of acupuncture, but are difficult to relate to a contemporary understanding of the body.[11] Chinese medicine forbade dissection, and as a result the understanding of how the body functioned was based on a system that related to the world around the body rather than its internal structures. The 365 "divisions" of the body were based on the number of days in a year, and the twelve meridians proposed in the TCM system are thought to be based on the twelve major rivers that run through China. However, these ancient traditions of Qi and meridians have no counterpart in modern studies of chemistry, biology and physics and to date scientists have been unable to find evidence that supports their existence.[7] A 2008 review of electrical impedance studies concluded that although results were suggestive, the studies available were of poor quality with significant limitations, and because of this there was no clear evidence to demonstrate the existence of acupuncture points or meridians.[45]
[edit] Traditional diagnosis
The acupuncturist decides which points to treat by observing and questioning the patient in order to make a diagnosis according to the tradition which he or she utilizes. In TCM, there are four diagnostic methods: inspection, auscultation and olfaction, inquiring, and palpation.[46]
• Inspection focuses on the face and particularly on the tongue, including analysis of the tongue size, shape, tension, color and coating, and the absence or presence of teeth marks around the edge.
• Auscultation and olfaction refer, respectively, to listening for particular sounds (such as wheezing) and attending to body odor.
• Inquiring focuses on the "seven inquiries", which are: chills and fever; perspiration; appetite, thirst and taste; defecation and urination; pain; sleep; and menses and leukorrhea.
• Palpation includes feeling the body for tender "ashi" points, and palpation of the left and right radial pulses at two levels of pressure (superficial and deep) and three positions Cun, Guan, Chi (immediately proximal to the wrist crease, and one and two fingers' breadth proximally, usually palpated with the index, middle and ring fingers).
Other forms of acupuncture employ additional diagnostic techniques. In many forms of classical Chinese acupuncture, as well as Japanese acupuncture, palpation of the muscles and the hara (abdomen) are central to diagnosis.
[edit] Traditional Chinese medicine perspective
Although TCM is based on the treatment of "patterns of disharmony" rather than biomedical diagnoses, practitioners familiar with both systems have commented on relationships between the two. A given TCM pattern of disharmony may be reflected in a certain range of biomedical diagnoses: thus, the pattern called Deficiency of Spleen Qi could manifest as chronic fatigue, diarrhea or uterine prolapse. Likewise, a population of patients with a given biomedical diagnosis may have varying TCM patterns. These observations are encapsulated in the TCM aphorism "One disease, many patterns; one pattern, many diseases". (Kaptchuk, 1982)
Classically, in clinical practice, acupuncture treatment is typically highly individualized and based on philosophical constructs as well as subjective and intuitive impressions, and not on controlled scientific research.[47]
[edit] Criticism of traditional Chinese medicine theory
Felix Mann, founder and past-president of the Medical Acupuncture Society (1959–1980), the first president of the British Medical Acupuncture Society[48] (1980), and the author of the first comprehensive English language acupuncture textbook Acupuncture: The Ancient Chinese Art of Healing first published in 1962, has stated in his book Reinventing Acupuncture: A New Concept of Ancient Medicine:
"The traditional acupuncture points are no more real than the black spots a drunkard sees in front of his eyes." (p. 14)
and...
"The meridians of acupuncture are no more real than the meridians of geography. If someone were to get a spade and tried to dig up the Greenwich meridian, he might end up in a lunatic asylum. Perhaps the same fate should await those doctors who believe in [acupuncture] meridians." (p. 31)[8]
Felix Mann tried to join up his medical knowledge with that of Chinese theory. In spite of his protestations about the theory, he was fascinated by it and trained many people in the west with the parts of it he borrowed. He also wrote many books on this subject. His legacy is that there is now a college in London and a system of needling that is known as "Medical Acupuncture". Today this college trains Doctors and western medical professionals only.
Medical acupuncture has caused much controversy amongst traditional practitioners; the British Acupuncture Council wished for it to be called 'treatment using needles', and removing from it the title 'Acupuncture', as it is so different to traditional methods but have had to retract this after pressure from the medical profession. Mann proposed that the acupuncture points related to the nerve endings and he reassigned the points different uses. He altered the theory so that the treatments given are no longer individual to each client, a central premise of traditional theory. Traditionally the needle combinations differ according to the age of the client, the length of time they had the condition, the type of pain they experience and their health history. In medical acupuncture none of this is addressed and the presenting symptom is treated using a set group of points.
A report for CSICOP on pseudoscience in China written by Wallace Sampson and Barry Beyerstein said:
"A few Chinese scientists we met maintained that although Qi is merely a metaphor, it is still a useful physiological abstraction (e.g., that the related concepts of Yin and Yang parallel modern scientific notions of endocrinologic [sic] and metabolic feedback mechanisms). They see this as a useful way to unite Eastern and Western medicine. Their more hard-nosed colleagues quietly dismissed Qi as only a philosophy, bearing no tangible relationship to modern physiology and medicine."[49]
George A. Ulett, MD, PhD, Clinical Professor of Psychiatry, University of Missouri School of Medicine states:
"Devoid of metaphysical thinking, acupuncture becomes a rather simple technique that can be useful as a nondrug method of pain control." He believes that the traditional Chinese variety is primarily a placebo treatment, but electrical stimulation of about 80 acupuncture points has been proven useful for pain control."[50]
Ted J. Kaptchuk,[51] author of The Web That Has No Weaver, refers to acupuncture as "prescientific." Regarding TCM theory, Kaptchuk states:
"These ideas are cultural and speculative constructs that provide orientation and direction for the practical patient situation. There are few secrets of Oriental wisdom buried here. When presented outside the context of Chinese civilization, or of practical diagnosis and therapeutics, these ideas are fragmented and without great significance. The "truth" of these ideas lies in the way the physician can use them to treat real people with real complaints." (1983, pp. 34-35)[52]
According to the 1997 NIH consensus statement on acupuncture:
"Despite considerable efforts to understand the anatomy and physiology of the "acupuncture points", the definition and characterization of these points remains controversial. Even more elusive is the basis of some of the key traditional Eastern medical concepts such as the circulation of Qi, the meridian system, and the five phases theory, which are difficult to reconcile with contemporary biomedical information but continue to play an important role in the evaluation of patients and the formulation of treatment in acupuncture."[11]
At least one study found that acupuncture "seems to alleviate pain just barely better than sticking needles into nonspecified parts of the body"[53] and concluded that some of acupuncture's effects may be due to the placebo effect.
According to The Straight Dope, a popular question-and-answer newspaper column published in the Chicago Reader:
"Traditional acupuncture theory is a quaint patchwork of folklore with about as much relevance to current medical practice as medieval European notions about the four bodily humors. While it may be useful as a guide to future research, no scientist would regard it as satisfactory as it stands.".[54]
[edit] Clinical practice


One type of acupuncture needle
Most modern acupuncturists use disposable stainless steel needles of fine diameter (0.007 to 0.020 in (0.18 to 0.51 mm)), sterilized with ethylene oxide or by autoclave. These needles are far smaller in diameter (and therefore less painful) than hypodermic injection needles since they do not have to be hollow for purposes of injection. The upper third of these needles is wound with a thicker wire (typically bronze), or covered in plastic, to stiffen the needle and provide a handle for the acupuncturist to grasp while inserting. The size and type of needle used, and the depth of insertion, depend on the acupuncture style being practiced.
Warming an acupuncture point, typically by moxibustion (the burning of a combination of herbs, primarily mugwort), is a different treatment than acupuncture itself and is often, but not exclusively, used as a supplemental treatment. The Chinese term zhēn jǐu (針灸), commonly used to refer to acupuncture, comes from zhen meaning "needle", and jiu meaning "moxibustion". Moxibustion is used to varying degrees among current schools of oriental medicine. For example, one well-known technique is to insert the needle at the desired acupuncture point, attach dried moxa to the external end of an acupuncture needle, and then ignite it. The moxa will then smolder for several minutes (depending on the amount adhered to the needle) and conduct heat through the needle to the tissue surrounding the needle in the patient's body. Another common technique is to hold a large glowing stick of moxa over the needles. Moxa is also sometimes burned at the skin surface, usually by applying an ointment to the skin to protect from burns, though burning of the skin is general practice in China.
[edit] An example of acupuncture treatment
In Western medicine, vascular headaches (the kind that are accompanied by throbbing veins in the temples) are typically treated with analgesics such as aspirin and/or by the use of agents such as niacin that dilate the affected blood vessels in the scalp, but in acupuncture a common treatment for such headaches is to stimulate the sensitive points that are located roughly in the centers of the webs between the thumbs and the palms of the patient's hands, the hé gǔ points. These points are described by acupuncture theory as "targeting the face and head" and are considered to be the most important points when treating disorders affecting the face and head. The patient reclines, and the points on each hand are first sterilized with alcohol, and then thin, disposable needles are inserted to a depth of approximately 3–5 mm until a characteristic "twinge" is felt by the patient, often accompanied by a slight twitching of the area between the thumb and hand..
In the clinical practice of acupuncturists, patients frequently report one or more of certain kinds of sensation that are associated with this treatment:
1. Extreme sensitivity to pain at the points in the webs of the thumbs.
2. In bad headaches, a feeling of nausea that persists for roughly the same period as the stimulation being administered to the webs of the thumbs.
3. Simultaneous relief of the headache.[55]
[edit] Infertility and acupuncture
Acupuncture regulates the hypothalamus and pituitary glands in your brain which can be thrown out of equilibrium due to stress, aging process, and other environmental factors inhibiting its ability to function properly. Acupuncture promotes the circulation of blood in the pelvic cavity which improves ovarian function. Acupuncture is beneficial in promoting follicle production, enhancing uterine blood flow, and improving uterine lining thickness. Thereby positively enhancing overall health increases the chances of conception.
Acupuncture may assist with treating some of the following fertility imbalances:
Advanced Maternal Age- Chromosomal problems go up with advancing maternal age, because the egg a woman conceives with is as old as she is. Women over 35 will have a significant decline of their eggs especially in the quality of eggs. By increasing blood flow to the uterus through acupuncture treatments this may help to improve the quality of the eggs. It can also help to improve ovulation and to increase the thickness of the uterine lining for implantation of the embryo.
Anovulation – Is the lack of ovulation. Ovulation, which is the release of an egg from the ovary, must happen in order to achieve pregnancy. Research shows that acupuncture and herbal medicine can induce ovulation in many patients.
Hormonal Imbalances - Acupuncture treatments can be especially beneficial for women faced with luteal phase defects, high FSH levels, low estrogen levels, or polycystic ovarian disease. Acupuncture influences the hormonal regulation centers in the brain and autonomic nervous system.
Stress – Women having too much stress can have hormonal imbalances which can cause the time when they release an egg to become delayed or not take place at all. Stress can also reduce blood flow to your reproductive organs. Acupuncture can combat stress increasing circulation and regulating hormones.
Male-Factor Infertility –Low sperm count, low motility - movement, morphology –shape can reduce chances of conception. Acupuncture increases blood flow and increases sperm count.
Miscarriage - There are a number of causes of miscarriage, including chromosomal abnormalities, illness, problems with the uterus or cervix, advanced maternal age, as well as hormonal imbalances. Acupuncture regulates hormones and optimizes progesterone production which is essential to maintaining the uterus lining. [56]
[edit] Indications according to acupuncturists in the West
The American Academy of Medical Acupuncture (2004) states: "In the United States, acupuncture has its greatest success and acceptance in the treatment of musculoskeletal pain.".[57] They say that acupuncture may be considered as a complementary therapy for the conditions in the list below, noting: "Most of these indications are supported by textbooks or at least 1 journal article. However, definitive conclusions based on research findings are rare because the state of acupuncture research is poor but improving."[57]
• Abdominal distention/flatulence
• Acute and chronic pain control
• Allergic sinusitis
• Anesthesia for high-risk patients or patients with previous adverse responses to anesthetics
• Anorexia
• Anxiety, fright, panic
• Arthritis/arthrosis
• Atypical chest pain (negative workup)
• Bursitis, tendinitis, carpal tunnel syndrome
• Certain functional gastrointestinal disorders (nausea and vomiting, esophageal spasm, hyperacidity, irritable bowel) *
• Cervical and lumbar spine syndromes
• Constipation, diarrhea • Cough with contraindications for narcotics
• Drug detoxification is suggested[58] but evidence is poor[59][60][61]
• Dysmenorrhea, pelvic pain
• Frozen shoulder
• Headache (migraine and tension-type), vertigo (Meniere disease), tinnitus
• Idiopathic palpitations, sinus tachycardia
• In fractures, assisting in pain control, edema, and enhancing healing process
• Muscle spasms, tremors, tics, contractures
• Neuralgias (trigeminal, herpes zoster, postherpetic pain, other)
• Paresthesias
• Persistent hiccups
• Phantom pain • Plantar fasciitis
• Post-traumatic and post-operative ileus
• Selected dermatoses (urticaria, pruritus, eczema, psoriasis)
• Sequelae of stroke syndrome (aphasia, hemiplegia)
• Seventh nerve palsy
• Severe hyperthermia
• Sprains and contusions
• Temporo-mandibular joint derangement, bruxism
• Urinary incontinence, retention (neurogenic, spastic, adverse drug effect)
• Weight Loss
[edit] Scientific theories and mechanisms of action
Many hypotheses have been proposed to address the physiological mechanisms of action of acupuncture.[62]
[edit] Gate-control theory of pain
The gate control theory of pain (developed by Ronald Melzack and Patrick Wall in 1962[63] and in 1965)[64] proposed that pain perception is not simply a direct result of activating pain fibers, but modulated by interplay between excitation and inhibition of these pain pathways. According to the theory, the gating of pain is controlled by the inhibitory action on the pain pathways. That is, the perception of pain can be altered (gated on or off) by a number of means, via psychology, pharmacology, or physiology. The gate-control theory was developed in neuroscience independent of acupuncture, which later was proposed as a mechanism to account for the hypothesized analgesic action of acupuncture in the brain stem reticular formation by a German neuroscientist in 1976.[65]
This leads to the theory of central control of pain gating, i.e., pain blockade at the brain (i.e., central to the brain rather than at the spinal cord or periphery) via the release of endogenous opioid neurohormones, such as the endogenous opioid-binding polypeptides, classified as either endorphins or enkephalins.
[edit] Neurohormonal theory


Modern acupuncture model.
Pain transmission can also be modulated at many other levels in the brain along the pain pathways, including the periaqueductal gray, thalamus, and the feedback pathways from the cerebral cortex back to the thalamus. Pain blockade at these brain locations is often mediated by neurohormones, especially those that bind to the opioid receptors (pain-blockade site).
Some studies suggest that the analgesic action of acupuncture is associated with the release of natural endorphins in the brain. This effect can be inferred by blocking the action of endorphins (or morphine) using a drug called naloxone. When naloxone is administered to the patient, the analgesic effects of morphine can be reduced, causing the patient to feel a more appropriate level of pain. When naloxone is administered to an acupunctured patient, the analgesic effect of acupuncture can also be reversed, causing the patient to report an increased level of pain.[66][67][68][69] It should be noted, however, that studies using similar procedures, including the administration of naloxone, have suggested a role of endogenous opioids in the placebo response, demonstrating that this response is not unique to acupuncture.[70]
One study performed on monkeys by recording the neural activity directly in the thalamus of the brain indicated that acupuncture's analgesic effect lasted more than an hour.[71] Furthermore, there is a large overlap between the nervous system and acupuncture trigger points (points of maximum tenderness) in myofascial pain syndrome.[72]
Evidence suggests that the sites of action of analgesia associated with acupuncture include the thalamus using fMRI (functional magnetic resonance imaging)[73] and PET (positron emission tomography)[74] brain imaging techniques,[75] and via the feedback pathway from the cerebral cortex using electrophysiological recording of the nerve impulses of neurons directly in the cortex, which shows inhibitory action when acupuncture stimulus is applied.[76] Similar effects have been observed in association with the placebo response. One study using fMRI found that placebo analgesia was associated with decreased activity in the thalamus, insula and anterior cingulate cortex.[77]
Recently, acupuncture has been shown to increase the nitric oxide levels in treated regions, resulting in increased local blood circulation.[78][79] Effects on local inflammation and ischemia have also been reported.[80]
[edit] Scientific research into efficacy

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[edit] Issues in study design
One of the major challenges in acupuncture research is in the design of an appropriate placebo control group.[12] In trials of new drugs, double blinding is the accepted standard, but since acupuncture is a procedure rather than a pill, it is difficult to design studies in which both the acupuncturist and patient are blinded as to the treatment being given. The same problem arises in double-blinding procedures used in biomedicine, including virtually all surgical procedures, dentistry, physical therapy, etc. As the Institute of Medicine states:
Controlled trials of surgical procedures have been done less frequently than studies of medications because it is much more difficult to standardize the process of surgery. Surgery depends to some degree on the skills and training of the surgeon and the specific environment and support team available to the surgeon. A surgical procedure in the hands of a highly skilled, experienced surgeon is different from the same procedure in the hands of an inexperienced and unskilled surgeon... For many CAM modalities, it is similarly difficult to separate the effectiveness of the treatment from the effectiveness of the person providing the treatment.[14]:126
Blinding of the practitioner in acupuncture remains challenging. One proposed solution to blinding patients has been the development of "sham acupuncture", i.e., needling performed superficially or at non-acupuncture sites. Controversy remains over whether, and under what conditions, sham acupuncture may function as a true placebo, particularly in studies on pain, in which insertion of needles anywhere near painful regions may elicit a beneficial response.[11][13] A review in 2007 noted several issues confounding sham acupuncture:
Weak physiologic activity of superficial or sham needle penetration is suggested by several lines of research, including RCTs showing larger effects of a superficial needle penetrating acupuncture than those of a nonpenetrating sham control, positron emission tomography research indicating that sham acupuncture can stimulate regions of the brain associated with natural opiate production, and animal studies showing that sham needle insertion can have nonspecific analgesic effects through a postulated mechanism of “diffuse noxious inhibitory control”. Indeed, superficial needle penetration is a common technique in many authentic traditional Japanese acupuncture styles.[81]
An analysis of 13 studies of pain treatment with acupuncture, published in January 2009 in the journal BMJ, concluded there was little difference in the effect of real, sham and no acupuncture.[82]
[edit] Evidence-based medicine
There is scientific agreement that an evidence-based medicine (EBM) framework should be used to assess health outcomes and that systematic reviews with strict protocols are essential. Organizations such as the Cochrane Collaboration and Bandolier publish such reviews. In practice, EBM is "about integrating individual clinical expertise and the best external evidence" and thus does not demand that doctors ignore research outside its "top-tier" criteria.[83]
The development of the evidence base for acupuncture was summarized in a review by researcher Edzard Ernst and colleagues in 2007. They compared systematic reviews conducted (with similar methodology) in 2000 and 2005:
The effectiveness of acupuncture remains a controversial issue. ... The results indicate that the evidence base has increased for 13 of the 26 conditions included in this comparison. For 7 indications it has become more positive (i.e. favoring acupuncture) and for 6 it had changed in the opposite direction. It is concluded, that acupuncture research is active. The emerging clinical evidence seems to imply that acupuncture is effective for some but not all conditions.[10]
For acute low back pain there is insufficient evidence to recommend for or against either acupuncture or dry needling, though for chronic low back pain acupuncture is more effective than sham treatment but no more effective than conventional and alternative treatments for short-term pain relief and improving function. However, when combined with other conventional therapies, the combination is slightly better than conventional therapy alone.[17][84] A review for the American Pain Society/American College of Physicians found fair evidence that acupuncture is effective for chronic low back pain.[85]
There are both positive[86] and negative[87] reviews regarding the effectiveness of acupuncture when combined with in vitro fertilisation.
A Cochrane Review concluded that acupuncture was effective in reducing the risk of post-operative nausea and vomiting with minimal side effects, though it was less than or equal to the effectiveness of preventive antiemetic medications.[18] A 2006 review initially concluded that acupuncture appeared to be more effective than antiemetic drugs, but the authors subsequently retracted this conclusion due to a publication bias in Asian countries that had skewed their results; their ultimate conclusion was in line with the Cochrane Review - acupuncture was approximately equal to, but not better than preventive antiemetic drugs in treating nausea.[88] Another Cochrane Review concluded that electroacupuncture can be helpful in the treatment of vomiting after the start of chemotherapy, but more trials were needed to test their effectiveness versus modern antivomiting medication.[89]
There is moderate evidence that for neck pain, acupuncture is more likely to be effective than sham treatment and offers short-term improvement compared to those on a waiting list.[90]
There is evidence to support the use of acupuncture to treat headaches that are idiopathic, though the evidence is not conclusive and more studies need to be conducted.[91] Several trials have indicated that migraine patients benefit from acupuncture, although the correct placement of needles seems to be less relevant than is usually thought by acupuncturists. Overall in these trials acupuncture was associated with slightly better outcomes and fewer adverse effects than prophylactic drug treatment.[92]
There is conflicting evidence that acupuncture may be useful for osteoarthritis of the knee, with both positive,[93][94] and negative[95] results. The Osteoarthritis Research Society International released a set of consensus recommendations in 2008 that concluded acupuncture may be useful for treating the symptoms of osteoarthritis of the knee.[96]
A systematic review of the best five randomized controlled trials available concluded there was insufficient evidence to support the use of acupuncture in the treatment of the symptoms of fibromyalgia.[97]
For the following conditions, the Cochrane Collaboration has concluded there is insufficient evidence to determine whether acupuncture is beneficial, often because of the paucity and poor quality of the research, and that further research is needed:
• Chronic asthma[98]
• Bell's palsy[99]
• Cocaine dependence[100]
• Depression[101]
• Primary dysmenorrhoea (incorporating TENS [102]
• Epilepsy[103]
• Glaucoma[104]
• Insomnia[105]
• Irritable bowel syndrome[106]
• Induction of childbirth[107]
• Rheumatoid arthritis[108]
• Shoulder pain[109]
• Schizophrenia[110]
• Smoking cessation[111]
• Acute stroke[112]
• Stroke rehabilitation[113]
• Tennis elbow[114]
• Vascular dementia[115]

Positive results from some studies on the efficacy of acupuncture may be as a result of poorly designed studies or publication bias.[116][117] Edzard Ernst and Simon Singh state that as the quality of experimental tests of acupuncture have increased over the course of several decades (through better blinding, the use of sham needling as a form of placebo control, etc.) the results have demonstrated less and less evidence that acupuncture is better than placebo at treating most conditions.[118]
[edit] Evidence from neuroimaging studies
Acupuncture appears to have effects on cortical activity, as demonstrated by magnetic resonance imaging and positron emission tomography. A 2005 literature review[119] concluded that neuroimaging data to date show some promise for being able to distinguish the effects of expectation, placebo, and real acupuncture. The studies reviewed were mostly small and pain-related, and more research is needed to determine the specificity of neural substrate activation in non-painful indications.
[edit] NIH consensus statement
In 1997, the United States National Institutes of Health (NIH) issued a consensus statement on acupuncture that concluded that despite research on acupuncture being difficult to conduct, there is sufficient evidence to expand its use and encourage further studies of the phenomenon. The statement was not a policy statement of the NIH but is the considered assessment of a panel convened by the NIH. The consensus group also noted the relative safety of acupuncture compared to certain other medical interventions. They stated that deciding when to use it in clinical practice depends on multiple factors, including the experience of the clinician, the information available on the treatment, and the individual patient's characteristics.[11]
The consensus statement, and the conference that made it, have been criticized by Wallace Sampson, writing for an affiliated publication of Quackwatch. Sampson stated that the meeting was chaired by a strong proponent of acupuncture, failed to include speakers who had obtained negative results on studies of acupuncture, and that he believed the report showed evidence of pseudoscientific reasoning.[120]
In 2006 the NIH's National Center for Complementary and Alternative Medicine continues to abide by the recommendations of the NIH Consensus Statement the effects of acupuncture have been documented, even if research is still unable to explain its mechanism and relationship to Western medicine.[22]
[edit] World Health Organization statement
In 2003, the World Health Organization's Department of Essential Drugs and Medicine Policy published a report on acupuncture that listed a series of diseases, symptoms or conditions for which acupuncture has been demonstrated as an effective treatment:[19]
• Acute bacillary dysentery
• Adverse reactions to radiotherapy and/or chemotherapy
• Allergic rhinitis
• Biliary colic
• Depression
• Essential hypertension
• Headache
• Induction of childbirth and correction of the malposition of fetus
• Inflammation of the tissues surrounding the shoulder
• Leukopenia
• Nausea and vomiting including morning sickness
• Pain in the epigastrium, face, neck, tennis elbow, lower back, knee, during dentistry and after operations
• Primary dysmenorrhea
• Primary hypotension
• Renal colic
• Rheumatoid arthritis
• Sciatica
• Sprains
• Strokes
The report also listed other conditions for which acupuncture may be effective.
The WHO explained the report's purpose:
"In order to promote the appropriate use of acupuncture in those Member States where acupuncture has not been widely used, this document is annexed with a brief abstract of each relevant reference for the assessment of acupuncture practice. The clinical conditions covered in the existing data are also included. It must be emphasized that the list of diseases, symptoms or conditions covered in this publication is based on collected reports of clinical trials and, so, can serve only as a reference. Only national health authorities can determine the diseases, symptoms and conditions for which acupuncture treatment can be recommended."
The report was controversial; critics say it is cited by supporters as an endorsement of the practice by the WHO.[20] Several scientists also expressed concern that the evidence supporting acupuncture was weak, and that the WHO had been biased by the involvement of practitioners of alternative medicine.[20] The report was criticized in the 2008 book Trick or Treatment for containing two major errors - including too many results from low-quality clinical trials, and including a large number of trials originating in China. The latter issue is considered problematic because trials originating in the West include a mixture of positive, negative and neutral results while all trials in China are positive (the book's authors attribute this to publication bias rather than fraud). The authors also stated that the report was drafted by a panel that included no critics of acupuncture at all, resulting in a conflict of interest.[21]
[edit] American Medical Association statement
In 1997, the following statement was adopted as policy of the American Medical Association (AMA), an association of medical doctors and medical students, after a report on a number of alternative therapies including acupuncture:
"There is little evidence to confirm the safety or efficacy of most alternative therapies. Much of the information currently known about these therapies makes it clear that many have not been shown to be efficacious. Well-designed, stringently controlled research should be done to evaluate the efficacy of alternative therapies."
Specifically regarding acupuncture, the AMA cited reviews conducted in 1992 and 1993 that stated there was not enough evidence to support acupuncture's effectiveness in treating disease, and called for further research.[121]
[edit] Safety and risks
Because acupuncture needles penetrate the skin, many forms of acupuncture are invasive procedures, and therefore not without risk. Injuries are rare among patients treated by trained practitioners.[122][123] In most jurisdictions, needles are required by law to be sterile, disposable and used only once; in some places, needles may be reused if they are first resterilized, e.g. in an autoclave.
Several styles of Japanese acupuncture use non-inserted needling, making for an entirely non-invasive procedure. In non-inserted needling the needle is brought to the skin, but never penetrates it, and various other acupuncture tools are used to tap or stroke along the meridians. Notable examples of these styles are Tōyōhari and the pediatric acupuncture style Shōnishin.
[edit] Adverse events
A survey of adverse events related to acupuncture gave rates of 671 minor adverse events per 10,000 treatments, and no major ones.[124] Another survey found that out of 3535 treatments, 402 resulted in minor adverse events including bleeding, bruising, dizziness, fainting, nausea, paresthesia, increased pain and in one case aphasia.[23] That survey concluded: "Acupuncture has adverse effects, like any therapeutic approach. If it is used according to established safety rules and carefully at appropriate anatomic regions, it is a safe treatment method."[23]
[edit] Other injury
Other risks of injury from the improper insertion of acupuncture needles include:
• Nerve injury, resulting from the accidental puncture of any nerve.
• Brain damage or stroke, which is possible with very deep needling at the base of the skull.
• Pneumothorax from deep needling into the lung.[125]
• Kidney damage from deep needling in the low back.
• Haemopericardium, or puncture of the protective membrane surrounding the heart, which may occur with needling over a sternal foramen (a hole in the breastbone that occurs as the result of a congenital defect.)[126]
• Risk of terminating pregnancy with the use of certain acupuncture points that have been shown to stimulate the production of adrenocorticotropic hormone (ACTH) and oxytocin.
• With unsterilized needles: transmission of infectious diseases
The chance of these is very small[citation needed]; the risk can be further reduced through proper training of acupuncturists. Graduates of medical schools and (in the US) accredited acupuncture schools receive thorough instruction in proper technique so as to avoid these events.[127]
[edit] Risks from omitting orthodox medical care
Receiving alternative medicine as a replacement for orthodox Western medicine could result in inadequate diagnosis or treatment of conditions for which orthodox medicine has a better treatment record. For this reason many acupuncturists and doctors prefer to consider acupuncture a complementary therapy rather than an alternative therapy.
Researchers also express concern that unethical or naive practitioners may induce patients to exhaust financial resources by pursuing ineffective treatment.[128][129] Some public health departments regulate acupuncture.[130][131][132]
[edit] Safety compared with other treatments
Commenting on the relative safety of acupuncture compared with other treatments, the NIH consensus panel stated that "(a)dverse side effects of acupuncture are extremely low and often lower than conventional treatments." They also stated:
"the incidence of adverse effects is substantially lower than that of many drugs or other accepted medical procedures used for the same condition. For example, musculoskeletal conditions, such as fibromyalgia, myofascial pain, and tennis elbow... are conditions for which acupuncture may be beneficial. These painful conditions are often treated with, among other things, anti-inflammatory medications (aspirin, ibuprofen, etc.) or with steroid injections. Both medical interventions have a potential for deleterious side effects but are still widely used and are considered acceptable treatments."
[edit] Legal and political status
Main article: Regulation of acupuncture
Acupuncturists may practice herbal medicine and manipulative therapy (tuina), or be a licensed physician or naturopath who incorporates acupuncture in a simplified form. In many states, medical doctors are not required to have any formal training to perform acupuncture. Over 20 states allow chiropractors to perform acupuncture with less than 200 hours training. The typical amount of hours of medical training by licensed acupuncturists is over 3,000 hours. License is regulated by the state or province in many countries, and often requires passage of a board exam.
In the US, acupuncture is practiced by a variety of healthcare providers. Those who specialize in Acupuncture and Oriental Medicine are usually referred to as "licensed acupuncturists", or L.Ac.'s. The abbreviation "Dipl. Ac." stands for "Diplomate of Acupuncture" and signifies that the holder is board-certified by the NCCAOM.[133] Professional degrees are usually at the level of a Master's degree.
A poll of American doctors in 2005 showed that 59% believe acupuncture was at least somewhat effective.[134] In 1996, the United States Food and Drug Administration changed the status of acupuncture needles from Class III to Class II medical devices, meaning that needles are regarded as safe and effective when used appropriately by licensed practitioners.[135][136] As of 2004, nearly 50% of Americans who were enrolled in employer health insurance plans were covered for acupuncture treatments.[137][138]
Canadian acupuncturists have been licensed in British Columbia since 2003. In Ontario, the practice of acupuncture is now regulated by the Traditional Chinese Medicine Act, 2006, S.O. 2006, chapter 27.[139] The government is in the process of establishing a college[140] whose mandate will be to oversee the implementation of policies and regulations relating to the profession.
In the United Kingdom, acupuncturists are not yet regulated by the government.
In Australia, the legalities of practicing acupuncture also vary by state. Victoria is the only state of Australia with an operational registration board.[141] Currently acupuncturists in New South Wales are bound by the guidelines in the Public Health (Skin Penetration) Regulation 2000,[142] which is enforced at local council level. Other states of Australia have their own skin penetration acts.
Many other countries do not license acupuncturists or require them to be trained.
[edit] See also
Wikiquote has a collection of quotations related to: Traditional Chinese medicine


Wikimedia Commons has media related to: Acupuncture

• Acupoint therapy
• Acupressure
• Acutouch
• Auriculotherapy
• Electroacupuncture
• Medical acupuncture
• Pressure point
• Susuk
• Trigger point
• Veterinary acupuncture
[edit] Footnotes
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2. ^ Energy Medicine: An Overview [NCCAM Backgrounder]
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79. ^ Blom M, Lundeberg T, Dawidson I, Angmar-Månsson B (1993). "Effects on local blood flux of acupuncture stimulation used to treat xerostomia in patients suffering from Sjögren's syndrome". Journal of oral rehabilitation 20 (5): 541–8. doi:10.1111/j.1365-2842.1993.tb01641.x. PMID 10412476.
80. ^ Lundeberg T (1993). "Peripheral effects of sensory nerve stimulation (acupuncture) in inflammation and ischemia". Scandinavian journal of rehabilitation medicine. Supplement 29: 61–86. PMID 8122077.
81. ^ Meta-analysis: acupuncture for osteoarthritis of the knee. Eric Manheimer, Klaus Linde, Lixing Lao, Lex M Bouter, Brian M Berman. Ann Intern Med. June 19, 2007;146 (12):868-77. Full text (PDF)
82. ^ Madsen, MV; Gøtzsche, PC; Hróbjartsson, A (2009). "Acupuncture treatment for pain: systematic review of randomised clinical trials with acupuncture, placebo acupuncture, and no acupuncture groups". BMJ 338: a3115. doi:10.1136/bmj.a3115. PMID 19174438. http://www.bmj.com/cgi/content/full/338/jan27_2/a3115.
83. ^ Vickers, AJ (2001). "Message to complementary and alternative medicine: evidence is a better friend than power" (pdf). BMC Complement Altern Med 1 (1): 1. doi:10.1186/1472-6882-1-1. PMID 11346455. PMC 32159. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC32159/pdf/1472-6882-1-1.pdf.
84. ^ Manheimer E, White A, Berman B, Forys K, Ernst E (2005). "Meta-analysis: acupuncture for low back pain" (PDF). Ann. Intern. Med. 142 (8): 651–63. PMID 15838072. http://www.annals.org/cgi/reprint/142/8/651.pdf.
85. ^ Chou R, Huffman LH (2007). "Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline". Ann Intern Med. 147 (7): 492–504. doi:10.1001/archinte.147.3.492. PMID 17909210.
86. ^ Manheimer E, Zhang G, Udoff L, Haramati A, Langenberg P, Berman BM, Bouter LM (2008). "Effects of acupuncture on rates of pregnancy and live birth among women undergoing in vitro fertilisation: systematic review and meta-analysis". BMJ 336 (7643): 545–9. doi:10.1136/bmj.39471.430451.BE. PMID 18258932.
87. ^ El-Toukhy, T; Sunkara, SK; Khairy, M; Dyer, R; Khalaf, Y; Coomarasamy, A (2008). "A systematic review and meta-analysis of acupuncture in in vitro fertilisation". BMJ 115 (10): 1203–13. doi:10.1111/j.1471-0528.2008.01838.x. PMID 18652588.
88. ^ Lee A, Copas JB, Henmi M, Gin T, Chung RC (2006). "Publication bias affected the estimate of postoperative nausea in an acupoint stimulation systematic review". J Clin Epidemiol. 59 (9): 980–3. doi:10.1016/j.jclinepi.2006.02.003. PMID 16895822.
89. ^ Ezzo, JM; Richardson, MA; Vickers, A; Allen, C; Dibble, SL; Issell, BF; Lao, L; Pearl, M et al. (2006). "Acupuncture-point stimulation for chemotherapy-induced nausea or vomiting". Cochrane database of systematic reviews (Online) (2): CD002285. doi:10.1002/14651858.CD002285.pub2. PMID 16625560. http://www.cochrane.org/reviews/en/ab002285.html.
90. ^ Trinh K, Graham N, Gross A, Goldsmith C, Wang E, Cameron I, Kay T (2007). "Acupuncture for neck disorders". Spine 32 (2): 236–43. doi:10.1097/01.brs.0000252100.61002.d4. PMID 17224820.; Trinh K, Graham N, Gross A, Goldsmith C, Wang E, Cameron I, Kay T (2006). "Acupuncture for neck disorders". Cochrane Database of Systematic Reviews 3. doi:10.1002/14651858.CD004870.pub3. http://www.cochrane.org/reviews/en/ab004870.html.
91. ^ Melchart, D.; Linde, K.; Fischer, P.; Berman, B.; White, A.; Vickers, A.; Allais, G.; Melchart, D. (2001). "Acupuncture for idiopathic headache". Cochrane database of systematic reviews (Online) (1): CD001218. doi:10.1002/14651858.CD001218. PMID 11279710. edit
92. ^ Linde, K.; Allais, G.; Brinkhaus, B.; Manheimer, E.; Vickers, A.; White, A.; Linde, K. (2009). "Acupuncture for migraine prophylaxis". Cochrane database of systematic reviews (Online) (1): CD001218. doi:10.1002/14651858.CD001218.pub2. PMID 19160193. edit
93. ^ White A, Foster NE, Cummings M, Barlas P (2007). "Acupuncture treatment for chronic knee pain: a systematic review.". Rheumatology 46 (3): 384–90. doi:10.1093/rheumatology/kel413. PMID 17215263.
94. ^ Selfe TK, Taylor AG (2008 Jul-Sep). "Acupuncture and osteoarthritis of the knee: a review of randomized, controlled trials.". Fam Community Health 31 (3): 247–54. doi:10.1097/01.FCH.0000324482.78577.0f (inactive 2009-11-14). PMID 18552606.
95. ^ Manheimer E, Linde K, Lao L, Bouter LM, Berman BM (2007). "Meta-analysis: acupuncture for osteoarthritis of the knee". Ann. Intern. Med. 146 (12): 868–77. doi:10.1001/archinte.146.5.868 (inactive 2009-11-14). PMID 17577006.
96. ^ Zhang, W; Moskowitz, RW; Nuki, G; Abramson, S; Altman, RD; Arden, N; Bierma-Zeinstra, S; Brandt, KD et al. (2008). "OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines" (pdf). Osteoarthritis and Cartilage 16 (2): 137–162. doi:10.1016/j.joca.2007.12.013. PMID 18279766. http://www.oarsi.org/pdfs/oarsi_recommendations_for_management_of_hip_and_knee_oa.pdf.
97. ^ Mayhew E; Ernst E (2007). "Acupuncture for fibromyalgia—a systematic review of randomized clinical trials". Rheumatology (Oxford, England) 46 (5): 801–4. doi:10.1093/rheumatology/kel406. PMID 17189243.
98. ^ McCarney, RW; Brinkhaus, B; Lasserson, TJ; Linde, K; McCarney, Robert W (2003). "Acupuncture for chronic asthma". Cochrane Database of Systematic Reviews 2003 (3): CD000008. doi:10.1002/14651858.CD000008.pub2. PMID 14973944. http://www.cochrane.org/reviews/en/ab000008.html. Retrieved 2008-05-02.
99. ^ He, L; Zhou, MK; Zhou, D; Wu, B; Li, N; Kong, SY; Zhang, DP; Li, QF et al. (2004). "Acupuncture for Bell's palsy". Cochrane Database of Systematic Reviews 2007 (4): CD002914. doi:10.1002/14651858.CD002914.pub3. PMID 17943775. http://www.cochrane.org/reviews/en/ab002914.html. Retrieved 2008-05-02.
100. ^ Gates, S; Smith, LA; Foxcroft, DR; Gates, Simon (2006). "Auricular acupuncture for cocaine dependence". Cochrane Database of Systematic Reviews 2006 (1): CD005192. doi:10.1002/14651858.CD005192.pub2. PMID 16437523. http://www.cochrane.org/reviews/en/ab005192.html. Retrieved 2008-05-02.
101. ^ Smith, CA; Hay, PP; Smith, Caroline A (2004-03-17). "Acupuncture for depression". Cochrane Database of Systematic Reviews 2004 (3): CD004046. doi:10.1002/14651858.CD004046.pub2. PMID 15846693. http://www.cochrane.org/reviews/en/ab004046.html. Retrieved 2008-05-02.
102. ^ Proctor, ML; Smith, CA; Farquhar, CM; Stones, RW; Zhu, Xiaoshu; Brown, Julie; Zhu, Xiaoshu (2002 volume=2002). "Transcutaneous electrical nerve stimulation and acupuncture for primary dysmenorrhoea". Cochrane Database of Systematic Reviews (1): CD002123. doi:10.1002/14651858.CD002123. PMID 11869624. http://www.cochrane.org/reviews/en/ab002123.html. Retrieved 2008-05-02.
103. ^ Cheuk, DK; Wong, V; Cheuk, Daniel (2006). "Acupuncture for epilepsy". Cochrane Database of Systematic Reviews 2006 (2): CD005062. doi:10.1002/14651858.CD005062.pub2. PMID 16625622. http://www.cochrane.org/reviews/en/ab005062.html. Retrieved 2008-05-02.
104. ^ Law, SK; Li, T; Law, Simon K (2007). "Acupuncture for glaucoma". Cochrane Database of Systematic Reviews 2007 (4): CD006030. doi:10.1002/14651858.CD006030.pub2. PMID 17943876. http://www.cochrane.org/reviews/en/ab006030.html. Retrieved 2008-05-02.
105. ^ Cheuk, DK; Yeung, WF; Chung, KF; Wong, V; Cheuk, Daniel KL (2007). "Acupuncture for insomnia". Cochrane Database of Systematic Reviews 2007 (3): CD005472. doi:10.1002/14651858.CD005472.pub2. PMID 17636800. http://www.cochrane.org/reviews/en/ab005472.html. Retrieved 2008-05-02.
106. ^ Lim, B; Manheimer, E; Lao, L; Ziea, E; Wisniewski, J; Liu, J; Berman, B; Manheimer, Eric (2006). "Acupuncture for treatment of irritable bowel syndrome". Cochrane Database of Systematic Reviews 2006 (4): CD005111. doi:10.1002/14651858.CD005111.pub2. PMID 17054239. http://www.cochrane.org/reviews/en/ab005111.html. Retrieved 2008-05-06.
107. ^ Smith, CA; Crowther, CA; Smith, Caroline A (2004). "Acupuncture for induction of labour". Cochrane Database of Systematic Reviews 2004 (1): CD002962. doi:10.1002/14651858.CD002962.pub2. PMID 14973999. http://www.cochrane.org/reviews/en/ab002962.html. Retrieved 2008-05-06.
108. ^ Casimiro, L; Barnsley, L; Brosseau, L; Milne, S; Robinson, VA; Tugwell, P; Wells, G; Casimiro, Lynn (2005). "Acupuncture and electroacupuncture for the treatment of rheumatoid arthritis". Cochrane Database of Systematic Reviews 2005 (4): CD003788. doi:10.1002/14651858.CD003788.pub2. PMID 16235342. http://www.cochrane.org/reviews/en/ab003788.html. Retrieved 2008-05-06.
109. ^ Green, S; Buchbinder, R; Hetrick, S; Green, Sally (2005). "Acupuncture for shoulder pain". Cochrane Database of Systematic Reviews 2005 (2): CD005319. doi:10.1002/14651858.CD005319. PMID 15846753. http://www.cochrane.org/reviews/en/ab005319.html. Retrieved 2008-05-06.
110. ^ Rathbone, J; Xia, J; Rathbone, John (2005). "Acupuncture for schizophrenia". Cochrane Database of Systematic Reviews 2005 (4): CD005475. doi:10.1002/14651858.CD005475. PMID 16235404. http://www.cochrane.org/reviews/en/ab005475.html. Retrieved 2008-05-06.
111. ^ White, AR; Rampes, H; Campbell, JL; White, Adrian R (2006). "Acupuncture and related interventions for smoking cessation". Cochrane Database of Systematic Reviews 2006 (1): CD000009. doi:10.1002/14651858.CD000009.pub2. PMID 16437420. http://www.cochrane.org/reviews/en/ab000009.html. Retrieved 2008-05-06.
112. ^ Zhang, SH; Liu, M; Asplund, K; Li, L; Liu, Ming (2005). "Acupuncture for acute stroke". Cochrane Database of Systematic Reviews 2005 (2): CD003317. doi:10.1002/14651858.CD003317.pub2. PMID 15846657. http://www.cochrane.org/reviews/en/ab003317.html. Retrieved 2008-05-06.
113. ^ Wu, HM; Tang, JL; Lin, XP; Lau, J; Leung, PC; Woo, J; Li, YP; Wu, Hong Mei (2006). "Acupuncture for stroke rehabilitation". Cochrane Database of Systematic Reviews 2006 (3): CD004131. doi:10.1002/14651858.CD004131.pub2. PMID 16856031. http://www.cochrane.org/reviews/en/ab004131.html. Retrieved 2008-05-06.
114. ^ Green, S; Buchbinder, R; Barnsley, L; Hall, S; White, M; Smidt, N; Assendelft, W; Green, Sally (2002). "Acupuncture for lateral elbow pain". Cochrane Database of Systematic Reviews 2002 (1): CD003527. doi:10.1002/14651858.CD003527. PMID 11869671. http://www.cochrane.org/reviews/en/ab003527.html. Retrieved 2008-05-06.
115. ^ Peng, WN; Zhao, H; Liu, ZS; Wang, S; Weina, Peng (2008). "Acupuncture for vascular dementia". Cochrane Database of Systematic Reviews 2007 (2): CD004987. doi:10.1002/14651858.CD004987.pub2. PMID 17443563. http://www.cochrane.org/reviews/en/ab004987.html. Retrieved 2008-05-06.
116. ^ Tang JL, Zhan SY, Ernst E (July 1999). "Review of randomised controlled trials of traditional Chinese medicine". BMJ 319 (7203): 160–1. PMID 10406751. PMC 28166. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=10406751.
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118. ^ Singh & Ernst, 2008, p. 79-82.
119. ^ Lewith GT, White PJ, Pariente J (September 2005). "Investigating acupuncture using brain imaging techniques: the current state of play". Evidence-based complementary and alternative medicine: eCAM 2 (3): 315–9. doi:10.1093/ecam/neh110. PMID 16136210. PMC 1193550. http://ecam.oxfordjournals.org/cgi/content/full/2/3/315. Retrieved 2007-03-06.
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121. ^ "Report 12 of the Council on Scientific Affairs (A-97) – Alternative Medicine". American Medical Association. 1997. http://www.ama-assn.org/ama/no-index/about-ama/13638.shtml. Retrieved 2009-10-07.
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123. ^ Norheim AJ (1996). "Adverse effects of acupuncture: a study of the literature for the years 1981–1994". Journal of alternative and complementary medicine (New York, N.Y.) 2 (2): 291–7. doi:10.1089/acm.1996.2.291. PMID 9395661.
124. ^ White, A; Hayhoe, S; Hart, A; Ernst, E (2001). "Adverse events following acupuncture: prospective survey of 32 000 consultations with doctors and physiotherapists". British Medical Journal 323 (7311): 485–6. doi:10.1136/bmj.323.7311.485. PMID 11532840. PMC 48133. http://www.bmj.com/cgi/content/full/323/7311/485.
125. ^ Leow TK (2001). "Pneumothorax Using Bladder 14". Medical Acupuncture 16 (2). http://www.medicalacupuncture.org/aama_marf/journal/vol16_2/case_2.html.
126. ^ Yekeler, Ensar; Tunaci, M; Tunaci, A; Dursun, M; Acunas, G. "Frequency of Sternal Variations and Anomalies Evaluated by MDCT". American Journal of Roentgenology 186 (4): 956–60. doi:10.2214/AJR.04.1779. PMID 16554563. http://www.ajronline.org/cgi/content/full/186/4/956. Retrieved 2007-11-24.
127. ^ Cheng, 1987.
128. ^ Be Wary of Acupuncture, Qigong, and "Chinese Medicine"
129. ^ Final Report, Report into Traditional Chinese Medicine - NSW Parliament
130. ^ Government of Ontario, Canada - News
131. ^ Traditional Chinese Medicine Act, 2006, S.O. 2006, c. 27
132. ^ CTCMA
133. ^ NCCAOM
134. ^ "More than half of the physicians (59%) believed that acupuncture can be effective to some extent." Physicians Divided on Impact of CAM on U.S. Health Care; Aromatherapy Fares Poorly; Acupuncture Touted. HCD Research, 9 September 2005. convenience links: Business Wire, 2005; AAMA, 2005. Link to internet archive version: Cumulative Report
135. ^ Updates-June 1996 FDA Consumer
136. ^ US FDA/CDRH: Premarket Approvals
137. ^ Report: Insurance Coverage for Acupuncture on the Rise. Michael Devitt, Acupuncture Today, January, 2005, Vol. 06, Issue 01
138. ^ Claxton, Gary; Isadora Gil, Ben Finder, Erin Holve, Jon Gabel, Jeremy Pickreighn, Heidi Whitmore, Samantha Hawkins, and Cheryl Fahlman (2004). The Kaiser Family Foundation and Health Research and Educational Trust Employer Health Benefits 2004 Annual Survey. pp. 106–107. ISBN 0-87258-812-2. http://www.kff.org/insurance/7148/upload/2004-Employer-Health-Benefits-Survey-Full-Report.pdf.
139. ^ Traditional Chinese Medicine Act, 2006, S.O. 2006, c. 27
140. ^ "Welcome to the TC-CTCMPAO". Ctcmpao.on.ca. http://www.ctcmpao.on.ca/index.html. Retrieved 2009-09-02.
141. ^ Welcome to the Chinese Medicine Registration Board of Victoria
142. ^ "Health NSW" (PDF). http://www.health.nsw.gov.au/public-health/ehb/general/skinpen/skin_pen_reg_2000.pdf.
[edit] References
• Barnes, LL (2005). Needles, herbs, gods, and ghosts: China, healing, and the West to 1848. Harvard University Press. ISBN 0674018729. http://books.google.com/books?id=jU0JMNtGWnIC&printsec=frontcover&source=gbs_navlinks_s#v=onepage&q=&f=false.
• Cheng, X (1987). Chinese Acupuncture and Moxibustion (1st ed.). Foreign Languages Press. ISBN 7-119-00378-X.
• Singh, S; Ernst E (2008). Trick or treatment: The undeniable facts about alternative medicine. W. W. Norton & Company. ISBN 0393066616.; Free preview at Google Books
[edit] Further reading
• Deadman, P; Baker K; Al-Khafaji M (2007). A Manual of Acupuncture. Journal of Chinese Medicine Publications. ISBN 0951054651.
• Jin, G; Jin JX; Jin LL (2006). Contemporary Medical Acupuncture - A Systems Approach (English). Springer. ISBN 7040192578. http://books.google.ca/books?id=OaMHyVg5nNcC&printsec=frontcover&source=gbs_navlinks_s#v=onepage&q=&f=false.
• Maciocia, G (1989). The Foundations of Chinese Medicine: A Comprehensive Text for Acupuncturists and Herbalists (2nd ed.). Churchill Livingstone. ISBN 0443039801. http://books.google.com/books?id=M4vch8pNGCMC&printsec=frontcover&source=gbs_navlinks_s#v=onepage&q=&f=false.
[edit] External links
• Acupuncture at the Open Directory Project

[hide]
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Acupuncture

Concepts Acupuncture point • Meridian • Qi • Regulation of acupuncture


Types Auriculotherapy • Dry needling • Electroacupuncture • Medical acupuncture


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Categories: Acupuncture | Traditional Chinese medicine | Manipulative therapy | Energy therapies | Pseudoscience
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etnopharmacy

A la recherche des origines de la médecine par les plantes chez l'animal : d'anciennes méthodes en réponse à de nouveaux problèmes
Michael Huffman
Primate Research Institute, Kyoto University, Japan


Les parasites sont à l'origine d'une variété de maladies qui affectent le comportement et le succès reproducteur des individus, il est donc important de les combattre. Quelle que soit l'espèce, la réponse adaptative typique de l'hôte en réponse à l'infection parasitaire est sans aucun doute le fruit d'un long processus évolutif. Etant donné la résistance accrue des parasites aux antiparasites modernes, l'étude des comportements d'automédication chez l'animal peut offrir des perspectives nouvelles pour le traitement des maladies parasitaires. Depuis la préhistoire, les hommes ont pu constater que les animaux sauvages ou domestiques consomment des herbes médicinales. Le folklore et certaines observations récentes montrent que la découverte des plantes médicinales et leur utilisation dérivent de l'observation du comportement d'animaux, comme les ours, les sangliers, les porcs-épics ou les éléphants. A ce jour, l'étude scientifique la plus systématique des comportements d'automédication chez l'animal concerne les singes anthropoïdes africains. Le régime alimentaire des grands singes comporte souvent une variété de plantes non nutritionnelles, contenant des métabolites secondaires, dont l'ingestion suggère un bénéfice médical. Les chimpanzés et les hommes qui coexistent dans les forêts sub-Sahariennes sont connus pour leur utilisation de Vernonia amygdalina dans le traitement des troubles gastro-intestinaux et des infections parasitaires. On retrouve donc dans le règne animal les racines biologiques de l'utilisation d'herbes médicinales chez l'homme.


Investigating the animal origins of herbal medicine. Old ways of solving new problems?
Michael Huffman
Primate Research Institute, Kyoto University, Japan


Parasites cause a variety of diseases that affect the behaviour and reproductive fitness of an individual. The need to counteract such pressure therefore should be great. Any species typical adaptive response of the host to parasitic infection is undoubtedly the product of a long evolutionary process. In light of the growing resistance of parasites to modern anthelmintics, the study of animal self-medicative behaviour promises to provide novel approaches for the treatment of parasitic diseases. From prehistoric times humans have looked to wild and domestic animals for sources of herbal remedies. Both folklore and recent examples provide accounts of how medicinal plants and their uses were obtained from watching the behaviour of such animals as bears, boars, porcupines and elephants. To date, the most striking systematic scientific studies of self-medication have been made on the African great apes. The great ape diet is often rich in plants containing secondary compounds of non-nutritional, often toxic, value that suggest ingestion for medicinal benefits. Chimpanzees and humans co-existing in the forests of sub-Saharan Africa are known to use Vernonia amygdalina for the treatment of gastrointestinal upset and parasite infections. The origins of herbal medicine have their roots deep within the animal kingdom.
Top

Pharmacopées du Proche-Orient Antique
Guy Mazars
Université de Strasbourg, France


Les plus anciens documents au monde relatifs à la pharmacologie sont ceux que nous ont légués les Civilisations du Proche-Orient Antique, l'Egypte et surtout la Mésopotamie, Ces documents ne fournissent pas seulement des listes de remèdes, ils nous renseignent également sur la préparation de ces remèdes et sur la façon de les utiliser. Selon une opinion très répandue, ces ébauches de pharmacopées, comme toutes celles de l'Antiquité, se seraient constituées de façon empirique. La nécessité de se nourrir ayant poussé les hommes à goûter aux végétaux qui les entouraient, ils ont pu constater que les crampes d'estomac cessaient lorsqu'ils mâchaient telles plantes, qu'il y en avait d'autres qui faisaient disparaître la fatigue ou la douleur, d'autres encore qui provoquaient la mort. C'est ainsi qu'auraient été sélectionnés, au fil des générations, la plupart des plantes médicinales et des poisons. Une telle explication laisse dans l'ombre des processus effectifs de choix des plantes pour des usages déterminés. L'examen des textes découverts par les archéologues montre que les plantes étaient déjà perçues en fonction de références culturelles, de systèmes de correspondances avec d'autres éléments de la culture, qui ont peut-être orienté les choix.


Pharmacopoeias of the ancient Near-east
Guy Mazars
Université de Strasbourg, France


The oldest documents in the world relating to pharmacology are those inherited from the Civilisations of the Ancient Near-East, Egypt and especially Mesopotamia. These documents do not provide only lists of remedies; they also inform us about the preparation of these remedies and the way of using them. According to a very widespread opinion, these outlines of pharmacopoeias, like all those of Antiquity, would have been constituted in an empirical way. The need for nourishing itself having pushed the men to taste the plants which surrounded them, they could note that the stomach cramps ceased when they chewed such plants, that there were of them others which made disappear tiredness or the pain, others still which caused death. Thus would have been selected, from generation to generation, the majority of the medicinal plants and the poisons. Such an explanation leaves in the shade of the effective processes of choice of the plants for given uses. The examination of the texts discovered by the archaeologists shows that the plants were already perceived according to cultural references, to systems of correspondences with other elements of the culture, which perhaps directed the choices.
Top

Apport de la palynologie des coprolithes à la connaissance du régime alimentaire, des maladies et de la pharmacopée des hommes préhistoriques
Josette Renault-Miskovsky
Laboratoire de Préhistoire du Muséum National d'Histoire Naturelle, France


La Palynologie étudie la forme et la signification des spores et des grains de pollen ; elle permet de connaître les végétaux du passé et de reconstituer leur histoire. Certains sédiments archéologiques du Paléolithique inférieur et moyen du Sud-Est de la France ont livré des spectres polliniques ayant fait l'objet d'un inventaire des plantes alimentaires susceptibles d'entrer dans le menu quotidien de nos ancêtres. Parmi les témoins de la Préhistoire ayant collecté une pluie pollinique fossile, il convient de citer surtout les coprolithes, notamment les coprolithes humains, et par exemple ceux de l'Abri sous-roche de Pedra-Furada (Piaui, Brésil), considéré actuellement comme l'un des plus anciens sites préhistoriques de l'Amérique. Ces excréments fossiles datés entre 8 500 et 7 000 BP ont fait l'objet d'une étude pollinique ; les résultats sont à la fois d'ordre paléoclimatique et paléoenvironnemental, mais ils présentent aussi le grand intérêt de mettre en évidence la gamme des plantes vraisemblablement sélectionnées par les habitants de Pedra-Furada, pour leur usage thérapeutique.


Contribution of the palynology of coprolithes to knowledge on the diet, the diseases and the pharmacopoeia of prehistoric men
Josette Renault-Miskowsky
Laboratoire de Préhistoire du Muséum National d'Histoire Naturelle, France


The Palynology studies the form and the signification of spores and grains of pollen; it allows the knowledge of past vegetations and to restore their story. Some archaeological sediments from low and middle Palaeolithic from the South-east of France gave large pollinical spectra, which allow an inventory of nutritious plants susceptible of composing the daily menu of our ancestor. Among witness of Prehistory which collected fossil pollinic rain, one can quote essentially coprolithes, more particularly human coprolithes, and for example these from the rock-shelter of Pedra-Furada (Piaui, Brazil), considered as one of the oldest prehistorical sites of America. These fossils excrements dated between 8 500 and 7 000 BP were studied by pollinical methods; the results were both paleoclimatical and paleoenvironmental, but they are also interesting by showing the range of plants probably selected by Pedra-Furada population for their therapeutic use.
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Contribution à l'étude des coprolithes humains, de leurs parasites et de leurs traitements à l'époque néolithique
Françoise Bouchet
Laboratoire de Paléoparasitologie, Université de Reims, France


Trois sites néolithiques situés respectivement en France au bord du lac de Chalain (Jura) et en Suisse au bord des lacs de Constance (site d'Arbon) et de Neuchatel (site de Concise) ont fait l'objet d'une étude paléoparasitologique. De nombreux oeufs extrêmement bien préservés ont été découverts et identifiés par leur morphologie et leur morphométrie : Oeufs de Trichuris sp., Fasciola sp., Diphyllobothrium sp., Capillaria sp., Dioctophymus sp.

Les deux derniers retiennent notre attention car ils posent le problème de l'émergence, voire de la prédominance de certaines parasitoses à une époque donnée et leur disparition ou leur faible représentation à d'autres moments. En effet ces deux parasitoses Capillarioses et Dioctophymoses sont anecdotiques de nos jours, en Europe de l'Ouest. Parfois associés à ces oeufs &Helminthes, des pollens et des spores végétales évoquent la possibilité de médication.


Contribution to learning anthropic coprolithes, parasitic diseases and evaluation of medication at Neolithic epoch
Françoise Bouchet
Laboratoire de Paléoparasitologie, Université de Reims, France


On three neolithic sites, one in France: Chalain (Jura), two in Switzerland: Arbon (Constance lake) and Concise (Neuchatel lake), palaeoparasitological studies have discovered a concentration of many well preserved eggs of parasitic intestinal worms, the identification of which is based on their morphology and morphometry. Five parasites have been identified: Trichuris sp., Fasciola sp., Diphyllobothrium sp., Capillaria sp., Dioctophymus sp.

The two last parasitosis are very interesting because they pose the problem of the emergence and disappearance of these diseases in prehistoric and historic periods. In fact, these two parasitosis are anecdotal of present days in European countries. Sometimes, the analysis reveal, in association with eggs, the presence of pollens and spores, and call to mind the possibility of medical treatment.
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Les animaux médecins d'eux-mêmes
Michel Ansay
Université de Liège, Belgique


Les travaux du Dr Huffman ont donné une ampleur nouvelle à des observations telles que celles que faisait déjà Plutarque (traduit par Amyot) au début de ce siècle : "les chiens, eux, se purgent, quand ils sont malades de la bile, avec l'herbe que l'on appelle l'herbe aux chiens Les animaux peuvent-ils déceler quelques "signatures" dans les plantes de leur environnement ?

Les développements en sont nombreux et relèvent aussi bien de l'éthologie (R. Chauvin), de l'ethnomédecine (Congo), de l'observation commune (la valériane chez le chat) que de ce que l'on appelle parfois l'instincto-thérapie (la sagesse ou l'intelligence du corps) chez l'homme. La pharmacologie moléculaire ne sera point absente car pourquoi avons-nous des récepteurs qui "attendent" une drogue, la morphine, voire même les benzodiazépines ? Y a-t-il des analogies entre le système immunitaire et une possible reconnaissance de molécules (plantes) "intéressantes" ? Faut-il encore chercher du côté des phéromones ? Les plantes émettent-elles des messages (J-M. Pelt) ? Faut-il réfléchir à la signification des échecs de la reconnaissance quand des animaux sont intoxiqués par des plantes (souvent il est vrai, après changement de biotope) ? Les "disrupteurs endocriniens" (pollutions,... ) peuvent-ils "brouiller" les messages et leur réception ? Faut-il évoquer les travaux sur l'auto-médication des animaux de laboratoire, sur les dépendances qui peuvent se développer chez les animaux ?


The animals as doctors to themselves
Michel Ansay
Université de Liège, Belgique


The scientific work carried out by Dr. Huffman has given enhanced value to observations such as those made by Plutarch (as translated into French by Amyot at the beginning of this century): when they are sick with excessive gall, dogs purge themselves with herbs called dog herbs. . . " Are dogs able to identify some "signatures" in the plants in their environment ?

Among the numerous developments are ethology (R. Chauvin), ethnomedicine (Congo), basic observation (valerian for cats) as well as what is sometimes called instinct therapy (the body's wisdom or intelligence) for human beings. Molecular pharmacology will not be absent and may explain why we have receptors, which are "waiting" for a drug morphine - or even benzodiazepines. Are there analogies between the immune system and the possible recognition of "interesting" plants or molecules? Should we still look for answers in pheromones? Do plants send messages (J-M Pelt)? Should we think of the meaning of failed recognition when animals suffer from plant poisoning (although one must admit it often happens after a biotope change)? Can endocrine disturbances (pollution...) cause interference to the messages and their reception? Should the works on laboratory animals' self-medication and on animals’ potential growing dependence be mentioned ?
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Les barrières naturelles à l'extension des maladies chez l'animal sauvage
Jean Blancou
Office international des épizooties, France


Le concept de barrières naturelles à l'extension des maladies animales est très ancien. Il recouvre non seulement le phénomène de la résistance génétique aux agents pathogènes, mais aussi l'influence de divers autres facteurs qui s'opposent à ce que ces agents n'infectent, ou ne parasitent, certaines espèces animales.

Après avoir rappelé certaines données historiques sur ce sujet, l'auteur décrit les trois principales composantes de ces barrières naturelles : la difficulté de rencontre entre l'animal sauvage et l'agent pathogène, la résistance innée de l'hôte à la pénétration de cet agent et, enfin, la résistance acquise de l'animal, basée sur des mécanismes de résistance immunitaire, cellulaire ou humorale.

L'auteur examine ensuite les défaillances possibles de ces trois composantes, elles-mêmes liées à de très nombreux facteurs : modification du mode de vie, du rythme biologique ou du régime alimentaire, effraction des barrières cutanées ou muqueuses, conditions adverses de l'environnement, etc.

Il conclut à la fragilité relative des barrières naturelles et souligne le risque que représentent, pour ces barrières, les mutations spontanées des agents pathogènes.


Natural barriers to the spread of disease in wild animals
Jean Blancou
Office International des Epizooties, France


The concept of natural barriers to the spread of animal diseases is a very ancient one. It incorporates not only the phenomenon of genetic resistance to pathogens, but also the influence of various other factors affecting the capacity of the pathogens to infect or to live as a parasite on certain animal species.

After having recalled historical data on the subject, the author described the three main parts composing these natural barriers: difficulties associated with wild animals coming into contact with the pathogen, the innate resistance of the host animal to penetration by the pathogen and, finally, the acquired resistance of the animal, based on cellular or humoral immune resistance mechanisms,

The author then examined possible weaknesses of these three components, which are linked to a variety of factors: modification of living conditions, biological rhythm or diet, penetration of skin or mucous barriers, adverse environmental conditions, etc.

He concluded that natural barriers were relatively fragile and highlighted the risk that spontaneous mutations of pathogens represent for these barriers.
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Plantes médicinales et biotechnologies : moteur de la nouvelle économie ?
Jean-Marie Pelt
Institut Européen d'Ecologie, Metz, France


En 1980 la Cour Suprême des Etats-Unis préconisait à l'Institut Américain pour la Propriété Industrielle d'accorder un brevet à une bactérie génétiquement modifiée. Ce jugement fit jurisprudence et posait les bases juridiques de l'appropriation de la Vie, désormais, considérée comme une marchandise. Il déclenchait en même temps un rush extraordinaire des entreprises de biotechnologies, désirant s'approprier au plus vite les précieux brevets qui leur permettraient d'accéder à de nouveaux marchés, évalués à des milliards de dollars...

Elargissant la brèche, en 1987, l'organisme américain attributaire de brevets déclarait que tous les organismes vivants multicellulaires, hommes et animaux compris dans leurs organes et dans leurs gènes, étaient potentiellement brevetables. Le champ d'application de ces brevets est parfois très large attribuant un réel et complet monopole d'une seule multinationale sur une espèce vivante.

Bref poursuivant une logique exacerbée par l'ultra-libéralisme, toutes les créatures naturelles sont devenues des marchandises, appropriables et négociables à merci.

Dans le monde entier, des voix s'élèvent, toujours plus nombreuses, pour contester de telles pratiques, Est-ce acceptable de poursuivre le pillage insensé des ressources du Sud au seul profit de quelques multinationales de plus en plus concentrées, qui imposent déjà leurs lois et surtout leurs prix sur les marchés. Jusqu’où ira ce défi prométhéen ? Quelles en seront les conséquences pour l'Homme, la Nature et la Vie ? L'avenir seul le dira. Un avenir sur lequel nous comptons peser de tout notre poids pour que soient garantis les droits et les chances des ethnies détentrices des savoirs traditionnels ainsi que des générations futures.


Medicinal plants and biotechnologies a booster for a new economy?
Jean-Marie Pelt
Institut Européen d'Ecologie, Metz, France


In 1980, the US Supreme Court allowed the American Institute for Industrial Property to grant a patent for a genetically modified bacteria. This judgement set a precedent and a legal basis for the appropriation of life, thus considered a merchandise. So, firms of biotechnology rushed to take over the precious patents, which would allow them to find new markets, worth billions of dollars. In 1987 the Institute widened the field of action and declared that all multicellular living organisms, human or animal, organs and genes, were potentially patentable. In consequence a multinational company may monopolize a living species and use it for different applications.

In the wake of this ultra-liberal logic all natural beings have become merchandises negotiable without limits. In the whole world more and more people protest against these actions. Can we accept this senseless pilferage of natural resources in the South for the sale profit of multinational companies who are already imposing their laws and prices on the market? How long will this Promethean challenge last? What will the consequences be for Man, Nature, Life? The future will say. A future we intend to preserve for the sake of ethnies owning traditional knowledge and the sake of future generations.
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Entre représentations, savoirs et pratiques. L'art des chamanes (et autres tradipraticiens)
Michel Perrin
Collège de France, Paris, France


L'art des chamanes - leur art thérapeutique entre autres - consiste en un jeu subtil entre un système spécifique de représentations, une logique des pratiques et l'usage de divers savoirs.

Pour le montrer, il faut d'abord proposer une définition minimale de chamanisme puis exposer des conceptions spécifiques de la maladie, de la nosologie et de la thérapie. il faut également introduire ou interroger des notions telles que celles de seuil d'angoisse, d'efficacité thérapeutique, d'efficacité symbolique, de spectre d'efficacité des simples, etc.

La plupart des exemples proviendront d'expériences personnelles "de terrain".

Bibliographie: Michel PERRIN, Les Praticiens du rêve (PUF, 1992), Le Chamanisme (PUF "Que sais-je ?", 2e éd. 1998), Le Chemin des Indiens morts (Payot, 3e éd. 1996), Tableaux kuna (Flammarion, 2e éd. 1999).


From representations to popular lore and practices. The art of shamans and traditional practitioners
Michel Perrin
Collège de France, Paris, France


The art of shamanism - especially their therapeutic art - consists of a subtle game between a specific representation system, a logical practice system and the use of various knowledges.

In order to show this, it is necessary to give at least a definition of shamanism, then to present its specific understanding of illness, nosology and therapy, One should also refer to or work with notions like threshold of anguish, therapeutical efficiency, symbolic efficiency, efficiency spectrum towards non-initiated persons etc.

Most examples will derive from personal "field" experiences.

Bibliography: Michel PERRIN : Les Praticiens du rêve (PUF, 1992), Le Chamanisme (PUF "Que sais-je ?", 2e éd. 1998), Le Chemin des Indiens morts (Payot, 3e éd. 1996), Tableaux kuna (Flammarion, 2e éd. 1999).
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The use of plants in the traditional, veterinary medicine in Sub-Sahara Africa Past, present and future


L'usage de plantes en médecine traditionnelle vétérinaire en Afrique Sub-Saharienne. Hier, aujourd'hui et demain

Martine Baerts et jean Lehmann
Université Catholique de Louvain, Belgique


Dans l'abondante littérature concernant l'Afrique peu d'indications nous sont fournies concernant la médecine traditionnelle vétérinaire. Les quelques études disponibles se contentent souvent d'enquêtes locales de courte durée et impliquent un petit nombre d'informateurs. Il est difficile dès lors de distinguer les réponses qui s'inscrivent dans le courant d'une tradition vécue par tout un peuple de celles données par quelques individus seulement. Nous tenterons de résumer les connaissances que nous avons de la médecine traditionnelle vétérinaire dans quelques zones de l'Afrique sub-saharienne aux temps passés et de signaler les quelques tendances qui se dessinent actuellement.

L'éleveur africain emploie des substances végétales et/ou animales comme remèdes pragmatiques et ingrédients magiques. La même substance peut indifféremment revêtir l'un ou l'autre de ces aspects. On découvre quelques indications concernant l'utilisation de ces substances dans des publications souvent dispersées. Cette récolte d'informations est synthétisée et publiée sous forme d'une banque de données (1). Dans certains cas des méthodes d'analyse statistique permettent de distinguer les plantes utilisées en phytothérapie traditionnelle des substances utilisées à des fins rituelles ou magiques.

La médecine traditionnelle vétérinaire du passé axée tant sur les rites, la magie que sur une certaine efficacité thérapeutique aurait dû disparaître avec les progrès des techniques modernes. Il n'en a rien été et dans de nombreux pays les plantes encore accessibles peuvent aider pour autant qu'une sélection sérieuse et que des modes opératoires bien testés soient mis à la disposition des éleveurs par des méthodes éducatives appropriées. A cette condition l'étude du passé n'aura pas été inutile.

(1) Banque de données PRÉLUDE : http://pc4.sisc.ucl.ac.be/prelude.html
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Les natures du chaman : la leçon de savoir-vivre des chamans amérindiens
Eric Navet
Institut d’Ethnologie, Université Marc Bloch de Strasbourg, France


Les sociétés amérindiennes conçoivent et vivent la Création comme un ensemble complexe en équilibre précaire, comprenant des parties visibles et d'autres invisibles qui, toutes, sont dans un rapport d'interrelation et d'interdépendance. La morale qui permet et organise le vivant le définit, selon l'expression des Indiens Ojibwé, comme un ensemble "beau, ordonné et harmonique". Dans ce cadre, le mythe met en scène l'être humain comme un "trouble-fête". Entre un idéal inaccessible en ce monde - celui de la "Terre sans mal" des Tupi-Guarani - et les contraintes du vivant, le chaman, véritable clé de voûte de l'édifice, grâce à un savoir puisé à toutes les sources - des natures humaines et non-humaines -, et par un va-et-vient constant entre ces "mondes" que la pensée rationnelle distingue comme "réels" et "imaginaires", apparaît, de façon holistique, comme le seul agent de régulation d'un système constamment menacé par le chaos.


The functions of shaman:
Eric Navet
Institut d’Ethnologie, Université Marc Bloch de Strasbourg, France


The Amerindian societies conceive and live the Creation as a complex whole in a precarious balance, including visible and invisible parts, which are all interrelated and interdependent. The ethics, which allows and organizes the living, defines it, according to the Ojibwé Indians, as a totality "beautiful, well ordered and harmonic". In this framework, the myth stages the human being as a troublemaker. Between an ideal unattainable in this world - the "Terre sans mal" of the Tupi-Guarani - and the constraints of the living, the shaman, keystone of the edifice, thanks to a knowledge drawn from many sources - from human and non-human natures -, and a backward and forward motion between theses worlds that the rational thinking distinguishes as "real" and "imaginary", appears, in a holistic way, as the only agent of regulation of a system constantly threatened with chaos.
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La transmission des savoirs traditionnels face à la modernité. Exemple de la Guyane française
Marie Fleury
Museum National d'Histoire Naturelle, Paris, France


Les Noirs marrons aluku (Boni), descendants d'esclaves échappés des plantations hollandaises au XVIIIe siècle, vivent actuellement le long du fleuve Maroni en Guyane française. Leur système thérapeutique, loin de s'inspirer du chamanisme des Amérindiens voisins, plonge ses racines en Afrique, et fait preuve d'une grande capacité de création, d'invention et d'adaptation à un nouveau contexte. Durant les deux siècles précédents, la pharmacopée s'est créée, enrichie et transmise de génération en génération. Mais, actuellement les Anciens montrent une certaine réticence à délivrer leurs connaissances, et les jeunes gens se plaignent de ne plus avoir accès au savoir traditionnel.

Pour essayer de comprendre les raisons de cette évolution, nous commencerons par définir ce qu'est une pharmacopée dans le contexte traditionnel, et surtout à quel type de pouvoir elle donne accès. Nous comparerons le mode de transmission traditionnel avec celui du système scolaire occidental, et regarderons dans quelle mesure il y a compatibilité entre savoirs traditionnels et savoirs modernes. Enfin nous verrons que si les savoirs traditionnels sont condamnés, ce n'est pas tant dans leur contenu, que dans leur mode de création et de propagation. C'est le contexte socioculturel qui leur donne un sens, et la possibilité de s'exprimer ; si celui-ci est fragilisé, c'est dans leurs raisons d'être que les savoirs traditionnels sont menacés.


Transmitting traditional knowledge in the modern age. The example of French Guyana
Marie Fleury
Museum National d'Histoire Naturelle, Paris, France


The maroons Blacks aluku (Boni), descendants of slaves escaped the Dutch plantations in the XVIIIth century, live at present along Maroni River in French Guyana. Their therapeutic system, far from being inspired by the shamanism of the nearby Amerindians, plunges its roots in Africa, and gives evidence of a big capacity of creation, invention and adaptation to a new context. During the previous two centuries, the pharmacopoeia built up itself, enriches and passed on by generation in generation. But, at present one attends a certain keeping back of the Ancient to be delivered their knowledge, and the young people complain no more to have access to traditional knowledge.

To try to understand the reasons of this evolution, we shall begin by defining what is a pharmacopoeia in the traditional context, and especially to which type of power it gives access. We shall compare the traditional mode of transmission with that of the Occidental school system, and shall look in which measure there is compatibility between traditional knowledges and modern knowledges. Finally we shall see that if traditional knowledges are condemned, it is not so much in their contents, that in their mode of creation and distribution. It is the sociocultural context, which gives them a sense, and the possibility of expressing; itself; if this one is weakened, it is in their reasons to be that traditional knowledges are threatened.
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Disappearing plants; Disappearing knowledge; Where is the future?
Christine Leon
Royal Botanic Gardens, Kew, UK


Over 33,000 plant species are threatened with extinction (Walter & Gillett, 1998) and up to 90% of the world's languages may disappear by the end of the 21st century (Terralingua, 2000). This rapid and progressive erosion of biological and cultural diversity represents an inestimable loss of both plant genetic resources and indigenous knowledge, much of which relates directly to medicinal plants. These facts raise important issues for healthcare systems worldwide, both now and for the future. The collection of some medicinal species, e.g. Rauvolfia serpentina, Prunus africana and Panax quinquefolius, is controlled by legal instruments such as CITES'. Such mechanisms may be adequate to prevent their over-exploitation but are comparable systems in place to protect against other pressures such as habitat degradation or loss? And what of the loss and erosion of indigenous knowledge about the identity, location and use of medicinal plants, many of which have longed played a vital role in traditional healthcare systems around the world? Who is responsible and what mechanisms if any are in place to halt such a decline. This forum aims to raise these and related issues. How real are the threats facing the survival of these biological, linguistic and cultural resources? What are the implications for i) ethnopharmacology, ii) healthcare systems around the world and indigenous knowledge of medicinal plants? What efforts are being made and what techniques/mechanisms exist to conserve, document and sustainably utilise these resources? Who is responsible at the end of the day? Does the ethnopharmacological community have a role to play? These will be some of the key issues proposed for discussion at this forum, with emphasis on their relevance to ethnopharmacology now and in the future.

Terralingua,2000. Terralingua: partnerships for Linguistic and Biological Diversity (Website: http://cougar.ucdfavis.edu/nas/terralin). >Walter, K.S. and Gillett, HJ. (1998). 1997 IUCN Red List of Threatened Plants. IUCN -The World Conservation Union, Gland. 1: CITES (Convention on the International Trade in Endangered Species of Fauna and Flora).


Plantes et connaissances en voie de disparition : quel avenir ?
Christine Leon
Royal Botanic Gardens, Kew, UK


Plus de 33.000 espèces sont menacées d'extinction (Walter & Gillett, 1998) et jusqu'à 90% des langues parlées dans le monde pourraient disparaître d'ici à la fin du 2lème siècle (Terralingua, 2000). Cette érosion rapide et progressive de la diversité biologique et culturelle représente pour la génétique une perte inestimable de ressources et de connaissances indigènes à la fois; la plupart de ces savoirs sont liés directement aux plantes médicinales. Ces faits soulèvent des questions importantes concernant les systèmes de santé dans le monde entier, maintenant et à l'avenir. La collecte de certaines espèces médicinales telles que Rauvolfia serpentina, Prunus africana et Panax quinquefolius est contrôlée à l'aide de moyens légaux comme le CITES'. De tels mécanismes permettent peut-être d'empêcher leur surexploitation, niais des systèmes comparables sont-ils en place afin de résister à d'autres pressions comme la dégradation ou la perte de l'habitat ? Et qu'en est-il de l'érosion et de la perte des connaissances indigènes quant à l'identité, la situation géographique et l'utilisation de plantes médicinales dont la plupart jouent depuis longtemps un rôle essentiel dans les systèmes de santé traditionnels à travers le monde ? Qui est responsable et quels sont les mécanismes - s'ils existent - qui sont en place pour stopper ce déclin ? Cette table ronde a pour but de soulever ces questions et d'autres qui leur sont liées. Quelles menaces pèsent réellement sur la survie de ces ressources biologiques, linguistiques et culturelles ? Quelles sont les conséquences pour 1) l'ethnopharmacologie, 2) les systèmes de santé dans le monde et les connaissances indigènes en matière de plantes médicinales ? Quels efforts sont entrepris et quels sont les mécanismes et les techniques qui existent afin de conserver, d'étudier et d'utiliser ces ressources tout en les préservant pour l'avenir ? Au bout du compte, qui est responsable ? La communauté ethnopharmacologique a-t-elle un rôle à jouer ? Voilà quelques-unes des questions fondamentales pouvant servir de base à la discussion lors de la table ronde, en mettant l'accent sur leur lien avec l'ethnopharmacologie maintenant et à l'avenir.

Terralingua, 2000. Terralingua: partnerships for Linguistic and Biological Diversity (Website: http://cougar.ucdfavis.edu/nas/terrafin). Walter, K.S. and Gillett, Hi. (1998). 1997 IUCN Red List of Threatened Plants. IUCN - The World Conservation Union, Gland. 1: CITES (Convention on the International Trade in Endangered Species of Fauna and Flora).
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De l’ethnopharmacologie aux résultats en laboratoire : différence signifie t-elle inapplicabilité ?
Michel Sauvain
Institut de Recherche pour le Développement, France


Depuis 1992, notre groupe de recherche (composé de chercheurs boliviens et français) travaille sur la problématique de l'évaluation de l'activité pharmacologique de plantes utilisées en médecine traditionnelle dans différentes ethnies de Bolivie (Chacobo, Moseten, Alteños et Tacanas). Les espèces sélectionnées ont été criblées contre le paludisme in vitro et sur l'animal. Plus de 200 espèces différentes ont été évaluées et seulement un faible pourcentage d'entre elles a montré une forte corrélation entre l'usage et les résultats biologiques.

Ces contradictions peuvent être expliquées suivant plusieurs angles de vue : La plante médicinale est censée alléger des symptômes qui sont plus ou moins reliés à une atteinte palustre, les critères de choix des plantes à tester doivent être discutés. Des traitements successifs sont fréquemment administrés jusqu'à ce que le patient soit guéri, ces traitements peuvent avoir ainsi un effet synergique qu'il sera difficile de démêler par la suite. La manière traditionnelle de préparer et d'administrer la plante médicinale ne peut pas être toujours prise en compte par le test de criblage qui doit répondre à une certaine standardisation pour être réalisable en laboratoire. L'absence d'activité sur l'animal peut être reliée à des taux d'absorption, de métabolisation différents de l'animal à l'homme. Le rôle de l'immunité acquise chez l'homme est difficilement pris en compte par les modèles animaux, etc... La validité et la justesse des tests de criblage conçus pour mettre en évidence une activité antipaludique d'extraits de plantes seront discutées.


From ethnopharmacology to laboratory results, does discrepancy mean irrelevancy?
Michel Sauvain
Institut de Recherche pour le Développement, France


Since 1992, our research team (a combination of Bolivian and French researchers) is working on the problematic of the evaluation of the biological activity of plants used traditionally in different Bolivian ethnias (Chacobo, Mosetenes, Alteños, Tacana). Species retained have been screened against malaria, in vitro and on the animal. More than 200 different species have been evaluated, and only a weak percentage did show a strong correlation between uses and biological results.

These discrepancies can be explained by different considerations: Firstly, the difficulties related with the interpretation of the traditional use of plants, generally presented as useful for alleviate different symptoms, more or less related with a malarial attack. The criterion to select the plant has to be discussed. Also, different successive treatments are administered to the patient until he cures. Synergism effects could be responsible for the antimalarial activity and the method to study this type of effect has to be invented. Then, the traditional way of using medicinal plant (preparation, administration) cannot always be taken into account in the screening test performed in the laboratory. Therefore the in vivo inactivity of extracts may be correlated with the way of administration, having a strong perturbating effect on the absorption rate, delivery process, metabolisation process. The laboratory tests have difficulties to measure the part of acquired human immunity, etc... The validity and accuracy of the antimalarial screening test aimed to evidenciate antimalarial agents from plant extract will be discussed.
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Alliance des savoirs traditionnels et scientifiques en Amérique Centrale
Jean-Pierre Nicolas
Université de Lille, jardins du Monde, France


La démarche ethnopharmacologique permet de proposer à une population qui en a le droit, une thérapeutique appropriée et efficace.

La démarche pratiquée en Amérique Centrale dans le cadre d'une association bretonne " jardins du Monde " a pour objectif d'étudier les pharmacopées traditionnelles et de partager ses données scientifiques avec ses partenaires de différentes O.N.G., avec qui elle établit des stratégies d'intégration de la prise en charge des soins de santé primaires dans une démarche globale de développement durable (hygiène, alimentation, agriculture durable, santé animale, environnement). Elle met en place des structures pilotes de développement intégré (jardins, laboratoires et pharmacies communautaires). Le développement de ces jardins s'effectue dans un souci de production de ressources renouvelables et intégrées à un mode de développement agricole durable qui ne peut être dissocié de l'action apportée à la biodiversité. - Laboratoires de fabrication de médicaments simples Une partie de la production des jardins communautaires est transformée sur place dans des laboratoires. Des phytomédicaments sont élaborés en fonction de protocoles galéniques. - Développement de pharmacies communautaires Une partie de la production de plantes et de produits dérivés est mise à la disposition de la communauté par des agents de santé dans des pharmacies communautaires. Ces produits voisinent avec des médicaments essentiels. Cela laisse le choix de la thérapeutique aux agents de santé et aux patients et surtout permet de dégager une valeur ajoutée et de contribuer ainsi au revenu de l'agent de santé qui assure la gestion de la pharmacie communautaire.
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Médicaments à base de plantes dans le contexte réglementaire européen
Fernand Sauer
Agence européenne pour l'évaluation des médicaments (EMEA)


En Europe, l'utilisation des médicaments à base de plantes a progressivement changé au cours du siècle dernier, parallèlement aux progrès de la médecine et de la recherche pharmaceutique. Les autorités compétentes ne reconnaissent pas toujours pleinement les médicaments à base de plantes. Souvent, les études mentionnées dans la documentation bibliographique de référence ne sont pas présentées en termes acceptables pour la communauté scientifique. Et pourtant, ces produits constituent un héritage utile en thérapeutique et de nombreuses substances pharmacologiquement actives dérivent des plantes.

La complexité des préparations à base de drogues végétales explique les attitudes différentes dans l'évaluation de la qualité, de la sécurité et l'efficacité des plantes médicinales dans les Etats membres de l'Union Européenne. Ceci se reflète en particulier dans la mise en oeuvre de la dérogation introduite par la directive 65/65/EEC du Conseil qui fonde les principes de l'évaluation des médicaments. Très souvent, l'efficacité de ces préparations ne peut être attribuée à un seul ingrédient chimique. En outre, la préparation ou la collecte des matières premières et la fabrication des extraits doivent également être prises en compte.

Conscient du fait que la diversité des situations dans les Etats membres pourrait avoir des retombées négatives sur la santé publique et la circulation des produits au sein de l'Union Européenne, le Parlement Européen avait exigé la création d'un groupe de travail sur les médicaments à base de plantes auprès de l'Agence européenne de l'évaluation des médicaments (EMEA).

On pense quelquefois que l'EMEA devrait se concentrer sur les médicaments innovateurs et notamment ceux issus de la biotechnologie qui constituent sa responsabilité principale. Conformément à son objectif déclaré de contribuer à la protection et la promotion de la santé publique en Europe, l'Agence s'est efforcée de prévenir les conflits au sujet de la reconnaissance des autorisations nationales qui pourraient conduire à des arbitrages par le Comité des spécialités pharmaceutiques (CPMP). C'est pourquoi, l'EMEA avait établi dès 1997 un groupe de travail ad hoc sur les médicaments à base de plantes. Ce groupe est composé d'experts et de représentants des Etats membres, du Parlement européen, de la Commission, ainsi que d'observateurs de la Pharmacopée européenne basée à Strasbourg.

Le travail considérable accompli depuis 1997 a permis de suggérer de nouvelles orientations et exigences relatives à la qualité, la sécurité et l'efficacité des médicaments à base de plantes. En 1999, le Conseil d'administration de l'EMEA a souhaité donner un caractère permanent à ces activités en en faisant un groupe de travail ordinaire de l'EMEA, et a accueilli entre-temps de nouveaux observateurs des pays d'Europe centrale et orientale, ainsi que des experts de la Norvège et de l'Islande,

Des normes spécifiques de qualité figurent sur le site Internet de l'EMEA (http://www.eudra.org/emea. html). Elles seront ensuite intégrées dans la série intitulée "la réglementation des médicaments dans la Communauté Européenne" publiée par la Commission. D'autres documents d'orientation sont encore en cours d'examen et devraient, à l'avenir, réduire les incertitudes liées à la démonstration de l'efficacité des médicaments à base de plantes, garantissant ainsi un niveau élevé de protection des consommateurs.


Herbal medicinal products in the European regulatory framework
Fernand Sauer
The European Agency for the Evaluation of Medicinal Products


The use of herbal medicinal products in Europe has gradually changed during the last century with the advances made in medicine and the progress of pharmaceutical research. Not all competent authorities fully recognise products of herbal origin as medicinal products. Study methods mentioned in bibliographical references for herbal medicinal products are not always presented in terms accepted by the scientific community. However, these products constitute a valuable heritage in therapy and many pharmacologically active substances have originated from plants.

Variable practices in the assessment of quality, safety and efficacy of herbal medicinal products in the Member States of the European Union originate in the complexity of herbal drug preparations. This is reflected in particular in the application of the derogation provided for in Council Directive 65/65/EEC which lays down the basic principles of medicines evaluation. In most cases, the efficacy of preparations of herbal origin cannot be attributed to one single chemical constituent. The production or collection of the starting material and the manufacture of extracts need also to be assessed.

Concerns that the heterogeneity of the marketing of herbal medicinal products in the Member States could have a negative impact on public health and on the movement of goods within the European Union led the European Parliament to request the creation of a working group on herbal medicinal products at the European Agency for the Evaluation of Medicinal Products (EMEA).

It is sometimes assumed that the EMEA should only focus its activity on innovative and biotechnology products, which constitutes its core responsibilities. However, in keeping with its mission statement to contribute to the protection and promotion of public health in Europe, the Agency has endeavoured to prevent possible conflicts in the mutual recognition of national authorisations, which could be referred to the Committee for Proprietary Medicinal Products (CPMP) for arbitration. Therefore, the EMEA established an ad hoc working group on herbal medicinal products in 1997. The group is composed of experts and representatives of the Member States, of the European Parliament, the European Commission and observers from the European Pharmacopoeia based in Strasbourg.

The considerable work achieved since 1997 resulted in the preparation of new guidance and requirements in the field of quality, safety and efficacy of herbal medicinal products. In 1999 the EMEA Management Board supported continuation of the work in the form of a permanent EMEA working party and welcomed observers from Central and Eastern European countries as well as experts from Norway and Iceland,

Specific quality guidelines are disseminated through the EMEA website (http://www.eudra.org/emea. html). They will later be integrated in the relevant volumes of the "Rules governing medicinal products in the European Community" published by the Commission. Other guidance documents have not yet reached full agreement but should prove useful in reducing uncertainties associated with the demonstration of the efficacy of herbal medicinal products and guarantee a high level of consumer protection.
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Plantes médicinales traditionnelles : suppléments alimentaires et/ou médicaments
Robert Anton
Université Louis Pasteur, Strasbourg, France


Les médicaments à base de plantes font l'objet depuis quelques années d'une réglementation nationale et européenne qui leur assure des critères de qualité pharmaceutique, une sécurité d'emploi avec une garantie d'innocuité (absence d'effets secondaires) et ce dans le cadre d'une utilisation traditionnelle en Europe. Cette réglementation a eu l'immense avantage d'apurer une anarchie incontrôlée qui s'est installée peu à peu sur le plan de la santé publique, en évitant aussi le recours à des indications thérapeutiques qui auraient pu induire le patient en erreur.

Il en est cependant tout autrement sur le plan de la consommation dite " alimentaire ". Si pour certaines catégories de produits (glucides, lipides, protéines, enzymes, oligo-éléments, vitamines... ), des règles précises ont été élaborées par des groupes de travail, auxquelles se sont joints des avis du Conseil Supérieur d'Hygiène Publique de France, fondés en grande partie sur la valeur nutritionnelle et la sécurité d'emploi de ces produits, il n'en est pas de même pour toute une série de plantes issues de la phytothérapie qui occupent de plus en plus le marché français et européen sous des étiquettes aussi variées que : " nutraceutique, compléments ou suppléments alimentaires, alicaments, cosmetic foods... " Le plus souvent, des allégations fonctionnelles aux confins de la thérapeutique sont même évoquées et les formes pharmaceutiques les plus diverses (gélules, comprimés, ampoules... ) sont disponibles. Les exemples sont légion: Echinacea, Hypericum, Ginkgo, Serenoa, sans parler des huiles essentielles !

A notre connaissance, les critères d'autorisation de mise sur le marché pour ces produits ne sont pas très clairs : certes, une législation européenne globale évoque le cas du nouvel aliment (novel food) et un comité d'experts au Conseil de l'Europe vient d'être créé pour développer une réflexion. Ceci nous interpelle donc sur une série de problèmes : une législation française peut-elle être conçue dans ce domaine et comment l'approcher ? pourra-t-elle être respectée, dans la mesure où la libre circulation de tels produits existe en Europe ? Comment assurer une sécurité d'emploi parfaite et une transparence de l'information vis-à-vis du consommateur ? Quels critères de qualité devront être retenus ? quelles listes de plantes, de formes galéniques particulières peuvent-elles être autorisées, quelles posologies journalières peuvent-elles être acceptées, quelles associations éventuelles tolérées, quelles allégations fonctionnelles permises...

L'exposé d'un point de vue devrait permettre d'ouvrir un débat pour émettre des hypothèses harmonieuses et concrètes dans le cadre de la politique de sécurité alimentaire et des produits de santé.


Traditional medicinal plants: food supplement and/or drugs?
Robert Anton
Université de Strasbourg, France


For several years, medicines derived from plants traditionally used in Europe have been submitted to national and European regulations that meet requirements of pharmaceutical quality, safety of use and guarantee of innocuity (absence of side effects). The advantage of these regulations has been to avoid an anarchy that appeared progressively on the market, preventing also the use of therapeutical indications that could have misled the patient.

The problem is completely different as fat as nutriments are concerned. Of course, precise rules have been set up by working parties for some categories of products (carbohydrates, lipids, proteins, enzymes, oligo-elements, vitamins etc.). Opinions of the Council for Public Hygiene in France (CSHPF) have been requested, mainly based on the nutritional value and safety of use of these products. But the French and European markets are nowadays flooded by a set of plants arising from phytotherapy, under following labels: nutraceutics, food complements, supplementary diets, cosmetic foods.... Most often, functional allegations that are close to those used in therapeutics are mentioned as well as very diverse pharmaceutical forms: capsules, tables, ampoules ... Numerous examples can be given: Echinacea, Hypericum, Ginkgo, Serenoa, without speaking of essential oils

As far as we know, criteria for the marketing authorization of these products are not clear enough: European global regulations mention the case of novel foods and a committee of experts of the Council of Europe bas just been created in order to begin works in this field.

This leads us to raise some problems: How can a French legislation be conceived in this field? How will it be respected, because such products are freely sold in Europe? Which criteria of quality must be retained? Which plants can be authorized, which pharmaceutical forms, daily dosages, possible associations, functional allegations can be admitted?

The presentation of one point of view should lead to a discussion in order to suggest some solutions, which could be consistent with a policy of safety concerning foods and health products.
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Evaluation clinique : efficacité et sécurité des médicaments anti-inflammatoires
Sigrun Chrubasik
Institut für Rechtsmedizin, University of Freiburg, Germany


Selon le European Scientific Cooperative on Phytotherapy (ESCOP), l'utilisation d'extraits normalisés de Harpagophytum procumbens et de Salix est recommandée en traitement complémentaire de l'ostéoarthrite et des douleurs rhumatismales. Une dose quotidienne contient jusqu'à 9 g d'Harpagophytum pur/brut (qui contient lui-même au minimum 100 mg de principe d'harpagoside) et des préparations au Salix qui comprennent jusqu'à 240 mg de salicylate prodrug salicine.

Cinq études prospectives et une étude de confirmation révèlent un effet antalgique sur l'ostéoarthrite : une préparation à base d'Harpagophytum semble être aussi efficace que le faible AINS diaceméine. Quatre études prospectives et deux études de confirmation / contre-étude prouvent ou indiquent la tendance de l'extrait d'Harpagophytum à apaiser les douleurs de la région lombaire. On a établi un lien entre le résultat, à savoir la disparition de la douleur chez les patients, et la prise quotidienne d'harpagoside. 6% des patients ont souffert de troubles gastro-intestinaux bénins et ce, indépendamment du dosage. Par mesure de précaution, l'ESCOP recommande de ne pas administrer d'extrait d'H. à des patients souffrant d'ulcères gastriques ou d'ulcères du duodenum. Le rapport élevé entre avantages et risques fait de l'extrait d'Harpagophytum une alternative sûre dans le traitement de la douleur. Etant donné que la quantité d'harpagoside dans les préparations disponibles peut doubler, seules des préparations qui ont prouvé leur efficacité devraient être employées, Cinq études prospectives et deux études en double aveugle démontrent que l'extrait de Salix est un analgésique potentiel. Un extrait à 240 mg de saliciline s'est révélé supérieur à la moitié de cette dose et celles-ci étaient supérieures au placébo. Les études n'indiquaient pas de réactions spécifiques ou en lien avec la dose d'écorce de saule mises à part quelques réactions allergiques ponctuelles. En cas de sensibilité aux salicylés, il serait préférable d'éviter l'utilisation de préparations au salicis cortex. Aucune contre-indication n'est connue; pas de mise en garde ou de précaution particulières. On n'a pas fait état d'effet toxique en cas de surdosage. Contrairement à l'acetylsalicylate, l'agrégation plaquettaire n'est que légèrement affectée. Cependant, étant donné l'effet synergique sur la coagulation il conviendrait d'éviter l'administration concomitante d'extrait d'écorce de saule et d'agents antithrombotique. Le rapport élevé entre avantages et risques encourage l'utilisation d'extraits d'harpagophyti radix et de salicis cortex avant l'utilisation d'AINS non-sélectifs et en tant qu'alternative économique aux coûteux inhibiteurs sélectifs COX-2.


Clinical evaluation: efficacy and safety of phyto-antiinflammatory drugs
Sigrun Chrubasik
Institut für Rechtsmedizin, University of Freiburg, Germany


According to the European Scientific Cooperative on Phytotherapy (ESCOP) standardized extracts of Harpagophytum procumbens and Salix species are recommended as co-treatment for osteoarthritic and rheumatic pain. Their daily dosages include up to 9 g Harpagophytum crude drug (which contains a minimum of 100 mg of the co-active principle harpagoside) and Salix preparations that contain up to 240 mg of the salicylate prodrug salicin.

Five exploratory studies and one confirmatory study indicate a pain-relieving effect in osteoarthritis: a Harpagophytum preparation appeared to be as effective as the weak NSAID diacerhein. Four exploratory and two confirmatory studies give evidence or show a trend that low back pain is alleviated with H extract. The outcome in terms of pain-free patients was related to the daily consumption of harpagoside. Mild gastrointestinal disturbances occurred in about 6% of patients independent of the dosage. As a precaution the ESCOP recommends to exclude patients suffering from gastric/duodenal ulcers from receiving H extract. The high benefit-risk ratio of Harpagophytum extract makes it a safe alternative for treating pain. Since the quantity of harpagoside in available preparations may vary by 2 orders of magnitude only preparations that have proven efficacy should be employed. Five exploratory studies and two double-blind studies give evidence that extract of Salix species is a potent analgesic. Extract with 240 mg salicin was superior to, half that dose and both were superior to placebo. The studies did not indicate specific and dose-related willow bark adverse events except the occasional occurrence of allergic reactions. In cases of sensitivity to salicylates, the use of salicis cortex preparations should be avoided. Contraindications are not known. Special warnings and special precautions are none required and toxic effects in overdose cases have not been reported. In contrast to acetylsalicylate, platelet aggregation is only minimally affected. However, due to the synergistic effect on blood clotting, concomitant administration of willow bark extract with antithrombotic agents should be avoided. The high benefit-risk ratio suggests using harpagophyti radix and salicis cortex extracts before the use of non-selective NSAIDs and as an economic alternative to the expensive selective COX-2 inhibitors.
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Conception d'un médicament antimalarique à base de plantes utilisées en médecine traditionnelle
Guy Balansard
Faculté de Pharmacie, Université de Marseille, France


La méthodologie adoptée a pour objet de valider des remèdes utilisés en médecine traditionnelle et de valoriser des plantes pouvant faire l'objet d'un développement.

Elle comporte trois phases :

* Enquêtes ethnobotaniques qui sont dans un premier temps généralistes et dans un deuxième temps ciblées sur la plante sélectionnée.

* Etudes phytochimiques, pharmacologiques et toxicologiques.

* Développement d'un médicament, suivant le modèle des autorisations de mise sur le marché des médicaments à base de plantes (Cahier de l'Agence n° 3) comportant un dossier pharmaceutique, une étude toxicologique à court terme et, après acceptation par un comité d'éthique, une étude clinique.


Designing an anti-malaria medicine On the basis of traditional knowledge on plants
Guy Balansard
Faculté de Pharmacie, Université de Marseille, France


The aim of the selected methodology is to validate remedies used in traditional medicine and to, make plants that may be developed more attractive.

The methodology consists of three steps

* Ethnobotanic studies which are made first on a general level, and then specialize in the selected plant

* Phytochemical, pharmacological and toxicological studies

* To design a drug according to the pattern of commercial exploitation licenses for plant-based medical products (Cahier n° 3 of the Agence Française de Sécurité Sanitaire des Produits de Santé), which consists of a pharmaceutical dossier, a short-term toxicological study and, after acceptance by an ethics committee, a clinical study.
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From phytotherapy to recombinatorial biochemistry: drugs of the future
Robert Verpoorte
Division of Pharmacognosy, Leiden/Amsterdam Center for drug Research


Since ancient times mankind has exploited nature for all kind of useful products and enjoyed the colours, flavours, and fragrances of flowers, food etc. Presently, many fine chemicals are derived from plants and used as medicaments, dyes, flavours, fragances, insecticides, etc. Originally most drugs were derived from plants, however, after the first successful introduction of synthetic drugs such as aspirin about 100 years ago, gradually synthesis became the most important source for drug development. Only in case of antibiotics and antitumor compounds, nature remained a major source for drug development. Major reason was the difficulties in finding the active compounds in crude extracts, assays using whole animals or isolated organs for testing activity are not suited for rapid bioassay guided fractionation of extracts. The methods for the antibiotic and antitumor activity on the other hand where more suitable for this purpose, explaining the success of natural products in these fields. In the past years, however, with the development of assays on the level of molecules (receptor binding and enzyme inhibition) a complete new perspective for natural products as the source for new leads bas evolued. High through put screens now allow the testing of thousands of samples per day. In combination with rapid and efficient separation methods and powerful spectrometric methods for identification and structure elucidation, active compounds from extracts from plants or any natural source can rapidly be identified. To fully exploit these new possibilities prefractionation of extracts and HPLC- on line bioassays are important tools to open up the full potential of nature. It offers the possibility to also find minor compounds and find new active components in the presence of known compounds.

At the same time are the developments in biotechnology important in this connection. Plant cell biotechnology offers the possibility to produce compounds of rare plants. Moreover, metabolic engineering can be used for improving productivity in plant and plant cell cultures, and even result in the production of complete new compounds (recombinatorial biochemistry). Using the biochemical capacities of plants or microorganisms, bioconversions as part of synthetic approaches to complex molecules are a further important aspect of modern biotechnology. These new perspectives has resulted in a rapidly expanding interest in natural products research, further supported by the developing awareness that in our food many secondary metabolites are present that play an important role in preventing diseases (e.g. cholesterol lowering, antioxidants). Food industry is thus now putting a large effort in studies of the secondary metabolites involved, eventually resulting in improved quality of our food, including the development of functional foods and nutraceuticals.


De la phytothérapie à la biochimie recombinante : les médicaments du futur
Robert Verpoorte
Département de pharmacognosie, Leiden/Amsterdam Center for drug Research


Depuis l'Antiquité, l'homme a exploité les ressources naturelles pour toutes sortes de produits utiles et a profité des couleurs, des goûts et des fragrances des fleurs, des aliments etc. A l'heure actuelle, un grand nombre de substances chimiques fines sont dérivées de plantes et utilisées comme médicaments, colorants, saveurs, fragrances, insecticides etc. A l'origine, la plupart des médicaments dérivaient de plantes; cependant, après la première introduction réussie de médicaments de synthèse tels que l'aspirine il y a près de 100 ans, la synthèse est devenue petit à petit la source la plus importante de développement des médicaments. La nature n'est restée une source majeure de développement de médicaments que dans le domaine des antibiotiques et des composés anti-tumoraux. La raison principale en a été la difficulté de découvrir les composés actifs dans les extraits bruts/purs; des essais utilisant des animaux entiers ou des organes isolés pour procéder à des tests ne sont pas adéquats pour le fractionnement rapide d'extraits sur la base d'essais biologiques. D'un autre côté, les méthodes utilisées dans la recherche sur les antibiotiques et l'activité anti-tumorale étaient mieux adaptées, ce qui explique le succès des produits naturels dans ces domaines. Cependant, au cours des dernières années, avec le développement des essais au niveau moléculaire (binding sur récepteur et inhibition enzymatique), les produits naturels ont vu s'ouvrir des perspectives de recherche entièrement nouvelles. Des tris à haut débit permettent aujourd'hui d'analyser des milliers d'échantillons par jour. La combinaison de méthodes de séparation rapides et efficaces et de méthodes spectrométriques performantes pour l'identification et l'élucidation des structures permet d'identifier rapidement des composés actifs d'extraits de plantes. Afin d'exploiter au maximum ces possibilités nouvelles, le pré-fractionnement d'extraits ainsi que les essais biologiques CLHP en ligne sont des instruments importants dans la découverte de tout le potentiel que recèle la nature. Il est ainsi possible de découvrir des composés secondaires et de nouveaux composés actifs en présence de composés connus.

Dans le même temps, les développements biotechnologiques dans ce domaine sont importants, La biotechnologie cellulaire chez les plantes permet de produire des composés de plantes rares. De plus, les recherches en métabolisme peuvent permettre d'augmenter la productivité des plantes et des cultures cellulaires de plantes, et peut même résulter dans la production de composés complètement nouveaux (biochimie recombinante). L'utilisation des possibilités biochimiques des plantes et des microorganismes permet des conversions biologiques dans le cadre des phénomènes de synthèse des molécules complexes, ce qui constitue un autre aspect important de la biotechnologie moderne. Ces nouvelles perspectives ont provoqué un intérêt qui s'est rapidement accru pour la recherche sur les produits naturels. Cet intérêt s'explique aussi par la prise de conscience qu'un nombre important de métabolites secondaires qui jouent un rôle important dans la prévention de maladies (p.ex. la baisse de cholestérol ou les antioxydants) sont présents dans notre alimentation. Ainsi, l'industrie agroalimentaire investit beaucoup dans des études sur les métabolites secondaires concernés, ce qui augmente finalement la qualité de notre alimentation, dont le développement de nourriture fonctionnelle et les nutraceutiques.
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Le développement des médicaments à base de plantes dans l'Union Européenne
Jean-Pierre Reynier
Vice-président de la Commission A.M.M., France


Un des buts que doit se fixer l'Europe pour les deux prochaines années est de définir les règles d'enregistrement des médicaments à base de plantes.

Ceux-ci doivent présenter des garanties concernant leur qualité pharmaceutique, leur sécurité d'emploi sur la base des données disponibles de toxicologie et de pharmacovigilance en y ajoutant les essais appropriés.

L'efficacité et les indications de ces produits doivent être en relation avec la qualité des études apportées, l'usage traditionnel doit être établi en Europe.

Une liste de plantes autorisées dans l'usage traditionnel pourrait être réalisée.

L'absence d'une politique claire peut faire courir des risques à la Santé Publique, alors qu'il existe certainement une place pour ces médicaments dans l'arsenal thérapeutique du médecin.


Development of plant-based medical products within the European Union
Jean-Pierre Reynier
Vice-président de la Commission A.M.M., France


One of Europe's goals within the next two years is to define registration regulations for plant-based medical products.

These products must guarantee pharmaceutical quality and sale use on the basis of the available data for toxicology and pharmacology vigilance, in addition to appropriate tests.

Efficiency and indications concerning these products must meet the criteria in terms of quality of the studies carried out and traditional use must become common practice in Europe.

Plants authorised in traditional use could be listed.

The absence of a clear policy may be a danger for Public Health while there is surely a place for these medical products within the general practitioner's therapeutical paraphernalia.
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Le Groupe Franco-Chinois sur les plantes
Antoine Sawaya
Chef du Département de l'Evaluation de la Qualité Pharmaceutique des Médicaments, AFSSAPS


Un groupe franco-chinois sur les plantes a été créé lors du séminaire sur l'enregistrement des médicaments en France et en Chine qui s'est déroulé à Pékin du 6 au 8 décembre 1999.

L'objectif de ce groupe est d'établir une liste de plantes médicinales issues de la pharmacopée traditionnelle chinoise qui pourrait être proposée à l'Agence Française de Sécurité Sanitaire des Produits de Santé en vue d'une éventuelle

inscription à la Pharmacopée Française et sur la liste des plantes figurant dans le cahier de l'Agence.

Les plantes qui seront proposées doivent satisfaire aux critères de qualité et d'innocuité exigés pour les médicaments à base de plantes en France. Un usage traditionnel doit être reconnu.

Ce groupe, présidé pour la partie française par le Professeur Reynier, est composé d'experts pharmacognostes, galenistes, toxicologues et cliniciens.

Le groupe franco-chinois se réunira officiellement 2 fois par an. Pour 2000, la première réunion aura lieu les 15 et 16 mai à Metz, la deuxième vers octobre-novembre à Pékin.

Les conclusions de ces réunions seront discutées au groupe de travail sur les médicaments à base de plantes de l'Agence Française de Sécurité Sanitaire des Produits de Santé, puis présentées à la Commission d'Autorisation de Mise sur le Marché des Médicaments, pour avis.


The Franco Chinese group on plants
Antoine Sawaya
Chef du Département de l'Evaluation de la Qualité Pharmaceutique des Médicaments, AFSSAPS


A Franco-Chinese group on plants was created at the seminar on drug registration in France and China, which took place in Beijing from 6 December until 8 December 1999.

The group aims at establishing a list of medicinal plants used in traditional. Chinese pharmacopoeia. This list could be proposed to the Agence Française de Sécurité Sanitaire des Produits de Santé so that these products could be registered in French pharmacopoeia and in the list of plants registered in the Agency’s cahier.

The proposed plants will have to meet the quality and innocuousness requirements for plant-based medical products in France, A traditional use must also be acknowledged.

This group, the chairman of which is Professor REYNIER, consists of specialists in the fields of pharmacognosy, galenical pharmacy, toxicology and clinical workers.

The Franco-Chinese group will meet officially twice a year. In 2000 the first meeting will take place on 15 and 16 Mai in Metz; the second will be organised in October or November in Beijing.

The outcome of these meetings will be discussed within the working group on plant-based medical products of the Agence Française de Sécurité Sanitaire des Produits de Santé and will then be presented to the committee in charge of commercial exploitation licenses for medical products, to collect its opinion.
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