The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (NIH) has announced the funding of 3 new Centers of Excellence and 2 International Centers for the study of traditional herbal medicines and other forms of complementary and alternative medicine (CAM).
Both traditional African and Chinese herbal medicines, particularly traditional herbal combinations, will be included in the research being funded in the new centers. Other modalities include acupuncture and a type of energy medicine (millimeter wave therapy).
According to an NCCAM press release dated October 14, 2005, with these new awards "NCCAM continues to enhance CAM research capacity by funding centers at leading US institutions and by establishing new global partnerships."1
Stephen E. Straus, MD, NCCAM director, stated, "We are excited by the addition of these centers to our research program and the unique collaborations and approaches they bring to studies of CAM practices. All 5 centers will strengthen our research portfolio for major health problemsÑHIV/AIDS, arthritis, asthma, and pain. Plus, the new international centers will conduct basic and clinical studies of promising CAM interventions drawn from traditional medicine indigenous to the locations of international partners."1
According to Chris Thomsen, NCCAM's director of communications, the funding of these new centers also reflects the recent implementation of NCCAM's 2005-2009 Strategic Plan, "Expanding Horizons of Health Care" (e-mail, October 16, 2005). The largest set of goals and objectives in the new plan (available online at www.nccam.nih.gov/about/plans/2005/) regards the organization's investment in research.2 "These centers and their activities will directly address our goals for international health research," Thomsen wrote. International Health Research is one of 8 areas of research explained in the strategic plan. Other key areas of the strategic plan include training CAM investigators, expanding outreach, and advancing the organization.
US Centers of Excellence for Research on CAM
The 3 new Centers of Excellence provide 5 years of financial support for experienced researchers at some of the leading universities in the United States. NCCAM states that these researchers apply "cutting-edge technologies" to identify the potential benefits and underlying mechanisms of CAM practices. The 3 new centers are described below.
1. Center for Arthritis and Traditional Chinese Medicine
First-year funding: $1,197,651 Principal Investigator: Brian Berman, MD Institution: University of Maryland, Baltimore, MD
This center will study traditional Chinese medicine (TCM) approaches (i.e., acupuncture and herbs) for the treatment of arthritis. Researchers will conduct a clinical trial of the 11-herb Chinese formula Huo-Luo-Xiao-Ling Dan (known as HLXL) for osteoarthritis of the knee, as well as assess acupuncture's effect on inflammatory pain in an animal model, and study the efficacy of HLXL in an animal model of autoimmune arthritis. The herbal components of HLXL are shown in Table 1. HLXL was developed by David Lee, PhD, of Harvard University as a modified version of another TCM formula, used primarily to treat Bi Syndrome (a syndrome that overlaps with the Western diagnosis of arthritis and inflammation) (M. Bahr-Robertson e-mail to C. Cavaliere, December 14, 2005).
|Table 1: Chinese Herbs in the HLXL Formula (Huo-Luo-Xiao-Ling Dan)|
|Chinese (Pinyin) Name||Latin Name & Authority*||Family|
|Ruxiang||Boswellia carterii Birdw.||Burseraceae|
|Qianghuo||Notopterygium incisum Ting ex H.T. Chang||Apiaceae|
|Danggui||Angelica sinensis (Oliv.) Diels.||Apiaceae|
|Baishao||Paeonia lactiflora Pall.||Paeoniaceae|
|Gancao||Glycyrrhiza uralensis Fisch.||Fabaceae|
|Yanhusuo||Corydalis yanhusuo W.T. Wang||Papaveraceae|
|Danshen||Salvia miltiorrhiza Bge.||Lamiaceae|
|Chuanxiong||Ligusticum chuanxiong S.H. Qiu||Apiaceae|
|Qinjiao||Gentiana macrophylla Pall.||Gentianaceae|
|Guizhi||Cinnamomum cassia Presl.||Lauraceae|
|Duhuo||Angelica pubescens Maxim.||Apiaceae|
|* The Latin name for Chinese herbs is sometimes based on the presumed genus and species used. It is a frequent practice in traditional Chinese medicine to substitute another herb for one that is commonly used, the substitute herb having the same "energetic properties" as the herb for which it is being substituted.|
2. Center for Chinese Herbal Therapy
First-year funding: $1,144,274 Principal Investigator: Xiu-Min Li, MD Institution: Mount Sinai School of Medicine, New York, NY
Center researchers will investigate a 3-herb Chinese formula, known as antiasthma herbal medicine intervention (ASHMI), as a therapy for allergic asthma. The herbs that comprise ASHMI are shown in Table 2. The formula recently demonstrated efficacy in treating asthma in a double-blind, placebo-controlled clinical trial.3 Unlike many traditional Chinese herbal formulations designed for treating symptoms associated with asthma, ASHMI does not contain ephedra (ma huang, Ephedra sinica' Stapf., Ephedraceae), a well-known and controversial source of ephedrine, which has been associated with adverse effects on the cardiovascular and central nervous system when used in various dietary supplements used for enhanced athletic performance and weight loss. However, there are few, if any, adverse reports on the safety of ma huang when it is used in traditional Chinese herbal formulations used for respiratory/pulmonary complaints. All 3 herbs in ASHMI have a long history of use in China, and a body of clinical evidence testifies to their use and safety in traditional herbal medicine. Studies of the herbal formula at the Center for Chinese Herbal Therapy will look at mechanism of action in an animal model, characterize the herbs' active components, and investigate the formula's use in asthma patients.
|Table 2: Chinese Herbs in the Antiasthma Herbal Medicine Intervention (ASHMI) Formula|
|Chinese (Pinyin) Name||Latin Name & Authority||Family|
|Ling-zhi||Ganoderma lucidum (Curtiss:Fr) P. Karst||Ganodermataceae|
|Ku-shen||Sophora flavescens Aiton||Fabaceae|
|Gancao||Glycyrrhiza uralensis Fisch ex. DC.||Fabaceae|
3. Center for Mechanisms Underlying Millimeter Wave Therapy
First-year funding: $1,025,895 Principal Investigator: Marvin Ziskin, MD Institution: Temple University School of Medicine, Philadelphia, PA
This center will study the mechanisms of action of millimeter wave therapy (use of low-intensity millimeter wavelength electromagnetic waves) for a variety of diseases and conditions, as well as look at the therapy's use in animal models of chronic neuropathic pain and pruritis (itching).
International Centers for Research on CAM
The 2 International Centers for Research on CAM are the outgrowth of planning grants awarded by NCCAM to 11 international teams in 2003. Each of these teams was given 2 years to develop a research collaboration and infrastructure that could compete for 4-year centers grants. The recipients of these international centers grants will now conduct research on CAM and traditional medicine practices in countries where the specific practices are indigenous. These partnerships between researchers in the United States and foreign institutions will address whether the traditional practices can aid in health care locally and globally and build CAM research capacity internationally. Co-funders for these centers include NIH's Office of Dietary Supplements, Office of AIDS Research, and Fogarty International Center (the International division of NIH).
The 2 NCCAM recipients are described below.
1. Functional Bowel Disorders in Chinese Medicine
First-year funding: $807,253 Principal Investigator: Brian Berman, MD Partner Institutions: University of Maryland, Baltimore, MD; Chinese University of Hong Kong, China; University of Illinois, Chicago, IL; University of Western Sydney, Sydney, Australia
This center will conduct multidisciplinary research on TCM practices (acupuncture and herbal medicine) for the treatment of irritable bowel syndrome (IBS). Researchers will study effects of acupuncture and a 20-herb TCM preparation in an animal model of IBS and conduct a preliminary study of the herbal preparation with IBS patients. The herbal formula was developed by Alan Bensoussan, PhD, of the University of Western Sydney. A clinical trial in 1998 based on this formula resulted in positive outcomes in patients with IBS.4 The formula's contents are shown in Table 3.
|Table 3: Chinese Herbs in Formula for Treatment of IBS*|
|Chinese (Pinyin) Name||Latin Name & Authority||Family|
|Dangshen||Codonopsis pilosula (Franch.) Nannf.||Campanulaceae|
|Huoxiang||Agastache rugosa (Fisch. & C.A. Mey.) KuntzePogostemon cablin (Blanco) Benth.‡||Lamiaceae Lamiaceae|
|Fangfeng||Ledebouriella seseloides (Hoffm.) H. Wolff.||Apiaceae|
|Yiyiren||Coix lacryma-jobi L.||Poaceae|
|Chaihu||Bupleurum chinense DC.||Apiaceae|
|Yinchen||Artemisia capillaris Thunb.||Asteraceae|
|Baizhu||Atractylodes macrocephala Koidz.||Asteraceae|
|Houpo||Magnolia officinalis Rehder & E.H. Wilson||Magnoliaceae|
|Chenpi||Citrus reticulata Blanco||Rutaceae|
|Paojiang||Zingiber officinale Roscoe||Zingiberaceae|
|Qinpi||Fraxinus chinensis Roxb.||Oleaceae|
|Fuling||Poria cocos F.A. Wolf||Polyporaceae|
|Baizhi||Angelica dahurica (Fisch. Ex Hoffm.) Benth. & Hook. F. ex Franch. & Sav.||Apiaceae|
|Cheqian zi||Plantago asiatica L.||Plantaginaceae|
|Huangbai||Phellodendron spp. Rupr.||Rutaceae|
|Zhigancao||Glycyrrhiza uralensis Fisch. Ex DC.||Fabaceae|
|Baishao||Paeonia lactiflora Pall.||Paeoniaceae|
|Muxiang||Saussurea spp. DC.||Asteraceae|
|Huanglian||Coptis chinensis Franch.||Ranunculaceae|
|Wuweizi||Schisandra chinensis Michaux||Schisandraceae|
|* The list of herbs in this formulation is based on those used in a formula tested in a clinical trial for IBS.4 The Latin name for Chinese herbs is sometimes based on the presumed genus and species used. It is a frequent practice in traditional Chinese medicine to substitute another herb for one that is commonly used, the substitute herb having the same "energetic properties" as the herb for which it is being substituted. |
‡ The Chinese herb huo xiang has often been noted as being derived from the genus Agastache; however, recently it has also been derived from the genus Pogostemon (S. Dharmananda e-mail to C. Cavaliere, March 16, 2006).
2. The International Center for Indigenous Phytotherapy Studies: HIV/AIDS, Secondary Infections and Immune Modulation
First-year funding: $1,100,000 Principal Investigator: William Folk, PhD Partner Institutions: University of Missouri, Columbia, MO; University of the Western Cape, Bellville, Republic of South Africa; along with University of KwaZulu-Natal, University of Cape Town, and the South African Medical Research Council
This center will study the safety and efficacy of traditional African plant-based therapies already in wide-spread use for HIV/AIDS and some of its secondary infections. Researchers will conduct a small clinical trial using sutherlandia (Sutherlandia frutescens', syn. Lessertia frutescens (L.) Goldblatt & J.C. Manning, Fabaceae) leaf in adults with HIV and conduct preclinical and clinical research with African wormwood (Artemisia afra' Jacq. ex. Willd., Asteraceae) aerial parts, which are used by traditional healers for treatment of many conditions seen in people with HIV/AIDS.
In addition, the National Cancer Institute (NCI) will fund a third international center:
International Center of Traditional Chinese Medicine for Cancer Principal Investigator: Lorenzo Cohen, PhD Partner Institutions: M.D. Anderson Cancer Center, Houston, TX; Fudan University Cancer Hospital, Shanghai, China
This center will conduct preclinical and clinical studies of 3 TCM approaches (herbs, acupuncture, and qi gong) for treating cancer and its symptoms, as well as treatment-related side effects. "The collaboration we have with Fudan University Cancer Hospital is mutually advantageous [and] ultimately we believe that together we can make an impact on cancer patients worldwide," said Lorenzo Cohen, PhD, principal investigator of the center and director of the Integrative Medicine Program at M.D. Anderson. "Traditional Chinese medicine has a remarkable history and by applying western research standards to traditional Chinese medicine, we can better understand possible new applications. Likewise, our collaborators in China are learning a great deal about the structure and design of clinical trials, new diagnostic imaging technology, population studies, and prognostic markers."5
—Mark Blumenthal and Courtney Cavaliere
1. NCCAM Expands Research Centers Program with Three Centers of Excellence and Two International Centers [press release]. National Centers for Complementary and Alternative Medicine, October 14, 2005. Available at: http://nccam.nih.gov/news/2005/101405.htm. Accessed October 23, 2005.
2. Expanding Horizons of Health Care: Strategic Plan 2005-2009. National Centers for Complementary and Alternative Medicine. Available at http://www.nccam.nih.gov/about/plans/2005/. Accessed October 31, 2005.
3. Wen M, Wei C, Hu, Z, Srivastava K, Ko J, Xi S, Mu D, Du J, Li G, Wallenstein S, Sampson H, Kattan M, Li X. Efficacy and tolerability of antiasthma herbal medicine intervention in adult patients with moderate-severe allergic asthma. J Allergy Clin Immunol'. 2005;116:3:517-524.
4. Bensoussan A, Talley N, Hing M, Menzies R, Guo A, Ngu M. Treatment of irritable bowel syndrome with Chinese herbal medicine. J Amer Med Assn'. 1998; 280(18):1585-1589.
5. M.D. Anderson and Shanghai Hospital awarded NCI grant to study traditional Chinese medicine in cancer cure [press release]. Houston, TX: MD Anderson Cancer Center, November 21, 2005.