{"id":49209,"date":"2020-12-11T14:34:13","date_gmt":"2020-12-11T13:34:13","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=49209"},"modified":"2020-12-18T17:22:24","modified_gmt":"2020-12-18T16:22:24","slug":"jeffrey-aronson-when-i-use-a-word-massage-and-malaria","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2020\/12\/11\/jeffrey-aronson-when-i-use-a-word-massage-and-malaria\/","title":{"rendered":"Jeffrey Aronson: When I Use a Word . . . Massage and malaria"},"content":{"rendered":"

Three words reflecting two types of Chinese therapies can be found among the biomedical words first cited from 1979 in the <\/span>Oxford English Dictionary<\/span><\/i> (<\/span>OED<\/span><\/i>) (Table 1)\u2014tui na, a form of massage, and qinghaosu and artemisinin, used in malaria.<\/span><\/p>\n

Table 1.<\/b> Biomedical words (n=38) in the <\/span>OED<\/span><\/i> for which the earliest citations are from 1978 (out of a total of 228); I have found five antedatings, from 2 to 84 years<\/span><\/p>\n

\"\"<\/p>\n

*Antedatings: ecotoxicity (<\/span>1978<\/span><\/a>), transposase (<\/span>1978<\/span><\/a>), lentivirus (<\/span>1977<\/span><\/a>), parvoviral (<\/span>1977<\/span><\/a>), tui na [t\u2018ui na] (<\/span>1895<\/span><\/a>)<\/span><\/p>\n

Tui na, from two Chinese words meaning to pull and grasp, is a type of therapeutic massage, a sort of mixture of acupressure and qigong. The 1979 citation in the <\/span>OED<\/span><\/i>, from the <\/span>Chicago Tribune<\/span><\/i>, informs us that \u201cTui-Na is very hard to learn and very hard to teach\u201d. But the technique is an ancient one, and it is not surprising that it was mentioned, along with other forms of Chinese massage, in the <\/span>British Medical Journal<\/span><\/i> in 1895 (Figure 1).<\/span><\/p>\n

Figure 1.<\/b> A description of tui na [t\u2018ui na] in the <\/span>British Medical Journal<\/span><\/i> for 26 October 1895<\/span><\/p>\n

\"\"<\/p>\n

In modern times, tui na has been trialled in a wide range of conditions. The results of some of these are summarized in Table 2. Investigators have generally reported no adverse effects, but in one patient with ankylosing spondylitis tui na <\/span>resulted<\/span><\/a> in bilateral fracture dislocation and fatal tetraplegia, so it is probably best avoided when there is pre-existing spinal damage.<\/span><\/p>\n

Table 2.<\/b> The results of trials of tui na in various conditions, reported in publications listed in PubMed<\/span><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
Condition<\/strong><\/td>\nType of study<\/strong><\/td>\nResult<\/strong><\/td>\nReferences<\/strong><\/td>\n<\/tr>\n
Parkinson\u2019s disease<\/td>\nOpen pilot study combining tui na, acupuncture, and qigong (n=25)<\/td>\nWorse motor scores; improved quality of life and less depression<\/td>\n2006<\/span><\/a><\/td>\n<\/tr>\n
Fibromyalgia<\/span><\/td>\nRelaxing yoga plus touch with tui na (n=16) versus relaxing yoga (n=17)<\/span><\/td>\nSome short term benefit<\/span><\/td>\n2007<\/span><\/a><\/td>\n<\/tr>\n
Dysmenorrhoea<\/span><\/td>\nAcupuncture (n=30) versus acupuncture plus tui na (n=30) for 3 months with follow-up for 3 cycles<\/span><\/td>\nImprovement in 73% versus 93%<\/span><\/td>\n2008<\/span><\/a><\/td>\n<\/tr>\n
Childhood anorexia<\/span><\/td>\nMeta-analysis of three RCTs (n=332)<\/span><\/td>\n“Larger randomized, controlled trials are required”<\/span><\/td>\n2014<\/span><\/a><\/td>\n<\/tr>\n
Knee osteoarthritis<\/span><\/td>\nObservational study n=30<\/span><\/td>\nLess pain; greater flexor power in the right knee and extensor power in the right knee; range of movement unchanged<\/span><\/td>\n2016<\/span><\/a><\/td>\n<\/tr>\n
Post-stroke spasticity<\/span><\/td>\nProspective multicenter blinded randomized placebo-controlled trial (n=90)<\/span><\/td>\nLess spasticity in four muscle groups (Modified Ashworth Scale); no effect on Fugl-Meyer Assessment<\/span><\/td>\n2017<\/span><\/a><\/td>\n<\/tr>\n
Low back pain<\/span><\/td>\nRandomized, unblended, controlled trial feasibility study of acupuncture and tui na alone and together (n=101)<\/span><\/td>\nSome improvement in self-rated pain, but mostly non-significant changes (depending on the statistical tests used)<\/span><\/td>\n2017<\/span><\/a><\/td>\n<\/tr>\n
Cervical radiculopathy<\/span><\/td>\nMeta-analysis of five studies (n=448)<\/span><\/td>\nReduced pain; low quality evidence<\/span><\/td>\n2017<\/span><\/a><\/td>\n<\/tr>\n
Obstructive sleep apnea\/hypopnea syndrome<\/span><\/td>\nSingle-blind, randomized trial (n=20)<\/span><\/td>\nSmall improvements (P=0.049, paired t-test)<\/span><\/td>\n2017<\/span><\/a><\/td>\n<\/tr>\n
Chronic fatigue syndrome<\/span><\/td>\nRandomized, single-blind, comparison with acupuncture (n=77)<\/span><\/td>\nSmall improvements<\/td>\n2017<\/span><\/a><\/td>\n<\/tr>\n
Acute diarrhoea in children<\/span><\/td>\nMeta-analysis of 26 studies (n=2644)<\/span><\/td>\nSmall improvement compared with pharmacotherapy; low quality evidence<\/span><\/td>\n2018<\/span><\/a><\/td>\n<\/tr>\n
Acute diarrhoea in children<\/span><\/td>\nMeta-analysis of 26 studies (n=2410)<\/span><\/td>\nSmall improvement compared with pharmacotherapy; low quality evidence<\/span><\/td>\n2018<\/span><\/a><\/td>\n<\/tr>\n
Upper limb spasticity after stroke<\/span><\/td>\nMulticenter, single-blind, randomized comparison with conventional treatment (n=444)<\/span><\/td>\nImprovement in three muscle groups in those treated within three months, but not later<\/span><\/td>\n2019<\/span><\/a><\/td>\n<\/tr>\n
Insomnia<\/span><\/td>\nMeta-analysis of 22 RCTs (n=1999)<\/span><\/td>\n\u201cmore high quality RCTs and well-designed protocols \u2026 are needed\u201d<\/span><\/td>\n2019<\/span><\/a><\/td>\n<\/tr>\n
Parkinson\u2019s disease<\/td>\nSystematic review of 12 studies<\/span><\/td>\n\u201cLongitudinal studies are needed to justify the introduction of massage therapy into clinical practice.\u201d<\/span><\/td>\n2020<\/span><\/a><\/td>\n<\/tr>\n
Mammary gland hyperplasia<\/span><\/td>\nRetrospective comparison with Chinese medicines (n=68)<\/span><\/td>\nImprovement in 94% versus 77%; recurrence rates 13% and 23%<\/span><\/td>\n2020<\/span><\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Qinghaosu and artemisinin, which are therapeutically more impressive, featured in the 2015 <\/span>Nobel Prize in Physiology or Medicine<\/span><\/a>, which was awarded for two novel therapies for infections. William C Campbell and Satoshi \u014cmura were honoured \u201cfor their discoveries concerning a novel therapy against infections caused by roundworm parasites\u201d. The novel therapy was avermectin. The drug we now call ivermectin is a mixture of avermectin H2B1a and avermectin H2B1b. Ivermectin is effective in the treatment of a range of parasitic conditions such as onchocerciasis, strongyloidiasis, and lymphatic filariasis. It has also been touted as a treatment for covid-19, but mechanistically, both <\/span>pharmacokinetically<\/span><\/a> and <\/span>pharmacodynamically<\/span><\/a>, it is an unlikely candidate, and randomized controlled trials have either been <\/span>retracted<\/span><\/a> or are small and inconclusive, with variations from the published protocols.<\/span><\/p>\n

The other winner of the 2015 Nobel prize was the Chinese scientist Tu Youyou, who rediscovered a remedy for fevers, and specifically malaria, first described by the physician Ge Hong (284\u2013363). In his treatise <\/span>Emergency Prescriptions Kept up One\u2019s Sleeve<\/span><\/i> we find a recipe for preparing a drug from <\/span>qinghao<\/span><\/a>, the blue-green herb (Figure 2). Qinghao is the Chinese name for the plant we call <\/span>Artemisia annua<\/span><\/i>. The suffix \u2013su means an active ingredient. So qinghaosu is an active ingredient extracted from the plant. Ge Hong had soaked the leaves of the plant in cold water and then wrung out the sap. Heat would have destroyed the labile active ingredients, which are cyclic endoperoxides, and the wringing out process is thought to have created an emulsion in which they were stable. Tu Youyou took note of Ge Hong\u2019s method and isolated the active ingredient, now called artemisinin.<\/span><\/p>\n

Figure 2.<\/b> Ge Hong (284-363) and an extract from <\/span>Emergency Prescriptions Kept up One\u2019s Sleeve<\/span><\/i> in Chapter 3, Section 16, \u201cPrescriptions for treating intermittent hot and cold conditions and all kinds of intermittent fevers\u201d: \u201cAnother recipe: take one bunch of qinghao, add two sheng of water, soak it, wring it out, take all of the juice, and ingest it\u201d<\/span><\/p>\n

\"\"<\/p>\n

The <\/span>Artemisia<\/span><\/i> genus includes several variants, such as <\/span>Artemisia absinthium<\/span><\/i>, which we call common wormwood, <\/span>A. gallica <\/span><\/i>(French wormwood), <\/span>A. pontica<\/span><\/i> (Roman wormwood), <\/span>A. maritima<\/span><\/i> (sea wormwood), and <\/span>A. arborescens<\/span><\/i> (tree wormwood). <\/span>Artemisia<\/span><\/i> is named after the Greek goddess Artemis, perhaps because it was used for obstetric or gynaecological purposes, with which she was associated, having supposedly helped her mother deliver her twin brother Apollo immediately after she herself was born. The origin of Artemis’s name is not known. If it was Greek, which it may not have been, it may have come from the word for a butcher, \u1f04\u03c1\u03c4\u1fb0\u03bc\u03bf\u03c2; Artemis, being a huntress, would have butchered the animals she killed. A similar word meaning safe or sound, \u1f00\u03c1\u03c4\u03b5\u03bc\u03ae\u03c2, may reflect her virginity. Or, like Ares and Arethusa, it may contain a hint of <\/span>\u1f00\u03c1\u03b5\u03c4\u03ae<\/span>, excellence or virtue. Or it may be from \u1f00\u03c1\u1fd0-\u0398\u1f73\u03bc\u03b9\u03db, comparing her favorably to the Titaness Themis, the goddess of divine law.<\/span><\/p>\n

Wormwood supposedly grew in the trail of the biblical serpent (or worm) as it left paradise, and <\/span>Culpeper<\/span><\/a> recommended it for worms, among many other things, as did <\/span>Mrs Grieve<\/span><\/a> in <\/span>The Modern Herbal<\/span><\/i>. But \u201cwormwood\u201d actually comes from a mishearing or misspelling of \u201cwermod\u201d, listed in the <\/span>Corpus Glossary of 725<\/span><\/a> as a gloss of the Latin word absinthium. This spurious connection between ivermectin, for worms, and artemisinin, from wormwood, is presumably not why the 2015 Nobel prize was shared out as it was.<\/span><\/p>\n

Jeffrey Aronson<\/strong>\u00a0is a clinical pharmacologist, working in the Centre for Evidence Based Medicine in Oxford’s Nuffield Department of Primary Care Health Sciences. He is also president emeritus of the British Pharmacological Society.<\/em><\/span><\/p>\n

Competing interests:<\/strong> None declared.<\/p>\n

\"\"<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

Three words reflecting two types of Chinese therapies can be found among the biomedical words first cited from 1979 in the Oxford English Dictionary (OED) (Table 1)\u2014tui na, a form […]<\/p>\n

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