From: Lan Lan Liang Yeh, PLoS Online
Published August 28, 2007 10:12 AM

Traditional Chinese Herbal Formula Effective In Treating Menstrual Discomfort

TAIPEI, TAIWAN - A new study shows that an 800 year old traditional Chinese medicine formula called "Four Agents Decoction", when used over time, is effective in helping relieve menstrual discomfort in young women. This was the first systematic evaluation of the herbal preparation. Scientists applied Western methodology to assess the herb's effectiveness and safety, both for primary dysmenorrhoea (menstrual discomfort) and to evaluate the compliance and feasibility for a future trial.


Most traditional Chinese herbal formulas consist of at least four herbs. Four-Agents-Decoction (Si Wu Tang) is a documented eight hundred year old formula containing four herbs and has been widely used to relieve menstrual discomfort in Taiwan.


How they did it


A randomised, double-blind, placebo-controlled, pilot clinical trial was conducted in an ad hoc clinic setting at a teaching hospital in Taipei, Taiwan. Seventy-eight primary dysmenorrheic young women were enrolled after 326 women with self-reported menstrual discomfort in the Taipei metropolitan area of Taiwan were screened by a questionnaire and subsequently diagnosed by two gynaecologists concurrently with pelvic ultrasonography.


A dosage of 15 odorless capsules daily for five days starting from the onset of bleeding or pain was administered. Participants were followed with two to four cycles for an initial washout interval, one to two baseline cycles, three to four treatment cycles, and three follow-up cycles. Study outcome was pain intensity measured by using unmarked horizontal visual analog pain scale in an online daily diary submitted directly by the participants for 5 days starting from the onset of bleeding or pain of each menstrual cycle. Overall-pain was the average pain intensity among days in pain and peak-pain was the maximal single-day pain intensity. At the end of treatment, both the overall-pain and peak-pain decreased in the Four-Agents-Decoction (Si Wu Tang) group and increased in the placebo group; however, the differences between the two groups were not statistically significant. The trends persisted to follow-up phase.


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Statistically significant differences in both peak-pain and overall-pain appeared in the first follow-up cycle, at which the reduced peak-pain in the Four-Agents-Decoction (Si Wu Tang) group did not differ significantly by treatment length. However, the reduced peak-pain did differ profoundly among women treated for four menstrual cycles (2.69 (2.06) cm, mean (standard deviation), for the 20 women with Four-Agents-Decoction and 4.68 (3.16) for the 22 women with placebo, p = .020.) There was no difference in adverse symptoms between the Four-Agents-Decoction (Si Wu Tang) and placebo groups.


Conclusion/significance


Four-Agents-Decoction (Si Wu Tang) therapy in this pilot post-market clinical trial, while meeting the standards of conventional medicine, showed no statistically significant difference in reducing menstrual pain intensity of primary dysmenorrhoea at the end of treatment. Its use, with our dosage regimen and treatment length, was not associated with adverse reactions. The finding of statistically significant pain-reducing effect in the first follow-up cycle was unexpected and warrants further study. A larger similar trial among primary dysmenorrheic young women with longer treatment phase and multiple batched study products can determine the definitive efficacy of this historically documented formula.


Authors: Lan Lan Liang Yeh1, Jah-Yao Liu2, Kao-Si Lin3, Yu-Shen Liu4, Jeng-Min Chiou5, Kung-Yee Liang6, Te-Feng Tsai7, Li-Hsiang Wang3, Chiung-Tong Chen8, Ching-Yi Huang1


1 Division of Clinical Research, National Health Research Institutes, Zhunan, Taiwan, 2 Department of Obstetrics and Gynaecology, Tri-Service General Hospital of National Defense Medical Centre, Taipei, Taiwan, 3 Department of Chinese Medicine, Tri-Service General Hospital of National Defense Medical Centre, Taipei, Taiwan, 4 Section of Obstetrics and Gynaecology, Taipei Municipal Hospital Zhongxiao Branch, Taipei, Taiwan, 5 Institute of Statistical Science of Academia Sinica, Taipei, Taiwan, 6 Division of Biostatistics and Bioinformatics, National Health Research Institutes, Zhunan, Taiwan, 7 Section of Chinese Medicine, Taipei Municipal Hospital Zhongxiao Branch, Taipei, Taiwan, 8 Division of Biotechnology and Pharmaceutical Research, National Health Research Institutes, Zhunan, Taiwan


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