Tibetan herbal formula Padma Digestin modulates gastrointestinal motility in vitro

[Phytotherapeutische Ansätze zur Behandlung des laryngopharyngealen Reflux in der HNO-Praxis]

Der gastroösophageale Reflux, auch GERD genannt (gastroesophageal reflux disease) ist mit einer Prävalenz von 20-30% der erwachsenen Bevölkerung ein weit verbreitetes Problem. Davon abzugrenzen ist der häufig in der HNO-Praxis anzutref-fende laryngopharyngeale Reflux (LPR), bei dem es sich um eine durch den Magensäurereflux bedingte Entzündung der oberen Atemwege handelt. Die Unterschiede im klinischen Bild charakterisieren die widersprüchliche Beziehung der beiden klinischen Entitäten und erschweren die Diagnosestellung. Darüber hinaus muss ein besonderes Augenmerk auf Beschwerden des Magen- und Darmtrakts gelegt und deren Behandlung nicht vernachlässigt werden. Neben diätetischen Ratschlägen zählen einige pflanzliche Arzneimittel zu den Therapieoptionen. Alginate, die ein Aufstossen verhindern, bewähren sich in der Praxis. Kombinationsarzneimittel aus der europäischen und tibetischen Tradition spielen eine wesentliche Rolle in der Behandlung, nicht nur des LPR sondern auch bei Verdauungsproblemen des oberen und unteren Verdauungstrakts, wie Reizmagen und Reizdarm.

The gastroesophageal reflux, also called GERD (gastroesophageal reflux disease), is a widespread problem with 20–30% of the adult population concerned. The laryngopharyngeal reflux (LPR), which is an inflammation of the upper respiratory system due to reflux of gastric acids, is a frequently encountered problem of the gastrointestinal practitioner and should be separated from GERD. The differences in the clinical image characterize the contradictory relationship of both clinical entities and complicate the diagnosis. In addition, the focus should also be turned on eventual disorders of the gastrointestinal tract and, if necessary, they should be treated, too. Besides dietetic advice some herbal medicines belong to the therapeutic options. Alginates, which prevent reflux, have proved a great value in the practice. Multicomponent mixtures originating from the European and Tibetan herbal medicine traditions play a major role in the treatment, not only for LPR, but also for the upper and lower digestive pathologies such as functional dyspepsia and irritable colon.

Contested Issues of Efficacy and Safety between Transnational Formulation Regimes of Tibetan Medicines in China and Europe

Tibetan medicines are key material objects for medical treatment and have become part of a global trend of 'pharmaceuticalisation', playing increasingly important political and socio-economic roles in an 'alternative modernity'. As I argue in this paper, they also have become key 'sites of contestation' between different epistemic values and styles of practice related to efficacy and safety that are reproduced in and through specific formulation regimes. Based on my multisited ethnography of production, prescription, and use practices of Tibetan medicines in China and Europe, this paper conceptualises three distinct formulation regimes, offering a heuristic model for transnational comparison-a classical, an industrialised or reformulated, and a polyherbal regime. The first two are the major orientations while the polyherbal is a conjoint hybrid with either the classical or the industrialised formulation regime. Globalised national drug safety regulations legalise and confer legitimacy to industrialised Tibetan formulas that follow biomedically defined efficacy, safety, and disease categories, while classical formulas produced by private physicians or small-scale cottage pharmacies are increasingly marginalised as producing 'unsafe' and at times illegal medicines, and need to find new ways for adapting and circulating their formulas.

The Tibetan herbal formula Padma Digestin in functional dyspepsia: an open-label study

BACKGROUND

The etiology of functional dyspepsia (FD) is multi-factorial. Its prevalence is high and it considerably impairs the patients' quality of life. The treatment options are limited. Padma Digestin, a multi-herbal formula from Tibetan Medicine, is traditionally used in malabsorption and dyspeptic symptoms as they do occur in FD, but as yet no clinical data exist on the formula. The aim of this study was to evaluate the safety, tolerability, and efficacy of Padma Digestin in patients with FD in a prospective, open, clinical phase III trial.

PATIENTS AND METHODS

Patients were recruited by general practitioners, internists, and gastroenterologists and treated with 2 × 3 capsules of Padma Digestin daily for 6 weeks. Dyspeptic symptoms were analyzed using the Domestic/International Gastroenterology Surveillance Study (DIGEST) questionnaire extended by the 2 symptoms stomach cramps and lack of appetite. The quality of life was assessed using the Psychological General Well-Being Index (PGWBI-S) questionnaire (short version).

RESULTS

37 patients were admitted and efficacy could be assessed in 31. In the overall efficacy assessment, the Padma Digestin treatment led to a statistically highly significant reduction of the respective most bothersome symptom scores regarding frequency, severity, and impairment of daily activities (p < 0.01). The treatment also led to significant improvements of the individual symptoms of postprandial fullness, nausea, localized and diffuse epigastric pain, stomach cramps, and lack of appetite. The onset of improvement was after a median of 7 days; time until disappearance of the symptoms was after a median of 22 days. The global efficacy and tolerability were rated as good or very good by the doctors and the patients in 84% and 78%, respectively. The PGWBI-S increased from 55 ± 19.5% to 70.5 ± 15.5%, which is nearly the normal value (73.5 ± 15.4%). As for safety, 11 patients reported a total of 17 adverse events (AE), 1 of which was serious but unrelated to the study medication. The AE were mild or moderate. The safety laboratory data showed no statistically significant or otherwise relevant changes.

CONCLUSIONS

The results show that the formula Padma Digestin has a high tolerability and efficacy in FD symptoms and positively influences psychological well-being and thus quality of life. It therefore represents a much needed extension of the therapeutic repertoire in FD.