Evaluation of the Chinese Herbal Remedies San Ren Tang, Wei Lin Tang, and Alisma for Feline Urinary Tract Disease

Though herbal remedies often have an aura of being somehow fundamentally different from drugs used as medicines, they are really just collections of chemical compounds. As such, they ought to be evaluated just as conventional pharmaceuticals are: identification and isolation of active compounds, in vitro experiments establishing potential beneficial and harmful effects, in vivo studies looking at absorption, metabolism, and safety, and finally well-controlled clinical trials escalating in size and complexity to determine safety and effectiveness in the target species and disease conditions. There is no reason such remedies cannot be effective therapies, but there is also no reason to assume they are safe or effective without following these steps. For a variety of practical and philosophical reasons, unfortunately, many potentially useful herbal products are not properly tested, and their use is based on much less reliable foundations, such as folk tradition and personal experience.

Therefore, I always appreciate it when I see important and necessary, though often not glamorous, preclinical research on such remedies. This kind of research can be invaluable in guiding us towards or away from specific remedies, though it is only one piece of the puzzle and cannot definitively confirm or refute the potential usefulness of specific herbal products. An abstract being presented at the upcoming American College of Veterinary Internal Medicine Forum presents the data from just such a laboratory study.

M. Daniels; J.W. Bartges; D.M. Raditic; C.A. Kirk; A. Callens; S. Marsden; G. Galyon
Evaluation of 3 Herbal Compounds Used for Management of Lower Urinary Tract Disease in Cats

The study evaluated three herbal products to see if they increased urine volume or changed the chemical constitution of the urine in was believed to reduce the risk of Feline Lower Urinary Tract Disease (FLUTD), a common and uncomfortable condition in cats. 6 healthy cats were used in the study, and they were randomly assigned to be given each of three products or a placebo in turn: San Ren Tang, Wei Ling Tang, and Alisma. A 24-hour urine sample was collected and analyzed after 2 weeks of treatment with each product for each cat. None of the products showed a significant difference from the placebo in any variable measured.

I am not familiar with the basis on which these products are recommended for FLUTD, so I cannot evaluate the plausibility of the underlying theory. However, the products are herbal remedies within the Traditional Chinese Medicine (TCM) approach, and I have already discussed elsewhere the principles of TCM and why they are fundamentally inconsistent with a scientific approach to medicine. Individual herbal products undoubtedly have active chemical compounds, both from the plant ingredients and often deliberate or accidental contaminants, but without proper scientific evaluation there is no valid way to designate specific products as treatments for specific conditions or to evaluate their safety and efficacy.

This study was not intended, of course, to definitively answer the question of whether these herbal preparations are safe or beneficial for cats with FLUTD. The particular urine characteristics measured are known to play a role in the risk of developing FLUTD symptoms, but there are other risk factors, and the precise steps leading to the condition in individual cats are not clearly understood. So these products could conceivably be beneficial even if they do not influence the variables looked at in this study. However, given the apparent lack of a sound scientific rationale for using them, and the lack of a plausible mechanism or established preclinical effects, such remedies cannot be routinely recommended. And given the limited resources available for research into new veterinary therapies, it seems it would be most efficient to focus those resources on therapies that seem promising on the basis of established scientific knowledge, rather than the far less reliable criteria of traditional use. Studies on herbal remedies should, therefore, focus on developing this important preclinical knowledge before proceeding with clinical trials.

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7 Responses to Evaluation of the Chinese Herbal Remedies San Ren Tang, Wei Lin Tang, and Alisma for Feline Urinary Tract Disease

  1. Linda says:

    I would love to know more details on how the study was conducted. This sounds like a classic case of testing Chinese medicine on the principle of Western medicine. It doesn’t work… Because in Chinese medicine, the diagnosis works on a ‘pattern’ and not a ‘disease’. For example, in this case, Urinary Tract Infection. Three different people diagnosed with the same ‘disease’ can have a different ‘pattern’. Rarely are two people (or animals) completely the same and therefore the treatment would naturally be different. So hence, I believe that the test was invalid. To change this, a diagnosis would be needed by a trained professional, rather than blindly using herbs that are ‘traditionally known to treat’.

  2. skeptvet says:

    Unfortunately, your objection hinges on the idea that the TCM system for diagnosis is different from the scientific system but equally valid. TCM diagnosis involves a set of metaphors and explanations for health and disease based on astrology, folk mythology, vitalism, and other pre-scientific ways of understanding illness, and there is no reason to believe these accurately represent reality. Such metaphorical systems developed in every culture prior to the implementation of the scientific approach, and they have been largely replaced by the scientific way of understanding health and disease in every part of the world because science has repeatedly proven more effective. Cultural relativism would suggest that all ways of describing health and illness should be viewed as equally valid, but empirical testing shows that some ideas are accurate reflections of reality and others are not. Science has achieved unprecedented improvements in human health and longevity that thousands of years of TCM, Ayurveda, Humoral Medicine, and other prescientific approaches could not. This is probably why TCM accounts for no more than 10% of the healthcare utilized by people in Taiwan, regardless of the cultural traditions there. http://skeptvet.com/Blog/2011/03/from-sbm-how-popular-is-acupuncture/

    So regardless of how the study was conducted, the notion that following TCM pattern diagnosis would have made a difference makes no sense unless one accepts that TCM diagnosis is accurate and meaningful, and there is no evidence for this beyond the usual claims based on history and anecdote, which are unreliable. If TCM remedies do have benefits, it is because they contain pharmacologically active compounds, and these need to be identified and tested the way any other plant-derived medicines are to establisht heir real risks and benefits.

  3. Pingback: Finally, A Journalist Takes a Skeptical View of Claims for Veterinary Acupuncture | The SkeptVet Blog

  4. Forrest says:

    Skeptvet. It’s like looking at women through the eyes of a man, or looking at men through the eyes of a woman. Which is right? Both are actually. The beauty of life is recognizing that different colors can come together to form a wonderful picture. Harmony is important. Divisiveness causes conflict!

  5. skeptvet says:

    Beautiful sentiments, but really just an expression of the post-modernist notion that there is no truth or reality, only opinion. That make work in assessing beauty, which is merely a cultural concept. But the actual, physical word has its true nature, and it matters whether our understanding of that is accurate or inaccurate. If you think childhood diseases is caused by imbalances of Qi, then most of your children die before 5 from infectious disease. If you apply science to those diseases and discover the true cause, then you can invent vaccines and your children mostly get to live to adulthood. The beauty of science is that truth reduces suffering and pretty, poetic statements about how there is no right answer allow that suffering to persist unnecessarily.

  6. Cynthia Weeks says:

    Try it..you’ll like it. Alopathic medicine didn’t work for me. Holistic and TCM DID.

  7. skeptvet says:

    Yeah, here’s a collection of articles explaining why anecdotes like this aren’t helpful or reliable:

    Why Anecdotes Can’t Be Trusted

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