Herbal and homeopathic compounds have been used to aid in childbearing and pregnancy for centuries. Much of this information is anecdotal and lacks scientific support, making it difficult to evaluate safety and efficacy. Increased public interest in alternative treatments leads to the need for a systematic review on the topic. Herbal remedies are most often used to treat the most common pregnancy-related problems like nausea, stretch marks and varicose veins. In contrast to this, concerns have also been raised about the adverse effects of these remedies. The primary objective of this research project was to conduct a systematic review to assess the maternal and neonatal outcomes of ingested herbal and homeopathic remedies using during pregnancy, birth and breastfeeding.

Submitted in partial compliance with the requirements for Master’s degree in Technology: Chiropractic, Department of Chiropractic, Durban University of Technology, Durban, South Africa, 2015. / Background Functional dyspepsia is a chronic pain/discomfort centred in the upper abdomen in the absence of any known structural cause. Epidemiological studies have shown that functional dyspepsia is a common complaint affecting all population groups that over time places considerable financial strain on public and private resources due to frequent doctors’ visits and expensive diagnostic procedures. The development of non-surgical and non-pharmaceutical treatments of functional dyspepsia would not only make economic sense but would also provide a means to improve patients’ quality of life in the least invasive way possible. Although not traditionally seen to be within the chiropractic scope of practice, anecdotal evidence suggests that chiropractic care and management may have the ability to alleviate visceral symptomatology. Objectives The purpose of this placebo controlled pilot study was to evaluate the preliminary effects of chiropractic manipulation versus inactive laser in the treatment of adult patients suffering from functional dyspepsia. Due to the small sample size, time and budgetary constraints it was hypothesised that the dyspepsia symptoms of participants treated with active chiropractic manipulation would not respond more favourably to the treatment, nor would these patients experience a greater improvement in terms of quality of life, compared to those participants receiving placebo treatment. Method Thirty participants with pre-diagnosed functional dyspepsia were selected after being screened according to the inclusion and exclusion criteria identified by the researcher. These participants were then divided into two groups using consecutive sampling. Data was collected at the Chiropractic Day Clinic at the Durban University of Technology. Group A received an active chiropractic manipulation using diversified technique to pre-identified levels in the cervical, thoracic and lumbar spine. Group B received inactive laser to pre-identified levels in the cervical, thoracic and lumbar spine. Both groups received one treatment a week for three weeks. The fourth and final consultation consisted only of data capturing. At each visit both groups of participants filled in three validated questionnaires: The numerical pain rating scale; PAGI-SYM physical symptom assessment; Results Results were statistically analysed using IBM SPSS version 20 and a p value ≤ 0.05 was considered to be statistically significant. Repeated measures ANOVA testing was used to assess the effect of each of the treatments separately and to assess the comparative effects of the spinal manipulation vs the placebo. Conclusion and Recommendations The gathered results and analysis were statistically insignificant. Clinical improvement in their symptomotology was however noted within both groups over the trial period in terms of treatment received and their perceived quality of life, symptomatology and pain levels. Both groups tended to have reduced pain and discomfort over time, improved: emotional distress, sleep disturbance, food problems, vitality, post-prandial fullness and abdominal pain. This study should be repeated with selected outcome measurements, and perhaps objective outcome measurements, and a larger sample size in order to determine any benefit. / M

Submitted in partial compliance with the requirements of the Master’s Degree in Technology: Homeopathy, Durban University of Technology, Durban, South Africa, 2016. / INTRODUCTION Dysmenorrhoea is defined as difficult menstrual flow or painful menstruation. Dysmenorrhoea is the most common gynaecological complaint in younger women who present themselves to clinicians. Primary dysmenorrhoea is defined as painful menstrual cramps without any evident pathology present. It refers to any degree of perceived cramping pain experienced during menstruation. Around 50% of menstruating females suffer from primary dysmenorrhoea. Prevalence decreases with age, with prevalence being highest in the 20 to 24 year old age group. This trial intended to evaluate the effectiveness of a phytotherapeutic complex in the treatment of primary dysmenorrhoea compared to homoeopathic similimum in a 30 cH plussed potency. This study aimed to provide the safe and effective alternative therapy for primary dysmenorrhoea, especially for the population that is contradicted to use the readily available forms of treatments. TRIAL DESIGN This double-blind randomised parallel clinical trial, aimed to determine the effectiveness of a phytotherapeutic complex consisting of Angelica sinensis1:10, Dioscorea villosa1:10, Matricaria chamomilla 1:10, Viburnum opulus 1:10, and Zingiber officinalis 1:10 in the treatment of primary dysmenorrhea, compared to homoeopathic similimum in a 30cH plussed potency. METHODOLOGY A sample group of 26 participants were voluntarily selected for the study on the basis of an inclusion and exclusion criteria. These participants were then randomly divided into two groups, 17 in the group receiving the phytotherapeutic complex, 8 in the control group receiving the similimum and 1 drop-out. Each participant had to attend a total of four consultations with the researcher over a three month period, at the Durban University of Technology (DUT) Homoeopathic Day Clinic. At each consultation the participant completed the Moos Menstrual Distress Questionnaire (MDQ) (Appendix B) as well as the Pain Rating Scale (PRS) (Appendix C). Intra-group analysis was performed using the non-parametric test for analysis of variance: Friedman’s test. Inter-group analysis was conducted using the Mann- Whitney U test for two independent samples. RESULTS Results from the intra-group analysis showed that in both groups most measured parameters relating to experience during the previous menstrual flow showed statistically significant reductions in intensity. This is to say that both the group receiving phytotherapy and the group receiving similimum experienced reductions in their symptoms as measured by both the MDQ and the PRS. Results from the inter-group analysis showed that there is no significant difference between the phytotherapy and similimum group in all symptoms except the water retention category, with regard to symptom perception during the last menstrual flow of the trial. CONCLUSION The conclusion reached in this study was that both the phytotherapeutic complex treatment and the homoeopathic similimum treatment were effective at reducing the clinical features of primary dysmenorrhea, but there was no significant difference between the phytotherapy and similimum group in all except the water retention category during the last menstrual period as measured by the MDQ Further, there was no statistically significant difference between groups treated with phytotherapy compared to similimum as measured by the PRS. / M

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Although Hormone Therapy (HT) is the most effective treatment for alleviating menopausal vasomotor symptoms and reducing bone loss, many women are reluctant to take this treatment due to side effects and concerns about safety. Epidemiological studies suggest that a significant proportion of women use Complementary and Alternative Medicine (CAM) therapies to alleviate vasomotor symptoms and improve quality of life. Anecdotal and clinical evidence indicate a number of CAM therapies, such as herbal medicine, may be effective in alleviating symptoms and modulating bone metabolism. Hence, in the context of concerns over the safety of HT and the extensive history of the clinical use of herbal medicine, this thesis investigated issues pertinent to CAM use and the menopausal transition. The aims of this thesis were to: • Examine the nature and extent of CAM use by women transitioning through menopause • Evaluate the effectiveness of a herbal formula containing Chinese herbs and Cimicifuga racemosa for alleviating vasomotor symptoms, improving quality of life and modulating bone turnover markers. From July 2003 until July 2004 the Women’s Health during Midlife Survey recruited 1,296 women aged 45-65 who were symptomatic when transitioning through menopause or asymptomatic but taking menopause specific treatments. A validated 19-item survey instrument assessed the use of CAM modalities and menopause specific products. The instrument was completed voluntarily and anonymously by women recruited from three strata; menopause clinics, clinics of general practice and government agencies. Approximately 54% of respondents had visited a CAM practitioner and/or used a CAM product during the previous 12 months. The most popular practitioners were the naturopath (7.2%) and acupuncturist (4.8%), while soy (25.4%) and evening primrose oil (EPO, 18.4%) were the most popular products. Massage and chiropractic were considered the most effective therapies, while phytoestrogen tablets and EPO were the most efficacious products. Although 26.4% of respondents indicated their doctor asked about CAM use, 71% of CAM users said they informed their physician about using CAM. Of the 60% of women using pharmaceutical medicines, 62.5% reported using a CAM product during the preceding 12 months. The survey results confirm the continued popularity of CAM use amongst women transitioning through menopause. A number of treatments were perceived to be effective in relieving symptoms. However, communication between medical practitioners and patients about CAM use is inadequate, and given the high use of pharmaceutical medicines this oversight may unnecessarily expose women to drugherb interactions. A randomised, double-blind, placebo controlled clinical trial was conducted to evaluate the effectiveness of a herbal formula derived from two traditional Chinese herbal formulae with the addition of Cimicifuga in alleviating vasomotor symptoms. The trial recruited 93 healthy women who reported at least six vasomotor symptoms per day. After a four week baseline period, women were randomly allocated to receive either herbal treatment or identical looking placebo tablets for 16 weeks. During the trial women recorded the number and severity of their flushes on a Daily Flush Diary, and at each monthly consultation two quality of life scales were completed. Forty nine eligible trial women were entered into a pilot study to assess the effect of the formula on bone turnover markers; bone specific alkaline phosphatase and deoxypyridinoline (corrected for creatinine). The herbal formula was found to be no more effective than placebo in reducing the frequency of flushing and the composite hot flush score or in improving quality of life. The pilot study found the formula had no effect on bone turnover markers after 16 weeks of treatment. Therefore, this formula cannot be recommended as a treatment for vasomotor symptoms and is unlikely to have any long term effect on bone. The use of CAM during the menopausal transition is very popular. Although this thesis found the current herbal formula to be an ineffective treatment, the scientific evaluation of potential CAM therapies is imperative so that health care professionals and consumers can make informed decisions concerning treatment options for the alleviation of symptoms. / Doctor of Philosophy (PhD)

published_or_final_version / Behavioral Health / Master / Master of Social Sciences

published_or_final_version / Chinese Medicine / Doctoral / Doctor of Philosophy

More than half of the women aged from 45-55 suffer from menopausal symptoms which can seriously affect the quality of life of the midlife women. The menopause transition has become a very active research area in healthy aging in the last several decades. In recent years, more and more women have turned to traditional Chinese medicine (TCM) to manage their menopausal symptoms. Among various Chinese medicine formulae, Er-Xian Decoction (EXD) is one of the most acceptable Chinese medicine formulae to relieve menopausal symptoms. Although EXD is popular in the management of menopausal symptoms, its effectiveness has not been evaluated by strictly designed clinical study. A systematic review was conducted to evaluate the current evidence to assess the efficacy and safety of EXD as a basic formula for menopausal symptoms. A total of 12 randomized controlled trials (RCTs) were included for further analysis. The results of these studies suggested that EXD was more effective than the control interventions, which included various HRT and other Chinese herbal medicine. Seven of the studies compared EXD with HRT and the meta-analysis seemed to suggest that EXD as a basic formula was superior to hormone replacement therapy. However, the included studies were insufficient in methodological quality and had a high probability of bias. A double-blind randomized controlled clinical trial was then conducted to assess the efficacy and safety of EXD for menopausal symptoms. Of 557 recruited women, 108 subjects were eligible to participate in the study and 101 subjects finished the study. Comparisons between placebo and EXD groups were conducted by using an analysis of covariance (ANCOVA) with baseline as covariate. EXD granules when compared with placebo significantly reduced the frequency and severity of hot flushes and night sweats. EXD compared with placebo significantly reduced the frequency of hot flushes (P=0.041) and the hot flush severity score (P=0.016). Superiority of EXD over placebo was also observed in greater improvement in total scores of MRS (P=0.028) and MENQOL questionnaires (P=0.021). There were no differences between EXD and placebo group in serum hormones and bone markers. There were no serious adverse events and the safety indices of whole blood counts, renal and liver functions were normal before and after the treatment. Both EXD and placebo were well tolerated. In summary, this Chinese herbal formula EXD was found to be superior to placebo in reducing hot flushes and improving menopausal symptoms in Hong Kong perimenopausal women. It was well tolerated, with no serious adverse events noted during the study period. / published_or_final_version / Chinese Medicine / Doctoral / Doctor of Philosophy