LAUSR

Ou et al. examined the effects of traditional Chinese herbal medicine (CHM) in the treatment of lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH), using claims data from Taiwan’s National Health Insurance Research Database with propensity score matching between CHM users and non-users. In this study, 3977 of 9170 patients (43%) with newly diagnosed LUTS/BPH received CHM for at least 14 days, which was in concordance with authors’ description that approximately 30% of patients in Taiwan visited CHM clinics with insurance covered by the National Health Insurance program. Although this study had significant limitations due to using claims data, the results were impressive, with an adjusted hazard ratio (aHR) of 0.82 in BPH-related complications as well as an aHR of 0.74 in BPH-related surgery, which reminds us of the findings of, for example, CombAT study. As in Taiwan, traditional Japanese Kampo medicine was covered by the Japanese health insurance system, and recent invited review of this journal by Minagawa et al. concluded that Kampo medicine has great potential for lower urinary tract disorders through multi-organ targeting strategies. I think that one of the major problems preventing the widespread use of CHM is its unique framework of pathophysiology and the relevant diagnostic as well as therapeutic procedures based on this framework. For example, in a systematic review of randomized controlled trials on LUTS/BPH, Ma et al. stated that from the point of view of CHM, LUTS/BPH was equivalent to the “Long Bi” (obstructed urination), and its hyperplastic nature could be classified into the category of “Zheng Iia” (tumor). The main syndrome differentiations of these were the Yang deficiency in the kidney and blood statis, which led to tonifying the Yang in the kidney and removing the bloods stasis as the major strategy to treat “Long Bi” and “Zheng Iia.” At least for me, it is difficult to fully understand the meanings of these descriptions. I hope future development of integrative CHM and Western medicine, combining the best features of two systems according to Taipei consensus on integrative traditional Chinese and Western medicine, because LUTS/BPH is considered one of the manifestations of systemic disorders, such as metabolic syndrome, and treatment should be targeted not only at lower urinary tract but also at systemic abnormalities.