Bastyr University Library, 14500 Juanita Dr. NE, Kenmore, WA 98028 425-602-3020 library@bastyr.edu Complementary and Alternative Medicine (CAM) Research Using Medline In the Bastyr University Library and on the Internet March 2007 Online version at: http://www.bastyr.edu/library/resources/researchguide/cammedline.asp

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MEDLINE is the world's premier biomedical database. Currently, it indexes around 4,600 scholarly journals, a small percentage of which pertain to complementary and alternative medicine. PubMed, a MEDLINE search interface, is provided by the National Library of Medicine at www.pubmed.gov.

The MeSH Database, on the left sidebar of the PubMed search screen, allows you to explore current Medical Subject Headings by providing definitions of terms, applicable subheadings and subject hierarchies (MeSH trees).

For detailed searching instructions, please refer to the Help and Tutorial features on the left sidebar of the Pubmed search screen.

Selected MeSH Headings for CAM Topics:

• Environment and Public Health: This broad heading includes the more specific headings Environmental Health, Preventive Medicine, and Public Health, which are all closely related to CAM.
• Food and Nutrition: The MeSH term Food is in the Technology and Food and Beverages Category of MEDLINE and deals with "anything which, when taken into the body, serves to nourish or build up the tissues or to supply body heat." A long list of individual food items that are MeSH headings is subsumed under this term. Nutrition is in the Biological Sciences Category of MEDLINE and covers "the science of food, its action, interaction, and balance in relation to health and disease."
• Diet and Diet Therapy: In MEDLINE, the MeSH term Diet is subsumed under the broader heading Nutrition and refers to "the regular course of eating and drinking adopted by a person or animal." The term Diet Therapy, however, is subsumed under Therapeutics. Diet Therapy refers to specific diets prescribed in the treatment of a disease and can also be used as a subheading with specific diseases, e.g. Diabetes Mellitus/diet therapy, Neoplasms/diet therapy.
• Food-Drug Interactions
• Herb-Drug Interactions (as of 2004)
• Therapeutics: Enter the term in PubMed's MeSH Database to see the MeSH tree (or subject hierarchy) for this term. Broad headings such as Complementary Therapies, Exercise Movement Techniques and Physical Therapy Techniques are subsumed here, as well as more specific ones such as:

  Aromatherapy	Orthomolecular Therapy
  Balneology	Phytotherapy
  Chelation Therapy	Placebos

  
  

MEDLINE Keyword and Phrase Searching:

Natural language text words and phrases are especially useful when researching CAM topics. PubMed does not actually perform adjacency searching, but does have some behind-the-scenes features that try to match phrases with MeSH concepts. If the phrase you enter is not found, using quotation marks will tell PubMed to "keep the terms together." Examples of natural language search terms are:

Traditional Chinese Medicine (TCM):

In November 2001, MEDLINE adopted the pinyin transliteration system for Chinese characters, replacing the outdated Wade-Giles system. For example, the pinyin Qi (the traditional Asian concept of the life force that travels along channels of the body, called meridians) now replaces the Wade-Giles form, Ch'i. Wade-Giles transliterations are associated with the correct pinyin forms in MEDLINE and will still be searched as keywords.

Chinese herbal medicine is an extremely complex field. Some major reasons for this are: 1) different spellings of the English names of herbs abound; 2) certain age-old Chinese herbs have significant botanical variations, depending on where the plants are gathered; 3) many herbs are used in combinations, or patent formulations, which set up synergistic effects that are difficult to assign to one plant or another. Standardization of herbal extracts and GMP (Good Manufacturing Practices) are also issues. Research interest in Chinese herbs is picking up but, to date, very few well-designed research studies of these substances have been performed.

Some Chinese herbs are MeSH headings, but most are not. Preliminary research to gather name variations, including the Latin forms, is especially important for Chinese herbal research in MEDLINE. The following MeSH headings and keywords are pertinent. Experiment combining selected ones with the connector OR.

Selected MeSH Headings:

• Medicine, Chinese Traditional (includes the MeSH headings Qi and Yin-Yang)
• Acupuncture (refers to the health profession only)
• Acupuncture Therapy (includes Acupressure, Moxibustion and other MeSH headings related to theory and practice)
• Drugs, Chinese Herbal
• Individual names of Chinese herbs that are MeSH headings, e.g. Astragalus Plant.
• Pulse (combine with other MeSH headings, e.g. Medicine, Chinese Traditional or Acupuncture Therapy)
• Tai Ji

Selected Keywords:

• Individual names of Chinese herbs (not MeSH)
• channel or channels (combine with other MeSH, e.g. Medicine, Chinese Traditional or Acupuncture Therapy)
• ch'i (still useful as a keyword even though Qi is the new MeSH heading)
• qi gong, and the alternate spelling qigong*
  
  Possible spelling variations of this term: (qi or chi or ki) with (kong or gung or kung or gong)
• tao (or dao)
• tongue diagnosis (combine with the MeSH heading Medicine, Chinese Traditional)
• tuina or tui na

*Both qi gong and qigong are associated with the broader MeSH term Breathing Exercises. Using either one will produce many irrelevant hits.

A Botanical Medicine MeSH Glossary

Note: Quoted definitions are taken from the NLM MeSH Browser, www.nlm.nih.gov/mesh/MBrowser.html.

• The scientific and/or common names of individual medicinal plants are often MeSH headings



• Angiosperms
  
  
  The MeSH term Herbs was discontinued in January 2002 and was replaced retrospectively in all citations by the botanical term, Angiosperms: "any member of the more than 250,000 species of flowering plants having roots, stems, leaves, .and well-developed conductive tissues.." Many medicinal and nutritional plants are subsumed under the term Angiosperms. (See below for further information on searching under individual plant names.)
  
  
• Herb-Drug Interactions
  
  
  This will be a MeSH term as of Jan. 2004. Until then, use one of the following search strings:
  
  herb AND drug AND interactions
  
  angiosperms AND drug AND interactions
  
  
• Use Phytotherapy for therapeutic aspects:
  
  
  The NLM definition of this term is: "Use of plants or herbs to treat diseases or to alleviate pain." Phytotherapy, literally "plant therapy," was a new MeSH heading as of January 2002. It was assigned retrospectively to all citations with a MeSH heading from the Angiosperms tree that also had the subheading therapeutic use.
  
  
• Antineoplastic Agents, Phytogenic
  
  
  This phrase is more specific than Phytotherapy and is used for anti-cancer agents obtained from "higher plants that have demonstrable cytostatic or antineoplastic activity."
  
  
• Plant Extracts, and the broader term Plant Preparations:
  
  
  Use these terms for pharmacognosy aspects: "Concentrated pharmaceutical preparations of plants obtained by removing active constituents with a suitable solvent, which is evaporated away, and adjusting the residue to a prescribed standard." The heading Drugs, Chinese Herbal is subsumed under this category.
  
  
• Ethnobotany
  
  
  Use this term for anthropological/traditional medicine aspects: "The plant lore and agricultural customs of a people. In the field of medicine, the emphasis is on traditional medicine and the existence and medicinal uses of plants and their constituents, both historically and in modern times."
  
  
• Medicine, Herbal
  
  
  Use for professional and occupational aspects: "The study of medicines derived from botanical sources." This heading does not apply to the medicinal plants themselves, but rather to the profession of herbalism.
  
  
• Plants, Medicinal
  
  

  This term is being phased out. The MeSH heading has been used for the medicinal botany aspects: "Plants whose roots, leaves, seeds, bark, or other constituent possess therapeutic, tonic, purgative, or other pharmacologic activity when administered to higher animals." According to one of the MeSH Division indexers, it is "a vague, non-taxonomic leftover that won't be used much anymore." The term Phytotherapy, in combination with the most specific plant (family, genus or species) available in MeSH, will be used instead.
  
  

Search Tips for Botanical and Nutritional Substances:

Scientific research on medicinal and nutritional plants is performed using whole plants, particular parts of plants, and/or various plant constituents (or chemical components), which are thought to be responsible for the therapeutic or physiological effect of the substance.

In MEDLINE, most of the research citations for medicinal plants will be found by searching under the constituents that have been identified as producing a therapeutic effect. For example, both milk thistle (a plant with well-researched liver-protective properties) and one of its major constituents, silymarin, are MeSH headings, but most of the research is indexed only under the latter term. Most of the research for St. John's wort is indexed under two of its therapeutic constituents, hypericin and hyperforin.

Constituents and whole plants live in separate MeSH trees, or subject areas. Constituents are in the Chemicals and Drugs Category, while whole plants are in Plant Families and Groups.

With these facts in mind, be creative. Experiment with searches that include some or all of the following, ORing them together: the plant's common name; the plant's scientific name or genus; and/or active constituent(s) specific to that particular plant, or the group of plants to which it belongs, that have been suggested as producing a therapeutic effect.

For example:

PubMed's Complementary Medicine Subset:

The National Center for Complementary and Alternative Medicine (NCCAM) and the National Library of Medicine (NLM), both at the National Institutes of Health (NIH), created this subset. This feature is especially useful for finding CAM information on specific health conditions, or to limit concepts such as placebo.

Enter search terms in the PubMed search box, then click the Limits button, open the Subsets menu and select Complementary Medicine.

The Complementary Medicine subset is updated daily, except Sunday and Monday. You can look at the complex search strategy used to identify citations at www.nlm.nih.gov/bsd/pubmed_subsets/comp_med_strategy.html.

Caution: The Complementary Medicine subset is generally more useful for health conditions than for botanical substances, many of which have little research to begin with, or are already included in the subset. Be careful limiting searches on complementary and alternative medicine. Do some preliminary work collecting search terms and then run the search. If you get too many hits, or many that aren't relevant, revise your search and then consider using a limiting feature such as the Complementary Medicine subset.

Using PubMed's Clinical Queries Feature with the Complementary Medicine Subset:

This method, which involves running your search twice, is most useful for finding research on CAM therapeutics for health conditions. Click Clinical Queries on the left sidebar of the PubMed search screen. Choose Clinical Queries Using Methodology Filters. (An explanation of this option is available on the site.)

Enter a health condition in the search box, choosing the appropriate category.

Run the search

Now, click the Limits button, open the Subsets menu and choose Complementary Medicine.

Click Go.

Choose Systematic Reviews, to search for clinically relevant review information on health conditions or botanical and nutritional substances, e.g. st johns wort, beta carotene.

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