**5. Tibetan Five Nectar Formula medicated bath therapy for pain relief in patients with RA**

Tibetan Five Nectar Formula is derived from five types of plants and has been considered to have anti-inflammatory and immunomodulating effects for rheumatoid arthritis when used as bath therapy. To understand the beneficial effect of Tibetan Five Nectar Formula Medicated-Bath Therapy on patients with rheumatoid arthritis, the author's research group has recently conducted a comprehensive review of the literature of Tibetan Five Nectar Formula Medicated-Bath Therapy on patients with rheumatoid arthritis (Jacobson et al., 2010).

Eighty-seven potentially relevant studies were identified. Nine non-randomized controlled trials of 757 subjects met eligibility criteria (Jacobson et al., 2010). All the trials were conducted in the Tibetan area of China and used the Five Nectar formula in the Tibetan Medicated-Bath. Bath temperatures were of 35-46 0C for 10-15 min, once or twice a day. Mean treatment duration ranged from 7-30 days per course, for 1-3 courses. Two studies stopped some or all western medications during treatment. The 9 studies also used supplemental oral Tibetan herbal therapy. The effect of the Tibetan Five Nectar Formula Medicated-Bath Therapy on clinical symptoms was measured with Physician-assessed composite outcomes. All studies reported a positive association between the Tibetan Five Nectar Formula Medicated-Bath Therapy and improved clinical pain symptoms within group comparisons. In addition, three studies reported an improvement in immune function. There are discordant trial designs and lack of reported qualitative outcomes measure were among other methodological limitations. The overall study quality was poor with no controls or randomization, blinding or reports of dropout rates. However, these studies suggest that Tibetan Five Nectar Formula Medicated-Bath Therapy may be helpful in the treatment of pain symptoms due to rheumatoid arthritis. However, they are of only weak evidentiary value due to uniformly poor methodological quality. Future studies with more rigorous design and adequate statistical analysis are warranted.
