Chang Nam Ko

Intradermal acupuncture on shen-men and nei-kuan acupoints in patients with insomnia after stroke.

This is the first study that focuses on the effects of intradermal acupuncture on insomnia after stroke. We enrolled hospitalized stroke patients with insomnia and assigned them into a real intradermal acupuncture group (RA group) or a sham acupuncture group (SA group) by randomization. The RA group received intradermal acupuncture on shen-men (He-7) and nei-kuan (EH-6) for 2 days, and the SA group received sham acupuncture on the same points. The effectiveness was measured by the Morning Questionnaire (MQ), Insomnia Severity Index (ISI), and Athens Insomnia Scale (AIS). These scales were examined by an independent, blinded neurologist before, and 1 and 2 days after treatment, repeatedly. Thirty subjects (15 in the RA group and 15 in the SA group) were included in the final analysis. The RA group showed more improvement on insomnia than the SA group. Repeated measures analysis detected that there were significant between-subjects effects in the MQ, the ISI and the AIS. In conclusion, we suggest that intradermal acupuncture on shen-men and nei-kuan is a useful treatment for post stroke-onset insomnia.

The Effect of Low versus High Frequency Electrical Acupoint Stimulation on Motor Recovery After Ischemic Stroke by Motor Evoked Potentials Study

Electrical acupoint stimulation (EAS) has been used to treat motor dysfunction of stroke patients with reportedly effective results. When we operate EAS treatment, we can modulate the intensity and frequency of stimulation. The purpose of this study is to evaluate the effect of different frequencies in treating motor dysfunction of ischemic stroke patients with EAS. The subjects of this study were 62 ischemic stroke patients with motor dysfunction in Kyunghee oriental medical center. They have been hospitalized after 1 week to 1 month from onset. They were treated with 2 Hz or 120 Hz EAS for 2 weeks, and had motor evoked potentials (MEPs) tests before and after 2 weeks of EAS treatment. We measured latency, central motor conduction time (CMCT) and amplitude of MEPs. After 2 weeks of treatment, we compared MEPs data of the affected side between the 2 Hz group and the 120 Hz group. The 2 Hz group showed more significant improvement than the 120 Hz group in latency, CMCT and amplitude (p = 0.008, 0.002, 0.002). In the case of the affected side MEPs data divided by normal side MEPs data, the 2 Hz group also showed higher improvement rate than the 120 Hz group in latency, CMCT and amplitude with significant differences (p = 0.003, 0.000, 0.008). These results suggest that low frequency EAS activates the central motor conduction system better than high frequency EAS, and EAS with low frequency could be more helpful for motor recovery after ischemic stroke than that with high frequency.

Effects of Moxibustion on the Recovery of Post-Stroke Urinary Symptoms

This study was conducted to test the effectiveness of moxibustion therapy for patients with post-stroke urinary symptoms using International Prostate Symptom Score (IPSS). Stroke patients with urinary symptoms were enrolled and assigned into the moxibustion group (MO group) and the control group by stratified randomization. The MO group received moxibustion treatment on Zhong-Ji (CV-3), Guan-Yuan (CV-4) and Qi-Hai (CV-6) for 10 days, and the control group did not receive it. The effectiveness of urinary symptoms and activities of daily living were measured by IPSS and Barthel Index (BI), respectively. These scales were examined by an independent blinded neurologist before treatment, and 10 days after therapy. Thirty nine subjects (20 in the MO group and 19 in the control group) were included in the final analysis. The MO group showed more improvement on urinary symptoms than the control group. In conclusion, we suggest that moxibustion on Zhong-Ji (CV-3), Guan-Yuan (CV-4) and Qi-Hai (CV-6) is effective to post-stroke urinary symptoms.

Anti-hypertensive Effect of Chunghyul-dan (Qingxue-dan) on Stroke Patients with Essential Hypertension

Hypertension is one of the modifiable risk factors for stroke. Lowering blood pressure is helpful for primary and secondary prevention of stroke. This study is aimed to assess the efficacy of Chunghyul-dan on stroke patients with stage 1 hypertension using 24 hours ambulatory blood pressure monitoring (24ABPM). Forty hospitalized stroke patients with stage 1 hypertension were included in the study and they were randomly assigned into two groups: group A was treated with Chunghyul-dan 1200 mg once a day for 2 weeks, while group B was not. Twelve subjects were dropped out because of unexpected early discharge or data errors, thus the remaining 28 subjects were included in the final analysis (15 in group A and 13 in group B). Blood pressure was monitored every 30 minutes for 24 hours at baseline and 2 weeks after medication. Blood pressure, pulse rate, trough/peak ratio (TPR) [the value calculated by dividing the blood pressure change at trough (22 to 24 hours after drug intake) by the change at peak (2 adjacent hours with a maximal blood pressure reduction between the second and eighth hour after drug intake)] and smoothness index (SI) (the value calculated as the ratio between the average of the 24 hours, treatment-induced blood pressure changes and its standard deviation) were compared to assess the efficacy of Chunghyul-dan. To assess the safety of Chunghyul-dan, any adverse effects during medication period were monitored. There was no significant difference in the baseline assessment between the two groups. Systolic blood pressure was lower in group A than in group B (141.37+/-8.96 mmHg versus 132.28+/-9.46 mmHg, P = 0.03), while diastolic blood pressure and pulse rate had no significant difference between the two groups. Systolic TPR and SI was 0.87 and 1.04 in group A, respectively. This suggests that Chunghyul-dan have anti-hypertensive effect on stroke patients with stage 1 hypertension.

Hwangryunhaedogtang (Huanglianjiedutang) Treatment for Pathological Laughter after Stroke and Importance of Patterns Identification: A Preliminary Study

This study was to test the importance of patterns identification (PI) and the effectiveness of hwangryunhaedogtang (huanglianjiedutang) (HT) treatment for patients with post stroke pathological laughter (PL). Fourteen subjects were enrolled. Eight subjects diagnosed with Yang Excess patterns (YEP) were assigned into group A and 6 subjects who had no YEP to group B. HT was administrated 3 times a day for 14 days to both groups. The duration of PL at one time, the frequency of PL in a day, and pathological laughter scale (PLS) were the primary outcome measures. Barthel index (BI) was the secondary outcome measure. The duration and the frequency of PL in group A were significantly decreased from 10.88 +/- 4.67 to 6.63 +/- 4.07 sec and from 6.38 +/- 2.72 to 3.00 +/- 1.77 times, respectively (p = 0.01) after 14 days administration of HT. PLS in group A was also significantly lowered from 9.13 +/- 1.73 to 4.75 +/- 0.71 points (p = 0.01). However, significant differences were not observed in BI in group A and in the primary and secondary outcome measures in group B. The duration and the frequency of PL and PLS were more markedly reduced in group A than in group B (p = 0.01, 0.02, and < 0.01, respectively). These results suggested that HT could be effective on subjects with post stroke PL diagnosed as YEP and PI, that prescription of herbal medications to such patients should be considered.

Chunghyul-Dan (Qingxie-Dan) Improves Arterial Stiffness in Patients with Increased baPWV

Arterial stiffness is an important, independent determinant of cardiovascular risk. Pulse wave velocity (PWV) has been used as a valuable index of arterial stiffness and as a surrogate marker for atherosclerosis. Chunghyul-dan (CHD) has anti-hyperlipidemic activity, anti-inflammatory activity and anti-atherogenic effects. To determine its clinical effect on increased arterial stiffness, we examined whether CHD improves arterial stiffness in patients with increased brachial-ankle PWV (baPWV). Thirty-five subjects with increased baPWV (> 1400 cm/sec) were recruited and randomized to a treatment group (20 subjects) or a control group (15 subjects). The treatment group was administered CHD at a dose of 600 mg three times a day for 8 weeks, and the control group received no medication (observation only). baPWV was assessed using a pulse pressure analyzer at baseline and after 8 weeks. Blood pressure and serum lipid profile were monitored in the treatment group. Our results indicate that baPWV was lowered significantly in the treatment group after 8 weeks of medication (p < 0.05), but not in the control group. Moreover, there were no significant changes in blood pressure and serum lipids profile except triglyceride level suggesting that the effect is largely independent of CHDs lipid-lowering effect or a blood pressure change. In conclusion, CHD appears to improve arterial stiffness in patients with increased PWV.

Clinical assessment of usefulness, effectiveness and safety of jackyakamcho-tang (shaoyaogancao-tang) on muscle spasm and pain: a case series.

This study is a retrospective single case series. Two hundred and thirty-seven patients were treated with jackyakamcho-tang (JKT) for relief of muscle spasm and pain; 81 of them were included in analysis. (The others were excluded because of insufficient medical records to confirm the diagnosis or assess the response.) There were 29 patients with nocturnal leg cramps, 28 with cervical spondylosis, 13 with thalamic pain and 11 with carpal tunnel syndrome, for which the effectiveness was assessed as 86.2%, 60.7%, 45.5% and 72.8%, respectively. Adverse effects (indigestion, diarrhea or edema) were seen in 11.1% of the total patients, but severe cases were only 3.7%. Taking the effectiveness and the safety into consideration, the usefulness was assessed as 86.2%, 57.1%, 53.9% and 72.8% for treating nocturnal leg cramps, cervical spondylosis, thalamic pain and carpal tunnel syndrome, respectively. In conclusion, we suggest that JKT is a useful herbal medicine with analgesic and anti-spasmodic effects.

Integrative treatment modalities for stroke victims in Korea

OBJECTIVES To suggest and discuss an integrative medicine model for stroke patients, we introduce our experience in Korea, describe treatment modalities used for stroke in Korean medicine, and present safety data on integrative care. SUMMARY For inpatients, integrative management is applied at the request of the primary physician with the consent of patients or their families. In the acute stage, neurologists or neurosurgeons take charge as the primary physicians. Korean medicine doctors cooperate as secondary physicians to the neurologists and neurosurgeons. After the acute stage, responsibilities are exchanged. The rehabilitation program is conducted under the supervision of rehabilitation medicine doctors. The most frequently used complementary and alternative medicine modalities are acupuncture (including manual acupuncture, electroacupuncture and intradermal acupuncture), moxibustion, herbal prescriptions, and acupuncture point injection. CONCLUSION Based on our field experiences, we believe it is worthwhile to continue efforts to integrate complementary and alternative medicine and Western medicine.

Chunghyul-dan acts as an anti-inflammatory agent in endothelial cells by regulating gene expression

Abstract Chunghyul-dan (CHD) is a combinatorial drug known to exert anti-inflammatory effects in endothelial cells. In this study, we employed global transcriptional profiling using cDNA microarrays to identify molecular mechanisms responsible for the anti-inflammatory activity of CHD in endothelial cells. An analysis of the microarray data revealed that transcript levels of monocyte chemotactic protein-1 (MCP-1), vascular cell-adhesion molecule-1 (VCAM-1) and activated leukocyte cell-adhesion molecule were dramatically altered in CHD-treated endothelial cells. These changes in gene expression were confirmed by RT-PCR, Western blotting and ELISA. Chronic CHD treatment also appeared to decrease MCP-1 secretion, probably as a result of decreased MCP-1 expression. In addition, we determined that chronic CHD treatment inhibited lipopolysaccharide-stimulated adhesion of THP-1 leukocytes to endothelial cells. The inhibitory effect of CHD on LPS-stimulated adhesion resulted from down-regulation of VCAM-1 expression. Transmigration of THP-1 leukocytes through endothelial cells was also inhibited by chronic CHD treatment. In conclusion, CHD controls a variety of inflammatory activities by regulating MCP-1 and VCAM-1 gene expression.

A Case Report of Bee Venom Acupuncture on Hip Joint Pain in Rehabilitation Stage of Stroke

Osteoarthritis in patients with an intracerebral hemorrhage can cause difficulties for stroke rehabilitation and can delay neurologic recovery. In an attempt to overcome these problems, we used bee venom acupuncture injections for hip joint pain in a patient with hip joint osteoarthritis who had suffered an intracerebral hemorrhage. A female patient of 72 years old complained of hip joint pain due to osteoarthritis during stroke rehabilitation. The pain was initially assessed as 7 in Numeric Rating Scale. Prior to bee venom therapy, this symptom was treated with medication, intra articular injection, transcutaneous electrical nerve stimulation, and acupuncture. However, her pain did not improve. She subsequently received bee venom injections at hip joint acupuncture points and her Numeric Rating Scale score changed from 7 to 2 after this treatment, indicating improvements in hip joint pain. Her scores on the McGill Pain Questionnaire for pain intensity and frequency were also improved. Herein, was port the observed effects of bee venom therapy for hip joint pain with osteoarthritis in this patient, but caution that further controlled studies are needed?