Korea Institute Of Oriental Medicine Research Articles

How the Patient-clinician Relationship Influences Treatment Experiences and Outcomes in Chronic Pain Patients: An fMRI Hyperscan Study

The patient-clinician therapeutic alliance is a powerful modulator shaping patients' treatment experience and clinical outcomes. Before and after a 3-week electro-acupuncture intervention (6 sessions), fMRI hyper-scanning was applied to investigate the influence of either an Augmented (warm/attentive) or a Limited (neutral/business-like) clinician interaction style. Eighteen women with fibromyalgia (mean age=41.41, SD=12.20, each group N=9), randomly assigned to an Augmented or Limited patient-clinician dyadic interaction style (trained acupuncturists), underwent a simultaneously recorded fMRI hyper-scanning procedure with a video connection between two scanners and an evoked cuff pressure pain/treatment paradigm. Questionnaires were used to assess the patients' experience by targeting treatment-related changes such as clinical pain levels, therapeutic alliance, trust, the clinician's warmth and competence, and the probability of continuing the treatment with this clinician after study participation. As rated by patients, pooled therapeutic alliance and clinicians' warmth in the Augmented (mean_alliance=43.21, SD=2.40; mean_warmth=4.00, SD=0.0) were significantly higher than in the Limited group (mean_alliance=22.79, SD=13.15; mean_warmth=2.54, SD=1.10; t_alliance(16)=4.31, p<0.001; t_warmth(16)=3.74; p=0.002). Additionally, over the course of all 6 acupuncture treatment sessions, most patients experienced immediate clinical pain relief after each treatment session (p<0.001), irrespective of augmented or limited group assignment. Pain catastrophizing was significantly reduced after the intervention (t(16)=3.79; p=0.002) in the Augmented (∆-7.88) but not the Limited group (∆1.44). Importantly, only the Augmented group reported a high probability to continue with the treatment after the study as well as a high pain relief expectation for future acupuncture treatments even though both groups experienced similar pain relief treatment outcomes over the course of the study intervention. Brain imaging data analysis focused on social mirroring areas such as the temporo-parietal junction (TPJ). In summary, this study highlights the importance of investigating variable interaction quality during longitudinal clinical therapies and its influence on clinical outcomes, treatment compliance, and brain processing of nociceptive signaling. Grant support from NIH - National Center for Complementary and Integrative Health (NCCIH: R61-AT009306, R33-AT009306), Neuroimaging Pilot Funding Initiative at the Martinos Center for Biomedical imaging (MGH R90DA023427), Korea Institute of Oriental Medicine (KIOM), Foundation for the Science of the Therapeutic Encounter, National Center for Research Resources (P41RR14075; CRC 1 UL1 RR025758), Harvard Clinical and Translational Science Center, Martinos Computing facilities, and National Institutes of Health (Grant Nos. S10RR023401, S10RR019307, S10RR019254, and S10RR023043). The funders had no role in study design, data collection and/or interpretation of the results. Also, all authors declare no existence of competing conflicts of interest.

Potentials of Chenpi on Metabolic Syndrome: A Review

Objectives: Metabolic Syndrome (MetS) is strongly related with central obesity, hypertriglyceridemia, low high-density lipoprotein-cholesterol (HDL-C), hyperglycemia, and hypertension. This study reviewed the potential of Chenpi in treatment of MetS through amelioration of co-related diseases, such as diabetes mellitus, hyperlipidemia, obesity, hepatic steatosis, and inflammation.Methods: Six electronic databases (Oriental Medicine Advanced Searching Integrated System (OASIS), Korean Traditional Knowledge Portal, Korea Institute of Oriental Medicine (KIOM), Research Information Sharing Service (RISS), PubMed, and Embase) were used to search for in vitro, in vivo, and clinical research that discusses the potential effects of Chenpi (Citrus unshiu Markovich, Citrus reticulata Blanco) on diabetes mellitus, hyperlipidemia, obesity, hepatic steatosis, and inflammation.Results: This review suggests the potential of Chenpi as a candidate for the treatment of metabolic syndrome through improvement of co-related diabetes, hyperlipidemia, obesity, hepatic steatosis, and inflammation. However, comparison of the results of each study was limited by a lack of quantification of the experimental materials.

Brain-to-brain patient-clinician connectivity is directionally modulated by chronic low back pain therapy: an electroencephalography hyperscan approach

In chronic pain management and treatment, a positive patient-clinician relationship is associated with higher patient satisfaction and treatment efficacy. In this study, we investigated synchronization of brain activity between patients and clinicians during an experimentally controlled augmented (empathetic) compared to limited (business-like) clinical interaction context. We recorded EEG simultaneously (hyperscanning, 16 dyads, 64 channels per subject) from low back pain patients and acupuncturists during a task with treatment trials (acupuncture) and no-treatment trials in conjunction with evoked cuff pain. EEG data were reconstructed using the algorithm exact LORETA on 17 Regions of Interest (ROIs) defined by our previous fMRI study (Ellingsen et al. 2020) and directed statistical connectivity patterns were obtained by comparing Granger Causality-based estimates for treatment and no-treatment trials (α=0.05, FDR corrected). Patients in the augmented group, compared to the limited group, rated therapeutic alliance and clinician warmth significantly higher. Low back pain intensity decreased after acupuncture treatment, irrespective of clinical context. EEG analysis suggested that in Theta band (linked with empathy for pain in prior EEG studies), inter-brain network density within social mirroring and pain/sensorimotor brain regions was altered when acupuncturists treated evoked pain. The number of significant inter-brain clinician-to-patient connections was higher in the no-treatment condition, while the number of patient-to-clinician connections were greater during treatment trials. Also, the density of patient-to-clinician inter-brain connections increased during treatment relative to no-treatment irrespective of clinical context, yet statistical significance was noted only for the augmented group. Both behavioral and simultaneous brain-to-brain responses across the patient/clinician dyad reflect clinical interaction context. EEG hyperscanning is an ecologically valid approach to identify inter-brain networks whose density and directionality within the dyad is altered by treatment and clinical context, highlighting new brain mechanisms linking therapeutic alliance and chronic pain therapy. Research supported by NIH - National Center for Complementary and Integrative Health, NIH-NIBIB National Institute of Biomedical Imaging and Bioengineering and Korea Institute of Oriental Medicine (KIOM).

Causal dynamics of patient/clinician facial expression transfer are associated with insula cortex brain-to-brain concordance

While patient/clinician relationships significantly impact pain outcomes, the behavioral and neural mechanisms supporting this phenomenon are unknown. Specifically, the precise role of facial expressions in contributing to analgesia and brain-to-brain communication has not been investigated. In this Hyperscan fMRI study, we explored how pain-related, directional facial communication between patient and clinician engaging in interactive pain treatment is associated with brain concordance. Dyads comprising 20 patients with fibromyalgia and 19 acupuncturists completed two synchronous fMRI scans (two different partners per participant). During fMRI, dyad members saw each other's face through closed-circuit video while interacting. The fMRI scan included a series of moderately painful and minimally/non-painful leg cuff pressure stimuli to the patient while the clinician observed. A separate fMRI scan included clinician-applied and remotely-activated electroacupuncture treatment to the patient while they received moderate cuff pressure pain. In-scanner videos were used for automated individual facial muscle unit (FMU) timeseries extraction. FMU data from pain/observation scans was fed into an interpretable machine learning classifier to determine which FMU's dynamics was most associated with pain. FMUs from the pain/treatment scans were used in conjunction with neural-network causality estimation to investigate directional non-verbal communication and their association with brain-to-brain dynamic fMRI concordance (as reported in Ellingsen et al., 2020). Causality analysis indicated a strong asymmetry in which the patients’ facial expressions elicited a range of facial expressions in clinicians, but not vice-versa. Patient lip movement FMUs were most associated with pain. Interestingly, patient-to-clinician causal influence of these FMUs on similar clinicians’ FMUs was associated with dynamic insula cortex brain-to-brain concordance, demonstrating the key role of this social mirroring and salience processing brain region with respect to facial expression mirroring between patients and clinicians. Supported by the National Institutes of Health, National Center for Complementary and Integrative Health (R61-AT009306), Norwegian Research Council /Marie Sklodowska-Curie Actions (FRICON/COFUND-240553/F20), Neuroimaging Pilot Funding Initiative at the Martinos Center for Biomedical imaging, MGH (R90DA023427), Korea Institute of Oriental Medicine (KIOM), Foundation for the Science of the Therapeutic Encounter, National Center for Research Resources (P41RR14075; CRC 1 UL1 RR025758), Harvard Clinical and Translational Science Center, Martinos Computing facilities, and National Institutes of Health (Grant Nos. S10RR023401, S10RR019307, S10RR019254, and S10RR023043).

A Novel Method in Predicting Hypertension Using Facial Images

Hypertension has been a crucial public health challenge among adults. This study aimed to develop a novel method for non-contact prediction of hypertension using facial characteristics such as facial features and facial color. The data of 1099 subjects (376 men and 723 women) analyzed in this study were obtained from the Korean Constitutional Multicenter Study of Korean medicine Data Center (KDC) at the Korea Institute of Oriental Medicine (KIOM). Facial images were collected and facial variables were extracted using image processing techniques. Analysis of covariance (ANCOVA) and Least Absolute Shrinkage and Selection Operator (LASSO) were performed to compare and identify the facial characteristic variables between the hypertension group and normal group. We found that the most distinct facial feature differences between hypertension patients and normal individuals were facial shape and nose shape for men in addition to eye shape and nose shape for women. In terms of facial colors, cheek color in men, as well as forehead and nose color in women, were the most distinct facial colors between the hypertension groups and normal individuals. Looking at the AUC value, the prediction power for women is better than men. In conclusion, we managed to explore and identify the facial characteristics variables related to hypertension. This study may provide new evidence in the validity of predicting hypertension using facial characteristics.

Introduction to Korea Institute of Oriental Medicine’s Korean Medicine Case Report Program

Several modalities that have been used in Korean medicine have not undergone evaluation. The Korea Institute of Oriental Medicine (KIOM), a South Korean national research agency, launched the Korean medicine case Report (KORE) program in May 2019 to promote case reports, especially among clinicians. The aim was to (1) introduce the KIOM-initiated KORE program, (2) report the results from the KORE program, and (3) present the challenges and limitation from the KORE program. We conducted a narrative review of the cases to which KORE was applied. A total of 16 proposals were reviewed since May 2019. Five proposals were rejected, and 7 case reports were included. Case reports for 3 therapies have been created under guidance. The KORE program makes it easier for Korean medicine doctors to initiate and complete case reports.

Qualitative study on the key elements of obesity counseling in Korean Medicine

Introduction:The increasing prevalence of obesity worldwide necessitates the provision of support for many patients. Patients with obesity appreciate receiving advice from doctors. Previous studies have qualitatively explored clinicians’ counseling for weight loss; however, this is limited to primary physicians or general practitioners working in community health centers. In contrast, Korean Medicine Doctors (KMDs) have treated patients with obesity using a holistic approach with a multicomponent approach on counseling. However, there is currently no data regarding KMDs’ consulting practices for weight loss. Therefore, the present study will explore KMDs’ experience in counseling for weight loss and describe the constituents of counseling for weight loss in Korean medicine practice.Methods:This qualitative study utilizes a phenomenological framework. The KMDs who have worked >1 year as practitioners in treating patients with obesity will be invited to describe their lived experiences of counseling patients for weight loss. Purposive and snowball sampling will be undertaken to ensure that the sample provides information-rich cases that are representative of KMDs’ experiences of counseling for weight loss. Face-to-face, individual, and semi-structured interviews will be conducted with the participants, which will be analyzed using a phenomenological method.Ethics and dissemination:Ethical approval was granted by the Human Research Ethics Committee of the Korea Institute of Oriental Medicine (I-1908/006-001). The results will be disseminated via journal articles and conference presentations.Trial registration number:Korean Clinical Trial Registry, KCT0004985.

Effects of Processed Polygonum multiflorum with KIOM Patent on Bone Remodeling-Related Protein Expression in Human Osteoblast-Like SaOS-2 Cells.

This present study evaluated the effects of processed P. multiflorum on osteogenesis using Sarcoma osteogenic (SaOS-2) cell lines and osteoclastogenesis of bone marrow-derived macrophage cells (BMM) and to elucidate differences in effect on the expression of bone-related proteins between commercially sold P. multiflorum and patented, in vitro-propagated Korea Institute of Oriental Medicine (KIOM) P. multiflorum. Raw P. multiflorum and P. multiflorum that were stir-baked and steamed in black bean juice were compared, and western blotting analysis was performed to investigate the expression of bone remodeling-related proteins in SaOS-2 cells. In the cells treated with P. multiflorum steamed in black bean juice, the expression of RANKL was decreased, whereas that of osteoprotegerin, alkaline phosphatase, Runx2, and osterix was increased. Owing to these results, we conclude that processed P. multiflorum can be used as an alternative treatment for bone diseases such as osteoporosis, osteopenia, periodontitis, and Paget's disease.

Abstract B111: A herbal formula BP10A enhanced anticancer effect of chemotherapeutic agents in the colon cancer PDTX model

Abstract BP10A is a novel two-herb medicine formula, consisting of Descurainiae sophia Semen and Peucedani praeruptorum Radix. This study was done to evaluate the antitumor efficacy of BP10A and its effect on the efficacy of the anticancer drugs oxaliplatin and irinotecan (CPT-11) in a colon tumor xenograft model. Chemical constituents from the ethanol extracts of BP10A were characterized with the ultra-performance liquid chromatography (UPLC) and each constituent was quantified with the UPLC-diode array detector method. Our study showed that BP10A exerted the cytotoxic effects in two colorectal cancer cell lines and its combination treatments with oxaliplatin or CPT-11 remarkably increased the in vitro cytotoxicity of each cancer drug assessed by the Ez-cytox assay. The in vivo antitumor activity of BP10A was evaluated in three colon cancer patient-derived tumor xenograft (PDTX) models with different genetic backgrounds. Oral administration with BP10A (250 and 500 mg/kg, daily) delayed tumor growth by 34-70% in the all PDTX models. Similarly, intraperitoneal injection of oxaliplatin (6 mg/kg) or CPT-11 (20 mg/kg) also suppressed tumor growth by 31.8-60.5% or by 24.3-50.4%, respectively. Furthermore, the combination treatment of BP10A with oxaliplatin or CPT-11 remarkably enhanced the antitumor activity of each anti-cancer drug and delayed tumor growth by 47.1-74.6% or by 74.4-82.9%, respectively. In accordance with the antitumor activity, the Ki-67 expression for tumor cell proliferation and the CD31 for angiogenesis were decreased, and TUNEL staining for tumor cell apoptosis was remarkably increased by the co-treatment of BP10A and the anticancer drugs as well as by each treatment of BP10A, oxaliplatin or CPT-11. Conclusively, BP10A has a strong tumor inhibitory effect against colon cancer and a synergistic effect with anticancer drugs, suggesting that BP10A could be considered as a good therapeutic candidate for the treatment of colon cancer. Funding source: This research was supported by a grant from Korea Institute of Oriental Medicine (K1515294). Citation Format: Jinhee Kim, Sarah Shin, No Soo Kim, Ok-Sun Bang. A herbal formula BP10A enhanced anticancer effect of chemotherapeutic agents in the colon cancer PDTX model [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference on Molecular Targets and Cancer Therapeutics; 2019 Oct 26-30; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2019;18(12 Suppl):Abstract nr B111. doi:10.1158/1535-7163.TARG-19-B111

The Study of Soldier’s Sasang constitutions

This research aims to analyze the Sasang constitutions of army soldiers using the measuring tools which were developed by the Korea Institute of Oriental Medicine the government-affiliated Ministry of Science. Then, this research compares the The Sasang constitutions of soldiers to the Sasang typology of Yi Je-Ma, who systemized Korean traditional medicine in 1800s. Also, by comparing each result of subjected army unit, we will recommend proper diet management at regular intervals in order to enhance morals of soldiers. Finally, we also suggest to apply Sasang constitution to consultation in military so as to strengthen the combat power of the army.

Evaluation of Dry Eye Syndrome Induced by Urban Particulate Matter Using Aerosol Exposure System

Dry eye syndrome (DES) is caused by multi‐factors and it is featured as tear deficiency and eye irritation. Air pollutions, represented as particulate matter (PM), are emerging threat of human health which induce various diseases including DES. However, the pathogenic mechanisms of DES via PM exposure are not completely identified. Though, several in vivo models of PM induced DES have been suggested, these were not properly reflect the phenomena of human who exposed to PM. In this study, we utilized inhalation device to mimic the atmospheric environment of PM exposure. Rats were exposed to urban PM (UPM) for 5 hours a day during 5 days. After exposure, tear volume was reduced in UPM exposure group. In addition, corneal irregularity and corneal epithelial cell apoptosis were significantly increased by UPM exposure. UPM also affected the tear film disruption via mucin‐4 reduction. Our purpose in this study was to demonstrate the application of new in vivo exposure model for DES induced by PM. We suggest that aerosol exposure system of PM can be used for risk assessment of DES.Support or Funding InformationThis study was carried out with the support of ‘R&amp;D Program for Forest Science Technology (Project No. 2017035A00‐1919‐BA01)’ provided by Korea Forest Service (Korea Forestry Promotion Institute). This work was also supported by Korea Institute of Oriental Medicine (Project No. KSN1812080).This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

The effect of Polydatin in dry eye disease in vivo and in vitro

Polydatin (PD, also named pieceid, (E)‐piceid, (E)‐polydatin, trans‐polydatin, 3,4′, 5‐trihydroxystilbene‐3‐b‐D‐glucoside) is a monocrystalline compound originally isolated from the root and rhizome of Polygonum cuspidatum Sieb. et Zucc. (Polygonaceae), a traditional East Asia medicine. Previous study demonstrated that Polydatin has antioxidant and anti‐inflammatory effect. However, the effect of Polydatin in dry eye diseases (DED) has not been mentioned. We investigated the effect of Polydatin in the models of dry eye in vivo and in vitro. The measurement of tear volume showed that the decreased tear volume in the extraorbital lacrimal gland excised rats was significantly recovered by the Polydatin 0.5% eye drops. In addition, the corneal irregularity and lissamine green staining score revealed that Polydatin eye drops (0.05% and 0.5%) remarkably inhibited the increased corneal irregularity and lissamine green staining scores by the extraorbital lacrimal gland. Tear film breakup time assay showed that the shortened tear film breakup time was reasonably increased in the Polydatin 0.5% eye dropped group. Moreover, we examined the effect of Polydatin in the hyperosmolarity‐induced human conjunctival epithelium. The results from realtime PCR demonstrated that Polydatin significantly inhibited the mRNA expression of TNF‐α, IL‐6 and MMP9 in a concentration dependent manner. Taken together, our results suggest that Polydatin may a potential therapeutic agent to treat dry eye disease through the recovery of damaged corneal layer and inhibition of inflammation in conjunctival epithelium.Support or Funding InformationThis work was supported by Korea Institute of Planning and Evaluation for Technology in Food, Agriculture, Forestry and Fisheries(IPET) through (High Value‐added Food Technology Development Program), funded by Ministry of Agriculture, Food and Rural Affairs(MAFRA) (#317033‐03).This work was also supported by Korea Institute of Oriental Medicine (Project No. KSN1812080).This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Case study projects by a Korean national research agency: Past 12 years and future

ObjectivesScientific rigor is a known challenge to establish in heavily individualized practices of traditional medicine. A national research agency in Korea carried out a 12-year project to promote case reports among clinics of Korean Medicine (KM). This report aims at providing challenges, achievements, and thoughts for future endeavors. MethodsWe reviewed all the projects executed by the Korea Institute of Oriental Medicine between 2005 and 2017 promoting case reports in clinics of KM. The findings were categorized stage of project development, themes of project stage, achievement, and challenges. ResultsThe implemented studies include eleven prospective- and five retrospective - case series, and one comparative trial. The project stages are divided into four, initial (surveying and building a database on Korean acupuncture), transitional (educating Korean Medicine doctors on writing case reports and building a case report system), stagnation (partially attributable to IRB's considering case report projects as clinical trial) and resurrection (building a rigorous evidence base from local clinics). The major challenges included practitioners' in clinics feeling burdened by the rigor of documentation requirement, the limited options of usable objective measurement tools available at general KM, and IRB's categorizing case report projects as clinical trials hence imposing unrealistic compliance burden. ConclusionsPromoting case reports in local clinics, while being warranted to remain as a crucial research method to build evidence based KM practice, requires supports from stakeholders including motivated clinicians of KM, extended use of diagnostic device available at KM practice, and insightful and flexible regulatory bodies’ decision making.

Test-retest reliability of the questionnaire in the Sasang constitutional analysis tool (SCAT)

BackgroundThe Sasang constitutional analysis tool (SCAT) is an integrated Sasang constitutional analysis system developed by the Korea Institute of Oriental Medicine. This study aimed to evaluate the reliability of a questionnaire for measuring personality and pathophysiological symptoms that is one of the components of the SCAT. MethodsIn this study, data were collected from university students in their twenties. Tests were administered twice, with an interval of 4 weeks between tests. Test-retest data from 176 students were collected and used for analysis. Internal consistency reliability was analyzed by using Cronbach's alpha coefficient, and test-retest reliability was analyzed by using Spearman's rank correlation coefficient. ResultsCronbach's alpha coefficient was 0.788 for personality, 0.511 for eating habits, 0.718 for digestion, 0.667 for heat- or cold-wise penchant, and 0.612 for water ingestion. Spearman's rank correlation coefficients, which were used to assess correlations between test and retest results, ranged from 0.444 to 0.828. ConclusionThe internal consistency and test-retest reliability of the SCAT questionnaire were found to be satisfactory.

Correction: Physiological characterization of a novel PPAR pan agonist, 2-(4-(5,6-methylenedioxybenzo[d]thiazol-2-yl)-2-methylphenoxy)-2-methylpropanoic acid (MHY2013).

// Hye Jin An 1, 2 , Bonggi Lee 1, 2, 5 , Dae Hyun Kim 1, 2 , Eun Kyeong Lee 1, 2 , Ki Wung Chung 1, 2 , Min Hi Park 1, 2 , Hyoung Oh Jeong 1, 2 , Sung Min Kim 1, 2 , Kyoung Mi Moon 1, 2 , Ye Ra Kim 1, 2 , Seong Jin Kim 1, 2 , Hwi Young Yun 1, 2 , Pusoon Chun 3 , Byung Pal Yu 4 , Hyung Ryong Moon 1, 2 , Hae Young Chung 1, 2 1 College of Pharmacy, Pusan National University, Busan 46241, Republic of Korea 2 Molecular Inflammation Research Center for Aging Intervention (MRCA), Pusan National University, Busan 46241, Republic of Korea 3 College of Pharmacy, Inje University, Gyeongsangnam-do 50834, Republic of Korea 4 Department of Physiology, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229-3900, USA 5 Korean Medicine (KM)-Application Center, Korea Institute of Oriental Medicine (KIOM), Daegu 41062, Republic of Korea Correspondence to: Hae Young Chung, email: hyjung@pusan.ac.kr Hyung Ryong Moon, email: mhr108@pusan.ac.kr Keywords: MHY2013, PPAR pan agonist, metabolic syndrome, FGF21, adiponectin Received: July 29, 2016 Accepted: December 27, 2016 Published: January 25, 2017 ABSTRACT Recently, agonists targeting multiple peroxisome proliferator-activated receptors (PPARs) have been developed to improve metabolic disorders and minimize the side effects of selective PPAR agonists such as weight gain and dyslipidemia. We newly synthesized six 2-methyl-2-( o -tolyloxy)propanoic acid derivatives based on the structure of a well-known PPAR pan agonist, bezafibrate. Of six compounds, MHY2013 was screened as the strongest activator of three PPAR subtypes based on protein docking simulation and luciferase assays. When treated orally in db/db mice, MHY2013 ameliorated obesity-induced insulin resistance, dyslipidemia, and hepatic steatosis without changes of the body weight and levels of liver and kidney injury markers. MHY2013 decreased the serum triglyceride and fatty acid levels, which is associated with an increase in fatty acid oxidation signaling in the liver and thermogenic signaling on white adipose tissue, respectively. Furthermore, MHY2013 markedly increased serum levels of insulin-sensitizing hormones including fibroblast growth factor 21 (FGF21) and adiponectin. In conclusion, this study suggests that, MHY2013 is a novel PPAR pan agonist that improves obesity-induced insulin resistance, dyslipidemia and hepatic steatosis and elevates insulin-sensitizing hormones in the blood.

Tongqiaozuoxue Decoction, a Traditional Korean Medicine, Improves Hypercoagulation Through Stimulating Adiponectin Expression

The efficacy and safety of traditional medicine could be proved through human trial for a long time, and now it has been required for the scientific evidence of its efficacy and identification of specific functional target. Tongqiaozuoxue Decoction (THD) is a water extract of 8 species of medicinal herb including Cnidium officinale Makino and Prunus persica Batsch, and has been used for the treatment of blood stasis and hypercoagulation in traditional Korean medicine. This study investigated the efficacy of THD and its functional target using animal model. Early vascular model was established through feeding high‐fat diet (HFD, 60% fat) for 12 weeks to C57BL/6 mice; these mice showed the phenotype of obesity, insulin resistance, chronic metabolic inflammation, hyperlipidemia, and prothrombotic state. THD was orally administered for last 4 weeks in a dose of 100mg/kg/day. THD significantly decreased plasminogen activator inhibitor‐1 (PAI‐1) level in serum and adipose tissue (AT) by 30% and 60%, respectively. Also, the plasma activity of tissue‐type plasminogen activator (tPA), the downstream target of PAI‐1, was increased by 2‐fold. Fibrin deposition was notably reduced in AT, demonstrated by immunohistochemistry. Meanwhile, adiponectin level was significantly increased both in serum and adipose tissue by 30% and 60%, respectively, although adipose tissue weight or total body weight were not changed by THD. Taken together, these results demonstrated that THD improve hypercoagulation through stimulating adiponectin expression.Support or Funding InformationThis study was supported by the grant of Korea Institute of Oriental Medicine

Integrative Medicine for Postoperative Patients: A Survey of Korean Medicine Doctors.

The purpose of this survey was to document the experience of Korean Medicine doctors (KMD) who provided postoperative care to patients through integrative medicine and to understand their opinions about integrative medicine utilization. Three researchers (two with a KMD license) of the Korea Institute of Oriental Medicine conducted the survey. The questionnaire was distributed via e-mail to the 17,041 members of the Association of Korean Medicine in 2015. In total, 487 KMD answered the questionnaires. The majority of respondents worked in a Korean Medicine (KM) clinic, KM hospital, or long-term care hospitals (94.7%). The respondents mostly treated patients after musculoskeletal (26.7%), spinal (23.7%), or neuropathic surgery (22.2%). Patients predominantly experienced pain (23.0%), fatigue and tiredness (17.4%), delayed scar recovery (13.7%), and paralysis (13.0%). We analyzed subgroups in accordance with institution of employment, specialization, and clinical experience. Most KMD wanted to utilize integrative medicine for postoperative care of patients (92.6%). Moreover, a relatively active collaboration was noted in long-term care hospitals (mean rate: 60.73% [95% CI: 42.25 to 79.20]). Further studies and clinical trials are needed to determine whether integrative medicine is essential for providing postoperative care to Korean patients.

Influence of Boiling Duration of GCSB-5 on Index Compound Content and Antioxidative and Anti-inflammatory Activity.

Background:GCSB-5, an herbal drug composition with an anti-inflammatory effect, is prepared by boiling, which is the most common herbal extraction method in traditional Korean medicine. Several parameters are involved in the process, i.e., extractant type, herb-to-extractant ratio, extraction temperature and pressure, and total boiling time.Objectives:The aim of this study was to examine the influence of boiling time on index compound amount and the antioxidative and anti-inflammatory activities of GCSB-5.Materials and Methods:Different samples of GCSB-5 were obtained by decocting for 30, 60, 90, 120, 150, and 240 min. Each sample was tested for hydrogen ion concentration (pH), total soluble solid content (TSSC), marker compound profiles, and antioxidative and anti-inflammatory activity.Results:pH was found to decrease while TSSC increased with extended decoction. Marker compound contents for GCSB-5 (acanthoside D for Acanthopanax sessiliflorus Seem, 20-hydroxyecdysone for Achyranthes japonica Nakai, and pinoresinol diglucoside for Eucommia ulmoides Oliver) remained relatively constant regardless of the length of boiling. Total D-glucose amount increased with longer boiling. The antioxidative and anti-inflammatory potentials of GCSB-5 were not substantially affected by decoction duration.Conclusion:Biological characteristics and marker compound content of GCSB-5 were not altered significantly in prolonged boiling.SUMMARY Longer boiling duration of GCSB-5 did not increase yield in a time-dependent manner, but yields of 210 and 240 min samples were significantly higherHydrogen ion concentration of GCSB-5 samples decreased while total soluble solid content and D-glucose concentration levels increased with boiling durationAlthough concentrations of some index compounds increased with extended boiling duration of GCSB-5, increase was small and not in a direct proportional relationshipAntioxidative and anti-inflammatory properties of GCSB-5 were not substantially affected by decoction duration. Abbreviations used: CAM: Complementary and alternative medicine; KIOM: Korea Institute of Oriental Medicine; KMD: Korean medicine doctor; TSSC: Total soluble solid content; pH: Hydrogen ion concentration; HPLC: High-performance liquid chromatography; NO: Nitric oxide; NO2: Nitric dioxide; LPS: Lipopolysaccharide; DMSO: Dimethyl sulfoxide.

Acupuncture for chronic diarrhea in adults: Protocol for a systematic review.

As 2 major common types of chronic diarrhea, functional diarrhea (FD) and diarrhea-predominant irritable bowel syndrome (IBS-D) affect 1.54% to 1.72% of people in China. Acupuncture is commonly used in clinical practice for patients with chronic diarrhea. Here, we present a protocol of systematic review aimed at systematically review all the clinical evidence on the effectiveness of acupuncture for treating FD and IBS-D in adults. The review will be performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement. We will search the following databases from their inception to January 2017: Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, China Biology Medicine disc, Wan-Fang Data, China National Knowledge Infrastructure, Citation Information by National Institute of Informatics, Oriental Medicine Advanced Searching Integrated System by Korea Institute of Oriental Medicine, and Japan Science and Technology Information Aggregator (J-stage). Clinical trial registrations will also be searched. Primary outcome measures are the change of bowel movements. The secondary outcomes include stool consistency, quality of life scales, other standardized rating scales, patient satisfaction, and acupuncture-related adverse effects assessment. This review does not require ethical approval and will be disseminated electronically or in print. CRD42015017574.

Modification of the Integrated Sasang Constitutional Diagnostic Model.

In 2012, the Korea Institute of Oriental Medicine proposed an objective and comprehensive physical diagnostic model to address quantification problems in the existing Sasang constitutional diagnostic method. However, certain issues have been raised regarding a revision of the proposed diagnostic model. In this paper, we propose various methodological approaches to address the problems of the previous diagnostic model. Firstly, more useful variables are selected in each component. Secondly, the least absolute shrinkage and selection operator is used to reduce multicollinearity without the modification of explanatory variables. Thirdly, proportions of SC types and age are considered to construct individual diagnostic models and classify the training set and the test set for reflecting the characteristics of the entire dataset. Finally, an integrated model is constructed with explanatory variables of individual diagnosis models. The proposed integrated diagnostic model significantly improves the sensitivities for both the male SY type (36.4% → 62.0%) and the female SE type (43.7% → 64.5%), which were areas of limitation of the previous integrated diagnostic model. The ideas of these new algorithms are expected to contribute not only to the scientific development of Sasang constitutional medicine in Korea but also to that of other diagnostic methods for traditional medicine.