KJC Korea
Journal Central

Objectives The main purpose of this study was to evaluate the bone healing effect of Pahyeolsandong-tang (PHT)(Poxiesanteng-tang) extract in tibia fracture-induced mice. Methods PHT was extracted using a solution of 35% ethanol in 60°C for 8 hours. Mice were randomly divided into 4 groups (normal, control, PHT 50 and PHT 100). Mice of experimental groups were medicated with PHT 50 or 100 mg/kg for 7 to 21 days. To clarify the effect of bone fracture healing, relative messenger RNA (mRNA) expressions of osteocalcin (OCN), runt-related transcription factor 2 (Runx2), osterix (OSX), Sox9, collagen type Ⅱ alpha 1 chain (Col2a1), receptor activator of nuclear factor kappa-B ligand (RANKL), osteoprotegerin (OPG) were examined. Results In in vitro experiment, relative mRNA expression of OCN, Runx2, Col2a1 was significantly increased in PHT treated group to compare with control differentiation group. In in vivo experiment, relative mRNA expression of OCN, Runx2, OSX, Sox9, Col2a1, RANKL, OPG was significantly increased in PHT treated group. Conclusions This study showed that PHT accelerates bone fracture healing through the activation of osteoclasts and osteoblasts. It was showed that PHT significantly promotes osteoblasts differentiation by osteoblast differentiation markers such as OCN, Runx2, Col1a2. Also it was investigated that PHT had stimulatory effect on osteoblasts function through enhancing OCN, Runx2, OSX, Sox9, Col2a1 and, osteoclasts function through enhancing RANKL and OPG markers. PHT effectively promotes bone fracture healing process through activation of osteoblasts and osteoclasts. (J Korean Med Rehabil 2020;30(4):1-16)

Objectives The purpose of this study is to evaluate the healing effect of Yukmijihwang- tang (YM) on femur fractured mice. Methods Mice were randomly divided into 6 groups: normal, control, positive control, YM with low, medium, high dosage each. All groups were prepared with femur fracture and treated diffrently. In order to measure bone regeneration effects, we analysed the levels of cyclooxygenase-2 (COX2), bone morphogenetic protein-2 (BMP2), collagen type Ⅱ alpha 1 chain (Col2a1), Sox9, runt-related transcription factor 2 (Runx2), and osterix genes expressed in bone. For morphological analysis, muscles were removed and femur was observed with naked eye. Results COX2 gene expression in bone marrow significantly decreased. BMP2 gene expression significantly increased. Col2a1 gene expression significantly increased. Sox9 gene expression increased as well. Runx2 gene expression in bone marrow increased, but there was no statistical significance. Osterix gene expression significantly increased. Union of the fracture site progressed more in YM group compared to the control group. The fracture union score was significantly decreased in YM group compared to the control group. Conclusions YM showed anti-inflammatory effect, promoted bone regeneration by stimulating the bone regeneration factor. In conclusion, YM can help fracture healing and it well be applied clinically to patients with fracture. (J Korean Med Rehabil 2020;30(4):17-30)

Objectives Danggwisoo-san and Jakyakgamcho-tang are frequently prescribed for traffic accident patients in Korea. The aim of this study was to examine index compound analysis, antioxidant activity and amount of starch measurement by extraction method. Methods Danggwisoo-san and Jakyakgamcho-tang were extracted with water and 70% ethanol. Antioxidant activity was measured by 2,2-Diphenyl-1-picrylhydrazyl, 2,2-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid) and ferric reducing antioxidant power according to the standard protocol. The contents of the indicator components nodakenin, paeoniflorin, and glycyrrhizin were measured by high-performance liquid chromatography, respectively. All starches were hydrolyzed and then total D-glucose was measured and compared. Results Antioxidant activity was excellent in 70% ethanol in all assays. The index component was jagged because its solubility was different depending on the extraction solvent. Starch content was significantly lower in 70% alcohol extract than water extract. Conclusions The results of this study showed that physiological activities and components are different according to extraction conditions. Each herbal medicine has a suitable extraction solvent. Also, the difference in starch content is an object to be considered as it may affect digestion and absorption. (J Korean Med Rehabil 2020;30(4):31-39)

Objectives The purpose of this study was to investigate the effects of Silbi-san on the antioxidant and fat accumulation inhibition and to analyze the anti-obesity effect by analyzing the changes in serum lipid composition in obese mice. Methods We compared contents of phytochemicals like total polyphenols and total flavonoid and antioxidant activities such as 2,2-dipheny-1-picrylhydrazyl and 2.2’-azino-bis (3-ethylbenzothiazoline-6-sulphonic acid) radical scavenging activity. After Silbi-san in 3T3-L1 cells in vitro and mouse adipose tissue ex vivo, we quantified intracellular triglyceride accumulation and lipolysis. Moreover, the anti-obesity activity though inhibiting pancreatic lipase were analyzed. In 3T3-L1 cells, morphological changes showed that control cells had many lipid while cells treated with Silbi-san had less lipid accumulation. 30% EtOH Silbi-san treatment also suppressed the fat absorption by inhibiting the activity of pancreatic lipase and led to high lipolysis through promoting glycerol release. The experimental group was divided into four groups: Normal group fed normal feed, Control group fed 60% high fat diet (HFD) and distilled water, drug group fed 60% high fat diet and 200 mg/kg of Silbi-san water extract, drug group fed 60% HFD and 200 mg/kg of Silbi-san 30% ethanol extract. Results Serum total cholesterol content and serum low density lipoprotein-cholesterol content were significantly decreased in the Silbi-san extract group compared to the control group, serum high density lipoprotein-cholesterol content was significantly increased in Silbi-san extract group. Conclusions In this study, the antioxidant and fat accumulation inhibitory effects of Silbi-san were confirmed. (J Korean Med Rehabil 2020;30(4):41-53)

Objectives This study aimed to analyze the trends of Korean traditional medicine treatment for idiopathic scoliosis. Methods We searched clinical studies used Korean traditional medicine for idiopathic scoliosis in 4 Korean online databases ‘Koreanstudies Information Service System’, ‘Earticle’, ‘Oriental Medicine Advanced Searching Integrated System’, ‘Research Information Sharing Service’. We selected 18 studies and analyzed their characteristics according to author, publication year, number/sex/age of patient, treatment period, intervention, outcome measure and result. Results Eighteen case report studies were selected by criteria and randomized controlled trials were not found. The most frequently used therapy was Chuna therapy. Cobb's angle was most commonly used outcome measure. Conclusions In this study, we reviewed studies used Korean traditional medicine treatments for idiopathic scoliosis. However, evidence is limited because all selected studies were case reports. This study suggests that further clinical studies are needed to provide higher evidence about Korean traditional medicine treatment for idiopathic scoliosis. (J Korean Med Rehabil 2020;30(4):55-64)

Objectives This study is aimed to evaluate the effectiveness of Chuna therapy for spondylolisthesis. Methods We searched th following 10 online databases without a language restriction (National Digital Science Library [NDSL], Research Information Sharing Service [RISS], Oriental Medicine Advanced Searching Integrated System [OASIS], KMBASE, MEDLINE/ PubMed, Cochrane library, Ebscohost, EMBASE, Ovid, China National Knowledge Infrastru [CNKI]) to find randomized controlled trials that used Chuna therapy for spondylolisthesis. The methodological quality of each randomized controlled clinical trial was assessed using the Cochrane risk of bias tool and meta-analyses were perfomed. Results Eleven randomized controlled trials were included. Chuna therapy showed statistically significant reduction of symptoms. Meta-analysis showed positive results for Chuna therapy for spondylolisthesis in terms of therapeutic effects to traction, chinese medicine, therapeutic exercise. Conclusion In this study, we reviewed studies about Chuna therapy used for spondylolisthesis. The studies showed that Chuna therapy can significantly effective on spondylolisthesis. But according to Cochrane risk of bias evaluation method, most of the studies's risk of bias were unclear. Therefore, more high-quality studies will be needed. (J Korean Med Rehabil 2020;30(4):65-77)

Objectives This study was performed to research the trends of Chinese acupuncture treatment for ankylosing spondylitis (AS). Methods We searched clinical studies about Chinese acupuncture treatment for AS through China National Knowledge Infrastructure. We analyzed the characteristics of selected studies according to research design, sample size, publication year, treatment methods, evaluation criteria and adverse events. Results 16 studies published from 2015 to 2020 were selected. They consisted of 11 randomized controlled trials and 5 case reports. In these studies, several types of acupuncture treatments were performed and especially there were many treatments that applied thermal stimulation of needles. The most commonly used evaluation criteria was effective rate. Conclusions This study showed that acupuncture treatment could be effective for AS. It suggested that various studies should be conducted to provide reliable evidence about acupuncture treatment for AS in Korea. (J Korean Med Rehabil 2020;30(4):79-88)

Objectives This study has been conducted to verify frequently used herbs and herbal formulas to treat obesity in Korea during 2015 to 2019. Methods Publications related to treatment of obesity using herbal medicines from 2015 to 2019 were retrieved from 12 databases (PubMed, EMBASE, Scopus, China National Knowledge Infrastructure [CNKI], Koreanstudies Information Service System [KISS], National Digital Science Library [NDSL], Research Information Sharing Service [RISS], DBPIA, KMBASE, KoreaMed, KoreanTK, Oriental Medicine Advanced Searching Integrated System [OASIS]). Extracted articles were analyzed in terms of publication year, journal, and type of herbs. Results A total of 136 studies have been included in this study. 33 herbal formulaes and 129 herbs have been analyzed. Taeyeumjowui-tang was the most frequently studied herbal formulae and Ephedrae Herba was the most frequently studied herb. Ginseng Radix was the most frequently studied single herb in isolation from herbal formulae. Conclusions These results suggest that various herbs and herbal formulae can be used to treat obesity. Since this study includes every type of study, additional studies based on clinic are thought to be necessary. (J Korean Med Rehabil 2020;30(4):89-103)

Objectives The objective of this study is to assess the effectiveness of electroacupuncture for patients with hip arthroplasty. Methods According to participants, intervention, comparison, outcome, study design, we searched for clinical studies that conducted electroacupuncture for patients with hip arthroplasty. Results Finally 11 randomized controlled trials were chosen for systemic review and meta-analysis. The frequently used evaluation tools were Incidence of postoperative cognitive dysfunction (POCD), heart rate, blood pressure. Almost studies showed electroacupuncture has effects for patients with hip arthroplasty. Through meta analysis, Electoacupuncture showed statistically significant effect of reducing the anesthetic dosage and incidence of postoperative psychonosema and adverse reactions in intra-operation period, reducing the incidence of POCD in peri-operation period, incidence of deep venous thrombosis in post-operation period. Conclusion 11 studies reported that electroacupuncture has significant effects on hip arthroplasty. But, many studies were assessed in a probable high risk of bias. And all studies published in one overseas country. So, it requires attention to comprehend this study. To make up for this limitaion, more well designed clinical research are needed. (J Korean Med Rehabil 2020;30(4):105-117)

Objective The purpose of this study was to investigate clinical studies between 2015 and 2020 on the traditional Chinese medicine treatment for carpal tunnel syndrome (CTS) using the China National Knowledge Infrastructure (CNKI) database. Methods We searched clinical studies on the Chinese medicine treatment published in traditional Chinese medical journals on CTS through the CNKI search. Fifteen published studies between 2015 and 2020 were chosen and examined for the year of publication, sample size, study design type, diagnosis and evaluation of diverse criteria, treatment period, purpose of the study, and classification based on the treatment technique. Results Out of 73 studies, 15 had practiced various Chinese medical treatments, such as acupuncture, moxibustion, manipulation, herbal medicine application therapy, and external herbal treatment. Conclusions Various studies have investigated the Chinese medicine treatment for CTS in China. To envelope the treatment of CTS in Korean medicine, steady and valuable therapies for high-level clinical research are required. In the future, this study could be helpful in the development of the treatment of CTS with Korean medicine. (J Korean Med Rehabil 2020;30(4):119-132)

Objectives Studies on Chinese herbal injections are increasing. But, its safety are still not well reported. We have reviewed the literature related to the safety of Chinese herbal injection, especially those related to anaphylaxis. Methods The PubMed database was used to select the literatures related to anaphylaxis in China and to study the quality control and safety of Chinese herbal injection. Results Chinese herbal injection is a major traditional medical treatment in China, but it is the cause of adverse drug reactions including anaphylaxis. In order to solve this problem, various proposals have been made to identify the pharmacological and chemical causes of major side effects and to use them safely clinically. In addition, various researches have been conducted from preclinical to postmarketing surveillance to secure the safety of Chinese herbal injection. Based on this, it was found that various efforts are needed to secure the safety of bee sting needles. Conclusion In order to secure the safety of chinese herbal injections, it is necessary to identify the main mechanism of action and the pharmacological components contributing to it, and to develop a standardized formulation based on this. In addition, institutional pharmacovigilance is required. (J Korean Med Rehabil 2020;30(4):133-142)

Objectives To analyze the prognosis of patients with low back pain according to the severity of abnormal lumbar lordotic angle and Ferguson's angle. Methods Data from electronic medical record of a total of 199 patients hospitalized in Korean medicine hospital were analyzed. With the sagittal view of lumbar spine X-ray, lumbar lordotic angle was defined as the angle between the superior endplate of L1 with the inferior endplate of L5. Ferguson’s angle was defined as the angle between the superior surfaces of the sacral with a horizontal line. ‘Measure Cobb’s Angle Tool’ of ‘INFINITT PACS’ was used to measure both angles. Lumbar lordotic angle and Ferguson's angle were subdivided into five sections. The number of days from onset and the duration of hospitalization were analyzed in each section. Results Severe hypolordotic lumbar lordotic angle group were found to have longer medical history and hospitalization duration than the control group. The ratio of long-term hospitalization (over 15 days) and chronic medical history (over 180 days) of patients with severe hypolordotic Ferguson’s angle were significantly higher than the control group. The ratio of patients with chronic medical history (over 180 days) was significantly higher in severe hyperlordotic Ferguson's angle group than the control group. Conclusions Severe hypolordotic lumbar lordotic angle was related to patient’s prognosis. Both severe hyperlordotic and severe hypolordotic Ferguson’s angle were found to be related to patient’s prognosis. However, a moderate loss of lumbar lordotic angle and Ferguson’s angle was not related to prognosis of low back pain patients. (J Korean Med Rehabil 2020;30(4):143-154)

Objectives This study is aimed to evaluate the feasibility of further clinical research of warm needle acupuncture as an effective and safe treatment for chronic low back pain. Methods Thirty participants will be randomly assigned to the Warm needle acupuncture group (n=15) and Dry needle acupuncture group (n=15). All patients will receive acupuncture therapy twice a week for 6 weeks, but only the experimental group will receive thermal stimulation. The primary outcome will be measured using the visual analogue scale for bothersomeness of low back pain, and the secondary outcome will be measured using the VAS for pain intensity, Oswestry disability index, 36-Item Short Form Health Survey, Beck's depression inventory, and amount of analgesics used. Conclusions The results of this study will be used to determine the feasibility of a future large-scale randomized controlled trial that provides clinical evidence for the efficacy and safety of warm needle acupuncture in the treatment of patients with chronic low back pain. (J Korean Med Rehabil 2020;30(4):155-164)

Objectives This survey study is designed to check the awareness and satisfaction of Korean herbal medicine in patients suffering from acute traffic accidents. Methods From May 1 to 20, 2020, patients who visited the hospital within 7 days after the accident and received prescription of Korean herbal medicine for the first-time symptoms were selected. Survey was conducted 10 days after the first visit to confirm the perception of Korean herbal medicine and expected to be used as a prior study to improve the quality of Korean medicine led by Korean herbal medicine. Results Most patients answered that they were aware of the prescribed Korean herbal medicine's dosage and treatment effects. 65% of the patients said they would like to receive other forms of prescription if possible. Most patients answered that portability is convenient and tastes better than normal. 48% of the respondents said that it was the first to time to take Korean herbal medicine, and 68% said that they were willing to take the Korean herbal medicine later. At the time of the first visit, the health condition assessed using EuroQol visual analogue scale (EQ-VAS) was 46.84, but 10 days after the treatment began, it increased significantly to 61.93. Conclusions The improvement of symptoms and high satisfaction with Korean medicine medical services contributed to the patient's willingness to visit the Korean medicine hospital again and to respond that they were willing to take further medication. EQ-VAS elevation suggests that overall patients' subjective health conditions have improved since treatment. (J Korean Med Rehabil 2020;30(4):165-178)

The aim of this study was to report the effect of Korean medicine treatments and vestibular rehabilitation practice on an stroke patient with dizziness. The patient received Korean medicine treatments, such as acupuncture and herbal medication, and vestibular rehabilitation practice. The effects of treatments were assessed with the Korean dizziness handicap inventory, Korean activities-specific balance confidence scale, Korean vestibular disorders activities of daily living scale. Researchers conducted gait analysis for evaluation patient’s gait disturbance’s improvement during treatments. The intensity of dizziness were significantly reduced after the complete treatment. After treatment with traditional Korean medicine and vestibular rehabilitation practice, the patient showed significant improvements in symptoms and gait parameters. This case proved that combined therapy of Korean medicine treatment and vestibular rehabilitation practice can be useful for stroke patients who suffered from dizziness. however, studies of larger populations are required in the future. (J Korean Med Rehabil 2020;30(4):179-186)

The objective of this study is to report an accidental detection of colorectal cancer (CRC) metastasis to spine during conservative treatment for lumbar disc herniation. We treated a 65-year-old female who was diagnosed with lumbar disc herniation on September 2019 by acupuncture, pharmacopuncture, cupping treatment, chuna manual therapy, herbal medicine treatment, medicine treatment and physical therapy. After that we analyzed medical record from December 12, 2019 to February 11, 2020. The patient was diagnosed with CRC and received tumor resection in 2014. After 2 times of chemotherapy, she arbitrarily interrupted the treatment. Since she stated that CRC treatment was terminated, we had difficulty in finding connection between symptom and CRC. During the treatment period, compression fracture at L3 body was found, which was caused by CRC metastasis. Rigorous question, appropriate radiological and clinical tests are required to patients who have history of malignant tumor. (J Korean Med Rehabil 2020;30(4):187-194)

Spinal epidural lipomatosis is a rare disorder characterized by overgrowth of fat in the extradural space, causing spinal stenosis with compression of the neural elements. This study reports on the effectiveness of Korean medicine treatment on a patient who was diagnosed on lumbar stenosis with lipomatosis. The patient was treated with Korean traditional medicine including pharmacopucture, acupuncture, Chuna manual treatment, and Korean herbal medicine, cupping. Numerical rating scale (NRS), Oswestry disability index (ODI), Euroqol five dimension (EQ-5D) index, lumbar range of motion were used as objective tools for evaluating the patient’s progress. Back NRS decreased from 6 to 3. In the case of lower limbl radiation NRS, 5 was reduced to 3 upon discharge. EQ-5D index also increased from 0.751 to 0.766. For ODI, the score dropped from 26.67 to 24.44 on hospitalization. As a result, clinical improvements were found in a patient. In conclusion, this study shows that Korean medicine treatment can be considered as effective conservative care for spinal stenosis with lipomatosis. (J Korean Med Rehabil 2020;30(4):195-201)

The aim of this study was to propose our rehabilitation protocol involving Korean medicine for patients with patellar fracture and report its effectiveness. Further, for the same patellar fracture patients, we created different protocols for those who underwent surgical treatment and those who required conservative treatment. Among patients who received inpatient treatment at our hospital for three years from August 2017 to August 2020, we included three patients who underwent surgical treatment for patellar fracture and one patient who required conservative treatment for patellar fracture. The degree of improvement of the patients was evaluated using physical examination findings of the knee joint, numeric rating scale, pain disability index, Lysholm knee score, and walking state. After each treatments, we observed that the range of motion of the knee joint, numeric rating scale, pain disability index, Lysholm knee score, and walking state improved in the patient groups. Even with the same patellar fracture, we observed that different rehabilitation treatments involving Korean medicine should be applied to patients who underwent surgical treatment and those who required conservative treatment. However, further studies are needed to design a rehabilitation protocol involving Korean medicine. (J Korean Med Rehabil 2020;30(4):203-217)

The objective of this study is to propose a Korean medical rehabilitation protocol for total knee replacement (TKR) and to report its effectiveness. This study was conducted as a retrospective study which analyzes the medical records of 4 patients undergoing Korean medical rehabilitation with protocol and continuous passive motion exercise for more than two weeks after TKR. We evaluated the outcome checking physical examination findings of the knee joint, numeric rating scale (NRS), Lysholm knee score (LKS) and walking state. After the treatment, we observed that the function of knee joint, NRS, LKS, walking state of patients were improved. This study showed that Korean medical rehabilitation protocol has effect on knee joint recovery after TKR. The limitation of this study was the insufficient number of cases and short-term follow up. Further studies should be done steadily to report the effectiveness of a Korean Medical rehabilitation protocol for TKR. (J Korean Med Rehabil 2020;30(4):219-231)

This study was performed to evaluate the effect of high frequency therapy applied to the region branching to the external carotid artery for peripheral facial paralysis sequelae. A patient suffering with facial edema due to facial paralysis sequelae had been treated with acupuncture, high frequency therapy on the branch area to the external carotid artery for 7 weeks. The evaluation of clinical outcome was done by degree of swelling by measuring the distance of the face and skin temperature of face through digital infrared thermographic imaging. After treatment, the patient's degree of swelling and the temperature difference between the affected side and normal side was decreased. In addition, the temperature was changed in the entire facial area as well as the treatment point of high frequency therapy. This result shows that acupuncture combined with high frequency therapy at the region branching to the external carotid artery could be an effective way to improve facial blood flow, although further clinical studies will be needed. (J Korean Med Rehabil 2020;30(4):233-241)