Integrative medicine (East Asian herbal medicine combined with conventional medicine) for psoriasis: A protocol for systematic review and meta-analysis

BACKGROUND

Psoriasis is a chronic, inflammatory, autoimmune skin disease. The aim of this review is to systematically evaluate the efficacy and safety of integrative medicine (East Asian herbal medicine combined with conventional medicine) used to treat inflammatory skin lesions of psoriasis.

METHODS

A comprehensive literature search will be conducted in 3 English databases (PubMed, Cochrane Library, and Embase), 4 Korean databases (Korean Studies Information Service System, Research Information Service System, Oriental Medicine Advanced Searching Integrated System, and Korea Citation Index), 2 Chinese databases (Chinese National Knowledge Infrastructure Database and Wanfang data), and 1 Japanese database (Citation Information by National Institute of Informatics) for randomized controlled trials from their inception until July 29, 2021. Statistical analysis will be performed using R version 4.1.2 and the R studio program using the default settings of the "meta" and "metafor" packages. The primary outcome will be an improvement in the psoriasis area severity index. All outcomes will be analyzed using a random-effects model to produce more statistically conservative results. If heterogeneity is detected in the study, the cause will be identified through sensitivity, meta-regression, and subgroup analyses. Methodological quality will be assessed independently using the revised tool for the risk of bias in randomized trials, version 2.0. The overall quality of evidence will be evaluated according to the Grading of Recommendations Assessment, Development, and Evaluation pro framework.

RESULTS

This study will review all available trials on the same subject and arrive at a more statistically robust conclusion based on a sufficient sample size of participants and additional analysis using data mining techniques will be performed on intervention prescription information in clinical studies collected according to rigorous criteria.

CONCLUSION

We believe that this study will provide useful knowledge on managing inflammatory skin lesions of psoriasis vulgaris using integrative medicine using East Asian herbal medicine.

East Asian Herbal Medicine for the Treatment of Children with Attention Deficit Hyperactivity Disorder: A Systematic Review and Meta-analysis

BACKGROUND

Attention deficit hyperactivity disorder (ADHD) is a mental illness that can place a significant burden on individuals, their families, and society. East Asian Herbal Medicine (EAHM) has long been used in East Asian nations to treat mental illness in children. Nevertheless, the evidence for the effectiveness of EAHM for the treatment of ADHD is insufficient. A systematic review was performed to examine the effectiveness and safety. In addition, research on core herbal combinations was also conducted to help clinicians in their prescription selection.

MATERIALS AND METHODS

This systematic review and meta-analysis were prepared according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The following databases were searched: 4 English databases (PubMed, Cochrane Library, Cumulative Index to Nursing & Allied Health Literature (CINAHL), EMBASE), 4 Korean databases (Korean Studies Information Service System (KISS), Research Information Service System (RISS), Oriental Medicine Advanced Searching Integrated System (OASIS), Korea Citation Index (KCI)), 2 Chinese databases (Chinese National Knowledge Infrastructure Database (CNKI), Wanfang Data), and 1 Japanese database (CiNii) database. The publication bias was evaluated using funnel plots. GRADE pro was used to evaluate the evidence of the study. The core herb combination of EAHM used in this study was revealed using apriori algorithm-based association rule mining.

RESULTS

This review assessed 42 studies that evaluated 3484 children and adolescents. In meta-analysis, EAHM monotherapy had a similar clinical efficacy rate to conventional medicine (CM) (n = 2166; random effects RR 1.09, 95% CI 1.05 to 1.13; heterogeneity χ2= 25.08, df = 23, p = 0.35, I²=8%). EAHM-combined therapy showed a better clinical efficacy rate than when conventional therapy was used alone (n = 746; fixed effects RR 1.19, 95% CI 1.12 to 1.26; heterogeneity χ2= 11.80, df = 9, p = 0.22, I²=24%). For adverse events, EAHM had a lower incidence than conventional therapy. In GRADE pro, each outcome varied from moderate to very low quality. The constituents of the herb combinations with consistent association rules were Fossilia Ossis Mastodi, Polygalae Radix, and Acori Graminei Rhizoma.

CONCLUSION

EAHM monotherapy has similar effects to CM but with fewer side effects. Hence, it will be helpful for children with ADHD suffering from the side effects of CM. EAHM-combined therapy has a better effect than conventional therapy. Accordingly, it will be useful for children with ADHD who do not respond to treatment with conventional therapy. Nevertheless, more well-designed studies will be needed to confirm this in the future.

Comparative Effectiveness of East Asian Traditional Medicine for Childhood Simple Obesity: A Systematic Review and Network Meta-Analysis

Childhood obesity leads to various comorbidities and usually persists into adulthood, increasing socioeconomic burden. In the absence of a clearly effective treatment, East Asian traditional medicine (EATM) therapies have been widely used. We aimed to analyze the comparative effectiveness and safety of EATM techniques for children with simple obesity through network meta-analysis (NMA). Twelve databases were searched for randomized controlled trials (RCTs) evaluating the effect of EATMs on childhood simple obesity. Individual EATMs were ranked based on the surface under the cumulative ranking curve. The risk of bias in the individual studies and publication bias in the NMA were evaluated. Thirty-three RCTs were included. Acupuncture, chuna, chuna plus acupressure, cupping plus acupressure, herbal medicine (HM), and HM plus acupuncture significantly reduced BMI compared with lifestyle management. Based on the treatment ranking, cupping plus acupressure was optimal for BMI reduction compared with a non-medical management, followed by chuna and HM. The quality of evidence for individual findings was usually moderate to low, and no serious adverse events of EATM were reported. Cupping plus acupressure might have a large beneficial effect, and chuna or HM probably have a moderate beneficial effect on reducing BMI in children with simple obesity.

Meditation-based intervention for obsessive-compulsive disorder: A PRISMA-compliant systematic review and meta-analysis

BACKGROUND

The purpose of this study was to investigate the effects of the meditation-based intervention on obsessive-compulsive disorder (OCD).

METHODS

The following databases were searched up to April 2021: the Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, Medline (via PubMed), PsycARTICLES, 4 Korean databases (Korean Medical Database [KMbase], Koreanstudies Information Service System [KISS], National Digital Science Library [NDSL], and Oriental Medicine Advanced Searching Integrated System [OASIS]), and China National Knowledge Infrastructure (CNKI). The search terms related to meditation-based intervention and OCD were used. This systematic review was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The selected articles were evaluated using the Cochrane risk of bias tool. The Review Manager (RevMan) 5.4 was used to perform the meta-analysis.

RESULTS

In all, 16 randomized controlled trials were selected. The meta-analysis showed that the group receiving the treatment combining medication and meditation-based intervention for OCD showed a more significant post-treatment improvement in Yale-Brown obsessive compulsive scale than the group receiving medication only. Compared with other non-medication interventions that are known to be effective in treating OCD, the Yale-Brown obsessive compulsive scale showed a significant improvement immediately after the meditation-based intervention. However, no significant difference was found in the follow-up monitoring data across all examined cases.

CONCLUSION

This study was conducted to verify the effects of meditation-based intervention on OCD. The results suggested that combined treatment with medication and meditation-based intervention was more effective in treating OCD than medication alone; the positive effects of meditation-based intervention may be greater than the effects of other non-medication interventions. However, the lack of significant difference in the follow-up indicates that long-term effect of meditation-based interventions is unclear.

TRIAL REGISTRATION NUMBER

PROSPERO CRD42021244408.

The efficacy and safety of yukmijihwang-hwan (Liuweidihuang-wan) for type 2 diabetes mellitus without complications: A protocol for systematic review and meta-analysis

BACKGROUND

This systematic review and meta-analysis of randomized controlled trials (RCTs) will aim to assess the efficacy and safety of Yukmijihwang-hwan for type 2 diabetes without complications.

METHODS

To identify eligible studies, we will perform a systematic search of the following electronic databases: MEDLINE (PubMed), EMBASE, the Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, Citation Information by NII, Korean Information Service System, Korean Medical Database, Oriental Medicine Advanced Searching Integrated System, and ScienceON. Search terms will include "Type 2 Diabetes" for participants as well as "Yukmijihwang-tang" or "Liuwei dihuang tang" for interventions. Two independent researchers will perform data extraction and assessment using Cochrane's risk of bias tool, with disagreements being resolved through discussions with a third researcher.

RESULTS

This study will evaluate the antidiabetic effects of Yukmijihwang-hwan from 3 perspectives (blood glucose level, insulin resistance, and β-cell function) as well as its safety by reviewing the reported adverse effects.

CONCLUSION

This systematic review will provide evidence regarding the antidiabetic efficacy and safety of Yukmijihwang-tang in type 2 diabetes mellitus.

Traditional uses, phytochemistry, pharmacology, toxicity and quality control of medicinal genus Aralia: A review

ETHNOPHARMACOLOGICAL RELEVANCE

Aralia, which belongs to Araliaceae family, is mainly distributed in Asia, such as China, Japan and South Korea. It has a long medicinal history and is widely used in the treatment of various diseases, such as hepatitis, rheumatoid arthritis, bruises, lumps and carbuncles.

AIM OF THE STUDY

The purpose of this review is to systematically evaluate the traditional uses, phytochemistry, pharmacology, toxicity and quality control of main medicinal plants of Aralia, discusses the application of ethnic medicine, modern scientific research and the relationship between them, and put forward some suggestions to promote the further development and utilization of Aralia.

MATERIALS AND METHODS

The relevant information on Aralia was collected through electronic databases (PubMed, Web of Science, Science Direct, Springer, CNKI and Wanfang), Chinese herbal classics, Ph.D. and M.Sc. dissertations, Chinese Pharmacopoeia. Plant names were verified by "The Plant List" (http://www.theplantlist.org). The literature cited in this review can be traced back to 1878 to 2021.

RESULTS

More than 290 chemical constituents have been isolated from the genus Aralia, including triterpenoid saponins, terpenoids, organic acids, flavonoids, polyacetylenes, phenylpropanoids and other constituents. Pharmacological studies have shown that the extracts and compounds of Aralia have a wide range of pharmacological activities, including anti-inflammation, analgesic, anti-tumor, liver protection, protection of cardiovascular and nervous system, regulating substance metabolism, antibacterial, antiviral and antioxidation.

CONCLUSIONS

The genus Aralia is not only an excellent traditional herbal medicine, but also a source of bioactive molecules with good application prospects. However, the structure-activity relationship, in vivo activity and action mechanism of its bioactive components need to be further studied. In addition, more toxicological and quality control studies are essential to evaluate the efficacy and safety of Aralia as medicine.

The traditional and modern uses of Selaginella tamariscina (P.Beauv.) Spring, in medicine and cosmetic: Applications and bioactive ingredients

ETHNOPHARMACOLOGICAL RELEVANCE

Extracts of the plant Selaginella tamariscina (P.Beauv.) Spring (spike moss) are used for a long time in Asia, for the treatment of multiple diseases and conditions. Aqueous and alcoholic leave extracts are used by local communities. In China, the plant (Juan bai) is listed on the Pharmacopoeia. In South Korea, the use of this plant (Kwon Baek) is mentioned in the book Dongui-Bogam (Heo Jun 1613), at the origin of the Hyungsang medicine. S. tamariscina is traditionally used in Vietnam (mong lung rong), Thailand (dok hin), Philippines (pakong-tulog) and other Asian countries.

AIM OF THE STUDY

To provide an analysis of the multiple traditional and current uses of S. tamariscina extracts (STE) in the field of medicine and cosmetic. The review is also intended at identifying the main natural products at the origin of the many pharmacological properties reported with these extracts (anti-inflammatory, antioxidant, antidiabetic, antibacterial, antiallergic, anticancer effects).

METHODS

Extensive database retrieval, such as SciFinder and PubMed, was performed by using keywords like " Selaginella tamariscina", "spike moss", "Selaginellaceae ". Relevant textbooks, patents, reviews, and digital documents were consulted to collate all available scientific literature and to provide a complete science-based survey of the topic.

RESULTS

Different solvents and methods are used to prepare STE. The process can largely modify the natural product content and properties of the extracts. STE display a range of pharmacological effects, useful to treat metabolic disorders, several inflammatory diseases and various cancers. A specific carbonized extract (S. tamariscina carbonisatus) has shown hemostatic effects, whereas standard STE can promote blood circulation. Many patented STE-containing cosmetic preparations are reviewed here. Several biflavonoids (chiefly amentoflavone) and phenolic compounds (selaginellin derivatives) are primarily responsible for the observed pharmacological properties. Potent inhibitors of protein tyrosine phosphatase 1 B (PTP1B), phosphodiesterase-4 (PDE4), and repressor of pro-inflammatory cytokines expression have been identified from STE.

CONCLUSION

The traditional use of STE supports the research performed with this plant. There are robust experimental data, based on in vitro and in vivo models, documenting the use of STE to treat type 2 diabetes, several inflammatory diseases, and some cancers (in combination with standard chemotherapy). Selaginella tamariscina (P.Beauv.) is a prime reservoir for amentoflavone, and many other bioactive natural products. The interest of the plant in medicine and cosmetic is amply justified.

Phytochemistry and pharmacological activities of Arundina graminifolia (D.Don) Hochr. And other common Orchidaceae medicinal plants

ETHNOPHARMACOLOGICAL RELEVANCE

Arundina graminifolia (Orchidaceae) has been widely used for heat clearance and detoxification, anti-inflammatory diuretic, and anti-microbes for two thousand years in national minorities, especially among the Dai people. It was known as "Zhuyelan" (Chinese: ), "Wenshanghai" (Chinese: ) and "Baiyangjie" (Chinese: ) in the Dai nationality, and mainly used as antidote, which is characterized by "relieving the poison before getting sick and treating illness". Therefore, it has been typically applied in the treatment of food poisoning, snake bites, rheumatism, stomachache and traumatic injuries. It is also used to treat bronchitis, tuberculosis and pneumonia in the Bulang and the Wa ethnic people.

AIM OF THIS REVIEW

This review aims to provide up-to-date information about the botanical characterization, traditional uses, phytochemistry, and pharmacology of A. graminifolia, and the related importantly medicinal plants (e.g. Bletilla striata, Cremastra appendiculata, and Dendrobium officinale) of the same Orchidaceae family. Our work aims to further promote scientific cognition, basic research and in-depth discovery of potential drug candidates for Minority Medicine of our nation.

MATERIALS AND METHODS

Relevant information was obtained via piles of resources including classic books about Chinese herbal medicine, and worldwide accepted scientific databases including Web of Science, Pubmed, Google Scholar, SciFinder, Elsevier, Springer, NCBI, ACS Publications, CNKI and Wanfang data.

RESULTS

Phytochemical investigations have been intensively performed for these two decades, over 134 compounds, mainly include stilbenoids, phenanthrenes, quinones, ketones, phenolic acids, and glycosides, have been isolated and identified from A. graminifolia. The literature surveys exhibited that the ethnomedicinal uses of A. graminifolia, such as detoxification, anti-inflammation and the ability to cure trauma and pain associated with infections, are correlated with its modern pharmacological activities, including antibacterial, anti-oxidation, anti-lipid peroxidation. Stilbenoids and phenanthrenes have been regarded as the main active substances, among which stilbenoids with open ring style have superior antitumor activity. Furthermore, phytochemical investigations, biological activities, as well as the main molecular mechanism involved the coexisted stilbenoids and phenanthrenes from other most common used medicinal plants of the same Orchidaceae family were presented, compared and discussed together.

CONCLUSIONS

This review presents the current research findings of A. graminifolia and three other related medicinal plants of the same family. Some of the traditional uses of A. graminifolia have been assessed by pharmacological studies. Despite A. graminifolia is used as an antidote and anti-aging dote, a few unsolved problems including the molecular mechanism underlying biological activities, pharmacokinetics, and in vivo detoxification tests still need to be settled extensively. Therefore, it is necessary to conduct a comprehensive survey and collect investigation information on A. graminifolia.

Traditional uses, phytochemistry, pharmacology and toxicology of the genus Gynura (Compositae): A comprehensive review

ETHNOPHARMACOLOGICAL RELEVANCE

Gynura cass., belonging to the tribe Senecoineae of the family Compositae, contains more than 40 accepted species as annual or perennial herbs, mainly distributed in Asia, Africa and Australia. Among them, 11 species are distributed in China. Many of the Gynura species have been used as traditional herbal medicines for the treatment of diabetes mellitus, rheumatism, eruptive fever, gastric ulcer, bleeding, abscesses, bruises, burning pains, rashes and herpes zoster infection in tropical Asia countries such as China, Thailand, Indonesia, Malaysia, and Vietnam. Some of the species have been used as vegetables, tea beverage or ornamental plants by the local people.

AIM OF THE STUDY

A more comprehensive and in-depth review about the geographical distribution, traditional uses, chemical constituents and pharmacological activities as well as safe and toxicity of Gynura species has been summarized, hoping to provide a scientific basis for rational development and utilization as well as to foster further research of these important medicinal plant resources in the future.

MATERIALS AND METHODS

A review of the literature was performed based on the existing peer-reviewed researches by consulting scientific databases including Web of Science, PubMed, Elsevier, Google Scholar, SciFinder and China National Knowledge Infrastructure.

RESULTS

Many of the Gynura species have been phytochemically studied, which led to the isolation of more than 338 compounds including phenolics, flavonoids, alkaloids, terpenoids, steroids, cerebrosides, aliphatics and other compounds. Pharmacological studies in vitro and in vivo have also confirmed the various bioactive potentials of extracts or pure compounds from many Gynura plants, based on their claimed ethnomedicinal and anecdotal uses, including antioxidant, anti-inflammation, anticancer, antidiabetic, antihypertension, antibacterial and other activities. However, pyrrolizidine alkaloids (PAs) pose a threat to the medication safety and edible security of Gynura plants because of toxicity issues, requiring the need to pay great attention to this phenomenon.

CONCLUSION

The traditional uses, phytochemistry and pharmacology of Gynura species described in this review demonstrated that these plants contain a great number of active constituents and display a diversity of pharmacological activities. However, the mechanism of action, structure-activity relationship, potential synergistic effects and pharmacokinetics of these components need to be further elucidated. Moreover, further detailed research is urgently needed to explain the mechanisms of toxicity induced by PAs. In this respect, effective detoxification strategies need to be worked out, so as to support the safe and reasonable utilization of Gynura plant resources in the future.

Successful treatment of restless leg syndrome with the traditional herbal medicines Dangguijakyak-san and Shihogyeji-tang: A case report (CARE-compliant)

RATIONALE

Dopamine replacement is currently the standard treatment for restless leg syndrome (RLS); however, various adverse effects are associated with long-term therapy, and the benefits disappear upon discontinuation. To overcome these limitations, interest in traditional East Asian medicine has increased.

PATIENT CONCERNS

A 72-year-old Asian woman originally admitted for an intracerebral hemorrhage presented with complaints of an unpleasant sensation throughout the body that appeared at night.

DIAGNOSES

The patient was diagnosed with chronic persistent RLS based on the 2012 Revised International Restless Leg Syndrome Study Group Diagnostic Criteria.

INTERVENTIONS

The patient was treated with extracts of the traditional herbal medicines Dangguijakyak-san (DS) and Shihogyeji-tang (ST). After 47 days of therapy, all herbal medicines were discontinued, and symptoms had not returned by the last follow-up 244 days after the initial treatment.

OUTCOMES

One week after initiating herbal treatment with DS and ST, the RLS symptoms began to improve, and the total hours of sleep had increased from 2 to 9 hours by day 21, with a Korean version of the international restless legs scale score of 11 points. On day 36, ST was discontinued, given the continued improvement of symptoms. On day 47, symptoms had disappeared (Korean version of the international restless legs scale score: 0), and sleep disturbances caused by RLS had completely resolved. After day 47, DS was also discontinued. There were no adverse effects associated with the administration of DS and ST, and the symptoms had not recurred by the last follow-up on day 244.

LESSONS

In this case, RLS related symptoms, which had been present for approximately 60 years, were improved using only the traditional herbal medicines DS and ST (without dopamine replacement), and no symptoms recurred for 244 days. This case suggests that if replacement therapy is difficult or not desired, herbal medicinal therapies may be an effective alternative. This also suggests that the effect of herbal medicine on RLS might be semi-permanent. Further investigations, including clinical trials, are needed to confirm these effects.

Traditional East Asian herbal medicines for the treatment of poststroke constipation: A protocol for systematic review and meta analysis

BACKGROUND

Post-stroke constipation is a major complication of stroke and increases the incidence of poor neurological outcomes and infectious complications and, therefore, warrants active and prompt treatment. In East Asian countries, several types of herbal medicines have been used for the treatment of post-stroke constipation because they are considered safer than existing pharmacotherapies. However, no systematic review has investigated the efficacy and safety of traditional East Asian herbal medicine in the treatment of post-stroke constipation. With this systematic review and meta-analysis, we aimed to evaluate the efficacy and safety of traditional East Asian herbal medicines for the treatment of post-stroke constipation.

METHODS AND ANALYSIS

Eight electronic databases will be searched for relevant studies published from inception to April 2021. Only randomized controlled trials (RCTs) that assess the efficacy and safety of traditional East Asian herbal medicines for the treatment of post-stroke constipation will be included in this study. The methodological qualities, including the risk of bias, will be evaluated using the Cochrane risk of bias assessment tool. After screening the studies, a meta-analysis of the RCTs will be performed, if possible.

RESULTS

This study is expected to generate high-quality evidence of the efficacy and safety of herbal medicines to treat post-stroke constipation.

CONCLUSION

Our systematic review will provide evidence to determine whether herbal medicines can be effective interventions for patients with post-stroke constipation.

ETHICS AND DISSEMINATION

Ethical approval is not required, as this study was based on a review of published research. This review will be published in a peer-reviewed journal and disseminated electronically and in print.

TRIAL REGISTRATION NUMBER

Research registry reviewregistry1117.

Adverse events from pharmacopuncture treatment in Korea: A protocol for systematic review and meta analysis

BACKGROUND

Pharmacopuncture is a combination of acupuncture and herbal medicine, which involves the injection of herbal extracts into acupuncture points (acupoints). Pharmacopuncture has become one of the major therapeutic tools used in Korea; however, safety is one of the major concerns associated with it. We aim to systematically review clinical studies on the adverse events of pharmacopuncture in Korea.

METHODS

To collect data on the incidence and characteristics of adverse events (AEs) and to evaluate pharmacopuncture safety, 2 or more researchers will conduct a comprehensive search of pertinent English and Korean databases using the keywords "pharmacopuncture" and "adverse events." Regardless of the participants' conditions or treatment types, we will include clinical studies on the AEs of pharmacopuncture. Studies that were not conducted in Korea, and acupoint injections containing Western medications, vitamins, or autologous serum will be excluded from this study. The severity of AEs will be classified using the common terminology criteria for adverse events, and the causality between pharmacopuncture and AEs will be assessed using the World Health Organization-Uppsala Monitoring Centre (WHO-UMC) causality scale. The quality of identifying and reporting the AEs will be assessed using the McHarm scale. The risk of selection bias will be assessed using the Cochrane risk of bias and the risk of bias for non-randomized studies tools. Studies will be assessed for heterogeneity utilizing Higgins's I2 statistics, and the risk of publication bias will be assessed and expressed in the form of a contour-enhanced funnel plot.

RESULTS AND CONCLUSION

Comprehensive investigation of all types of clinical studies in Korea will provide clearer evidence of the safety of pharmacopuncture. The results of this study will be useful for traditional medical doctors and patients who use such treatments and interventions.Systematic Review Registration: Open Science Foundation (osf.io/umhyz).

Extract of high hydrostatic pressure-treated danshen (Salvia miltiorrhiza) ameliorates atherosclerosis via autophagy induction

Danshen (Salvia miltiorrhiza) is a traditional medicinal plant widely used in Asian countries for its pharmacological activities (e.g., amelioration of cardiovascular diseases). In this study, we investigated the anti-atherosclerotic activity of raw danshen root extract prepared using high hydrostatic pressure (HHP) at 550 MPa for 5 min and hot water extraction. This method was useful for elimination of bacteria from cultured danshen plants and for better extraction yield of active principles. The HHP-treated danshen extract (HDE) inhibited proliferation of human umbilical vein endothelial cells (HUVECs) and induced autophagy that was assessed by LC3 conversion and p62 degradation. HDE suppressed foam cell formation in oxLDL-induced RAW264.7 macrophages; lysosomal activity simultaneously increased, measured by acridine orange staining. HDE also reduced atherosclerotic plaque development in vivo in apolipoprotein E knock-out (ApoE^−/−) mice fed a high cholesterol diet. Taken together, these results indicated that HDE exhibited anti-atherosclerotic activity via autophagy induction.

Bacterial compositions of indigenous Lanna (Northern Thai) fermented foods and their potential functional properties

Many indigenous fermented foods of Northern Thailand and neighbouring regions have traditionally been known for their health benefits. In this study, we explored the communities of bacteria in selected fermented foods which are commonly consumed among ethnic groups around Northern Thailand, for which information on their microbial compositions or their functional properties is still limited. The selected food groups included Thua Nao (alkaline fermented soybean product), Nham (fermented pork sausage/loaf), Nam phak (fermented Chinese cabbage) and Miang (fermented leaves from Miang Tea trees). Bacteria in these fermented foods were isolated and enumerated. Bacterial communities were determined using a culture-independent (pyrosequencing) approach. Lactic acid bacteria were recovered from all of these fermented food samples, with levels ranging from 3.1 to 7.5 log CFU/g throughout the fermentation processes. Analysis of the 16S rRNA gene from the fermented food samples using 454-pyrosequencing resulted in 113,844 sequences after quality evaluation. Lactic acid bacteria were found in high proportions in Nham, Nam phak and Miang. Bacillus was predominant in Thua nao, in which significant proportions of Lactic acid bacteria of the family Leuconostocaceae were also found. Groups of lactic acid bacteria found varied among different food samples, but three genera were predominant: Lactococcus, Lactobacillus and Leuconostoc, of which many members are recognised as probiotics. The results showed that these traditional Thai fermented food products are rich sources of beneficial bacteria and can potentially be functional/probiotic foods.

Comparative effectiveness of East Asian traditional medicine for treatment of idiopathic short stature in children: A protocol for systematic review and network meta-analysis

BACKGROUND

There are many East Asian traditional medicine (EATM) therapies that are widely used and effective for idiopathic short stature (ISS) in children. However, the comparative effectiveness of these therapies remains unclear. We describe the methods that will be used to comparatively evaluate the efficacy and safety of EATM therapies for the treatment of pediatric ISS.

METHODS AND ANALYSIS

Fourteen electronic English, Korean, Chinese, and Japanese databases will be searched up to August 2020 for relevant randomized controlled trials of various EATMs for the treatment of pediatric ISS, without language or publication status restrictions. The primary outcome will be growth-related anthropometric indicators, and acceptability, measured through drop-outs that occur during treatment for any reason. We will conduct a pairwise meta-analysis for direct comparisons if multiple studies use the same types of intervention, comparison, and outcome measure. A frequentist network meta-analysis will be performed to summarize the available direct and indirect evidence regarding various EATM options for pediatric ISS. The risk of bias for the included studies will be evaluated using the Cochrane Collaboration's risk of bias tool.

CONCLUSIONS

The findings of this review will provide evidence for the comparative effectiveness and ranks of current EATMs and help to inform clinical practitioners, patients, and policy makers in decision making.

ETHICS AND DISSEMINATION

Ethical approval is not required because individual patient data are not included. The findings of this systematic review will be disseminated through a peer-reviewed publication or conference presentations.

PROTOCOL REGISTRATION NUMBER

OSF (URL: https://osf.io/s4vp7), PROSPERO CRD42020187160.

Cynanchum paniculatum (Bunge) Kitag. ex H. Hara: A review of its ethnopharmacology, phytochemistry and pharmacology

ETHNOPHARMACOLOGICAL RELEVANCE

Cynanchum paniculatum (Bunge) Kitag. ex H. Hara (C. paniculatum), is a broadly used traditional medicinal plant by East Asians. The roots and rhizomes of this herb were named 'Xu-Chang-Qing' since the Qin or Han Dynasty (B.C.221-220) in China. It is pungent and warm in nature and associated with the liver and stomach meridians. Moreover, the efficacy of this herb are dispelling wind, resolving dampness, relieving pain and itching. It is used for treating the onset of rheumatic arthralgia, stomachache, toothache, lumbago, soft tissue injury, rubella and eczema.

AIM OF THE STUDY

The purpose of this paper is to provide a systematic review about the botany, traditional uses, phytochemistry and pharmacology of C. paniculatum on the strength of the studies in the past two decades.

MATERIALS AND METHODS

A comprehensive search on previous literature was conducted on databases such as Web of Science, Pubmed, Sciencedirect, American Chemical Society (ACS), Google scholar and China national knowledge internet (CNKI). The search was based on the botany, traditional uses, phytochemistry and pharmacology of C. paniculatum. The key search words were 'Cynanchum paniculatum' and 'Radix Cynanchi Paniculati'. In addition, some published books were searched for more information on the herb.

RESULTS

Over 150 compounds have been isolated and identified from C. paniculatum, including C₂₁ steroids, volatile oils, carbohydrates and phenanthroindolizidine alkaloids. Extensive pharmacological activities of the extracts or compounds of C. paniculatum in vivo and in vitro were confirmed including anti-inflammatory, anti-nociceptive, sedative antiviral, antitumor, neuroprotective, treating snake bites, immunomodulatory, anti-radiation, vasodilatory, acaricidal potentials and anti-adipogenic activities.

CONCLUSIONS

In this paper, the botany, traditional uses, phytochemistry and pharmacology of C. paniculatum were reviewed. This herb has long been used as traditional medicine. It was reported with numerous chemical ingredients and various pharmacological activities with anti-inflammatory, antitumor, neuroprotection, etc. In the future, C. paniculatum still needs further study, such as identifying the active compounds, clarifying the pharmacological mechanisms, discussing quality and safety.

Potential forensic implications of kerokan therapy - a traditional Indonesian therapy associated with neck bruising

Kerokan is a traditional Indonesian treatment involving abrading the skin over various parts of the body with a blunt object such as a coin or a piece of ginger which may create suspicious injuries. Here, the case of a 30-year-old woman who had undergone kerokan therapy is reported. She was complaining of retro-sternal pain and epigastric discomfort and subsequently became markedly short of breath and died. The observation of injuries predominantly located around the neck initiated a police investigation and forensic autopsy. Scattered abrasions, blisters and bruises were present on the forehead, the bridge of the nose extending to the ala, the upper and anterior aspect of the chin and the sternal notch, with discrete fresh and scabbed abrasions around the neck, over the sternum and on the backs of both hands. There were, however, no facial or conjunctival petechiae and no bruising of the underlying strap muscles, or fractures of the hyoid bone or thyroid cartilage. Histology revealed that myocarditis was the cause of death. Traditional practices may cause unusual bruises, abrasions, blisters and burns that may raise suspicion of inflicted injury from an assault. Knowledge of the manifestations of socio-ethnic practices such as kerokan is important in the evaluation of trauma in specific cultural groups.

Herbal medicine on cancer-related fatigue of lung cancer survivors: Protocol for a systematic review

BACKGROUND

Lung cancer is one of the most common cancers worldwide, and approximately half of the patients with lung cancer receiving chemotherapy suffer from cancer-related fatigue (CRF). Herbal medicines (HMs) have been used in Oriental countries for centuries as tonics. Various beneficial effects of HM on fatigue and cancer have been reported. However, the effectiveness and safety of HM for CRF in lung cancer patients have not been synthesized. The purpose of this systematic review is to evaluate the effectiveness and safety of HM for CRF in patients with lung cancer, regardless of their cancer type or stage.

METHODS AND ANALYSIS

A comprehensive search will be conducted in 12 electronic medical databases including 5 English-language databases (Medline via PubMed, EMBASE via Elsevier, the Cochrane Central Register of Controlled Trials [CENTRAL], the Allied and Complementary Medicine Database [AMED] via EBSCO, and the Cumulative Index to Nursing and Allied Health Literature [CINAHL] via EBSCO), 4 Korean-language databases (Oriental Medicine Advanced Searching Integrated System [OASIS], Koreanstudies Information Service System [KISS], Research Information Service System [RISS], and Korea Citation Index [KCI]), 2 Chinese-language databases (China National Knowledge Infrastructure [CNKI] and Wanfang Data), and 1 Japanese-language database (CiNii). Only randomized controlled trials (RCTs) and quasi-RCTs on HM for CRF will be allowed. The severity of fatigue assessed using a validated tool will be considered as theprimary outcome. The secondary outcomes will include the patients' quality of life, activities of daily life, incidence of adverse events, and total effective rate. Two independent researchers will perform the study selection, data extraction, and quality assessment. RevMan version 5.3 will be used for data synthesis. The methodological quality of the included RCTs will be assessed using the Cochrane Collaboration's risk of bias tool. In the meta-analysis, for dichotomous data and continuous data, risk ratio and mean difference, respectively, will be estimated with their 95% confidence intervals. According to the heterogeneity, either a fixed-effects or a random-effects model will be used.

ETHICS AND DISSEMINATION

Ethical approval is not required because individual patient data are not included. The findings of this systematic review will be disseminated through a peer-reviewed publication or conference presentation.

PROSPERO REGISTRATION NUMBER

CRD42019141660.

Cangfu daotan decoction for polycystic ovary syndrome: A protocol of systematic review and meta-analysis

BACKGROUNDS

Polycystic ovary syndrome (PCOS) is common endocrine disorder in women and can lead to serious social burdens associated with various reproductive and metabolic abnormalities. Existing therapy is controversial in its effectiveness including side effects. In traditional Korean Medicine, Cangfu Daotan Decoction (CDD), also known as Changbudodam-tang, is used for PCOS patients who are in the type of stagnation of phlegm and dampness. In this study, we aimed to evaluate the efficacy and safety of CDD for PCOS as alternative treatment.

METHODS

Two researchers will search the following databases from their inception to February 2019 for relevant randomized controlled trials (RCTs): The Cochrane Library, PubMed, EMBASE, Chinese National Knowledge Infrastructure Database (CNKI), and 5 Korean medical databases (Korean Studies Information Service System, KoreaMed, DBPIA, Oriental Medicine Advanced Searching Integrated System, and Research Information Service System). The primary outcome will be the scales that assessed drug efficacy including total response rate, sex hormone level (LH, FSH, Testosterone, LH/FSH ratio), BMI, ovulation rate, and pregnancy rate. Adverse events will be assessed as the secondary outcome. Study selection, data extraction, and assessment of risk of bias will be conducted by 2 researchers independently. Statistical analysis will be performed by using the Cochrane Review Manager (RevMan 5.3) software.

RESULTS AND CONCLUSION

This review will provide the latest knowledge and evidence on the efficacy and safety of CDD for PCOS women through the analysis of various evaluation scales.

ETHICS AND DISSEMINATION

This systematic review does not require ethical approval and will be published in a peer-reviewed journal.

PROSPERO REGISTRATION NUMBER

CRD42019134270.

Kikyo-to vs. Placebo on Sore Throat Associated with Acute Upper Respiratory Tract Infection: A Randomized Controlled Trial

Objective Kikyo-to (KKT) is a fixed combination of glycyrrhiza root and platycodon root extracts. It is an herbal medicine traditionally used in Japan for relieving sore throat associated with acute upper respiratory tract infection (URTI). No controlled studies have yet demonstrated its effect, however. We investigated the efficacy of KKT on sore throat associated with acute URTI. Methods Patients with sore throat who were diagnosed with URTI at the General Medicine Department Office, Akashi Medical Center Hospital, between December 2017 and May 2018 were enrolled. Participants were randomly assigned to two groups at a 1:1 ratio, with stratification by age and sore throat score on a Visual Analogue Scale (VAS), to receive 2.5 g of either KKT or a placebo. Participants and investigators were blinded to group allocation. The primary outcome was the change in sore throat score on VAS 10 minutes after KKT administration. Secondary outcomes were the impact of the sore throat on daily life (none, mild, moderate, and severe) at 10 minutes after administration. Results Thirty-five participants were assigned to each group (n=70, total). The difference in the mean change of sore throat score according to VAS within 10 minutes between the two groups was not statistically significant (KKT 14.40 vs. placebo 17.00; p=0.39). The proportion of patients with a moderate or greater impact of their sore throat on their daily life was also not significantly different between the groups (KKT 22.9% vs. placebo 40.0%; p=0.20). Patients reported no side effects. Conclusion KKT did not significantly relieve sore throat associated with acute URTI compared with placebo.

Forsythia suspensa Protects against Bone Loss in Ovariectomized Mice

In traditional oriental medicine, the fruit of Forsythia suspensa has been used as a nutritional supplement to alleviate inflammation and treat gastrointestinal diseases. However, there is no information available on its beneficial effects on bone. We investigated the beneficial effects of F. suspensa water extract (WFS) on osteoclast differentiation and bone loss. The microarchitecture of trabecular bone was analyzed by micro-computed tomography. Osteoclast differentiation was evaluated based on tartrate-resistant alkaline phosphatase activity, and bone resorption activity was examined on a bone-like mineral surface. The mechanism of action of WFS was assessed by evaluating the expression and activation of signaling molecules. Phytochemical constituents were identified and quantitated by ultrahigh-performance liquid chromatography-tandem mass spectrometry. WFS reduced ovariectomy-induced trabecular bone loss and inhibited receptor activator of nuclear factor-κB ligand (RANKL)-induced osteoclast formation and resorption activity. WFS suppressed RANKL-induced expression of nuclear factor of activated T cells cytoplasmic 1, a crucial transcription factor for osteoclast differentiation by decreasing c-Fos protein levels and suppressing the activation of p38 and c-Jun-N-terminal kinase. We also identified 12 phytochemicals in WFS including lignans, phenylethanoids, and flavonoids. Collectively, these results suggest that WFS inhibits osteoclast differentiation and can potentially be used to treat postmenopausal osteoporosis.

Nonsurgical integrative Korean Medicine treatment of discal cyst: A case report and a retrospective chart review analysis

RATIONALE

Discal cysts are rare lesions characterized by pain caused by neurogenic compression with similar symptoms as those of disc herniation. This study aims to report the spontaneous regression of discal cyst achieved through nonsurgical integrative Korean Medicine treatment and the clinical epidemiological features of discal cyst cases collected from 4 institutions.

PATIENT CONCERNS

A 31-year-old woman had low back pain and radiating pain equivalent to a numeral rating scale (NRS) of 8 and had limitations in daily work and activities.

DIAGNOSES

The patient was diagnosed as having discal cysts that compressed the left S1 based on findings of L-spine magnetic resonance imaging (MRI) performed at our hospital.

INTERVENTIONS

The patient received nonsurgical Korean Medicine treatment and after 24 days of treatment in the hospital, she underwent 16 additional treatments as an outpatient.

OUTCOMES

Spontaneous regression was confirmed in the L-spine MRI follow-up at 36 days and 99 days after the initial test, and the patient underwent once-a-week follow up to examine NRS, Oswestry Disability Index (ODI), EuroQol-5 Dimensions (EQ-5D), and fear-avoidance beliefs questionnaire (FABQ) after 4 weeks, and 2, 3, and 6-month follow-ups after that. The patient was discharged in a painless condition, and she was able to carry on for 5 months without increased pain.

LESSONS

Discal cysts are more rapid progress than disc herniation, it seems valid to attempt nonsurgical treatment. Epidemiologically, this is the first study to present the clinical epidemiological characteristics of discal cysts, it would provide valuable information to clinicians who treat and study discal cysts.

Evaluation of anti-proliferative activity of medicinal plants used in Asian Traditional Medicine to treat cancer

ETHNOPHARMACOLOGICAL RELEVANCE

The extensive biodiversity of plants in Southeast Asia and inadequate research hitherto warrant a continued investigation into medicinal plants. On the basis of a careful review of fresh medicinal plant usage to treat cancer from previous ethnobotanical interviews in Singapore and from the traditional uses of the indigenous plants, fresh leaves of seven locally grown medicinal plant species were evaluated for anti-proliferative activity.

AIM OF THE STUDY

To evaluate the anti-proliferative activity of local medicinal plant species Clausena lansium Skeels, Clinacanthus nutans (Burm. f.) Lindau, Leea indica (Burm. f.) Merr., Pereskia bleo (Kunth) DC., Strobilanthes crispus (L.) Blume, Vernonia amygdalina Delile and Vitex trifolia L.

MATERIALS AND METHOD

Fresh, healthy and mature leaves of the seven medicinal plants were harvested from various locations in Singapore and Malaysia for Soxhlet, ultrasonication and maceration extractions in three different solvents (water, ethanol and methanol). Cell proliferation assay using water soluble tetrazolium salt (WST-1) assay was performed on twelve human cancer cell lines derived from breast (MDA-MB-231, T47D), cervical (C33A), colon (HCT116), leukemia (U937), liver (HepG2, SNU-182, SNU-449), ovarian (OVCAR-5, PA-1, SK-OV-3) and uterine (MES-SA/DX5) cancer.

RESULTS

A total of 37 fresh leaf extracts from seven medicinal plants were evaluated for their anti-tumour activities in twelve human cancer cell lines. Of these, the extracts of C. lansium, L. indica, P. bleo, S. crispus, V. amygdalina and V. trifolia exhibited promising anti-proliferative activity against multiple cancer cell lines. Further investigation of selected promising leaf extracts indicated that maceration methanolic extract of L. indica was most effective overall against majority of the cancer cell lines, with best IC₅₀ values of 31.5 ± 11.4 µg/mL, 37.5 ± 0.7 µg/mL and 43.0 ± 6.2 µg/mL in cervical C33A, liver SNU-449, and ovarian PA-1 cancer cell lines, respectively.

CONCLUSION

The results of this study provide new scientific evidence for the traditional use of local medicinal plant species C. lansium, L . indica, P. bleo, S. crispus, V. amygdalina and V. trifolia in cancer treatment. These results highlight the importance of the upkeep of these indigenous plants in modern society and their relevance as resources for drug discovery.

Connecting Western and Eastern Medicine from an Energy Perspective

Although Western medicine and Eastern medicine are worlds apart, there is a striking overlap in the basic principle of these types of medicine when we look at them from the perspective of energy. In both worlds, opposing forces provide the energy that flows through networks in an organism, which fuels life. In this concept, health is the ability of an organism to maintain the balance between these opposing forces, i.e., homeostasis (West) and harmony (East), which creates resilience. Moreover, strategies used to treat diseases are strikingly alike, namely adjusting the flow of energy by changing the connections in the network. The energy perspective provides a basis to integrate Eastern and Western medicine, and opens new directions for research to get the best of both worlds.

A systematic review of herbal medicines for the treatment of cancer cachexia in animal models

OBJECTIVE

The aim of this study is to summarize preclinical studies on herbal medicines used to treat cancer cachexia and its underlying mechanisms.

METHODS

We searched four representing databases, including PubMed, EMBASE, the Allied and Complementary Medicine Database, and the Web of Science up to December 2016. Randomized animal studies were included if the effects of any herbal medicine were tested on cancer cachexia. The methodological quality was evaluated by the Collaborative Approach to Meta-Analysis and Review of Animal Data from Experimental Studies (CAMARADE) checklist.

RESULTS

A total of fourteen herbal medicines and their compounds were identified, including Coptidis Rhizoma, berberine, Bing De Ling, curcumin, Qing-Shu-Yi-Qi-Tang, Scutellaria baicalensis, Hochuekkito, Rikkunshito, hesperidin, atractylodin, Sipjeondaebo-tang, Sosiho-tang, Anemarrhena Rhizoma, and Phellodendri Cortex. All the herbal medicines, except curcumin, have been shown to ameliorate the symptoms of cancer cachexia through anti-inflammation, regulation of the neuroendocrine pathway, and modulation of the ubiquitin proteasome system or protein synthesis.

CONCLUSIONS

This study showed that herbal medicines might be a useful approach for treating cancer cachexia. However, more detailed experimental studies on the molecular mechanisms and active compounds are needed.

Herbal medicine Yukgunja-tang for functional dyspepsia protocol for a systematic review of randomized controlled trials

BACKGROUND

Functional dyspepsia (FD) is a common functional gastrointestinal disorder characterized by recurrent dyspeptic symptoms. Yukgunja-tang (YGT) is a traditional herbal formula that has been used for treating FD. This systematic review protocol aims to provide a guideline for investigating the efficacy and safety of YGT in the treatment of FD.

METHODS

The following databases will be searched from their inception until July 2018: Medline (via PubMed), EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), Allied and Complementary Medicine Database (AMED), KoreaMed, National Digital Science Library (NDSL), Korean Medical Database (KMbase), Oriental Medicine Advanced Searching Integrated System (OASIS), Korean Studies information Service System (KISS), China National Knowledge Infrastructure Database (CNKI), and Citation Information by Nii (CiNii). Randomized controlled trials (RCTs) that used YGT or modified YGT for treating FD will be included. The control groups in these RCTs will include placebo, no-treatment waiting, and conventional western medicine groups. Trials testing YGT as an adjunct to western medicine for synergistic effect will also be included. The main outcome will be the total clinical efficacy rate. Data extraction and risk of bias assessment will be performed by two independent assessors. RevMan V.5.3 will be used for data analysis.

RESULTS

This study will provide a high-quality synthesis of current evidence of YGT for FD from several aspects including dyspepsia-related symptoms, quality of life and adverse events.

CONCLUSION

The conclusion of our systematic review will provide evidence to judge whether YGT is an effective intervention for patient with FD.

ETHICS AND DISSEMINATION

The protocol does not need ethics approval because identifying information of the participants will not be revealed. The systematic review will be published in a peer-reviewed journal and disseminated electronically and in print.

TRIAL REGISTRATION NUMBER

PROSPERO CRD42018090139.

Integrative medicine for managing the symptoms of lupus nephritis: A protocol for systematic review and meta-analysis

BACKGROUND

Integrative medicine is claimed to improve symptoms of lupus nephritis. No systematic reviews have been performed for the application of integrative medicine for lupus nephritis on patients with systemic lupus erythematosus (SLE). Thus, this review will aim to evaluate the current evidence on the efficacy of integrative medicine for the management of lupus nephritis in patients with SLE.

METHODS AND ANALYSES

The following electronic databases will be searched for studies published from their dates of inception February 2018: Medline, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL), as well as 6 Korean medical databases (Korea Med, the Oriental Medicine Advanced Search Integrated System [OASIS], DBpia, the Korean Medical Database [KM base], the Research Information Service System [RISS], and the Korean Studies Information Services System [KISS]), and 1 Chinese medical database (the China National Knowledge Infrastructure [CNKI]). Study selection, data extraction, and assessment will be performed independently by 2 researchers. The risk of bias (ROB) will be assessed using the Cochrane ROB tool.

DISSEMINATION

This systematic review will be published in a peer-reviewed journal and disseminated both electronically and in print. The review will be updated to inform and guide healthcare practice and policy.

TRIAL REGISTRATION NUMBER

PROSPERO 2018 CRD42018085205.

Phytochemical and analytical characterization of constituents in Urceola rosea (Hook. & Arn.) D.J. Middleton leaves

In Vietnam and China the leaves of Urceola rosea are widely used as herbal remedy and food. However, in contrast to the plants stem, little information was available on major constituents. In this study, the first in-depth phytochemical investigation of U. rosea leaves is described, which resulted in the isolation of thirteen compounds, mainly flavonoids (kaempferol and quercetin derivatives) and triterpenes. Furthermore, an analytical procedure for the quantification of five major compounds was developed. The HPLC separation was performed on a Synergi MAX-RP column using acetonitrile and 0.1% formic acid as mobile phase. Method validation confirmed that the assay shows good linearity (R²≥0.9997), precision (intra-day R.S.D≤4.31%, inter-day R.S.D≤3.52%) and accuracy (recovery rates ranged from 96.8 to 102.6%). Detection limits were always lower than 0.07μg/mL. The analysis of several plant samples revealed distinct differences, as for example the content of total phenolics varied from 0.44 to 1.73%.

Effectiveness of Shin'iseihaito in Asthmatic Patients with Upper Airway Diseases: A Retrospective Cohort Study

BACKGROUND

Severe asthma is often associated with sinonasal diseases. Shin'iseihaito is a Japanese traditional herbal medicine, which is used to treat rhinosinusitis. However, its effectiveness in the treatment of asthma has not been elucidated.

OBJECTIVE

The aims of this study were to examine the effectiveness of Shin'iseihaito in asthmatic patients with upper airway disease and to identify the characteristics of responders.

METHODS

The medical records were retrospectively analyzed of asthmatic patients concomitant with upper airway disease in the outpatient department who had been administered Shin'iseihaito at least once from September 2011 to February 2015. They were classified into responders and non-responders, and the differences in characteristics were compared between the two groups.

RESULTS

Shin'iseihaito was effective in 21/40 (52.5%) patients. There was no significant difference between responders and non-responders with regard to age, sex, or age of asthma onset. However, the frequency of aspirin intolerance, the treatment step of asthma, and serum immunoglobulin E levels were significantly higher in responders than they were in non-responders (p = 0.022, p = 0.017, and p = 0.017, respectively). The frequency of occurrence of concomitant eosinophilic chronic rhinosinusitis was not significantly different in both groups.

CONCLUSION

Shin'iseihaito could be a potential alternative for the treatment of asthma in patients with upper airway diseases.

Dermatological Implications of Coining: An Eastern Medicine Cultural Practice

A 36-year-old Chinese man with no significant medical history presented to his clinician's office for follow-up of results from recent blood work. Upon entering the room, the patient was wearing a mask. After reviewing his lipid panel, he mentioned that he had been "fighting a cold." He reported 3 days of cough with chest tightness and mild shortness of breath. He denied fever. The patient was using an overthe- counter cough medicine but reported no chronic medication use. On initial inspection, the patient had a vivid purple eruption on his arms. The patient denied pain or itching. After the patient lifted his shirt, the full extent of the discoloration was seen configured in a symmetric fashion over the anterior torso and abdomen (Figure 1). The eruption was purple-red in color and distributed in a linear pattern over the anterior chest contouring the outline of the underlying ribs. Additional vertically arrayed areas of erythematous skin consisting of microecchymoses were appreciated on the anterior abdomen. These appeared to follow an intentional pattern. No other petechiae, palpable purpura, or isolated ecchymoses were seen. When questioned further, our patient readily admitted that he had participated in a common traditional Chinese treatment consisting of "scraping bruises" to relieve his bronchitis.

Longgu (Fossilia Ossis Mastodi) alters the profiles of organic and inorganic components in Keishikaryukotsuboreito

Longgu (Fossilia Ossis Mastodi) is a non-botanical crude drug, defined as "the ossified bone of large mammal" in the Japanese Pharmacopoeia sixteenth edition (JP16). It is a non-reproducible drug and is now facing the threat of exhaustion. To solve this problem, we aimed to clarify the role of longgu in Kampo prescriptions, which has not yet been scientifically ascertained. In this study, we focused on decoction of Keishikaryukotsuboreito (KRB). The profile of inorganic and organic components in the extract was analyzed by inductively coupled plasma mass spectrometry (ICP-MS) and gas chromatography flame ionization detection (GC/FID), respectively. Twenty-five elements were detected by ICP-MS in KRB and longgu-free KRB (KB) decoctions. However, 23 elements were detected in unadultrated longgu (R) decoctions, and their total amount was 30 times lower than those of the KRB and KB decoctions were. No organic compounds were detected in R decoctions by GC/FID, though many were detected in KRB and KB decoctions. KRB decoctions were distinguished from KB decoctions by multivariate analysis. The only difference in the crude drugs was the presence of longgu, and therefore the difference in the profiles was attributed to the effect of longgu. Longgu was submitted to terahertz (THz) wave spectrometry after the decocting process. The THz spectra indicated that longgu adsorbed compounds during the KRB decoction. These results suggested that longgu not only releases its components, but also adsorbs ingredients from other crude drugs during decoction.

Anti-platelet and anti-thrombotic effect of a traditional herbal medicine Kyung-Ok-Ko

ETHNOPHARMACOLOGICAL RELEVANCE

Kyung-Ok-Ko (KOK), a traditional herbal prescription, contains six main ingredients; Rehmannia glutinosa var. purpurae, Lycium chinense, Aquillaria agallocha, Poria cocos, Panax ginseng, and honey. KOK has been widely taken as a traditional oriental medicine for improving blood circulation or age-related symptoms, such as dementia and stroke. However, the effect of KOK on platelet activity has not been clarified.

MATERIALS AND METHODS

To evaluate the effect of KOK on platelet function, we evaluated its effect on functional markers of platelet activation such as aggregation and shape change. As a mechanism study for the effect of KOK, we examined its effect on granule secretion, intracellular Ca(2+) increase, and PLCγ and Akt activation. To investigate the effect of orally administered KOK (0.5, 1, 2 g/kg), we examined its ex vivo effect on platelet aggregation in rat, and its in vivo anti-thrombotic effect in mice thromboembolism model. Furthermore, the effect of KOK on bleeding time was examined to estimate its potential side effect.

RESULTS

KOK (0.3, 1, 3, 10 mg/ml) inhibited collagen-induced platelet aggregation and shape change in rat platelets in a concentration-dependent manner. The mechanism for the anti-platelet effect of KOK seems to involve the inhibition of ATP release, intracellular Ca(2+) elevation, and the phosphorylation of PLCγ and Akt. In rat ex vivo study, KOK (2 g/kg, p.o. for 1 day, and 0.5, 1, 2 g/kg, p.o. for 7 days) also had significant inhibitory effects on collagen-induced platelet aggregation. In addition, KOK showed a significant protective effect against thrombosis attack in mice. The prolongation of bleeding time by KOK was much less than that by ASA, suggesting a beneficial potential of KOK than ASA in view of side effect.

CONCLUSIONS

These findings suggest that KOK elicits remarkable anti-platelet and anti-thrombotic effects with less side effect of bleeding, and therefore, it may have a therapeutic potential for the prevention of platelet-associated cardiovascular diseases.

A survey of medicinal plants for diabetes treating from Chana and Nathawee district, Songkhla province, Thailand

ETHNOPHARMACOLOGICAL RELEVANCE

Diabetes mellitus is a chronic disease which cannot be cured and must be suffered for whole life. Nowadays, many patients wanting to treat themselves by herbal medicine are increasing. Therefore, surveying of medicinal plants for treating diabetes and disseminating the knowledge, might give people more choice to consume herbs. The purposes of this qualitative study were to compile the medicinal plants and their folk use to treat diabetes by local healers in Chana and Nathawee district, Songkhla province.

MATERIALS AND METHODS

Semi-structured interviews were used to gather about the local names, parts of plants used, preparation and use method, and local properties. Descriptive statistics, use value and interpretation were used to analyze the data.

RESULTS

A total of 38 species belonging to 37 genera in 28 families were used as herbs for treating diabetes. The family mostly used as herbal medicine was Rubiaceae (4 species; 10.53%). The part of herbal medicine mostly used was the root (8 speciess; 21.05%). Decoction and drinking were the most favorite preparation form and use method. Interestingly, the most used herbal plant is Lagerstraemia speciose Pers (0.83 of Use Value).

CONCLUSION

It was found that the local healers possess the different knowledge based on their experience received secretly from the family and adapted by themselves. Thus, this study is important due to assistance for collecting the variety of knowledge before disappearing.

An Oriental Medicine, Hyungbangpaedok-San Attenuates Motor Paralysis in an Experimental Model of Multiple Sclerosis by Regulating the T Cell Response

The preventive and therapeutic mechanisms in multiple sclerosis are not clearly understood. We investigated whether Hyungbangpaedok-san (HBPDS), a traditional herbal medicine, has a beneficial effect in experimental autoimmune encephalomyelitis (EAE) mice immunized with myelin oligodendrocyte glycoprotein peptide (MOG_35-55). Onset-treatment with 4 types of HBPDS (extracted using distilled water and 30%/70%/100% ethanol as the solvent) alleviated neurological signs, and HBPDS extracted within 30% ethanol (henceforth called HBPDS) was more effective. Onset-treatment with HBPDS reduced demyelination and the recruitment/infiltration and activation of microglia/macrophages in the spinal cord of EAE mice, which corresponded to the reduced mRNA expression of pro-inflammatory cytokines (TNF-α, IL–6, and IL–1β), iNOS, and chemokines (MCP–1, MIP–1α, and RANTES) in the spinal cord. Onset-treatment with HBPDS inhibited changes in the components of the blood-brain barrier such as astrocytes, adhesion molecules (ICAM–1 and VCAM–1), and junctional molecules (claudin–3, claudin–5, and zona occludens–1) in the spinal cord of EAE mice. Onset-treatment with HBPDS reduced the elevated population of CD4⁺, CD4⁺/IFN-γ⁺, and CD4⁺/IL–17⁺ T cells in the spinal cord of EAE mice but it further increased the elevated population of CD4⁺/CD25⁺/Foxp3⁺ and CD4⁺/Foxp3⁺/Helios⁺ T cells. Pre-, onset-, post-, but not peak-treatment, with HBPDS had a beneficial effect on behavioral impairment in EAE mice. Taken together, HBPDS could alleviate the development/progression of EAE by regulating the recruitment/infiltration and activation of microglia and peripheral immune cells (macrophages, Th1, Th17, and Treg cells) in the spinal cord. These findings could help to develop protective strategies using HBPDS in the treatment of autoimmune disorders including multiple sclerosis.

The medicinal fungus Antrodia cinnamomea suppresses inflammation by inhibiting the NLRP3 inflammasome

ETHNOPHARMACOLOGICAL RELEVANCE

Antrodia cinnamomea--a medicinal fungus that is indigenous to Taiwan--has been used as a health tonic by aboriginal tribes and the Asian population. Recent studies indicate that Antrodia cinnamomea extracts exhibit hepato-protective, anti-hypertensive, anti-oxidative, anti-inflammatory, immuno-modulatory, and anti-cancer effects on cultured cells and laboratory animals. This study aims to explore the anti-inflammatory activity of an Antrodia cinnamomea ethanol extract (ACEE) and elucidate its underlying mechanisms of action using lipopolysaccharide (LPS)-primed, ATP-stimulated human THP-1 macrophages.

MATERIALS AND METHODS

The effects of ACEE on cell viability were studied using the MTT assay. The expressions of genes, proteins, and pro-inflammatory cytokines were measured by quantitative real-time RT-PCR, Western blotting and ELISA, respectively. The ACEE was further investigated for its effects on reactive oxygen species (ROS) production using ROS detection kit.

RESULTS

Our results showed that ACEE significantly inhibits ATP-induced secretion of interleukin-1β (IL-1β), interleukin-18 (IL-18) and tumor necrosis factor-α (TNF-α) by LPS-primed macrophages. ACEE also suppresses the transcription and activation of caspase-1, which is responsible for the cleavage and activation of IL-1β and IL-18. Of note, ACEE not only reduces expression of the inflammasome component NLRP3 and the purinergic receptor P2X7R but also inhibits ATP-induced ROS production and caspase-1 activation. Furthermore, the anti-inflammatory properties of ACEE correlate with reduced activation of the MAPK and NF-κB pathways.

CONCLUSION

The results of the present study indicate that Antrodia cinnamomea suppresses the secretion of IL-1β and IL-18 associated with inhibition of the NLRP3 inflammasome in macrophages. These findings suggest that ACEE may have therapeutic potential for the treatment of inflammatory diseases.

How current Clinical Practice Guidelines for low back pain reflect Traditional Medicine in East Asian Countries: a systematic review of Clinical Practice Guidelines and systematic reviews

OBJECTIVES

The aims of this study were to investigate whether there is a gap between evidence of traditional medicine (TM) interventions in East-Asian countries from the current Clinical Practice Guidelines (CPGs) and evidence from current systematic reviews and meta-analyses (SR-MAs) and to analyze the impact of this gap on present CPGs.

METHODS

We examined 5 representative TM interventions in the health care systems of East-Asian countries. We searched seven relevant databases for CPGs to identify whether core CPGs included evidence of TM interventions, and we searched 11 databases for SR-MAs to re-evaluate current evidence on TM interventions. We then compared the gap between the evidence from CPGs and SR-MAs.

RESULTS

Thirteen CPGs and 22 SR-MAs met our inclusion criteria. Of the 13 CPGs, 7 CPGs (54%) mentioned TM interventions, and all were for acupuncture (only one was for both acupuncture and acupressure). However, the CPGs did not recommend acupuncture (or acupressure). Of 22 SR-MAs, 16 were for acupuncture, 5 for manual therapy, 1 for cupping, and none for moxibustion and herbal medicine. Comparing the evidence from CPGs and SR-MAs, an underestimation or omission of evidence for acupuncture, cupping, and manual therapy in current CPGs was detected. Thus, applying the results from the SR-MAs, we moderately recommend acupuncture for chronic LBP, but we inconclusively recommend acupuncture for (sub)acute LBP due to the limited current evidence. Furthermore, we weakly recommend cupping and manual therapy for both (sub)acute and chronic LBP. We cannot provide recommendations for moxibustion and herbal medicine due to a lack of evidence.

CONCLUSIONS

The current CPGs did not fully reflect the evidence for TM interventions. As relevant studies such as SR-MAs are conducted and evidence increases, the current evidence on acupuncture, cupping, and manual therapy should be rigorously considered in the process of developing or updating the CPG system.

Onsen (hot springs) in Japan--transforming terrain into healing landscapes

Japan is situated on the Pacific fire rim and has a large number of hot springs (onsens). There are over 27,000 sources of such springs and the country has a well regulated system of onsens. Within this geographical and cultural peculiarities certain unique traditional health practices have evolved, prominent among which is Touji or onsen therapy. The article highlights various healing practices surrounding onsens, institutionalization of these practices, current policy regulations, standards and their contemporary challenges. This research used publicly available information from literature sources and data through expert interviews. It draws attention to the fact that touji has been marginalized in the recent health policies. The study highlights that onsen as a therapeutic landscape has an important role in maintaining health and wellbeing in the country and holds immense value in building social cohesion in local communities. The study points to the need for appropriate studies on the social and symbolic healing elements related to onsen landscapes, as well as the need for developing a comprehensive strategy for strengthening their culturally specific health management roles.

[Preliminary application of atomic force microscopy on identification of native habitat of Chinese medicine decoction pieces]

Identification of the native habitat of Chinese medicine decoction pieces plays an important role in the use of Chinese Heber medicine. However, the traditional method always based on subjective description, lack of quantitative information. In this study, nanomechanical analysis of Ophiopogonis Radix, Polygonati Odorati Rhizoma and Curcumae Aromaticae Radix coming from different districts was carried out by using the force-distance curve of atomic force microscopy (AFM), including stiffness (represented by the slope of the force curve) and adhesion work (calculated via the adhesion area of the retrace line in force-distance curve). The results showed that the Ophiopogonis Radix from Sichuan province (slope 0.03 +/- 0.001) was significantly stiffer but less sticky [adhesion work 393.98 +/- 49.21 x 10(-10)) J] in comparison with that from Hubei province [slope 0.018 +/- 0.001, adhesion work (985.67 +/- 91.61) x 10(-10) J]; the Polygonati Odorati Rhizoma Hunan province was stiffer (slope 0.03 +/- 0.002) and stickier [adhesion work (413.67 +/- 92.58) x10(-10) J] than that from Dongbei province [slope 0.019 +/- 0.002, adhesion work (27.37 +/- 11.05) x 10(-10) J]; the Curcumae Aromaticae Radix from Sichuan province was also stiffer (slope 0.019 +/- 0.0017) but less stickier [adhesion work (1179.79 +/- 225.05) x 10(-10) J] than that from Hubei province [slope 0.013 +/- 0.0006, adhesion work (2831.27 +/- 93.71) x 10(-10)]. It is indicated that changes in mechanical properties of Chinese medicine decoction pieces correlate well with their origin. This method may provide quantitative information for the identification of the native habitat of Chinese medicine decoction pieces.

Phototoxicity of oriental medicinal plants: measurement and possible applications

Phototoxicity can be either harmful and induce adverse skin reactions or beneficial and be used therapeutically as in psoralen and UV-A or photodynamic therapy. Hundreds of medicinal plants are widely used in Asia and Western countries in oriental medicine, yet the phototoxicity of oriental medicinal plants is an understudied area. In this contribution, the authors discuss some methods used to measure the phototoxicity of plants and give an overview of the results of their previous and ongoing studies into the phototoxicity of medicinal plants. The authors argue that because they found that more than a quarter of oriental medicinal plants can be phototoxic, such research is helpful for dermatologists and that active phototoxic components extracted from oriental medicinal plants may be used therapeutically.

Traditional birth attendant training and local birthing practices in India

Training birth attendants (TBAs) provide essential maternal and infant health care services during delivery and ongoing community care in developing countries. Despite inadequate evidence of relevance and effectiveness of TBA training programmes, there has been a policy shift since the 1990s in that many donor agencies funding TBA training programmes redirected funds to providing skilled attendants during delivery. This study aimed to assess the ways in which a TBA training programme in India has been successful in disseminating evidence-based knowledge on birthing practices. TBAs practicing within 16 villages targeted by training programme initiatives were administered with structured questionnaires. The post training birthing practices of trained (24) and untrained (14) TBAs was compared and birthing practices adopted by women assisted by trained (16) and untrained (9) TBAs was analysed. Positive post training practices were hand washing, use of a clean blade for cutting the cord, immediate breastfeeding and weighing of babies. Nevertheless, the training could be further improved with up to date and evidence-based information and more comprehensive instructions. The findings suggest an integration of local and evidence-based knowledge is needed to improve the training. Raising community awareness of public health measures related to maternal and child health is also recommended.

[Analysis of Chinese medicine tablets on coating quality based on support vector machine]

A new non-destructive and rapid method was developed to discriminate the coating process of Rukuaixiao tablets mainly based the support vector machine (SVM) with the near-infrared spectroscopy (NIRs). After the samples that differ in the sugar-coat were acquired, the sample set partitioning based on joint x-y distance (SPXY) method was used to select the training sets and internal principal component analysis (internal PCA) was to select the optimal wavelength. The discrimination model was developed based on support vector machine (SVM), and varieties of pre-processing methods were compared. The results showed that the accuracy of the prediction set was 98.81%. It is concluded that the accuracy of the method is high to use for the quality evaluation of tablet's coating process.

[A retrospective study on type 2 diabetes mellitus treated with integrated Chinese and Western medicine]

OBJECTIVE

To compare the therapeutic efficacy and cost-efficacy of different treatment methods for treatment of type 2 diabetes mellitus (T2DM).

METHODS

Based on the electronic inpatient clinical information systems, clinical materials of T2DM patients were collected and assigned according to the therapeutic method used, to the groups of Western medicinal (WM) treatment (A), WM combined Chinese drug injection treatment (B) and the WM combined Chinese decoction or patent drugs treatment (C). Depending on the data of symptom scores, blood sugar and blood lipids, etc., the efficacy of different treatments were analyzed in terms of improving symptoms, elevating the quality of life (QOL), controlling blood sugar, reducing dosage of insulin used and diminishing economic expense, with the enumeration data analyzed by chi2 test and the measurement data by ANOVA.

RESULTS

Treatment C showed a better efficacy than the other two in improving symptoms, elevating QOL, controlling blood sugar, reducing dose of insulin used and lightening the financial burden (P < 0.05).

CONCLUSION

Selective use of Chinese drugs depending on syndrome differentiation is recommended during combined application of Chinese and Western medicine; and the Chinese medicine injection is not advised as the first scheme for treatment of T2DM.

[Identification of gastrodia elata blume by Fourier transform infrared spectroscopy]

In this paper, a method of rapid and undamaged identification of wild and cultivated Gastrodia elata Blume, and one of its fakes by Fourier transform infrared spectroscopy (FTIR) is reported. The results show that Gastrodia elata Blume and its fake have different characteristic infrared spectra, by which Gastrodia elata Blume can be identified from its fake. Wild winter, wild spring, and cultivated Gastrodia elata Blume can be discriminated by FTIR, according to the differences of their spectral peaks and absorbance ratios. By the differences of absorbance ratios of several peaks, different grade of Gastrodia elata Blume may be classified. FTIR has proved to be a rapid, simple and nondestructive method for the identification of Gastrodia elata Blume.