Acupuncture for cerebral vasospasm after subarachnoid hemorrhage: a retrospective case-control study.

OBJECTIVES: To examine the possibility of acupuncture as a new promising treatment to prevent delayed cerebral vasospasm, retrospective comparison was done of patient outcomes in patients with subarachnoid hemorrhage (SAH) treated with and without acupuncture. MATERIALS AND METHODS: Twenty (20) patients with SAH were treated after their ruptured aneurysms had been secured. Acupuncture treatments were applied to the bilateral Zusanli (ST36) and Neiguan (PC6) once a day for 2 weeks, starting within 3 days of the aneurysm rupture. The incidence of angiographic vasospasm and delayed ischemic neurological deficit (DIND), the patient's functional status at discharge, and mortality rate were analyzed. Patient outcomes were compared with those of an age- and severity-matched comparison group composed of patients treated in the hospital without acupuncture. RESULTS: None of the patients who received acupuncture died. Angiographic vasospasms occurred in 5 patients (25.0%) and DIND in 2 (10%). In terms of functional impairment, the modified Rankin score at discharge was ≤2 in 7 patients (35%). In the control group, angiographic vasospasms occurred in 10 patients (55.6%) and DIND in 7 (38.9%), similar to the reported incidence in conventionally treated patients. CONCLUSIONS: Patients with SAH who received acupuncture had a significantly lower incidence of DIND and significantly improved function at discharge, suggesting that acupuncture is effective in preventing cerebral vasospasm. In light of these promising results, a randomized controlled trial is warranted to determine the efficacy of acupuncture in a clinical setting.

Paeonol attenuates inflammation-mediated neurotoxicity and microglial activation.

Chronic activation of microglial cells endangers neuronal survival through the release of various proinflammatory and neurotoxic factors. The root of Paeonia lactiflora Pall has been considered useful for the treatment of various disorders in traditional oriental medicine. Paeonol, found in the root of Paeonia lactiflora Pall, has a wide range of pharmacological functions, including anti-oxidative, anti-inflammatory and neuroprotective activities. The objective of this study was to examine the efficacy of paeonol in the repression of inflammation-induced neurotoxicity and microglial cell activation. Organotypic hippocampal slice cultures and primary microglial cells from rat brain were stimulated with bacterial lipopolysaccharide. Paeonol pretreatment was performed for 30 minutes prior to lipopolysaccharide addition. Cell viability and nitrite (the production of nitric oxide), tumor necrosis factor-alpha and interleukin-1beta products were measured after lipopolysaccharide treatment. In organotypic hippocampal slice cultures, paeonol blocked lipopolysaccharide-related hippocampal cell death and inhibited the release of nitrite and interleukin-1beta. Paeonol was effective in inhibiting nitric oxide release from primary microglial cells. It also reduced the lipopolysaccharide-stimulated release of tumor necrosis factor-alpha and interleukin-1ß from microglial cells. Paeonol possesses neuroprotective activity in a model of inflammation-induced neurotoxicity and reduces the release of neurotoxic and proinflammatory factors in activated microglial cells.

Effects of GV20 acupuncture on cerebral blood flow velocity of middle cerebral artery and anterior cerebral artery territories, and CO2 reactivity during hypocapnia in normal subjects.

OBJECTIVES: Acupuncture has been gaining popularity among practitioners of modern medicine as an alternative and complementary treatment. However, the mechanism of its therapeutic effect still remains uncertain. The present study chose the GV20 acupoint to evaluate acupoint effectiveness, hypothesizing that its stimulation induces cerebrovascular responses. DESIGN AND SETTING: The effects of GV20 acupuncture treatment on middle cerebral artery (MCA) and anterior cerebral artery (ACA) blood flow velocities, and CO(2) reactivity during hypocapnia were evaluated in 10 healthy male subjects (mean age 25.6 ± 0.8 years). Measurements were done at rest and during hypocapnia, and were repeated four times each at different cerebral artery territories with an interval of 1 week. MCA and ACA blood flow velocities were measured with a transcranial Doppler flowmeter. Blood flow velocity was corrected to 40 mm Hg of end-tidal CO(2) partial pressure (P(ETCO2)), and was expressed as CV40. CO(2) reactivity was measured as percent change in mean blood flow velocity/mm Hg P(ETCO2). RESULTS: Mean MCA and ACA blood flow velocities at rest, CV40, and CO(2) reactivity during hypocapnia increased significantly after GV20 acupuncture treatment, whereas mean arterial blood pressure and pulse rate at rest did not change significantly. The increases in MCA and ACA blood flow velocity were associated with improved CO(2) reactivity after GV20 acupuncture treatment. CONCLUSIONS: The data suggest that GV20 acupuncture treatment increases cerebral blood flow. The results of this small-scale study provide preliminary evidence for acupuncture effectiveness.

Clinical approach to the standardization of oriental medical diagnostic pattern identification in stroke patients.

In Korea, many stroke patients receive oriental medical care, in which pattern-identification plays a major role. Pattern-identification is Oriental Medicine's unique diagnostic system. This study attempted to standardize oriental medical pattern-identification for stroke patients. This was a community-based multicenter study that enrolled stroke patients within 30 days after their ictus. We assessed the patients' general characteristics and symptoms related to pattern-identification. Each patient's pattern was determined when two doctors had the same opinion. To determine which variables affect the pattern-identification, binary logistic regression analysis was used with the backward method. A total of 806 stroke patients were enrolled. Among 480 patients who were identified as having a certain pattern, 100 patients exhibited the Fire Heat Pattern, 210 patients the Phlegm Dampness Pattern, nine patients the Blood Stasis Pattern, 110 patients the Qi Deficiency Pattern, and 51 patients the Yin Deficiency Pattern. After the regression analysis, the predictive logistic equations for the Fire Heat, Phlegm Dampness, Qi Deficiency, and Yin Deficiency patterns were determined. The Blood Stasis Pattern was omitted because the sample size was too small. Predictive logistic equations were suggested for four of the patterns. These criteria would be useful in determining each stroke patient's pattern in clinics. However, further studies with large samples are necessary to validate and confirm these criteria.

Short-term reactions to acupuncture treatment and adverse events following acupuncture: a cross-sectional survey of patient reports in Korea.

OBJECTIVES: The objective of this study was to explore the type and frequency of short-term reactions, de qi associated with acupuncture treatment, and to determine the incidence of adverse events following acupuncture treatment in Korea. SUBJECTS AND METHODS: This study is a retrospective and cross-sectional survey of patient reports using 1095 subjects; 585 subjects are outpatients of the East-West NEO Medical Center and the remaining 510 subjects are outpatients of the Kyung Hee Medical Center. In the period of June to November 2006, the participating subjects, who had all received acupuncture, consented and completed a single survey form. On this form, patients were asked to report their short-term reactions to the acupuncture, de qi, a patient satisfaction score (using the Visual Analogue Scale [VAS]) and any adverse events related to the acupuncture treatment. The 8 acupuncturists involved in this study were Korean medicine doctors who had more than 10 years' experience working as practitioners. RESULTS: The average age of the 1095 subjects was 58 years old. Positive short-term acupuncture reactions were reported by 878 (80.2%) of the 1095 subjects. Seventy-five (75) (6.8%) subjects described negative short-term acupuncture reactions. The most common positive short-term acupuncture reaction was that of a "relaxed" feeling in 472 (43.1%), followed by 90 (8.2%) who acknowledged a feeling of "less pain"; 16 (1.5%) felt "energized"; 16 (1.5%) experienced "tingling" and a sensation of "Heat" or "Coldness" was reported by 10 (0.9%). Negative short-term acupuncture reactions included feelings of "pain" 37 (3.4%), tiredness 24 (2.2%), and dizziness 9 (0.8%). Traditionally, the needling sensations of de qi refer to a patient's response to treatment, such as distension, pulling, soreness, heaviness, and numbness. Some (39.7%) subjects reported de qi during needling. A number experienced "distension" 333 (30.4%), "soreness" 52(4.7%), "pulling" 22(2.0%), "heaviness" 18(1.6%), and "numbness" 10 (0.9%). Positive short-term acupuncture reactions and de qi ratings were highest in those less than 40 years of age (83/96 86.5%, 50/96 52.1%). No reaction responses to acupuncture were the highest frequency in subjects over 70 years of age (31/187, 16.6%). Patient satisfaction level using VAS was comparatively high: 72.9 +/- 19.9. The only adverse events reported were bleeding in 92 (8.4%) of the participants. The majority of patients treated with acupuncture had suffered from stroke (430; 16.9%), headache (185; 16.9%), hypertension (97; 8.9%), or dizziness (85; 7.8%). CONCLUSIONS: Short-term acupuncture reactions and de qi were related to the age group. With the exception of bleeding, there were no adverse events related to the acupuncture treatment in this study. We consider acupuncture treatment to be very safe if the practitioners are well educated, trained and experienced. The number of post-treatment positive short-term acupuncture reactions was 12 times higher than that of the negative short-term reactions. Overall, subjects were comparatively satisfied with the acupuncture treatment.

An fMRI study of neuronal specificity of an acupoint: electroacupuncture stimulation of Yanglingquan (GB34) and its sham point.

The neuronal specificity of acupoints has not been entirely supported by the results of fMRI studies. The objective of this study was to investigate the neuronal specificity of an acupoint with electroacupuncture stimulation (EAS) using functional magnetic resonance imaging (fMRI). Functional MR imaging of the entire brain was performed in 12 normal healthy subjects during EAS of GB34 (Yanglingquan) and its sham point over the left leg in counter-balanced order. Anatomically, both GB34 and its sham point belong to the L5 spinal segment. EAS at the left GB34 specifically activated the right putamen, caudate body, claustrum, thalamus, cerebellum, as well as the left caudate body, ventral lateral thalamus, and cerebellum, all related to motor function. EAS at the sham point of the left GB34 specifically activated the right BA6, BA8, BA40, BA44, thalamus, as well as the left thalamus and cerebellum. Taken together, these findings suggest that EAS at an acupoint and its sham point, in the same spinal segment, induced specific cerebral response patterns. These findings support neuronal specificity of the acupoint studied. EAS at GB34 appears to be more related to motor function than EAS at its sham point, suggesting specificity of the GB34 acupoint. The results of this study provide neurobiological evidence for the existence of acupoint specificity, although further studies are necessary to better understand this phenomenon.

The effect of low versus high frequency electrical acupoint stimulation on motor recovery after ischemic stroke by motor evoked potentials study.

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

Hwangryunhaedogtang (huanglianjiedutang) treatment for pathological laughter after stroke and importance of patterns identification: a preliminary study.

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

The role of intestinal microflora on daidzein excretion in urine in humans treated with Chungpesagantang.

This study examined the relationship between the metabolism of the constituents of herbal medicines by human intestinal microflora and the level of metabolites excreted in the urine. This was performed by administering Chungpesagantang (CST) to volunteers and measuring their fecal metabolic activity CST to and urine excretion of daidzein, one of the metabolite of CST The metabolic activity of of CST dadizein was 54.8 +/- 16.7 mmol/h/g wet feces. When CST was administered orally to the subjects, the amount of daidzein excreted in the urine over 24 h was 103.7 +/- 55.8 mg, which accounted for 20.2% of the puerarin, daidzin and daidzein contained in CST. However, neither puerarin nor daidzin were excreted in the urine. The profile of daidzein excreted in the urine was found to be in proportion to that of the metabolic activity of the CST components. This suggests that the daidzein level excreted in the urine of the subjects administered CST is associated with the daidzein glycoside-hydrolyzing activity of the fecal microflora.

Effects of moxibustion on the recovery of post-stroke urinary symptoms.

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

Chunghyul-dan (Qingxie-dan) improves arterial stiffness in patients with increased baPWV.

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

Anti-hypertensive effect of chunghyul-dan (qingxue-dan) on stroke patients with essential hypertension.

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

Inhibition of human endothelial cell proliferation by Gami--Jeonggi--San (Jiawei--Zhenqi--San) is accompanied by transcriptional up-regulation of p53 and Waf1 tumor suppressor genes.

The effects of Gami-Jeonggi-San (GJS) on proliferation of human endothelial cell (HUV-EC-C) were investigated using a flow cytometry and a quantitative RT-PCR analysis of gene expression. An accumulation of cells at G(1) phase of the cell cycle was found at 72 h after treatment (10 microl/ml) while no detectable reduction of PCNA expression was recognized. To elucidate that the cell cycle inhibitory effect of GJS stems from its capability of transcriptional regulation of the cell cycle-controlling genes, we investigated mRNA expression of p53, Waf1, PCNA, Cyclin D1, Cdc2, Histone H3, c-Myc, and c-Fos. Significantly elevated mRNA levels of the p53 tumor suppressor gene and its down-stream mediator gene, Waf1, whose increased expressions were known to trigger G(1) cell cycle arrest, were observed. In contrast, a marked reduction of two early G(1)-specific, cell cycle stimulating genes, c-Myc and c-Fos, were found at 24h after treatment, while there were no detectable changes in expressions of G(1)-S or G(2)-M transition-related genes, indicating the G(1) specificity of GJS effect on the cell cycle. These results suggest that the pharmacological effects of GJS might be derived in part from inhibition of cellular proliferation of human endothelial cells, and that GJS inhibition of the cell cycle might stem from its regulatory capability on the transcription of the cell cycle-controlling genes, including p53 and Waf1 tumor suppressor genes.

Chunghyuldan activates NOS mRNA expression and suppresses VCAM-1 mRNA expression in human endothelial cells.

Chunghyuldan (CHD), a combinatorial drug that has antihyperlipidemic and anti-inflammatory activities, has been shown to improve arterial stiffness and inhibit stroke recurrence in clinical study. To understand the molecular basis of CHD's clinical effects, we explored its effect on cell proliferation and expression of nitric oxide synthase (NOS) and vascular cell adhesion molecule (VCAM-1) in human umbilical vein endothelial cells (HUVECs). Cell number counting and [3H]thymidine incorporation assay demonstrated that nontoxic doses of CHD have an inhibitory effect on DNA synthesis and suppress cell cycle progression of HUVECs. CHD treatment led to a marked induction of NO production through up-regulation of NOS mRNA expression in a dose- and time-dependent manner, whereas it suppressed VCAM-1 expression. CHD inhibition of VCAM-1 expression was totally blocked by pretreatment with the NO synthesis inhibitor L-NMMA, whereas pretreatment with the NO donor DETA-NO further decreased VCAM-1 level in CHD-treated HUVECs, indicating that VCAM-1 regulation by CHD is mediated through increased NO synthesis by CHD. In addition, TNF-alpha-mediated VCAM-1 activation was substantially impeded by CHD treatment. Collectively, our data suggest that anti-inflammatory or anti-hyperlipidemic effects of CHD might be associated with its ability to activate NO production and suppress VCAM-1 expression in human endothelial cells.

Inhibitory effect of Chunghyuldan in prostaglandin E2 and nitric oxide biosynthesis of lipopolysaccharide-induced RAW 264.7 cells.

Chunghyuldan (Daio-Orengedokuto in Japanese) (CHD) has been used as an antihyperlipidemic and antiischemic agent in Korea. To evaluate in vitro the efficacy of Chunghyuldans (CHDs) metabolized with and without human intestinal microflora against brain ischemia, we investigated its anti-inflammatory effect on LPS-induced RAW264.7 cells. Both metabolized CHD (MCHD) and CHD showed antioxidant activities in vitro, and inhibited nitric oxide (NO) and prostaglandin E2 (PGE2) productions in lipopolysaccharide (LPS)-induced RAW264.7 cells. These also inhibited enzyme activities and protein expressions of inducible NO synthase and cyclooxygenase-2 in LPS-induced RAW264.7 cells. MCHD-inhibitory activity against NO and PGE2 productions in LPS-induced RAW264.7 cells was more potent than those of CHD. These results suggest that CHD may show potent anti-inflammatory activity in vivo and can improve brain ischemia.

Metabolic activities of ginsenoside Rb1, baicalin, glycyrrhizin and geniposide to their bioactive compounds by human intestinal microflora.

To evaluate the pharmacological actions of herbal medicines, metabolic activities of herbal medicine components, ginsenoside Rb1, glycyrrhizin, geniposide and baicalin to their bioactive compounds compound K, 18beta-glycyrrhetic acid, genipin and baicalein by fecal specimens were measured. Their metabolic activities were 646.1+/-591.4, 29.4+/-51.7, 926.3+/-569.6 and 3884.6+/-1400.1 micromol/h/g, respectively. The profiles of these metabolic activities of baicalin and ginsenoside Rb1 were not significantly different to those of water extracts of Scutellariae Radix and Ginseng Radix. None of the metabolic activities tested were different between males and females, or between ages. However, the difference in these metabolic activities in individuals was significant. These results suggest that the human intestinal microflora enzymes that convert herbal components to their bioactive compounds may be used as selection markers of responders to traditional medicines.

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

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

Effect of Uwhangchungsimwon on expression of nitric oxide synthase and vascular cell adhesion molecule-1 in human endothelial cells.

For molecular biological characterization of the effects of Uwhangchungsimwon (UC) on the expression of nitric oxide synthase (NOS) gene and cell adhesion-regulating gene, vascular cell adhesion molecule-1 (VCAM-1), the human endothelial cell line (ECV304) was treated with the extract of UC and transcription of genes was examined using quantitative reverse transcriptase-polymerase chain reaction (RT-PCR) analysis. UC showed a transcription-activating effect on the NOS gene and a suppressing effect on the VCAM-1 gene in human endothelial cells, and these effects were found in a dose- and time-dependent manner. Down-regulation of VCAM-1 expression by UC was directly mediated by increased nitric oxide (NO) production, which was associated with increased NOS gene transcription. This study strongly suggests that the clinical effects of UC on stroke might be derived at least in part from its ability to induce NOS expression, which was followed by significant reduction of VCAM-1 expression.

Antispastic effect of electroacupuncture and moxibustion in stroke patients.

Spasticity is a frequently observed motor impairment that develops after stroke. The objective of this study was to evaluate the efficacy of electroacupuncture (EA) and moxibustion (Mox) on spasticity due to stroke. The subjects consisted of 35 stroke patients with elbow spasticity whose mean duration of stroke was 2.97 months. Fifteen patients were randomized to the EA group, ten to Mox, and ten to control. Every other day, 30 minutes of electrical stimulation with a frequency of 50 Hz was given through four needles on the Ch'ü-Ch'ih-San-Li (LI-11-LI-10) and Wai-Kuan-Ho-Ku (TB-5-LI-4) points of the paretic side. Direct Mox was applied to Ch'ü-Ch'ih (LI-11), San-Li (LI-10), Wai-Kuan (TB-5) and Ho-Ku (LI-4) points three times a day every other day. The control group was given only the routine acupuncture therapy for stroke and range of motion (ROM) exercise, which were also applied to the EA and Mox groups. The efficacy of treatment was measured before, immediately, 1 hour, 3 hours, 1 day, 5 days, 10 days and 15 days after the start of treatment using a modified Ashworth scale (MAS). In the EA group, spasticity was significantly reduced immediately, 1 hour and 3 hours after treatment (p < 0.05). Reductions were significant on the 5th day and thereafter (p < 0.05). In the Mox group, there was no significant change in the MAS scores after the first treatment. In the Mox and control group, there was no significant change in MAS scores. This study suggests that EA can temporarily reduce spasticity due to stroke, and if applied repeatedly it can maintain reduced spasticity.

Safety and efficacy assessment of chungpyesagan-tang for acute ischemic stroke.

Chungpyesagan-tang is one of the most well-known traditional herbal formulations frequently used for treatment of acute stroke in Korea. Therefore, this study aims to assess the clinical safety and efficacy of chungpyesagan-tang on acute ischemic stroke. We recruited acute cerebral infarction subjects within 1 week after onset time. Then, we prescribed chungpyesagan-tang to an Oriental medical treatment group (OM-group) for 2 weeks and enrolled a Western medical treatment group (WM-group) which received only Western biomedical care as a control. In this study, the OM-group was composed of 75 subjects. However, 14 of them dropped out, as two had progressive stroke while 12 complained of diarrhea. Thus, 61 cases were included in the analysis and compared to the 76 cases of the WM-group. The improvement of OM-group was better than that of the WM-group according to the National Institute of Health Stroke Scale (NIHSS), but not by the Modified Barthel Index (MBI). There were no definite abnormalities on labortory safety asessment. Therefore, we suggest that chungpyesagan-tang may have therapeutic effects, acting to reduce the severity of stroke and improving functional recovery without definite hepatic or renal toxicity when given for the first 2 weeks after a stroke.