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Background Atopic dermatitis (AD) is a chronic recurrent inflammatory skin disease that affects 1–3% of adults worldwide. Currently, it is not possible to completely cure AD; therefore, alternative treatments need to be developed to meet the patients’ needs. Here, based on our previous pilot study, we conducted the first confirmatory randomized controlled trial to evaluate the effect of acupuncture in patients with mild to moderate AD. Methods A randomized, participant- and assessor-blinded, sham-controlled trial was designed with an intervention period twice-weekly for 4 weeks and a 4-week follow-up. We equally allocated 36 participants to the verum acupuncture (VA) and sham acupuncture (SA) groups. The main outcome measure was the change in SCORing Atopic Dermatitis index (SCORAD) score before and after treatment. Results A total of 36 participants, aged 19 to 38 years, were enrolled, and 35 were included in the intention-to-treat analyses. The mean change in total SCORAD score differed significantly among the two groups at 4 weeks after randomization (P P Conclusions Twice-weekly acupuncture treatment was effective in reducing AD symptoms in patients with mild to moderate AD without serious adverse events. Trial registration Clinical Research Information Service Identifier: KCT0002796.

Acupuncture has been known to be effective for atopic dermatitis, especially ameliorating itch; however, its mechanisms are still unclear. The aim of this study was to test the anti-itch effects of acupuncture and to investigate its possible mechanisms. Acupuncture was performed at Gok-Ji (LI11) acupoints just before the injection of pruritogens in the mouse cheek model of acute itch and of MC903-induced atopic dermatitis displaying serotonergic chronic itch. Acupuncture significantly reduced acute itch triggered by compound 48/80, chloroquine, or especially serotonin. It also markedly reduced scratching behaviors evoked by the serotonin 5-HT2 receptor agonist α-methylserotonin and selective 5-HT7 receptor agonist LP 44. In addition, acupuncture treatment at LI11 had the preventive and therapeutic effects on persistent itch as well as the robust skin inflammation with epidermal thickening in mice with MC903-induced atopic dermatitis. It also considerably reduced the increased expression of 5-HT2A, 5-HT2B and 5-HT7 receptors in atopic dermatitis-like skin lesions in mice treated with MC903. Taken together, these findings highlight that acupuncture significantly ameliorates not only skin inflammation, but also acute and chronic serotonergic itch, possibly through blockade of serotonin 5-HT2 and 5-HT7 receptors.

Objective: Itch is an unpleasant sensation associated with an urge to scratch and is a major health care issue associated with atopic dermatitis (AD). Contagious itch, i.e., subjective feelings of itchiness induced by watching others’ scratching behavior, is common in patients with AD. Using electroencephalography, we examined alpha (8–13 Hz) oscillations in sensorimotor areas associated with the desire to scratch in patients with AD. Methods: Thirty-six patients with AD and 34 healthy controls (HCs) participated in this study. They evaluated their itch levels after watching short videos of a model scratching or tapping parts of his body. Neural oscillations were recorded from nine electrodes, including those placed over sensorimotor areas. Time–frequency analysis was used to compare mu rhythm suppression over the sensorimotor areas in response to these videos between patients with AD and HCs. Results: The behavioral test showed that the visual stimuli induced increased feelings of itchiness in patients with AD relative to HCs under the tapping and scratching conditions. The time–frequency analysis revealed that mu rhythm suppression in response to scratching images was significantly prominent in patients with AD, but not in HCs. Conclusion: Patients with AD exhibited increased susceptibility to contagious itch. This phenomenon might be related to enhanced mu rhythm suppression in sensorimotor areas of the brain in these patients. Our findings provide new insight into the neurophysiological basis of itch sensations in patients with AD.

This study is aimed toward estimating the lifetime risks, life expectancy, expected years of life lost (EYLL), and lifetime costs related to different subtypes of stroke in South Korea. We included 13,994 patients diagnosed with stroke (ICD-10, I60-I63) in the National Health Insurance Service-National Sample Cohort of Korea between 2006 and 2015. Lifetime risks were calculated using the cumulative incidence rate for patients aged 18–84. Lifetime survival data were obtained through the Kaplan–Meier method and extrapolated with a rolling-over extrapolation algorithm. The lifetime costs were estimated by multiplying the average monthly expenditures with the survival probabilities and adding the values over lifetime. The lifetime risks of stroke in Korea have been decreasing consistently over the last decade with the exception of subarachnoid hemorrhage in females, which appears to have slightly increased. The EYLL is higher in hemorrhagic stroke than in ischemic stroke (6–9.7 vs. 4.7). Expected lifetime costs reimbursed by the NHIS would amount to about $71,406 accompanied with $14,921 copayment from the patients for hemorrhagic stroke, and $50,551 and $11,666, respectively, for ischemic stroke. Further studies are warranted to combine survival with quality of life and functional disability to obtain a more detailed outcome assessment of the potential impact of the prevention of stroke.

Aims Acupuncture, particularly electroacupuncture (EA) has been shown to have the lipid-lowering effects, but not completely investigated. The present study was aimed to examine whether EA could attenuate poloxamer-407 (P-407)-induced hyperlipidemia in the rats and to investigate its potential mechanisms. Main methods Rats received P-407 (0.4 g/kg, i.p.) to induce hyperlipidemia. EA was performed at ST36 and ST40 acupoints a total of three times with 12 h-interval starting 1 h before the P-407 injection at 0.6 mA intensity and 2 Hz frequency for 10 min. Key findings In P-407-induced hyperlipidemic rats, EA stimulation at ST36 and ST40 acupoints significantly lowered the serum levels of triglycerides, total cholesterol, LDL-cholesterol and atherogenic index, while markedly increasing the serum HDL-cholesterol levels. Meanwhile, hyperlipidemic rats had significantly higher expression of sterol regulatory element-binding protein (SREBP)-2, without any difference in SREBP-1 expression in the liver, as compared with normal ones. EA significantly attenuated the expression of SREBP-2 with a subsequent decrease in 3-hydroxy-3-methylglutaryl coenzyme A reductase and an increase in low-density lipoprotein receptor at both mRNA and protein levels in the liver of hyperlipidemic rats. These changes did not occur after electrical stimulation at a non-acupoint. Significance Taken together, our findings indicate that EA stimulation to P-407-induced hyperlipidemic rats improves the lipid abnormalities, which may be associated with regulation of the expression of key enzymes of cholesterol synthesis in the liver through modulation of SREBP-2.

Using fMRI, the acupuncture studies related with modifying disease process in patients still stay in the beginning, whereas the physiological response to acupuncture has been published abundantly. In this study, we reviewed acupuncture studies performed in patient and reported the changes of brain activity using fMRI. Only randomized controlled studies were included. We systemically searched PubMed and EMBASE and extracted data by two independent researchers. We also performed an ALE-meta analysis to investigate significant brain responses of acupuncture. Fifteen studies were finally included in our review. The studies were performed in stroke, carpal tunnel syndrome, migraine, irritable bowel syndrome, lumbar disc herniation, Parkinson’s disease (PD) and mild cognitive impairment. The common changes of brain activity by acupuncture were identified in the sensory system and insular cortex, whereas other brain regions showed heterogeneous activity according to each disease status. Meta-analysis indicated the different brain responses between verum and sham acupuncture were found in the frontal lobe (BA 6) in the brain disorders such as stroke and PD and the parietal lobe (BA 40), insula (BA 13), limbic lobe (BA 23) and occipital lobe (BA 18) in the pain related disease. However, the correlations between the changes of clinical symptoms and brain activities are limited. Some specific changes of brain activities induced by acupuncture can be detective through patient imaging studies. However, it was difficult to draw an obvious conclusion due to the heterogeneity of the diseases and the interventions. Further well-designed patient centered fMRI studies considering clinical points are required.

Background: Acupuncture has been reported to have significant effects, not only in alleviating impaired motor function, but also rescuing dopaminergic neuron deficits in rodent models of Parkinson's disease (PD). However, a systemic analysis of these beneficial effects has yet to be performed.Objective: To evaluate the neuroprotective effect of acupuncture in animal models of PD.Methods: A literature search of the PubMed, MEDLINE, EMBASE, China National Knowledge Infrastructure, Research Information Service System, and Japan Society of Acupuncture and Moxibustion databases was performed to retrieve studies that investigated the effects of acupuncture on PD. The quality of each included study was evaluated using the 10-item checklist modified from the Collaborative Approach to Meta-Analysis and Review of Animal Data from Experimental Studies. RevMan version 5.3 (Foundation for Statistical Computing, Vienna, Austria) was used for meta-analysis.Results: The 42 studies included scored between 2 and 7 points, with a mean score of 4.6. Outcome measures included tyrosine hydroxylase (TH) level and dopamine content. Meta-analysis results revealed statistically significant effects of acupuncture for increasing both TH levels (33.97 [95% CI 33.15–34.79]; p < 0.00001) and dopamine content (4.23 [95% CI 3.53–4.92]; p < 0.00001) compared with that observed in PD control groups. In addition, motor dysfunctions exhibited by model PD animals were also mitigated by acupuncture treatment.Conclusions: Although there were limitations in the number and quality of the included studies, results of this analysis suggest that acupuncture exerts a protective effect on dopaminergic neurons in rodent models of PD.

Introduction Herbal prescriptions are frequently sought as complementary medicine treatment for inflammatory bowel disease (IBD). However, variability in pattern identification of Traditional Medicine has been criticised. Using patient data on clinical remission, we aimed to develop pattern identification (PI) algorithms refined by identified pattern and key symptoms which practitioners can easily differentiate. Methods Symptoms of IBD patients with remission were divided into Large intestine, Water-dampness, Respiratory, Upper gastrointestinal (GI) tract, and Coldness patterns. Using the term frequency-inverse document frequency (TF-IDF) method, symptoms described as indications of the herbal prescriptions and 5 patterns were matched. Decision tree modeling was used for prediction of relevant patterns from symptoms. Five-fold cross validation and sensitivity analysis was conducted to validate the model. Results Incomplete feeling of bowel emptying for Large intestine pattern, water dampness for Water-dampness pattern, chronic rhinitis for Respiratory pattern, gastric stuffiness for Upper GI tract pattern, and abdominal pain for Coldness pattern were selected by TF-IDF analysis. Overall accuracy of the decision tree was 64.4 %. In the treatment algorithm by the decision tree modeling, associations emerged between presence of incomplete feeling of bowel emptying and Large intestine type (100 %), chronic rhinitis and Respiratory type (100 %), water dampness symptoms and Water-dampness type (78.4 %), and gastric stuffiness and Upper GI tract type (58.3 %). Conclusions The PI algorithm we suggest can help clinicians determine patterns of IBD. Future studies with a large sample could yield an improved algorithm that predicts not only patterns but also corresponding herbal medicine prescriptions.

Atopic dermatitis (AD) is a chronic inflammatory skin disease with persistent itching, which impairs quality of life (QoL). Although various conventional treatments for AD exist, patients with AD often seek complementary and alternative therapies when conventional therapy has failed to relieve their AD symptoms or has had adverse effects. Acupuncture treatment may relieve AD symptoms, but controlled trials are needed to confirm this. Following our pilot study, which found that acupuncture treatment improves AD symptoms in mild-to-moderate AD patients, we will assess the effect of acupuncture treatment for symptom relief of AD using a trial with a complemented protocol. This is a two-arm, randomized, participant- and assessor-blinded, sham-controlled trial. A total of 36 mild-to-moderate AD patients will be randomly assigned in a 1:1 ratio to receive eight sessions twice weekly of either verum acupuncture (VA) or nonpenetrating sham acupuncture (SA) over four weeks. The primary outcome measured will be the change in the total Scoring Atopic Dermatitis (SCORAD) score. Secondary outcomes will be (1) changes in AD symptoms, QoL, dyspepsia symptoms, and electroencephalography (EEG) between baseline and week 4 and (2) changes in AD symptoms and QoL at baseline and at weeks 2, 4, and 8. This study will assess acupuncture treatment for the alleviation of AD symptoms in patients with mild-to-moderate AD. This clinical trial gas been registered in Korean Clinical Trial Registry (registration number: KCT0002796; date of registration: April 13, 2018).

Objectives To assess the feasibility of a definitive trial investigating the effects of acupuncture on atopic dermatitis symptoms including itching. Design A randomized, sham-controlled preliminary trial with three arms with a 4-week intervention period and a 4-week follow-up. Interventions Thirty participants were allocated to three arms (the verum acupuncture group 1 [VA1, 3 times weekly for 4 weeks], the verum acupuncture group 2 [VA2, twice weekly for 4 weeks], and the sham acupuncture group [SA, twice weekly for 4 weeks]) at a 1:1:1 ratio. Main outcome measures We determined the visual analogue scale (VAS) for itching and insomnia, SCORing Atopic Dermatitis (SCORAD), Eczema Area and Severity Index (EASI), Patient Oriented Eczema Measure (POEM), and Dermatology Life Quality Index (DLQI) scores over the course of the study. Baseline index score (BIS) comparison according to general symptom was performed. Results The SCORAD, VAS (Pruritus), VAS (Insomnia), POEM, DLQI, and EASI were significantly improved in the VA groups. Significant BIS mean differences were observed most predominantly in epigastric tenderness and dyspepsia. There was no significant difference between VA1 and VA2 groups in all the main evaluation indices. Conclusions For the following research, the authors suggest SCORAD (Total) as primary outcome and SCORAD (objective), VAS (Itch), VAS (insomnia), EASI, POEM, and DLQI as secondary outcomes. Thirty six participants should be conducted a 4-week acupuncture period (twice weekly) and a 4-week follow-up. It is necessary to compare the differences of general symptoms according to presence of epigastric tenderness or dyspepsia at the screening level.

Ethnopharmacological relevance Maekmoondong-tang (MMDT) is a traditional herbal medication widely used to improve cough in Korea, Japan, and China. It is composed of six herbs (Ophiopogonis Tuber, Pinelliae Tuber, Glycyrrhizae Radix, Zizyphi Fructus, Ginseng Radix, and Oryzae Semen). Aim of the study This study is aimed to systematically review the relevant randomised controlled trials (RCTs) to determine the effectiveness and safety of MMDT for cough. Materials and methods Electronic and hand-searching of 7 databases (Cochrane Library, MEDLINE, EMBASE, OASIS, RISS, CNKI and CiNii) was systematically conducted up to February 2015 for RCTs testing MMDT in patients with cough. The primary outcome was cough symptom improvement using cough diary, visual analog scale, or response rate. Risk of bias of the included trials was evaluated with the Cochrane risk of bias assessment tool. The dichotomous data were pooled to obtain a risk ratio (RR) of cough persisting after treatment, with 95% confidence intervals (CI). Results Nine RCTs involving 2453 participants were included. The methodological quality was largely poor for a majority of the studies. MMDT reduced the severity of cough by 74% compared with the conventional antitussive medications in various conditions (n=1145; RR of cough persisting after treatment=0.26; 95% CI, 0.19–0.34, I2=0%). The addition of MMDT to conventional medication in patients with postinfectious cough significantly alleviated symptoms up to day 5 but the effect was not maintained one week afterwards. For other diseases/conditions including chronic obstructive pulmonary disease, lung cancer surgery, and asthma, the evidence is inconsistent for MMDT/mMMDT for cough. Adverse events appear to be rare but the reporting was poor. Conclusions The current evidence from our systematic review and meta-analysis on MMDT for cough is inconclusive and we propose that rigorously designed, placebo-controlled trials of MMDT should be conducted to establish its place in management of cough.

Summary Objectives To assess the effectiveness of traditional herbal medicine (THM) as adjunctive therapy for breast cancer as evidenced by randomized controlled trials (RCTs). Methods Five electronic English and Chinese databases were systematically searched up to February, 2014. All RCTs involving THM in combination with conventional cancer therapy for breast cancer were included. Results Eight RCTs involving 798 breast cancer patients were systematically reviewed. Three studies reported a significant difference in the improvement of quality of life (QOL) compared to the control group. Two studies reported an increase in the white blood cell count after treatment. Data on hot flashes and sleep quality were evaluated. However, no significant differences in immediate tumor response were observed. Conclusion THM combined with conventional therapy in the treatment of breast cancer is efficacious in improving QOL and in decreasing the number of hot flashes per day. More research and well-designed, rigorous, large clinical trials are necessary to further address these issues.

This study aims to test the feasibility of a randomised clinical trial to evaluate how acupuncture affects atopic dermatitis (AD) symptoms and quality of life and to explore potential biomarkers that may be associated with AD. It is a sham-controlled trial in which 30 eligible patients will be randomly allocated in a 1 : 1 : 1 ratio to one of three groups: verum acupuncture (VA) group 1 (3 times weekly for 4 weeks); VA group 2 (twice weekly for 4 weeks); or sham acupuncture group (SA; twice weekly for 4 weeks). SA will consist of nonpenetrating acupuncture. Outcome measures will include the Visual Analogue Scale for itch, SCORing Atopic Dermatitis, and Eczema Area and Severity Index to evaluate AD symptoms improvement along with the Patient Oriented Eczema Measure and Dermatology Life Quality Index to assess quality of life. Measures will be collected at baseline, once weekly during the treatment period, and after a 4-week follow-up period. Blood collection will be at baseline and 4 and 8 weeks after treatment and compared with healthy controls. Illumina sequencing will be used to profile microRNA expression in each group to explore candidate microRNA biomarkers for specific effects of acupuncture in patients with AD. This trial is registered via US National Institutes of Health Clinical Trials registry (ClinicalTrials.gov) on 15 July 2016, identifier: NCT02844452.

Objective Although there is a growing interest in the use of acupuncture during pregnancy, the safety of acupuncture is yet to be rigorously investigated. The objective of this review is to identify adverse events (AEs) associated with acupuncture treatment during pregnancy. Methods We searched Medline, Embase, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Allied and Complementary Medicine Database (AMED) and five Korean databases up to February 2013. Reference lists of relevant articles were screened for additional reports. Studies were included regardless of their design if they reported original data and involved acupuncture needling and/or moxibustion treatment for any conditions in pregnant women. Studies of acupuncture for delivery, abortion, assisted reproduction or postpartum conditions were excluded. AE data were extracted and assessed in terms of severity and causality, and incidence was determined. Results Of 105 included studies, detailed AEs were reported only in 25 studies represented by 27 articles (25.7%). AEs evaluated as certain, probable or possible in the causality assessment were all mild/moderate in severity, with needling pain being the most frequent. Severe AEs or deaths were few and all considered unlikely to have been caused by acupuncture. Total AE incidence was 1.9%, and the incidence of AEs evaluated as certainly, probably or possibly causally related to acupuncture was 1.3%. Conclusions Acupuncture during pregnancy appears to be associated with few AEs when correctly applied.

Objectives : The purpose of this study is to evaluate the efficacy of acupuncture treatment on the inflammatory lesions and body image disturbances in patients with vulgaris acnes. Methods : Fifteen inflammatory acne patients were enrolled and treated with facial acupuncture during 4 treatment sessions. We evaluated the number of papules and nodules using the Korean Acne Grading System (KAGS). We also evaluated patients` general subjective satisfaction and objective changes of inflammatory acnes symptoms using DermaVision-pro. Moreover, we observed the skin quality-of-life scale with skindex-29 and body image disturbance questionnaire (BIDQ) as secondary outcome. Adverse events were recorded as well at every visit. Results : After 4 treatment sessions, there were significant reductions in the number of papules and nodules of the patients. We found that subjective satisfactions of patients were enhanced as well as the objective inflammatory symptoms. We also found significant improvements in the quality of life and BIDQ. No serious treatment-related adverse events were reported. Conclusions : This study demonstrated that standardized facial acupuncture were effective and safe in the treatment of facial inflammatory acnes.

Objectives. This systematic review aimed to summarize and evaluate the findings of studies investigating the local microcirculatory effects following acupuncture stimulation.Methods. MEDLINE, EMBASE, OASIS, and Cochrane library were searched to identify randomized controlled trials (RCTs) published before January 30, 2015. Studies demonstrating any type of microcirculation response to manual acupuncture in healthy subjects and patients were included. The risk of bias and the reliability of the experimental conditions were evaluated to determine quality assessment.Results. Eight RCTs met the inclusion criteria; there was at least one acupuncture-induced change in a microcirculatory parameter. Of the seven studies in healthy subjects, four reported significant increases in blood flow following acupuncture compared with control, whereas one other study observed reductions in microcirculation immediately after acupuncture needling. The studies that assessed patients with either fibromyalgia or trapezius myalgia found significant increases in blood flow in the skin and muscle. Additionally, the degree and duration of increases in microcirculation varied depending on the condition of the subjects and the manipulation technique.Conclusions. The current evidence regarding the local effects of acupuncture in terms of blood flow remains insufficient for reliable conclusions due to few well-designed studies. Additional well-designed studies are needed to clarify these issues.

Acacetin (5,7-dihydroxy-4′-methoxyflavone), a constituent of flavone naturally present in plants, has anti-cancer and anti-inflammatory activities. Neuroinflammation is thought to be one of the major pathological mechanisms responsible for Parkinson’s disease (PD), and has been a primary target in the development of treatment for PD. In the present study, we evaluated the neuroprotective effect of acacetin in PD induced by 1-methyl-4-phenylpyridine (MPP+)/or 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) and examined the related pathways in vitro and in vivo. In primary mesencephalic culture, acacetin protected dopaminergic (DA) cells and inhibited production of inflammatory factors such as nitric oxide, prostaglandin E2, and tumor necrosis factor-α against MPP+-induced toxicity in a dose-dependent manner. Then, we confirmed the effect of acacetin (10 mg/kg/d for 3 d, per os (p.o.)) in a mouse model of PD induced by MPTP (30 mg/kg/d for 5 d, intraperitoneally (i.p.)). In the behavioral test (pole test), the acacetin-treated mice showed decreased time of turning and locomotor activity, which were longer in MPTP-only treated mice. In addition, the acacetin-treated group inhibited degeneration of DA neurons and depletion of dopamine level induced by MPTP toxicity in the substantia nigra and striatum of the brain. Moreover, the acacetin-treated group inhibited microglia activation, accompanied by production of inducible nitric oxide synthases and cyclooxygenase-2. These results suggest that acacetin can protect DA neurons against the neurotoxicity involved in PD via its anti-inflammatory action.

Supplemental Digital Content is available in the text, Acupoint herbal patching (AHP), which involves local point stimulation with a herbal medicine patch, has long been used to treat patients with asthma in East Asian countries. However, its evidence is equivocal. This systematic review aims to summarize and critically evaluate the efficacy and safety of AHP for asthma. A literature search was conducted in PubMed, EMBASE, the Cochrane library, and the China National Knowledge Infrastructure for studies published on or before April 2014, which were randomized controlled trials (RCTs) examining AHP therapy by itself or in combination with other treatments in asthma patients. Trials needed to report pulmonary function outcomes to be included in analyses. The risk of bias of included studies was assessed using the Cochrane risk of bias assessment tool. For statistical pooling, risk ratio, mean difference (MD), or standardized MD was calculated with 95% confidence intervals (CIs) in a random-effects model. We ultimately included 16 RCTs with 1287 asthmatic patients in analyses. Treatment with AHP improved forced expiratory volume in 1 second (FEV1) by 13% (MD = 12.99%, 95% CI 5.17%–20.81%) and asthmatic symptoms by 60% (risk ratio of unchanged or getting worse symptoms with AHP = 0.4, 95% CI 0.27–0.58) over that observed with placebo. However, evidence is limited due to the heterogeneity and paucity of data. When added to conventional therapies, AHP significantly improved the FEV1/forced vital capacity ratio by 11.6% (95% CI 8.49%–14.79%) and reduced the risk of asthmatic symptoms by 69% (95% CI 0.16–0.58). Compared with conventional medication, AHP significantly improved FEV1 (standardized MD = 0.46, 95% CI 0.05–0.87), but a substantial heterogeneity was detected (I2 = 53%). When added to Chinese herbal medicine, there were no additional benefits of AHP on pulmonary function or global symptom improvement. No serious adverse events were associated with AHP. Evidence for AHP efficacy is encouraging, but not conclusive, because of clinical diversity and the high risk of bias in the examined studies. Further clinical and basic research is needed to determine the role of AHP in lung function and symptom improvement in patients with asthma.

Background Bee venom acupuncture (BVA), a novel type of acupuncture therapy in which purified bee venom is injected into the specific acupuncture point on the diseased part of the body, is used primarily for relieving pain and other musculoskeletal symptoms. In the present study, therapeutic potential of BVA to improve atopic dermatitis, a representative allergic dysfunction, was evaluated in the mouse model of trimellitic anhydride (TMA)-induced skin impairment. Methods Mice were treated with 5 % TMA on the dorsal flank for sensitization and subsequently treated with 2 % TMA on the dorsum of both ears for an additional 12 days after a 3-day interval. From the 7th day of 2 % TMA treatment, bilateral subcutaneous injection of BV (BV, 0.3 mg/kg) was performed daily at BL40 acupuncture points (located behind the knee) 1 h before 2 % TMA treatment for 5 days. Results BVA treatment markedly inhibited the expression levels of both T helper cell type 1 (Th1) and Th2 cytokines in ear skin and lymph nodes of TMA-treated mice. Clinical features of AD-like symptoms such as ear skin symptom severity and thickness, inflammation, and lymph node weight were significantly alleviated by BV treatment. BV treatment also inhibited the proliferation and infiltration of T cells, the production of Th1 and Th2 cytokines, and the synthesis of interleukin (IL)-4 and immunoglobulin E (IgE)—typical allergic Th2 responses in blood. The inhibitory effect of BVA was more pronounced at BL40 acupoint than non-acupuncture point located at the base of the tail. Conclusions These results indicate that BV injection at specific acupuncture points effectively alleviates AD-like skin lesions by inhibiting inflammatory and allergic responses in a TMA-induced contact hypersensitivity mouse model. Electronic supplementary material The online version of this article (doi:10.1186/s12906-016-1019-y) contains supplementary material, which is available to authorized users.

Background: Traditional Korean medicine (TKM) therapy of scalp and penetration acupuncture has been used for the treatment of stroke in Korea. This study investigated the efficacy of scalp and penetration acupuncture in combination with TKM medication. Methods: Twenty-four stroke patients were enrolled in the program. Control group (n = 12) received herbal medicines (Baepungtang, Sopungtang or Sosokmyeongtang) and conventional body acupuncture. Treatment group (n = 12) received scalp and penetration acupuncture in addition to herbal medicines and conventional body acupuncture. Improvements in the motor functions were scored by the modified Barthel index (MBI). Results: After 4 weeks of treatment, statistical analysis showed significant improvement in the MBI scores for both groups. Significant difference in the MBI scores between two groups, however, was not observed. Conclusion: The supportive effect of scalp and penetration acupuncture in the treatment of stroke needs further investigation.

Background: Acupuncture has been widely used for a range of neurological disorders. Despite its popularity, the evidence to support the use of acupuncture is contradictory. Methods: This review was designed to summarize and to evaluate the available evidence of acupuncture for neurological disorders. Results: Most of the reviewed studies suffer from lack of methodological rigor. Owing to paucity and poor quality of the primary studies, no firm conclusion could be drawn on the use of acupuncture for epilepsy, Alzheimer's disease, Parkinson's disease, ataxic disorders, multiple sclerosis, amyotrophic lateral sclerosis and spinal cord injury. For stroke rehabilitation, the evidence from recent high-quality trials and previous systematic reviews is not convincing. Conclusion: More rigorous trials are warranted to establish acupuncture's role in neurological disorders.

Summary Background Rumex japonicus Houtt. (RJH) is one of the herbs used in Eastern countries for the treatment of atopic dermatitis (AD). It has been shown to have an antioxidative effect in human skin disease. Objectives To examine whether RJH extract (RJH-E) suppresses the development of AD-like skin lesions in NC/Nga mice, which are induced by the repeated application of picryl chloride (PC). Methods The efficacy of RJH-E in NC/Nga mice was assessed by measuring symptom severity, scratching behaviour, Staphylococcus aureus numbers on an ear, and serum levels of IgE, interleukin (IL)-4 and interferon (IFN)-γ. Results Oral administration of RJH-E to NC/Nga mice treated with PC inhibited the development of AD-like skin lesions as exemplified by a significant decrease in total skin symptom severity scores, and a decrease in hypertrophy, hyperkeratosis and infiltration of inflammatory cells in the skin. The scratching behaviour and numbers of S. aureus, which are known to be exacerbated in AD, were also significantly reduced by RJH-E. No significant change was observed in the serum levels of IFN-γ, whereas IgE and IL-4 levels were significantly reduced by RJH-E. Conclusions These results suggest that RJH-E inhibits the development of AD-like skin lesions in NC/Nga mice by suppressing the T-helper 2 cell response. Our results indicate that RJH treatment could provide an effective alternative therapy for the management of AD.

Tripterygium wilfordii is a Chinese herb with immunosuppressive effects and an established history of use in the treatment of rheumatoid arthritis (RA). We have carried out a systematic review of randomised clinical trials (RCTs) which assess the effectiveness of T. wilfordii in this indication. We included only randomised and controlled studies which tested the effectiveness of T. wilfordii monopreparations in the treatment of RA. Studies in any language were included. A search of five electronic databases from inception to February 2005 identified 18 articles which could potentially meet our inclusion criteria. Only 16 of these could be retrieved from the scientific literature and after reading these in full, only two unique RCTs meeting our inclusion criteria were identified. Both indicated that T. wilfordii has beneficial effects on the symptoms of RA. However, the literature indicates that T. wilfordii is associated with serious adverse events which make the risk-benefit analysis for this herb unfavourable. Therefore, we cannot recommend its use.

Parkinson's disease (PD) is a chronic neurodegenerative disorder, and it has been suggested that treatments promoting survival and functional recovery of affected dopaminergic neurons could have a significant and long-term therapeutic value. In the present study, we investigated the neuroprotective effects of acupuncture on the nigrostriatal system in rat unilaterally lesioned with 6-hydroxydopamine (6-OHDA, 4 microg/microl, intrastriatal injection) using tyrosine hydroxylase (TH) and receptor for brain-derived neurotrophic factor, trkB, immunohistochemistries. Two weeks after the lesions were made, rats presented with asymmetry in rotational behavior (118.3 +/- 17.5 turns/h) following injection with apomorphine, a dopamine receptor agonist (0.5 mg/kg, sc). In contrast, acupunctural treatment at acupoints GB34 and LI3 was shown to significantly reduce this motor deficit (14.6 +/- 13.4 turns/h). Analysis via TH immunohistochemistry revealed a substantial loss of cell bodies in the substantia nigra (SN) (45.7% loss) and their terminals in the dorsolateral striatum ipsilateral to the 6-OHDA-induced lesion. However, acupunctural treatment resulted in the enhanced survival of dopaminergic neurons in the SN (21.4% loss) and their terminals in the dorsolateral striatum. Acupuncture also increased the expression of trkB significantly (35.6% increase) in the ipsilateral SN. In conclusion, we observed that only acupuncturing without the use of any drug has the neuroprotective effects against neuronal death in the rat PD model and these protective properties of acupuncture could be mediated by trkB.

The purpose of this study was to investigate the potential subchronic toxicity of plant sterol esters by a 13-week repeated oral dose in Sprague-Dawley rats. The test article was administered once daily by gavage to male and female rats at dose levels of 0, 1000, 3000 and 9000 mg/kg/day for 13 weeks. At the end of treatment period, 10 rats/sex/group were sacrificed, while six rats/sex in the negative control and highest dose groups were sacrificed after a 4-week recovery period. During the test period, clinical signs, mortality, body weights, food and water consumption, ophthalmoscopy, urinalysis, hematology, serum biochemistry, gross findings, organ weights and histopathology were examined. Slight decreases in body weight gain were noted at lower doses but were only statistically different from the control animals in the highest dose group. In histopathological examinations, an increase in the incidence of cardiomyopathy with mononuclear cell infiltration was observed in males of the 9000 mg/kg group. Decreased body weight gain and increased incidence of cardiomyopathy observed in the highest dose group were not recovered until the end of the recovery period. There were no adverse effects on mortality, clinical signs, food and water consumption, ophthalmoscopy, urinalysis, hematology, serum biochemistry, necropsy findings and organ weights in any treatment group. Based on these results, it was concluded that the 13-week repeated oral dose of plant sterol esters resulted in the suppression of body weight gains in both sexes and cardiomyopathy in males at a dose level of 9000 mg/kg/day. The target organ was determined to be heart in males, but not in females. The no-observed-adverse-effect level (NOAEL) was considered to be 3000 mg/kg/day for both sexes.

Apoptosis has been implicated in the pathogenesis of neurodegenerative diseases such as stroke and Alzheimer's disease. Apo-1/Fas gene is one of the mediators of apoptosis in stroke. Mval polymorphism is the first polymorphic marker identified in the Apo-1/Fas gene promoter, which was typed by PCR and followed by Mval digestion and gel electrophoresis. DNA isolated from peripheral blood collected from 91 stroke patients and 103 healthy blood donors was used for genotypes of GG, GA and AA by sequence specific primer PCR. Mval polymorphism was examined based on Fas gene promotor region by restriction fragment length polymorphism (RFLP). The Fas-GG genotype was the least frequent in patients with stroke and healthy controls (P = 0.57). In normal Korean controls the Mval polymorphism GA, AA and GG were 48.6%, 34.9% and 16.5%. In stroke patients were 56.2%, 29.6% and 14.2% respectively. And the allelic frequencies of Mval*2 (G) allele were less frequent than Mval*1 (A) allele in patients with stroke and healthy controls (P = 0.76). In normal Korean controls Mval*1 (A) and Mval*2 (G) alleles were 59.2% and 40.8%. In stroke patients were 57.6% and 42.4%, respectively. Our results, pending confirmation in a larger study, indicate that the Fas genotype may not appear to be a risk factor for stroke in Korean stroke patients.

Our previous study with functional magnetic resonance imaging (MRI) demonstrated that acupuncture stimulation of the vision-related acupoint, Bl-67, activates the visual cortex of the human brain. As a further study on the effect of Bl-67 acupuncture stimulation on the visual cortex, we examined c-Fos expression in binocularly deprived rat pups. Binocular deprivation significantly reduced the number of c-Fos-positive cells in the primary visual cortex, compared with that of normal control rat pups. Interestingly, acupuncture stimulation of Bl-67 resulted in a significant increase in the number of c-Fos-positive cells in the primary visual cortex, while acupuncture stimulation of other acupoints less important for visual function had no significant effect on c-Fos expression in the primary visual cortex. The results suggest the possibility of vision-related acupoint (Bl-67) having an influence over the activity of the primary visual cortex.

© 2017 by the authors; licensee MDPI, Basel, Switzerland. Atopic dermatitis (AD) and stress create a vicious cycle: stress exacerbates atopic symptoms, and atopic disease elicits stress and anxiety. Targeting multiple pathways including stress and allergic inflammation is, therefore, important for treating AD. In this study, we investigated the remedial value of Polygala tenuifoliaWilld. (PTW) for treating immobilization (IMO) stress-exacerbated atopy-like skin dermatitis and its underlying mechanism. Trimellitic anhydride (TMA) was applied to dorsal skin for sensitization and subsequently both ears for eliciting T-cell-dependent contact hypersensitivity in mice, which underwent 2 h-IMO stress and PTW administration for the latter 6 and 9 days in the ear exposure period of TMA, respectively. To elicit in vitro degranulation of human mast cell line-1 (HMC-1), 10 μM substance P (SP) and 200 nM corticotrophin-releasing factor (CRF) were sequentially added with 48 h-interval. PTW extract (500 μg/mL) was added 30 min before CRF treatment. IMO stress exacerbated TMA-induced scratching behavior by 252%, and increased their blood corticosterone levels by two-fold. Treatment with 250 mg/kg PTW significantly restored IMO stress-exacerbated scratching behavior and other indicators such as skin inflammation and water content, lymph node weights, and serum histamine and immunoglobulin E (lgE) levels. Furthermore, it also reversed TMA-stimulated expression of tumor necrosis factor (TNF)-α and interleukin (IL)-4 mRNAs in ear tissues. PTW significantly inhibited SP/CRF-stimulated degranulation of HMC-1 cells, subsequent tryptase secretion, and protein kinase A (PKA) activity. PTW also selectively inhibited p38 mitogen-activated protein kinase (MAPK) phosphorylation in SP/CRF-treated HMC-1 cells. PTW significantly inhibited HMC-1 cell degranulation and alleviated IMO stress-exacerbated atopic dermatitis symptoms by modulating the PKA/p38 MAPK signaling pathway.

Background Ankle sprain is one of the most frequently encountered musculoskeletal injuries; however, the efficacy of acupuncture in treating ankle sprains remains uncertain. We therefore performed a systematic review to evaluate the evidence regarding acupuncture for ankle sprains. Methods We searched 15 data sources and two trial registries up to February 2012. Randomized controlled trials of acupuncture were included if they involved patients with ankle sprains and reported outcomes of symptom improvement, including pain. A Cochrane risk of bias assessment tool was used. Risk ratio (RR) or mean difference (MD) was calculated with 95% confidence intervals (CIs) in a random effects model. Subgroup analyses were performed based on acupuncture type, grade of sprain, and control type. Sensitivity analyses were also performed with respect to risk of bias, sample size, and outcomes reported. Results Seventeen trials involving 1820 participants were included. Trial quality was generally poor, with just three reporting adequate methods of randomization and only one a method of allocation concealment. Significantly more participants in acupuncture groups reported global symptom improvement compared with no acupuncture groups (RR of symptoms persisting with acupuncture = 0.56, 95% CI 0.42–0.77). However, this is probably an overestimate due to the heterogeneity (I 2 = 51%) and high risk of bias of the included studies. Acupuncture as an add-on treatment also improved global symptoms compared with other treatments only, without significant variability (RR 0.61, 95% CI 0.51–0.73, I 2 = 1%). The benefit of acupuncture remained significant when the analysis was limited to two studies with a low risk of bias. Acupuncture was more effective than various controls in relieving pain, facilitating return to normal activity, and promoting quality of life, but these analyses were based on only a small number of studies. Acupuncture did not appear to be associated with adverse events. Conclusions Given methodological shortcomings and the small number of high-quality primary studies, the available evidence is insufficient to recommend acupuncture as an evidence-based treatment option. This calls for further rigorous investigations.

Angelicae Gigantis (AG) Radix, commonly used medicinal food, has been reported as a promising candidate for inflammatory diseases. However, the anti-allergic effects of AG and its molecular mechanisms have yet to be clarified. The present study investigated the anti-allergy effects of ethanol extracts of AG on mast cell-mediated allergic inflammation in vivo and in vitro. The finding of this study demonstrated that AG reduced anti-dinitrophenyl IgE antibody-induced passive cutaneous anaphylaxis, compound 48/80-induced histamine release, 2,4-dinitrofluoro benzene-induced contact hypersensitivity. In addition, AG inhibited the production of interleukin (IL)-6, IL-8, and TNF-α, as well as the activation of Jun N-terminal kinase and nuclear factor-κB in phorbol 12-myristate 13-acetate plus calcium ionophore A23187-stimulated human mast cells. In conclusion, our results provide a novel insight into the pharmacological actions of AG as a potential candidate for use in allergic inflammatory diseases.

To assess the clinical evidence for and against acupuncture as a treatment for Bell's palsy.We conducted a literature search of 15 databases from their inception to December 2010 without language restrictions. We included all randomized clinical trials (RCTs) regardless of their controls. Methodological quality was evaluated using the Cochrane risk of bias assessment tool.Of the 3 474 articles, only eight RCTs met our inclusion criteria. Four RCTs tested the effects of acupuncture against drug therapy on disease response rate. The meta-analysis of these data showed significant improvements in the acupuncture group [n=463, risk ratio (RR)=1.07, 95% CI: 1.02 to 1.13; P=0.006, I(2)=0%]. Six RCTs tested the effects of acupuncture plus drug therapy versus drug therapy alone. The meta-analysis of this set of RCTs also showed the favorable effects of acupuncture on disease response rate (n=512, RR=1.11, 95% CI: 1.05 to 1.17; P=0.001, I(2)=13%).The evidence supporting the effectiveness of acupuncture for treating Bell's palsy is limited. The number and quality of trials are too low to form firm conclusions. Further rigorous RCTs are warranted but need to overcome the many limitations of the current evidence.

STUDY DESIGN A retrospective case report. OBJECTIVE The objective of this article is to report an unusual complication of dry needling. SUMMARY OF BACKGROUND DATA Epidural hematomas after dry needling are quite unusual and only a few cases of epidural hematoma after acupuncture have been reported in the literature. We are presenting the first report of acute cervical epidural hematoma after dry needling. METHODS A 58-year-old woman presented with quadriparesis and neck pain. Magnetic resonance imaging of the spine revealed a hyperintense mass in the T2-weighted magnetic resonance image at the C2-T2 level, which proved to be an epidural hematoma. RESULTS Symptoms related to the epidural hematoma resolved after decompression. CONCLUSION Though rare, epidural hematomas are a possible complication when applying needling therapies. Therapists need to have precise knowledge of human anatomy, especially in the region where he or she will puncture. Continuous attention must be paid throughout the whole procedure.

Acupuncture is a widely used symptomatic treatment for carpal tunnel syndrome (CTS). The objective of this systematic review was to evaluate the evidence of the effectiveness of acupuncture and acupuncture-like treatments for CTS. Systematic searches were conducted on 11 electronic databases without language restrictions. All randomized controlled trials (RCTs) of acupuncture as a treatment of CTS were included. Methodological quality was assessed using the Cochrane risk of bias tool. Six RCTs met our inclusion criteria. Their methodological quality was generally low. Two RCTs compared the effectiveness of acupuncture with a sham control. The others used active controls. A meta-analysis of acupuncture versus steroid block therapy favored acupuncture (2 studies, n=144; risk ratio, 1.28; 95% CI, 1.08 to 1.52; P = .005; heterogeneity, I 2 = 10%) in terms of responder rate. Our systematic review and meta-analysis demonstrate that the evidence for acupuncture as a symptomatic therapy of CTS is encouraging but not convincing. The total number of included RCTs and their methodological quality were low. Further rigorous studies are required to establish whether acupuncture has therapeutic value for this indication. Perspective This systematic review of RCTs focused on clinical trials testing the effectiveness of acupuncture for CTS. The existing evidence is not convincing enough to suggest that acupuncture is an effective therapy for CTS. Further RCTs should overcome the limitation of previous studies.

Background Contralateral acupuncture (CAT) involves inserting needles in the meridian on the side opposite the disease location and is often used in post-stroke rehabilitation. The aim of this systematic review is to summarize and critically evaluate the evidence for and against the effectiveness of CAT for post-stroke rehabilitation as compared to ipsilateral acupuncture (IAT). Methods Seventeen databases were searched from their inceptions through June 2010. Prospective clinical trials were included if CAT was tested as the sole treatment or as an adjunct to other treatments for post-stroke rehabilitation and compared to IAT. Results Eight randomized clinical trials (RCTs) met our inclusion criteria. Four of them reported favorable effects of CAT compared to IAT for at least one outcome. A meta-analysis showed superior effects of CAT compared to IAT on recovery rate (n = 361; risk ratio (RR), 1.12; 95% confidence intervals (CIs), 1.04 to 1.22, P = 0.005). Subgroup analysis also showed favorable effects of using CAT on patients with cerebral infarction (n = 261; RR, 1.15; 95% CIs, 1.04 to 1.27, P = 0.006). Further analysis including patients with cerebral infarction and intracranial hemorrhage, however, failed to show these advantages (n = 100; RR, 1.11; 95% CIs, 0.85 to 1.46, P = 0.43). Conclusion The results of our systematic review and meta-analysis suggest that there is limited evidence for CAT being superior to IAT in the treatment of cerebral infarction. The total number of RCTs included in our analysis was low, however, and the RCTs included had a high risk of bias. Future RCTs appear to be warranted.

We investigated the feasibility of a future acupuncture trial in the symptom management of rheumatoid arthritis (RA). Twenty-five patients meeting the American College of Rheumatology (ACR) criteria were recruited and given 14 sessions of individualised acupuncture treatment for 6 weeks. Improvement in symptoms was assessed using ACR 20, 50 and 70; disease activity score (DAS28); tender joint count; swollen joint count; morning stiffness and health-related quality of life using the Korean Health Assessment Questionnaire and the SF-36 at baseline and after 6 weeks. Erythrocyte sedimentation rate (ESR) was also assessed. At 6 weeks, 44%, 20%, and 12% of patients achieved ACR 20, 50 and 70 responses, respectively. Acupuncture also produced statistically significant improvements in DAS28, pain and global activity, swollen joint count, health-related quality of life (SF-36) and ESR. No major acupuncture-related adverse events were reported. Acupuncture treatment as used in this pilot study was safe and well-tolerated. The use of acupuncture for symptom management in RA warrants further investigation.

The effects of acupuncture and electroacupuncture on an animal model of arthritic pain were examined. Under halothane anesthesia, arthritic pain was induced by the injection of carrageenan into the knee joint cavity of male Sprague-Dawley rats. Behavioral performance was tested before and after the termination of acupuncture or electroacupuncture. Electrophysiologically, the responses of afferents to a movement cycle were recorded before and after acupuncture or electroacupuncture. After the acupuncture procedure, the weight-bearing force of the rats was significantly improved and the neural responses to noxious movement stimulation were reduced. Electroacupuncture significantly improved weight-bearing behavior and inhibited neural responses of articular afferents to noxious stimulation. These results indicate that acupuncture and electroacupuncture may provide a potent strategy in relieving arthritic pain.

Acupuncture is widely used to alleviate symptoms in a variety of painful conditions. In obstetrics and gynecology, acupuncture has also been applied to a range of conditions including labor pain. This systematic review aims to critically evaluate the evidence on analgesic effect of acupuncture during labor. Computerized literature searches of 7 databases were performed for randomized clinical trials (RCTs) of acupuncture involving needle insertion for pain during labor. Three RCTs were identified and their methodologic quality was generally good. Two RCTs compared adjunctive acupuncture with usual care only and reported a reduction of meperidine and/or epidural analgesia. One placebo acupuncture controlled trial showed a statistically significant difference in both subjective and objective outcome measures of pain. No adverse events were reported in any of the trials. It is concluded that the evidence for acupuncture as an adjunct to conventional pain control during labor is promising but, because of the paucity of trial data, not convincing. Further research is warranted to clearly define its place in labor pain management.

Objectives: The safety of on acupuncture and moxibustion treatment during pregnancy is as important as their effectiveness. To establish a rationale and research strategy for future studies, we performed a traditional literature review to summarize how and under what conditions acupuncture and moxibustion treatment was given during pregnancy. Methods: An extensive traditional literature search for acupuncture and moxibustion treatment during pregnancy was conducted in comprehensive medical texts and in texts on acupuncture and moxibustion and on obstetrics and gynecology. Treatment conditions, methods, and contraindications were summarized and tabulated. Results: Twenty-eight books were included in our review. Most frequent reason for acupuncture and moxibustion treatment during pregnancy was difficult delivery, including breech presentations; commonly used acupuncture points for difficult labor included LI4, SP6, BL67, BL60, KI6, ST30, SP12, LR4, LR3, PC6, CV3, CV14, KI13, and GB21, indicating that those acupuncture points may have to be avoided during pregnancy. Descriptions of other symptoms or conditions were sparse. For habitual abortion or recurrent miscarriage, moxibustion on GV4, BL23, CV3, KI8, and KI2 was indicated. A combination of LI4 and SP6, and CV4 were consistently contraindicated during pregnancy across the reviewed books. Conclusions: Our traditional literature review has shown that the use of acupuncture and moxibustion treatment during pregnancy has been limited. Given that more and more pregnant women are interested in safe and effective treatment, further research of acupuncture’s safety and efficacy during pregnancy is urgently needed.

Parkinson's disease (PD) is caused by the selective loss of dopaminergic neurons in the substantia nigra (SN) and the depletion of striatal dopamine (DA). Acupuncture, as an alternative therapy for PD, has beneficial effects in both PD patients and PD animal models, although the underlying mechanisms therein remain uncertain. The present study investigated whether acupuncture treatment affected dopamine neurotransmission in a PD mouse model using 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP). We found that acupuncture treatment at acupoint GB34 improved motor function with accompanying dopaminergic neuron protection against MPTP but did not restore striatal dopamine depletion. Instead, acupuncture treatment increased dopamine release that in turn, may lead to the enhancement of dopamine availability in the synaptic cleft. Moreover, acupuncture treatment mitigated MPTP-induced abnormal postsynaptic changes, suggesting that acupuncture treatment may increase postsynaptic dopamine neurotransmission and facilitate the normalization of basal ganglia activity. These results suggest that the acupuncture-induced enhancement of synaptic dopamine availability may play a critical role in motor function improvement against MPTP.

Introduction Korean herbal medicine (KHM) is widely used as a therapeutic modality during pregnancy in Korea. The purpose of this review is to identify use and adverse events (AEs) associated with KHM during pregnancy in Korean medicine literature. Methods We searched Pubmed, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and five Korean databases to identify relevant studies published before January 2015. Studies were included regardless of their design if they reported original data and involved KHM for any conditions in pregnant women. For safety problems, we also excluded studies if there was no information about maternal and fetal outcomes. Results Fifty-two studies were included in this review. The most frequently reported indication for KHM was hyperemesis gravidarum (26.3%). Anjeonicheon-tang and Atractylodes Rhizome White were the most commonly used in KHM prescriptions and as single herbs during pregnancy. Some studies reported mild or unassessable AEs like diarrhea, pruritis, and preterm birth. Severe AEs were all considered unlikely to have been caused by KHM. Conclusions Hyperemesis gravidarum and maintaining pregnancy accounted for more than two-thirds of clinical indications for KHM during pregnancy in Korean medicine literature. Few studies reported on mild AEs associated with KHM, but due to a lack of large prospective surveys, this finding is not conclusive. Prospective studies with a larger sample size are needed to confirm the safety of KHM during pregnancy.

Background Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder. Many patients suffer from IBS that can be difficult to treat, thus complementary therapies which may be effective and have a lower likelihood of adverse effects are being sought. This systematic review and meta-analysis aimed at critically evaluating the current evidence on moxibustion for improving global symptoms of IBS. Methods We searched Medline, EMBASE, the Cochrane Central Register of Controlled Trials, AMED, CINAHL, and CNKI databases for randomised controlled trials (RCTs) of moxibustion comparing with sham moxibustion, pharmacological medications, and other active treatments in patients with IBS. Trials should report global symptom improvement as an outcome measure. Risk of bias for each RCT was assessed according to criteria by the Cochrane Collaboration, and the dichotomous data were pooled according to the control intervention to obtain a risk ratio (RR) of global symptom improvement after moxibustion, with 95% confidence intervals (CI). Results A total of 20 RCTs were eligible for inclusion (n = 1625). The risk of bias was generally high. Compared with pharmacological medications, moxibustion significantly alleviated overall IBS symptoms but there was a moderate inconsistency among studies (7 RCTs, RR 1.33, 95% CI [1.15, 1.55], I2 = 46%). Moxibustion combined with acupuncture was more effective than pharmacological therapy but a moderate inconsistency among studies was found (4 RCTs, RR 1.24, 95% CI [1.09, 1.41], I2 = 36%). When moxibustion was added to pharmacological medications or herbal medicine, no additive benefit of moxibustion was shown compared with pharmacological medications or herbal medicine alone. One small sham-controlled trial found no difference between moxibustion and sham control in symptom severity (mean difference 0.35, 95% CI [−0.77, 1.47]). Moxibustion appears to be associated with few adverse events but the evidence is limited due to poor reporting. Conclusions This systematic review and meta-analysis suggests that moxibustion may provide benefit to IBS patients although the risk of bias in the included studies is relatively high. Future studies are necessary to confirm whether this finding is reproducible in carefully-designed and conducted trials and to firmly establish the place of moxibustion in current practice.

reported inverse association between green tea extract with progress of cancer progress compared with placebo. Conclusion: The association direction of green tea consumption and cancer incidence is diverse with regards to study types, countries and cancer types. There seems to be a decrease in large number of population-based observational studies after the year 2008. Contact: Xun Li, tina000341@163.com Corresponding Author: Jiangping Liu (Centre for EvidenceBased Chinese Medicine, Beijing University of Chinese Medicine), Jianping l@hotmail.com

Results: With regard to infertility factors of subjects, seventeen had unknown factor, eleven had tubal or peritoneal factor, eight had uterine factor, and six had ovulation factor. Thirty subjects showed thermograms of lower abdominal coldness in accordance of two practitioners. Subjects with tubal or peritoneal factor of infertility shown lower abdominal coldness with most high frequency of 90.9% (p=0.237). Conclusion: In cross analysis process, correlation of lower abdominal coldness and tubal or peritoneal factor of infertility was not statistically significant, however, this would suggest clinically significant clue for the treatment. Thermography turns out to be a useful tool for identification of lower abdominal coldness in infertile woman. Further study is supposed to investigate the physiopathological mechanism of lower abdominal coldness in infertilewomenwith large sample size. Contact: Jeong-Eun Yoo, korea dr yoo@naver.com