Bojungikgi-tang for Chemotherapy-induced Leukopenia: A Systematic Review and Meta-Analysis.

Chemotherapy-induced leukopenia is a common side effect of cytotoxic anticancer drugs. It can deprive patients of treatment opportunities, resulting in the delay, reduction, or discontinuation of chemotherapy or other anticancer drug administration. Two researchers searched English, Chinese, Japanese, and Korean electronic databases, without limiting the time period and language, using search terms such as "Bojungikgi," "WBC," "leuko," and "neutrop." Among the human randomized controlled studies in which Bojungikgi-tang was administered to patients who underwent chemotherapy, studies reporting leukopenia-related outcomes were selected, and data extraction, bias risk assessment, and meta-analysis were performed on the selected papers. Ten studies were selected, and a systematic review with meta-analysis was conducted. Nine papers were published in China and the total number of participants was 715. As a result of administering Bojungikgi-tang to these patients, the number of patients with chemotherapy-induced leukopenia significantly decreased (OR: 0.41, 95% CI: 0.27-0.61, P = .0001, I2 = 35%). Further, white blood cell counts were compared with that of the control group, and it showed an effect on prevention (MD: 0.64, 95% CI: 0.46-0.83, P < .00001, I2 = 90%). A pronounced effect was observed, especially when administered after a diagnosis based on the pattern identification, such as Qi deficiency. (OR: 0.32, 95% CI: 0.18-0.58, P = .0002, I2 = 0%). However, all studies had a high risk of bias due to non-blinding, and most studies had a high or uncertain risk of bias in creating random assignment orders and concealing them. Bojungikgi-tang has an effect on the prevention and treatment of chemotherapy-induced leukopenia. The effect rate can be increased when administered after proper diagnosis, and the possibility of adverse reactions and side effects is lower than that of Granulocyte-Colony Stimulating Factor (G-CSF) injection. Bojungikgi-tang appears to be useful in the treatment and prevention of leukopenia caused by cytotoxic anticancer drugs. However, it is necessary to conduct high-quality clinical studies in the future, considering the possibility of local and language bias, heterogeneity of carcinoma and intervention, and the risk of bias.Registration: PROSPERO CRD4202341054.

Acupuncture for Regulating Blood Pressure of Stroke Patients: A Systematic Review and Meta-Analysis.

Background: Blood pressure (BP) after a stroke is affected by autonomic regulation, the Cushing reaction, and basal history of hypertensive, arteriosclerotic conditions. To prevent recurrent stroke attack and its complications, BP must be regulated to within the normal range through monitoring, rest, and medication. Previous studies have reported that acupuncture may be effective in lowering BP in patients with hypertension. Objectives: This study was aimed at evaluating the efficacy of acupuncture in regulating BP in stroke patients, including both cerebral infarction and hemorrhage. Methods: A review was conducted of articles published in English, Korean, Chinese, and Japanese across 16 electronic databases (Pubmed, EMBASE, Cochrane Central Resister of Controlled Trials, AMED, CINAHL, CNKI, Wanfang, VIP, CiNii, and seven Korean databases) up to April 2020. Only randomized controlled trials that evaluated the efficacy of acupuncture for stroke patients were included and meta-analyzed, and BP data and risk of bias were extracted by scanning the full texts. Data analysis was performed by using RevMan 5.3. Results: From the 16 electronic databases, 7623 relevant articles were identified, and 847 stroke patients of 10 trials met the inclusion criteria. Two trials reported that BP was lowered more in the group who had received acupuncture treatment than the group who were treated with conventional medication. Two trials reported that BP was lowered after auricular acupuncture treatment more than those observed in the group receiving conventional medical treatment. Six trials reported that BP in cerebral infarction patients was lower than in the control group. None of the trials reported any adverse events. Conclusions: It was concluded that acupuncture may be a suitable treatment option for regulating BP after stroke. However, the trials are not free from bias. Further reviews would yield positive results if well-designed trials are conducted.

Herbal Medicine for Dumping Syndrome: A Systematic Review and Meta-Analysis.

Background: Dumping syndrome is a common complication of surgical treatment of gastric cancer, but conventional therapy has limitations related to symptom care due to its structural cause and the decreased quality of life. Objectives: The objective of this review was to assess the clinical evidence for the effectiveness of herbal medicine as a treatment for dumping syndrome. Methods: A literature review was conducted using 16 databases from their inceptions to March 2018. All randomized controlled trials (RCTs) of herbal medicine used to treat dumping syndrome patients were included and meta-analyzed. Methodological quality was assessed using the Cochrane Handbook for Systematic Reviews of Interventions. Results: A total of 174 dumping syndrome patients of 3 trials met all inclusion criteria. Two trials assessed the effectiveness of herbal medicine on the symptom response rate compared with conventional pharmacotherapy. Their results suggested significant effects in favor of herbal medicine (risk ratio [RR] = 1.37, 95% confidence interval [CI] = 1.16-1.63, P = .0003, heterogeneity τ2 = 0, χ2 = 0.02, P = .88, I2 = 0%). One trial assessed its effectiveness on the improvement rate of overall symptoms compared with conventional conservative complex therapy, such as postural management, diet regulation, and counseling (RR = 1.23, 95% CI = 0.96-1.58). Conclusions: Due to the small sample size, scarcity of reported articles, and lack of quality of the current RCTs, it was concluded that the effectiveness of herbal medicine in treating dumping syndrome is unclear.

Herbal medicine for hemorrhage-related hydrocephalus: A systematic review of randomised controlled trials.

BACKGROUND & OBJECTIVE: Hemorrhage related hydrocephalus is a common complication intraventricular hemorrhage, subarachnoid hemorrhage, intracranial hemorrhage and traumatic brain injury. It increases morbidity and disability. The aim of this review is to assess the efficacy of herbal medicine for hemorrhage related hydrocephalus. METHODS: We searched randomized controlled trials (RCTs) investigating herbal medicine through 13 electronic databases. Extracting and assessing the data were performed independently by two authors. The Cochrane risk of bias tool was used to assess the risk of bias. RESULTS: We identified 15 trials investing 12 different herbal formulas. The methodological quality was generally low. In the 11 RCTs of comparisons with conventional treatment alone, herbal medicine plus conventional treatment showed a significant improvement on ventriculomegaly after treatment. Also, the 12 RCTs showed a significant difference on clinical signs and symptoms between two groups. We pooled the data of five trials compared Zhongfengxingnao liquid and Salviae Miltiorrhizae Radix plus conservative treatment with conservative treatment. There were significant effects on normalizing ventricle volume (Huckman index, RR 2.49; 95% CI 1.24-5.00, n = 80) and improving of Chinese scale of clinical neurologic deficit (MD -8.07; 95% CI -9.40 to -6.75, n = 264). CONCLUSION: Herbal medicine has potential benefits on improving ventriculomegaly and clinical signs and symptoms. However, a relatively small participants number and methodological limitations reduced the strength of the evidence. More rigorous trials are warranted.

Herbal Medicine for Xerostomia in Cancer Patients: A Systematic Review of Randomized Controlled Trials.

BACKGROUND: Xerostomia (dry mouth) causes many clinical problems, including oral infections, speech difficulties, and impaired chewing and swallowing of food. Many cancer patients have complained of xerostomia induced by cancer therapy. OBJECTIVE: The aim of this systematic review is to assess the efficacy of herbal medicine for the treatment of xerostomia in cancer patients. MATERIALS AND METHODS: Randomized controlled trials investigating the use of herbal medicines to treat xerostomia in cancer patients were included. We searched the following 12 databases without restrictions on time or language. The risk of bias was assessed using the Cochrane Risk of Bias Tool. RESULTS: Twenty-five randomized controlled trials involving 1586 patients met the inclusion criteria. A total of 24 formulas were examined in the included trials. Most of the included trials were insufficiently reported in the methodology section. Five formulas were shown to significantly improve the salivary flow rate compared to comparators. Regarding the grade of xerostomia, all formulas with the exception of a Dark Plum gargle solution with normal saline were significantly effective in reducing the severity of dry mouth. Adverse events were reported in 4 trials, and adverse effects of herbal medicine were reported in 3 trials. CONCLUSIONS: We found herbal medicines had potential benefits for improving salivary function and reducing the severity of dry mouth in cancer patients. However, methodological limitations and a relatively small sample size reduced the strength of the evidence. More high-quality trials reporting sufficient methodological data are warranted to enforce the strength of evidence regarding the effectiveness of herbal medicines.

The efficacy and safety of Danggui-Sayuk-Ga-Osuyu-Saenggang-tang on Korean patients with cold hypersensitivity in the hands: study protocol for a pilot, double-blind, randomized, placebo-controlled, parallel-group clinical trial.

BACKGROUND: In recent years, cold hypersensitivity in the hands (CHH) has become a common ailment of women in Korea. It can lead to gynecological problems such as irregular menstruation, miscarriage, and infertility. Traditionally, Korean herbal medicine has been the primary treatment method used to balance thermoregulation in the human body; however, its effectiveness has not been confirmed through systematic study. Thus, in this trial, we will investigate the feasibility of a full randomized clinical trial, Danggui-Sayuk-Ga-Osuyu-Saenggang-tang (DSGOST) in Korean women with CHH. METHODS: This study will be a pilot, multicenter, double-blind, randomized, parallel-group, two-arm, placebo-controlled clinical trial. A total of 66 participants will be randomly divided into two groups, a DSGOST treatment group and a placebo control group, in a 1:1 ratio using a web-based randomization system. Each group will take DSGOST or placebo three times daily for 6 weeks. The primary outcome will be measured using Visual Analogue Scale (VAS) scores of CHH. Secondary outcomes will include changes in skin temperature of the hands, Clinical Global Impressions (CGI) scale scores, recovery rate of skin temperature of the hands after the cold stress test, and the Korean version of the WHO Quality of Life Scale, abbreviated version (WHOQOL-BREF). DISCUSSION: This trial will be the first trial to reflect the newly defined disease range of CHH which was compiled by Korean medicine expert consensus. This study will provide considerable evidence for further large-scale trials and general clinical guidelines for CHH in the Korean medical field. TRIAL REGISTRATION: This study is registered at ClinicalTrials.gov, ID: NCT02645916 . Registered on 30 December 2015.

Effect of the semen extract of Thuja orientalis on inflammatory responses in transient focal cerebral ischemia rat model and LPS-stimulated BV-2 microglia.

In the central nervous system inflammation is dependent upon the synthesis of various inflammatory mediators by local neurons, astrocytes and especially microglia. In this study, we investigated the anti-inflammatory activities of the semen extract of Thuja orientalis (Thujae Orientalis Semen; TOS) on transient middle cerebral artery occlusion (tMCAO)-induced ischemia in rats and the production of inflammatory mediators such as nitric oxide (NO), prostaglandin E(2) (PGE(2)) and proinflammatory cytokine, interleukin (IL)-1ß in lipopolysaccharide (LPS)-stimulated BV-2 mouse microglia. TOS extract significantly decreased the infarction volumes of ischemic brains and also inhibited microglia activation and neuronal death. In addition, TOS extract significantly decreased the production of NO, PGE(2) and IL-1ß in LPS-stimulated BV-2 microglia. TOS extract also attenuated the expression of inducible nitric oxide synthase (iNOS), cyclooxygenase-2 (COX-2) and IL-1ß mRNAs and proteins in activated microglia. Furthermore, TOS extract significantly suppressed the phosphorylation of c-Jun N-terminal kinase (JNK) and p38 MAPK, and the nuclear translocation of NF-κB p65 in activated microglia. Our results indicate that TOS extract is capable of inhibiting microglia activation in an ischemic brain through the down-regulation of inflammatory responses, suggesting that the TOS extract may have therapeutic potential as an anti-inflammatory drug for ischemic stroke.