DOI QR코드

DOI QR Code

Pharmacopuncture for Stroke: An Overview of Meta-Analyses

뇌졸중의 약침 치료에 대한 메타분석의 통합적 고찰

  • Kim, Mikyung (Dept. of Korean Internal Medicine, College of Korean Medicine, Sang-Ji University) ;
  • Han, Chang-ho (Research Institute of Korean Medicine, Pusan National University)
  • 김미경 (상지대학교 한의과대학 한방내과) ;
  • 한창호 (부산대학교 한의과학연구소)
  • Received : 2019.10.21
  • Accepted : 2019.12.17
  • Published : 2019.12.30

Abstract

Objectives: This study is an overview of the meta-analysis and systematic review of randomized controlled trials investigating the clinical effectiveness and safety of pharmacopuncture for patients with stroke. Methods: Core electronic databases were searched from their inception to 21 May 2019. A measurement tool to assess systematic reviews (AMSTAR 2) was applied to screen high-quality studies. The results of these studies were summarized, and additional meta-analysis was conducted. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to evaluate the certainty of evidence. Results: Sixteen studies met eligibility criteria. Four were excluded owing to insufficiency of AMSTAR 2 or low data reliability. The finally selected 12 studies were about pharmacopuncture using either a single herb extract, such as Dengzhan xixin, Sanch, Ginkgo biloba, or Acanthopanax, or a mixture of herbs, such as Compound danshen, Shenxiong, Xingnaojing, or Mailuoning. Most of the patients were from China, with acute ischemic stroke. All the studies using a pharmacopuncture versus a non-pharmacopuncture design reported the significant superiority of pharmacopuncture on every outcome measure. On the other hand, in a few studies, pharmacopuncture was inferior to active control in improving neurological deficit. Few studies reported adverse events. Conclusions: It is difficult to apply the results of this study directly to Korea, because the level of evidence is generally low and the clinical settings and social acceptance of pharmacopuncture therapy differ in Korea and China. Further studies are warranted to confirm the domestic applicability of evidence generated in China and to create evidence that supports the domestic situation.

Keywords

References

  1. Hong KS, Bang OY, Kang DW, Yu KH, Bae HJ, Lee JS, et al. Stroke statistics in Korea: part I. Epidemiology and risk factors: a report from the korean stroke society and clinical research center for stroke. J Stroke 2013;15(1):2-20. https://doi.org/10.5853/jos.2013.15.1.2
  2. Thiele I, Linseisen J, Heier M, Holle R, Kirchberger I, Peters A, et al. Time trends in stroke incidence and in prevalence of risk factors in Southern Germany, 1989 to 2008/09. Sci Rep 2018;8(1):11981. https://doi.org/10.1038/s41598-018-30350-8
  3. Katan M, Luft A. Global Burden of Stroke. Semin Neurol 2018;38(2):208-11. https://doi.org/10.1055/s-0038-1649503
  4. Liao CC, Lin JG, Tsai CC, Lane HL, Su TC, Wang HH, et al. An investigation of the use of traditional Chinese medicine in stroke patients in Taiwan. Evid-Based Complementary and Altern Med 2012;2012:387164. https://doi.org/10.1155/2012/387164
  5. Wang J, Cui M, Jiao H, Tong Y, Xu J, Zhao Y, et al. Content analysis of systematic reviews on effectiveness of traditional Chinese medicine. J Tradit Chin Med 2013;33(2):156-63. https://doi.org/10.1016/S0254-6272(13)60118-1
  6. Lee YS, Kwon S, Chae Y, Jang BH, Ko SG. A retrospective cohort study on the outcomes of ischemic stroke patients with adjuvant Korean Medicine treatment. Sci Rep 2018;8(1):1656. https://doi.org/10.1038/s41598-018-19841-w
  7. Lai CY, Chiang JH, Lin JG, Yen HR, Tu CH. Chinese herbal medicine reduced the risk of stroke in patients with Parkinson's disease: A population-based retrospective cohort study from Taiwan. PLoS One 2018;13(9):e0203473. https://doi.org/10.1371/journal.pone.0203473
  8. Ton G, Liao HY, Chiang JH, Chen YH, Lee YC. Chinese Herbal Medicine and Acupuncture Reduced the Risk of Stroke After Bell's Palsy: A Population-Based Retrospective Cohort Study. J Altern Complement Med 2019;25(9):946-56. https://doi.org/10.1089/acm.2018.0496
  9. Chen HZ. Interpretation of "Guidelines for Diagnosis and Treatment of Acute Ischemic Cerebrovascular Diseases for Chinese and Western Medicine". Clinical Journal of Traditional Chinese Medicine 2013;25(11):949-54.
  10. Dept. of CVD &neurorehabilitation, Neurological disorders branch, Chinese Medical Association. Chinese guideline of stroke rehabilitation: simplified version. Chin J Neurol 2012;45(3):201-6. https://doi.org/10.3760/cma.j.issn.1006-7876.2012.03.015
  11. Park SU, Cho SY, Park JM, Ko CN, Park HJ, Lauren Walls B, et al. Integrative treatment modalities for stroke victims in Korea. Complement Ther in Clin Pract 2014;20(1):37-41. https://doi.org/10.1016/j.ctcp.2013.10.007
  12. Zhou L, Chen Y, Liu J, Liu ZI, Gao Y. Evaluating the implementation of evidence-based TCM Clinical Practice Guidelines for Cerebral Infarction. Eur J Integr Med 2014;6(2):147-55. https://doi.org/10.1016/j.eujim.2014.03.006
  13. Woo JA, Nam YJ, Park YJ, Kwon YK. Review of Recent Clinical Trials for Depression in Traditional Chinese Medicine-Based on Randomized Controlled Trials and Systematic Reviews. J Physiol & Pathol Korean Med 2015;29(6):458-66. https://doi.org/10.15188/kjopp.2015.12.29.6.458
  14. Kim M, Han CH. E-mail survey on the current status of clinical practice and activation measures for Korean medicine in stroke care. J Korean Med 2017;38(3):143-59. https://doi.org/10.13048/jkm.17032
  15. Zhang X, Liu XT, Kang DY. Traditional Chinese Patent Medicine for Acute Ischemic Stroke: An Overview of Systematic Reviews Based on the GRADE Approach. Medicine 2016;95(12):e2986. https://doi.org/10.1097/md.0000000000002986
  16. Liu S, Wu JR. Comparative efficacy of Chinese herbal injections for treating acute cerebral infarction: a network meta-analysis of randomized controlled trials. BMC complem Altern M 2018;18(1):120. https://doi.org/10.1186/s12906-018-2178-9
  17. Li HQ, Wei JJ, Xia W, Li JH, Liu AJ, Yin SB, et al. Promoting blood circulation for removing blood stasis therapy for acute intracerebral hemorrhage: A systematic review and metaanalysis. Acta Pharmacol Sin 2015;36(6):659. https://doi.org/10.1038/aps.2014.139
  18. Han SY, Hong ZY, Xie YH, Zhao Y, Xu X. Therapeutic effect of Chinese herbal medicines for post stroke recovery: A traditional and network meta-analysis. Medicine 2017;96(49):e8830. https://doi.org/10.1097/MD.0000000000008830
  19. Shea BJ, Reeves BC, Wells G, Thuku M, Hamel C, Moran J, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ 2017;358:j4008. https://doi.org/10.1136/bmj.j4008
  20. Schunemann H, Brozek J, Guyatt G, Oxman A. GRADE Handbook: handbook for grading the quality of evidence and the strength of recommendations using the GRADE approach. 2013. BMJ Open: first published as 2018;10.
  21. Zhang X, Liu XT, Kang DY. GRADE in systematic reviews of acupuncture for stroke rehabilitation: recommendations based on highquality evidence. Sci Rep 2015;5:16582. https://doi.org/10.1038/srep16582
  22. Wu B, Liu M, Zhang S. Dan Shen agents for acute ischaemic stroke. The Cochrane Database Syst Rev 2007;18(2):CD004295.
  23. Sze FK, Yeung FF, Wong E, Lau J. Does Danshen improve disability after acute ischaemic stroke? Acta Neurol Scand 2005;111(2):118-25. https://doi.org/10.1111/j.1600-0404.2004.00369.x
  24. Liu XT, Ren PW, Peng L, Kang DY, Zhang TL, Wen S, et al. Effectiveness and safety of ShenXiong glucose injection for acute ischemic stroke: a systematic review and GRADE approach. BMC Complem Altern M 2016;16:68. https://doi.org/10.1186/s12906-016-1038-8
  25. Li JG, Wang LQ, Yang XY, Chen Z, Lai LYW, Xu H, et al. Chinese herbal medicine Dengzhan Xixin injection for acute ischemic stroke: A systematic review and meta-analysis of randomised controlled trials. Complement Ther Med 2017;34:74-85. https://doi.org/10.1016/j.ctim.2017.08.004
  26. Wang J, Xie Y, Zhao S, Zhang J, Chai Y, Li Y, et al. Dengzhanxixin injection for cerebral infarction: A systematic review and meta-analysis of randomized controlled trials. Medicine 2017;96(32):e7674. https://doi.org/10.1097/MD.0000000000007674
  27. Cao W, Liu W, Wu T, Zhong D, Liu G. Dengzhanhua preparations for acute cerebral infarction. Cochrane Database Syst Rev 2008;(4):CD005568.
  28. Chen X, Zhou M, Li Q, Yang J, Zhang Y, Zhang D, et al. Sanchi for acute ischaemic stroke. Cochrane Database Syst Rev 2008;(4):CD006305.
  29. Xu YM, Wang XC, Zhang SJ, Xu TT, Li HY, Hei SY, et al. Role of Xingnaojing combined with naloxone in treating intracerebral haemorrhage: A systematic review and meta-analysis of randomized controlled trials. Medicine 2018;97(43):e12967. https://doi.org/10.1097/md.0000000000012967
  30. Wu L, Zhang H, Xing Y, Gao Y, Li Y, Ren X, et al. Meta-Analysis of the Effects of Xingnaojing Injection on Consciousness Disturbance. Medicine 2016;95(7):e2875. https://doi.org/10.1097/md.0000000000002875
  31. Yang W, Shi Z, Yang HQ, Teng J, Zhao J, Xiang G. Mailuoning for acute ischaemic stroke. Cochrane Database Syst Rev 2015;1:CD007028.
  32. Zeng X, Liu M, Yang Y, Li Y, Asplund K. Ginkgo biloba for acute ischaemic stroke. The Cochrane Database Syst Rev 2005;(4):CD003691.
  33. Li W, Liu M, Feng S, Wu B, Zhang S, Yang W, et al. Acanthopanax for acute ischaemic stroke. Cochrane Database Syst Rev 2009(3):CD007032.
  34. Yei YC. Effectiveness of Ouhyul Pharmacopuncture on Central Post Stroke Pain [Master's Thesis]. Kyung Hee University Graduate School 2016.
  35. Bae HH, Park YC. The Effect of Combined Treatment with Neutral Eohyeol Acupuncture Point Injection on the Function and Life of Patients with Stroke Caused by Stroke (Randomized Controlled Double Blind Study). J Pharmacopunct 2004;7(1):77-86.
  36. Seo YR, Jung WS, Park SU, Moon SK, Park JM, Park JY. The effect of ouhyul herbal acupuncture point injections on shoulder pain after stroke. Evid Based Complement Alternat Med 2013;2013:504686.
  37. Heo SW, Kwon MJ, Kim HG, Jung KK, Kim SM, Min YK, et al. Clinical Study on Effect of Ginger Herbal Acupuncture Therapy on Shoulder Pain of Paralytic Patients. J Acupunct Res 2006;23(5):145-54.
  38. Cho SW, Go KH, Nam JH, Kim MS, Lee SY, Lee IS, et al. The Effectiveness o f Zingiberis Rhizom a Herbal Acupuncture Therapy and Bee Venom Herbal Acupuncture Therapy on the Poststroke Hemiplegic Shoulder Pain. JKMR 2005;15(4):77-87.
  39. Noh JH, Park JA, Youn HM, Jang KJ, Song CH, Ahn CB, et al. The effect of Hominis Placenta Pharmacopuncture on Leg spasticity of stroke patients (A Pilot study, Double blind, Randomized, Controlled Clinical Trial). J Pharmacopunct 2009;12(4):97-110. https://doi.org/10.3831/KPI.2009.12.4.097
  40. Lim SM, Lee SH. Effectiveness of bee venom acupuncture in alleviating post-stroke shoulder pain: A systematic review and meta-analysis. J Integr Med 2015;13(4):241-7. https://doi.org/10.1016/S2095-4964(15)60178-9
  41. Zhang L, Yan J, Liu X, Ye Z, Yang X, Meyboom R, et al. Pharmacovigilance practice and risk control of Traditional Chinese Medicine drugs in China: Current status and future perspective. J Ethnopharmacol 2012;140(3):519-25. https://doi.org/10.1016/j.jep.2012.01.058
  42. Li H, Deng J, Deng L, Ren X, Xia J. Safety profile of traditional Chinese herbal injection: An analysis of a spontaneous reporting system in China. Pharmacoepidem DR S 2019;28(7):1002-13. https://doi.org/10.1002/pds.4805
  43. Rutherford BR, Cooper TM, Persaud A, Brown PJ, Sneed JR, Roose SP. Less is more in antidepressant clinical trials: a meta-analysis of the effect of visit frequency on treatment response and dropout. J Clin Psychiatry 2013;74(7):703-15. https://doi.org/10.4088/JCP.12r08267
  44. National development institute of Korean medicine. A survey of Korean medicine use and herbal drug consumption 2017. Secondary National development institute of Korean medicine. A survey of Korean medicine use and herbal drug consumption 2017 2018. https://www.koms.or.kr (Accessed 10 Dec 2019).

Cited by

  1. 혈관성 치매의 약침 치료에 대한 중의학 임상연구 동향 vol.31, pp.4, 2019, https://doi.org/10.7231/jon.2020.31.4.315