Objective: To investigate the effect of Alpiniae oxyphyllae fructus (AOF) on the alleviation of musculoskeletal disorders caused by aging, we conducted experiments on osteoporosis and muscle atrophy. Methods: The experimental group was classified into a control group, aging-elicited (AE) group and AOF group. The control group comprised 8-week-old Institute of Cancer Research (ICR) mice. The AE and AOF groups were ICR mice at 50 weeks of age. For the AE group, 10 mL of distilled water was administered once a day for 180 days without any treatment. An AOF extract (0.54 g/kg) was dissolved in distilled water and administered to the mice in the AOF group once a day for 180 days. Results: In the experiment on the alleviation of osteoporosis, the distribution of glucosaminoglycan in the bone matrix of the femoral bone was increased in the AOF group; moreover, the osteocalcin (OCN) positive reaction was increased and 8-OHdG positivity was decreased. In addition, AOF positively decreased RANKL, positively increased OPG, and positively decreased MMP-3. Muscle fiber loss in the endomysium following muscle degeneration of the quadriceps was reduced more in the AOF group compared with the AE group, and caspase-3 positive responses were also decreased. In addition, the 8-OHdG and p-lkB positivity in the AOF group decreased compared with the AE group, and the Myo-D positivity increased. Conclusion: We found that increasing bone formation alleviates osteoporosis, and that reducing bone loss alleviates muscle atrophy by reducing muscle loss and increasing muscle development.

Objectives: The purpose of this study was to assess the effects of Korean medicine for non-alcoholic fatty liver disease (NAFLD). We analyzed the result of randomized controlled trials (RCTs) that applied Korean medicine to NAFLD patients through meta analysis and systematic review. Methods: The key question was to the effects of Korean medicine for NAFLD patients according to the PICO-SD (participants, intervention, comparison, outcome, study design) and we included only RCTs. We searched 10 databases including NDSL, KMBASE, KISS, KISTI, KoreaMed, Koreantk, OASIS, Cochrane, Pubmed, EMBASE without a language restriction. We assessed risk of bias by Cochrane group's Risk of Bias tool. Results: The finally selected 12 RCTs were analyzed. Total number of participants was 1189 (male 719, female 470) as 684 and 505 in the oriental medicine group (i.e. herbal drugs, acupuncture, acupoint embedding therapy) and control group (conventional drugs, placebo), respectively. The meta analysis results of examining 7 RCTs comparing the therapeutic efficacy of herbal medicine with that of Western medicine showed statistically significant (p<0.05) differences in the efficacy evaluation, liver function test results, blood lipids, and TNF-${\alpha}$. Furthermore, the meta analysis results of investigating 3 RCTs comparing the therapeutic efficacy of herbal medicine with that of a placebo showed statistically significant (p<0.05) differences in the liver function test results, blood lipids, and waist circumference. Conclusions: The research showed that Korean medicine for NAFLD can be effective treatment. But more studies are required to enhance the level of evidence and we should report on safety.

Objective: This study reviewed recent clinical research trends regarding the effects of herbal medicine treatment containing diuretic herbs on nonalcoholic fatty liver disease (NAFLD) in China. Methods: We reviewed clinical studies on NAFLD from the China Academic Journal of the China National Knowledge Infrastructure from January 1, 2016, to September 10, 2018. Results: Thirty-nine papers from 86 studies were reviewed. The most commonly used herbal prescriptions included Alismatis Rhizoma(澤瀉), Salviae miltiorrhizae Radix (丹蔘), Crataegii Fructus (山査), Polia Sclerotium (茯?), Bupleuri Radix (柴胡), and Cassiae Semen (決明子). The treatment effective rate, liver function test, serum lipid test, radiological examination, and symptom comparisons were used to analyze the treatments. In 32 of the papers, the effective treatment rate was 76.9%-100%, and the effectiveness in the experimental group was significantly higher than that in the control group (p<0.05). The risk ratio for the treatment effective rate was 1.26. The mean difference of ALT was -13.44 U/L (95% confidential interval, -24.45 U/L, -2.44 U/L, p=0.0166). Conclusion: Herbal medicine containing diuretic herbs has been demonstrated to be an effective and useful treatment for NAFLD. Clinical studies that are more scientific and systematic should be actively conducted in the future, and the results of the current study could be used as basic data in future clinical studies on herbal medicine treatment for NAFLD.

Objective: This study investigated the effects of Hansu-Daebowon (HDW) on bone resorption in vitro and bone loss in vivo. Methods: Osteoclast differentiation was measured by counting TRAP (+) MNC formed from RAW 264.7 in the presence of RANKL. Bone pit formation was determined in an artificial bone slice loaded with RANKL-stimulated osteoclasts. To elucidate the mechanisms of the inhibitory effects of HDW on bone resorption and osteoclast differentiation, osteoclastogenic genes (i.e. TRAP, MMP-9, NFATc1, c-Fos, and Cathepsin K) were measured using real time PCR. Furthermore, bone loss was observed using micro-CT in an LPS-treated mammal model. Results: HDW inhibited the bone pit formation in vitro and inhibited bone loss in vivo. Moreover, HDW decreased the number of TRAP (+) MNCs in the presence of RANKL, and HDW inhibited the expressions of cathepsin K, MMP-9, TRAP, NFATc1, and c-Fos in the osteoclasts. Conclusion: HDW exerts inhibitory effects on bone loss and bone resorption resulting from the inhibitions of osteoclast differentiation and osteoclastogenic gene expression.

Objective: This study investigated the trends in pancreatic cancer research on Korean medicine in order to establish a direction for further study. Methods: Pancreatic cancer research on Korean medicine was reviewed using databases such as OASIS, KoreanTK, KISS, RISS, KISTI, and NDSL. The search terms were "pancreatic cancer" "Korean medicine," and "herbal medicine." There was no restriction on publication dates, and the reviewed studies were analyzed according to the type of research. Results: Nineteen studies were reviewed. The numbers and types of research were as follows: 9 clinical studies including case reports, 2 review studies, and 8 in vitro studies; there was no in vivo study. Among the clinical research were 3 descriptive studies and 6 case reports. The baseline characteristics and quality of life of pancreatic cancer patients were analyzed in the descriptive studies. In the case reports, interventions such as herbal medicine, pharmacopuncture, and acupuncture were used. Research articles on the review of pancreatic cancer were titled "Preliminary Study for Development of Korean Medicine Clinical Practice Guideline for Pancreatic Cancer" and "Systemic Review on the Tumor Dormancy Therapy." Cell lines such as PANC-1, MIA PaCa-2, and AsPC-1 were used for in vitro studies. These studies have reported decreased cell viability, induced apoptosis, and changes in cancer-related gene expression. Conclusion: Through this review, we found that using Korean medicine for treating pancreatic cancer is applicable. However, due to overall limited the number of study, the benefit of Korean medicine for pancreatic cancer may be substantiated to a limited degree. Better methodological quality and large controlled trials are expected to further quantify the therapeutic effect of Korean medicine.

Objective: This study aimed to ascertain what should be considered in the "Guideline for Clinical Trials with Herbal Medicinal Products for Liver Cancer," by analyzing existing guidelines and clinical trials. Methods: Committee for the development of a guideline, consisting of 6 Korean medicine doctors, reviewed guidelines and clinical trials on using herbal medicine for treating liver cancer. The trials were analyzed in terms of inclusion and exclusion of participants, intervention, comparators, outcomes, and trial design. We then compared the results of our analysis with the guidelines to identify issues we must to consider when following the "Guideline for Clinical Trials with Herbal Medicinal Products for Liver Cancer." Several guidelines for antitumor agents and clinical trials on herbal medicine were obtained from the Ministry of Food and Drug Safety homepage, etc. The search terms were as follows: "liver neoplasms"; "herbal medicine"; "medicine, Korean traditional"; and "medicine, Chinese Traditional.". Results: Ten articles were obtained from pubmed and Embase. There was no guideline for clinical trials on using herbal medicine for treating liver cancer. All the participants in the reviewed articles had primary liver cancer, and the type of intervention varied (e.g., decoction, patches, and capsules. The comparators included placebos and conventional treatments such as chemotherapy. The outcome assessment methods were tumor response, quality of life, survival, and liver function tests. Adverse events occuring during the trial were also evaluated. Conclusion: Findings were derived by reviewing existing guidelines and comparing them with clinical trials on liver cancer and herbal medicinal products. These results will be utilized in the development of the "Guideline for Clinical Trials with Herbal Medicinal Products for Liver Cancer."

Objective: This study investigated the effect of Yin deficiency medicine on halitosis patients and the relationship between subjective recognition and objective symptoms of oral malodor. Methods: We administered Yin deficiency medicine, such as Jaeumganghwa-tang, and conducted the Halitosis Associated Life-quality Test (HALT) and $OralChroma^{TM}$. Subjective recognition of halitosis was evaluated using HALT. Objective symptoms of halitosis were evaluated using $OralChroma^{TM}$. In addition, before and after administering medicine, we determined the halitosis according to percentages at the patient's word. Results: The total gas and HALT were not related to each other after Maekmoondong-tang or Saengmaek-san were administered to 10 halitosis patients. Conclusion: Yin deficiency medicine is effective in treating halitosis. Moreover, the subjective recognition and objective symptoms of halitosis are not related to each other.

Background: Because of fear of reoperation and low efficiency, some patients with failed back surgery syndrome (FBSS) opt for Korean medicine treatment. Gold standard treatment is not present for FBSS, therefore both surgical and non-surgical treatment are possible. Studies of Korean conservative medicine for FBSS had a short duration of treatment and mainly pre- and post-treatment comparisons. And case of female patients who have worsened after childbirth is rare. The purpose of this study was to report long-term follow-up and rare cases of FBSS. Case summary: A 33-year-old female patient diagnosed with lumbar disc herniation complained with low back pain and radicular pain in the left leg after surgery in 2011. Acupuncture and decoction (Cheongpa-jeon, GCSB-5) were administered to her twice a day for about 6 years and 6 months. The patient's complaints improved with each hospitalization, and Magnetic Resonance Imaging (MRI) showed a slight decrease in the size of the recurrent disc (L4/5) and a newly developed disc (L5/S1) that had deteriorated after delivery. Conclusion: Korean medicine could be used to manage the pain of lumbar spine FBSS patients for 6-7 years and to alleviate lumbago after delivery.

Objective: The purpose of this study was to report on the alleviation of symptoms of a myasthenia gravis (MG) patient after Korean medicine treatment. Methods: A 39 year-old male patient who suffered from MG was examined. The patient was treated with herbal medicine, acupuncture, and pharmacopuncture. The Myasthenia Gravis Composite (MGC) scale and Myasthenia Gravis Activities of Daily Living (MG-ADL) profile were used to assess the change of MG symptoms after Korean medicine treatment. Results: The MGC and MG-ADL scores indicated significant improvement after 14 days of treatment. In addition, the degrees of fatigue, dyspepsia, vomiting, sweating, and dizziness were decreased. Conclusion: This study may suggest that Korean medicine treatment could be effective in treating the symptoms of MG.

Objectives: This case is significant as a rare observational record at the Korean medical practice field. This case reports progression of co-administration of Korean herbal medicines and conventional medicines for cough in patients with myocardial infarction relapse suspected of developing acute respiratory infection. Methods: First, the chest radiography, CBC count and urinalysis were performed to estimate patient's systematic condition. After the estimated diagnosis, the patient was treated with modified Dingchuan decoction, antibiotics, and complex syrup for cough. We used the Cough-Specific Quality-of-Life Questionnaire (CQLQ) to assess patient's respiratory symptoms. Results: Co-administration of Korean herbal medicines and conventional medicines resulted improving of cough and sputum symptoms. Laboratory analysis items and total score of CQLQ also showed significantly improved results. Adverse effects were not observed. Conclusions: In this case, we concluded that co-administration of Korean herbal medicine and conventional medicine may be an effective therapy for the treatment of cough in patients with myocardial relapse of developing acute respiratory infection.

Objective: We report on the administration progression and adverse event of Er-Xian decoction for menopausal hot flushes. A hot flush is a rapid and intense heat-dissipation reaction that involves considerable sweating, enlargement of the peripheral blood vessels, and internal body heat. Er-Xian decoction is a prescription for treating menopausal hot flush symptoms in postmenopausal women. We report administration progression and adverse event of Er-Xian decoction for menopausal hot flush. Methods: We used the Menopause Rating Scale and Menopause-Specific Quality of Life questionnaire to evaluate the progression of hot flushes, and we conducted a literature review to determine the effective dosage of Er-Xian decoction. Result: In all cases, Facial hot flushes and evaluation variables were improved by the administration of EXD. However, in Case 1, a rise of liver function indexes which may be related to EXD administration was observed. Conclusion: Considering that menopausal flushing usually lasts for several years, The resluts are meaningful that the short-term administration of EXD led to improvement of symptoms. In order to further use EXD in the future, it will be necessary to conduct follow-up studies on the subject of safety verification, such as repeated dose toxicity studies.