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Kang G, Kim CH, Ko MM, Jung J. Evaluation of clinical effectiveness of blood stasis leaflet in patients with blood stasis: A prospective, randomized, and crossover trial. Medicine (Baltimore) 2024; 103:e38702. [PMID: 38941368 PMCID: PMC11466129 DOI: 10.1097/md.0000000000038702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 06/05/2024] [Indexed: 06/30/2024] Open
Abstract
BACKGROUND Blood stasis (BS) refers to a pattern of symptoms resulting from circulatory dysfunction or stagnation in the human body. Due to its historical origin and diverse interpretations, communication between patients and doctors of traditional Korean medicine (DKMs) presents challenges. Efforts to improve patients understanding in traditional Korean medicine (TKM) have led to the development of disease-specific standard clinical practice guidelines. However, there is a limited focus on creating clinical practice guidelines or informative leaflet specifically addressing BS, which is a frequently encountered pattern of symptoms in TKM. METHODS This study aimed to bridge the gap between patients and DKMs by developing an informative leaflet focusing on BS for metabolic diseases. We assessed its appropriateness through expert advisory meetings and the Delphi process, and evaluated its clinical effectiveness. We conducted a prospective, randomized, crossover trial to compare the clinical effectiveness of using BS leaflets in TKM treatment. The hypothesis investigated whether the leaflet group would show higher scores in satisfaction of DKMs' explanations, understanding of DKMs' explanations, improving the reliability of TKM, satisfaction with treatment time, improvement in explanations compared to previous TKM experiences, and necessity of managing BS treatment, compared to the no-leaflet group. RESULTS In a study involving 40 patients (mean age: 62.3 ± 7.8 years), symptoms persisted for an average of 16.75 ± 9.3 hours daily, with a severity rating of 2.53. The leaflet group exhibited significantly higher satisfaction scores than the no-leaflet group in all aspects (all P < .0001). After confirming the absence of sequence and period effects using a linear-mixed effect model, we were able to ascertain the presence of a treatment effect, as evidenced by statistically significant higher scores across all survey items in the leaflet group compared to the no-leaflet group (all P < .0001). CONCLUSION Expert consensus on symptoms aligning with the BS pattern resulted in the development of an informative leaflet. Its utilization notably improved patient satisfaction, comprehension, and trust in TKM treatment, unaffected by temporal influences, thus demonstrating its clinical effectiveness. In summary, the BS leaflet significantly enhanced patient understanding and optimized treatment procedures.
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Affiliation(s)
- Geonhui Kang
- Korean Medicine Science Research Division, Korea Institute of Oriental Medicine, Yuseong-gu, Daejeon, Republic of Korea
| | - Cheol-Hyun Kim
- Department of Internal Medicine and Neuroscience, College of Korean Medicine, Wonkwang University, Iksan, Republic of Korea
| | - Mi Mi Ko
- Korean Medicine Science Research Division, Korea Institute of Oriental Medicine, Yuseong-gu, Daejeon, Republic of Korea
| | - Jeeyoun Jung
- Korean Medicine Science Research Division, Korea Institute of Oriental Medicine, Yuseong-gu, Daejeon, Republic of Korea
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Kang BK, Jang S, Ko MM, Jung J. Development of the Blood Stasis Questionnaire for Gynecological Diseases: An Analytical Cross-Sectional Study. Complement Med Res 2024; 31:319-326. [PMID: 38631295 DOI: 10.1159/000538568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 03/26/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVES Blood stasis is the slowing or stagnation of blood and can cause metabolic, musculoskeletal, and gynecological diseases. This study developed the Blood Stasis Questionnaire for gynecological disease (BSQ-GD) by extracting clinical indicators related to gynecological diseases using the Blood Stasis Questionnaires I and II (BSQ-I and II, respectively) and analyzed the clinical data of a cross-sectional study. PATIENTS AND METHODS In total, 103 women aged between 25 and 65 years who met gynecological disease criteria were enrolled in this study. Blood stasis scores (BSS) were evaluated using the BSQ-II and categorized into BSS and non-BSS groups. To assess the reliability of BSQ-GD, the internal consistency coefficient was employed using Cronbach's α. Furthermore, correlation analyses were conducted for the clinical symptoms related to gynecological diseases, and the discriminant validity was confirmed by comparing the two groups. The prediction accuracy was determined using logistic regression and the cut-off value of the BSQ-GD was established via the sensitivity and specificity calculations. RESULTS The BSQ-GD showed satisfactory internal consistency (Cronbach's α coefficient = 0.71) and validity, with significant differences in mean scores between blood stasis (22.30 ± 3.34) and non-blood stasis (14.93 ± 3.49) groups. The cut-off value of the BSQ-GD score was 19 points when the Youden index (73.45) and the concordance probability (0.75) were at their maximum. The area under the receiver operating characteristic curve was approximately 96%, and the sensitivity and specificity of the diagnostic accuracy according to the cut-off value are 80.95% and 92.50%, respectively. CONCLUSION The BSQ-GD can be an appropriate instrument to estimate blood stasis in patients with gynecological diseases; its diagnostic sensitivity according to the cut-off value is high.
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Affiliation(s)
- Byoung-Kab Kang
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Soobin Jang
- Department of Preventive Medicine, College of Korean Medicine, Daegu Haany University, Gyeongsan, Republic of Korea,
| | - Mi Mi Ko
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Jeeyoun Jung
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
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Han K, Yoo JE, Kim JE, Kwon O, Kim AR, Park HJ, Jung SY, Kim M, Yang C, Cho JH, Lee JH. Beneficial effect of Gyejibokryeong-hwan on climacteric syndrome with blood stasis pattern: A randomized, double-blinded, placebo-controlled clinical pilot trial. Integr Med Res 2023; 12:100951. [PMID: 37187679 PMCID: PMC10176163 DOI: 10.1016/j.imr.2023.100951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 04/16/2023] [Accepted: 04/19/2023] [Indexed: 05/17/2023] Open
Abstract
Background Gyejibokryeong-hwan (GBH), a herbal mixture that is widely used for climacteric syndrome, is studied for its efficacy; however, no study evaluated the GBH indication, which is a blood-stasis pattern based on traditional Chinese medicine theory. Methods This is a randomized, double-blinded, placebo-controlled clinical pilot trial. Fifty subjects with climacteric syndrome were recruited and randomly assigned to GBH group or placebo group. Subjects were administered GBH or placebo granules for 4 weeks followed by 4 weeks of observation period. For the primary outcome, the Menopause Rating Scale (MRS) was evaluated. For the secondary outcomes, quality of life, degrees of abdominal resistance and tenderness, blood-stasis pattern questionnaire and degree of upward movement of Qi were evaluated. Results After 4-week intervention, the mean change of total MRS score significantly decreased in the GBH group compared to the placebo group (p = 0.037). The quality of life related to physical health (p = 0.008) and blood-stasis pattern (p = 0.018) significantly improved in the GBH group but not in the placebo group. Conclusion Our findings provide evidence of the feasibility of recruiting subjects with GBH indications and show that GBH may have clinical efficacy for the treatment of menopausal symptoms, especially urogenital symptoms, without any significant adverse events. Trial registration Clinical Research Information Service (CRIS identifier: KCT0002170).
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Affiliation(s)
- Kyungsun Han
- Korean Medicine Science Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - Jeong-Eun Yoo
- Department of Obstetrics and Gynecology, College of Korean Medicine, Daejeon University, Daejeon, South Korea
- Laon Integrative Medicine Research Center, Daejeon, South Korea
| | - Jung-Eun Kim
- Korean Medicine Science Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Ojin Kwon
- Korean Medicine Science Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - Ae-Ran Kim
- Clinical Research Coordinating Team, R&D Strategy Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - Hyo-Ju Park
- Clinical Research Coordinating Team, R&D Strategy Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - So-Young Jung
- Clinical Research Coordinating Team, R&D Strategy Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - Mikyung Kim
- Korean Medicine Science Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
- Department of Internal Medicine, College of Korean Medicine, Sangji University, Wonju, South Korea
| | - Changsop Yang
- Korean Medicine Science Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - Jung-Hyo Cho
- Department of Internal Korean Medicine, College of Korean Medicine, Daejeon University, Daejeon, South Korea
| | - Jun-Hwan Lee
- Korean Medicine Science Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
- Korean Medicine Life Science, University of Science & Technology (UST), Campus of Korea Institute of Oriental Medicine, Daejeon 34054, South Korea
- Corresponding author at: Korea Institute of Oriental Medicine, 1672 Yuseong-daero, Yuseong-gu, Daejeon 34054, South Korea.
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A prediction model of qi stagnation: A prospective observational study referring to two existing models. Comput Biol Med 2022; 146:105619. [DOI: 10.1016/j.compbiomed.2022.105619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 05/10/2022] [Accepted: 05/12/2022] [Indexed: 11/22/2022]
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Birch S, Alraek T, Lee MS, Lee JA, Kim TH. Understanding blood stasis in traditional East Asian medicine: a comparison of Asian and Western sources. Eur J Integr Med 2021. [DOI: 10.1016/j.eujim.2021.101341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Ko MM, Jang S, Jung J. An observational study on diagnosis index of metabolic disease with blood-stasis. Medicine (Baltimore) 2020; 99:e21140. [PMID: 32629750 PMCID: PMC7337439 DOI: 10.1097/md.0000000000021140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Treating blood stasis is effective in treating obesity and metabolic diseases in traditional Korean medicine. The aim of this prospective observational study is to determine the effectiveness of the diagnosis index for metabolic diseases with blood stasis by analyzing clinical data and blood samples. METHODS AND ANALYSIS We will perform a prospective observational study. Participants who meet the inclusion criteria will be recruited from the Dongguk university Ilsan Oriental hospital. The outcomes are resistin, serum amyloid P component, C-reactive protein, D-dimer, and blood stasis scores. In addition, the blood pressure, ankle-brachial pressure index, brachial-ankle pulse wave velocity, body mass index, waist circumference, and levels of blood lipid will be assessed. DISCUSSION Through this study, we could collect specific data for diagnosing metabolic diseases with blood stasis. Therefore, the findings of this study will provide a summary of the current state of evidence regarding the effectiveness of the diagnosis index in managing metabolic disease with blood stasis. ETHICS AND DISSEMINATION The study was approved by the Institutional Review Board of the Dongguk University Ilsan Oriental Hospital (DUIOH-2018-09-001-007). The results will be published in a peer-reviewed journal and will be disseminated electronically and in print. TRIAL REGISTRATION NUMBER Clinical Research Information Service: KCT0003548.
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Jang S, Ko MM, Kang BK, Jung J. Perception of metabolic diseases related to blood stasis: A survey of Korean medicine doctors. Eur J Integr Med 2020. [DOI: 10.1016/j.eujim.2020.101103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Yoshino T, Katayama K, Yamaguchi R, Imoto S, Miyano S, Mima H, Watanabe K. Classification of patients with cold sensation by a review of systems database: A single-centre observational study. Complement Ther Med 2019; 45:7-13. [DOI: 10.1016/j.ctim.2019.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 03/31/2019] [Accepted: 05/08/2019] [Indexed: 12/24/2022] Open
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Four Subgroups of Blood Stasis Syndrome Are Identified by Manifestation Cluster Analysis in Males. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2019; 2019:2647525. [PMID: 31360206 PMCID: PMC6644214 DOI: 10.1155/2019/2647525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 05/23/2019] [Accepted: 06/23/2019] [Indexed: 11/17/2022]
Abstract
Blood stasis syndrome (BSS) is an important pathological condition in traditional East Asian medicine and is associated with ischemic heart disease, cerebral vascular accident, diabetes mellitus, chronic renal failure, severe traumatic injury, and dysmenorrhea. However, previous studies have been unable to reveal the clinical and biological characteristics or biological markers of BSS. We hypothesized that the heterogeneity among the manifestations of BSS or non-BSS could interfere with an analysis to describe the characteristics of BSS. In this study, male participants based on the severity of BSS-associated symptoms and signs were clustered and classified into four subgroups: BSS subgroups (1), (2), (3), and (4). Non-BSS core subgroup was redefined using manifestation cluster analysis. Biological characteristics of subgroups BSS(1) and BSS(2) belong to the range of the non-BSS core subgroup (1), whereas that of subgroups BSS(3) and BSS(4) are characterized by different biological parameters such as systemic inflammatory conditions and elevated D-dimer level. Our results suggested that patients in subgroups of BSS(3) and BSS(4) are more likely to be exposed in an inflammatory state than other BSS subgroups. We found the heterogeneity among the manifestations which could mask the characteristics of BSS and identified the clinical and biological profiles of the four BSS subgroups through comparisons of the redefined non-BSS and BSS subgroups. This finding could provide accurate diagnostic criteria and new approaches for BSS treatments in different subgroups.
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A Study on the Development of a Korean Metabolic Syndrome Questionnaire Using Blood Stasis Clinical Data. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2019; 2019:8761417. [PMID: 31263505 PMCID: PMC6556799 DOI: 10.1155/2019/8761417] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 04/16/2019] [Indexed: 11/17/2022]
Abstract
Objective The aims of this study were to extract clinical indicators related to metabolic diseases using the Blood Stasis Questionnaires I and II (BSQ-I and II) developed in 2013 and 2014, respectively, and to develop a BSQ on metabolic syndrome (BSQ-MS). Methods A total of 2,158 patients, comprising 1,214 from 7 traditional Korean medical hospitals in 2013 and 944 from 3 traditional Korean medical hospitals in 2014, were asked to complete the BSQ-I and BSQ-II. For the 370 patients who met the metabolic syndrome criteria, reliability and validity of the BSQ-MS were assessed using Cronbach's alpha, while prediction accuracy was determined by logistic regression. Results The BSQ-MS included a total of 15 clinical signs and symptoms. It showed satisfactory internal consistency (Cronbach's α coefficient=0.70) and validity, with significant differences in mean scores between the blood stasis (14.09±6.14) and non-blood stasis (9.09±5.60) subject groups. The cut-off value of BSQ-MS score was 9 points, the area under the receiver operating characteristic curve was approximately 77%, the sensitivity and specificity of the diagnostic accuracy according to the cut-off value were 82.9% and 49.7%, respectively, and the sensitivity and specificity of the prediction accuracy by logistic regression were 72.2% and 71.6%, respectively. Conclusion These results suggest that the BSQ-MS is an appropriate instrument for estimating blood stasis in patients with metabolic syndrome, although its sensitivity for diagnosis according to the cut-off value is low.
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Kang BK, Park TY, Jung J, Ko M, Lee MS, Lee JA. The Optimal Cut-Off Value of Blood Stasis Syndrome Score in BSS Diagnosis in Korea. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2017; 2017:8049481. [PMID: 29085435 PMCID: PMC5612313 DOI: 10.1155/2017/8049481] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 07/12/2017] [Accepted: 07/24/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE In the traditional oriental medicine, it is sometimes difficult to diagnose Blood Stasis Syndrome (BSS) in patients, because the diagnosis of BSS is based on the subjective signs and symptoms of patients. This study is aimed at developing the prediction tool of BSS using cut-off value for BSS score. The identification of a cut-off value for BSS score to diagnose BSS would be helpful. METHODS A total of 887 patients admitted to six traditional Korean medical hospitals in 2013 and three hospitals in 2014. All patients have an identical pattern as a result of diagnostic decision of two experts. The cut-off value for BSS score for BSS diagnosis was determined by the receiver-operating characteristic curve. RESULTS The area under the curve of this curve was 0.897. The optimal cut-off point for detection of BSS was 49.0. The sensitivity and specificity of this cut-off value were 80.8% and 83.2% in modelling data (2013 dataset) and 84.6% and 83.1% in validation data (2014 dataset), respectively. CONCLUSION Our study suggests that a BSS score cut-off value of 49.0 can be used to detect BSS in the traditional Korean medical hospitals. This cut-off value for diagnosis of BSS will make up the lack of objectivity.
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Affiliation(s)
- Byoung-Kab Kang
- KM Fundamental Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Tae-Yong Park
- Institute for Integrative Medicine, Catholic Kwandong University International St. Mary's Hospital, Incheon 22711, Republic of Korea
| | - Jeeyoun Jung
- KM Fundamental Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Mimi Ko
- KM Fundamental Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Myeong Soo Lee
- Clinical Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Ju Ah Lee
- KM Fundamental Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
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