The Analgesic Effect and the Mechanism of Electroacupuncture on Thermal Hyperalgesia in the Rat Model of Collagenase-induced Arthritis: Mediation by Adrenergic Receptors

서병관,박동석,백용현 대한침구의학회 2011 대한침구의학회지 Vol.28 No.2

목적 : Collagenase-induced osteoarthritis(OA) 동물 모델에서 전침의 adrenergic mechanism을 연구하고자 한다. 방법 : Collagenase-induced arthritis(CIA)를 유발하기 위하여 5주령의 male Sprague-Dawley rat의 뒷다리 좌측 무릎 관절에 0.05ml의 4mg/ml collagenase solution을 intra-articular 주입하고, 다시 4일 후에 같은 부위에 같은 농도의 collagenase solution을 intra-articular boosting injection 시행한 뒤, gross, histopathological features 및 biomarker activity 변화를 관찰하였다. 예비실험을 통하여 CIA rat model에서 진통효과를 발휘하는 것으로 확인한, 足三里 (ST_(36))에 대한 저빈도 train pulse EA stimulation (2Hz, 0.07 mA, 0.3ms)을 침치료 방법으로 적용하였다. 전침의 진통기전을 확인하기 위하여, α1-adrenergic antagonist (prazosin, 1 mg/kg, i.p.), α2-adrenergic receptor antagonist (yohimbine, 2mg/kg, i.p.), α1-adrenergic receptor agonist(phenylephrine, 2mg/kg, i.p.), α2-adrenergic receptor agonist(clonidine, 40μg/kg, i.p.)을 전침시행 20분 전에 복강 내로 전처치하였다. Tail flick unit(Ugo Basile Model 7360)을 이용하여 열자극에 대한 통증역치를 측정하였다. 결과 : 퇴행성관절염 징후(gross, histopathological features)와 통증역치의 변화가 최대값을 나타내는 CIA 유발 4주차에 저빈도 전침자극(train pulse, 2Hz, 0.07mA, 0.3ms)을 족삼리(ST_(36))에 적용하였으며, 족삼리 전침의 진통효과는 α2-adrenergic receptor antagonist(yohimbine, 2mg/kg, i.p.)전처치에 의해 억제되었으나, α1-adrenergic antagonist(prazosin, 1 mg/kg, i.p.)전처치에는 억제되지 않았다. 또 α2-adrenergic receptor agonist(clonidine, 40μg/kg, i.p.)의 전처치를 통하여 유의한 synergistic analgesic effect가 관찰되었으나, α1-adrenergic receptor agonist(phenylephrine, 2mg/kg, i.p.)의 전처치는 전침의 진통효과에 synergistic effect를 미치지 않는 것으로 나타났다. 결론 : 저빈도 족삼리 전침은 CIA로 유발된 염증성 통증에 대하여 진통효과를 발휘하며, 이는 α2- adrenergic receptor에 의하여 매개되는 것으로 보이며 α1-adrenergic receptor는 영향을 미치지 않는 것으로 사료된다. .

제통단이 퇴행성 슬관절염 환자의 삶의 질에 미치는 영향

서병관,류성룡,강중원,우현수,이상훈,이재동,최도영,김건식,이두익,이윤호 EAST-WEST MEDICAL RESEARCH INSTITUTE KYUNG HEE UNI 2005 東西醫學硏究所 論文集 Vol.2005 No.-

Objectives : to evaluate the effects of Jetongdan, the newly developed herbal medicine, on the quality of life in patients with osteoarthritis of knee Methods : Placebo-controlled, randomized clinical trial on the 80 patients with osteoarthritis of the knee was fulfilled. After enrollment, they took medication as they enrolled. And they were asked to answer the questionnaires (Korean Health Assessment Questionnaire (KHAQ), Lequesne's functional index (LF1), visual analogue scale (VAS)) and analysed with the erythrocyte sedimentation rate (ESR) at baseline, after 4 weeks and 8 weeks of medication. Results : Total KHAQ score, some categories of KHAQ like hygiene, activities were significantly improved after 8 weeks of medication. And the change of the KHAQ score was significantly correlated with the change of VAS. But LFI, VAS, ESR level was not significantly improved, and it was considered because of the short medication period and small size of study population. Conclusion : In conclusion, Jetongdan could improve the health-related quality of life in patients with osteoarthritis of knee. Further study in the large population, in long period were recommended.

Antinociceptive Effect and the Mechanism of Bee Venom Pharmacopuncture on Inflammatory Pain in the Rat Model of Collagen-induced Arthritis: Mediation by 5HT-3 & Muscarinic Cholinergic Receptors

서병관,백용현,박동석 대한침구의학회 2011 대한침구의학회지 Vol.28 No.1

. 배경 및 목적 : 봉독약침요법(bee venom pharmacopuncture, BVP)은 rheumatoid arthritis(RA)의 치료에 활용되고 있으나, RA로 인한 염증성 통증에 대한 봉독약침의 진통효과와 specific mechanism은 아직까지 명확하게 밝혀지지 않았다. 이에 본 연구에서는 RA animal model로서 collagen-induced arthritis(CIA) rat model에서 봉독약침의 a1-adrenergic, 5HT-3 그리고 muscarinic cholinergic mechanism을 확인하고자 한다. 방법 : CIA를 유도하기 위하여 male Sprague–Dawley rat에 freund’s incomplete adjuvant에 乳化시킨 bovine type II collagen을 주입하고 14일 후 booster injection 시행하였다. 진통효과는 tail flick latency (TFL)로 평가하였다. 결과 : 관절염의 유도 이후 염증성 통증 역치는 시간이 지나면서 낮아지며, 5주 이후로는 통증 역치에 큰 변화가 없이 유지되었다. 첫 번째 immunization으로부터 5주 경과 후 족삼리(ST_(36))에 봉독약침처치(0.25 mg/ kg)를 시행하여 유의한 진통효과를 관찰하였다. 또한 봉독약침의 진통효과는 ondansetron(5HT-3 receptor antagonist, 0.5㎎/kg, i.p.), atropine(muscarinic cholinergic receptor antagonist, 1㎎/kg, i.p.)의 전처치에 의하여 억제되었으나, prazosin(a1-adrenergic receptor antagonist, 1㎎/kg, i.p.)의 전처치에 의해서는 억제되지 않았다. 결론 : 봉독약침은 CIA로 인한 염증성 통증에 유의한 진통효과를 나타내며 그 analgesic mechanism은 5HT-3와 muscarinic cholinergic receptor에 의하여 매개되며 a1-adrenergic receptor에 의하여 매개되지는 않았다.

퇴행성 슬관절염 환자의 증상 중증도 지표와 DITI의 상관성 연구

서병관,류성룡,강중원,안경애,이재동,최도영,김건식,이두익,이윤호,이상훈 대한침구의학회 2005 대한침구의학회지 Vol.25 No.6

Objectives: To investigate the applicability of thermography as severity measurement in the patients with osteoarthritis (OA) of the knee Methods: Data were obtained from 80 patiens with OA of the knee. They were asked to answer two disease-specific questionnaire (Western Ontario and McMaster Universities (WOMAC) OA index, Lequesne's Functional Index (LFI)), one generic instrument (Korean Health Assessment Questionnaire (KHAQ)), VAS in order to assess the severity of disease, quality of life, and degree of pain and taken thermography in standardized environment. Results: The thermal difference between ipsilateral side and contralaterla side of lateral aspect of knee was correlated with that of medial aspect of knee, and the thermal difference of anterior thigh was correlated with that of lateral, medial aspect of knee and patella region. Age, duration of disease, duration of morning stiffness, sex, crepitus, and painful side of knee were not correlated with the thermal differences of each region. LFI, WOMAC, WOMAC pain subscale, WOMAC stiffness subscale, WOMAC physical function, KHAQ, VAS were not correlated with the thermal differences of each region. Conclusions: Futher study on the thermography on OA of the knee in population with appropriate severity grade and the standardization of analysis of thermographic data were recommended.

퇴행성 슬관절염의 맞춤형 침구 임상시험 프로토콜 개발을 위한 전화조사

서병관,이상훈,서정철,이승덕,김선웅,최선미,김용석 대한침구의학회 2005 대한침구의학회지 Vol.22 No.5

Objectives : This study was accomplished in order to find out how Korean medical doctors take acupuncture prescription for knee osteoarthritis in clinical practice Methods : The survey questions were developed by the consensus from 4 professors and 10 residents who major in acupuncture & moxibustion for developing clinical trial protocol on individualized acupuncture treatment for knee osteoarthritis. 206 persons having more than 10 years experience were randomly selected from a list of Korean medical doctors. Telephone interviews with them were conducted by the well-trained interviewers between May 21 and May 27 in 2005. Results : 139 of 206 Korean medical doctors made an acupuncture prescription prior to treatment of knee osteoarthritis. 103 of 139 Korean medical doctors used both local and remote points, and 26 of them used remote points only, and 10 of them used local points only. In case of doctors who use remote points, the five element (45 of 129) or Saam (28 of 129) acupoints were used dominantly, and its was based on the pattern identification of the Jangbu organs related with the pain (56 of 129) or of the pain location (35 of 129). Conclusion : This study showed that Koran medical doctors prefer to use remote points such as five element or Saam acupoints based on the pattern identification of the Jangbu organs related with the pain or the pain location. These resulut may be useful for developing protocols for clinical trial on acupuncture on knee osteoarthritis.

퇴행성 슬관절염 환자의 증상 중증도 지표와 DITI의 상관성 연구

서병관,류성룡,강중원,안경애,이재동,최도영,김건식,이두익,이윤호,이상훈 EAST-WEST MEDICAL RESEARCH INSTITUTE KYUNG HEE UNI 2005 東西醫學硏究所 論文集 Vol.2005 No.-

Objectives : To investigate the applicability of thermography as severity measurement in the patients with osteoarthritis (OA) of the knee. Methods : Data were obtained from 80 patiens with OA of the knee. They were asked to answer two disease-specific questionnaire (Western Ontario and McMaster Universities (WOMAC) OA index, Lequesne's Functional Index (LFI)), one generic instrument (Korean Health Assessment Questionnaire (KHAQ)), VAS in order to assess the severity of disease, quality of life, degree of pain and taken thermography in standardized environment. Results : The thermal difference between ipsilateral side and contralaterla side of lateral aspect of knee was correlated with that of medial aspect of knee, and the thermal difference of anterior thigh was correlated with that of lateral, medial aspect of knee and patella region. Age, duration of disease, duration of morning stiffness, sex, crepitus, and painful side of knee were not correlated with the thermal differences of each region. LFI, WOMAC, WOMAC pain subscale, WOMAC stiffness subscale, WOMAC physical function, KHAQ,, VAS were not correlated with the thermal differences of each region. Conclusion : Further study on the thermography on OA of the knee in population with appropriate severity grade and the standardization of analysis of thermographic data were recommended.

제통단이 퇴행성 슬관절염 환자의 삶의 질에 미치는 영향

서병관,류성룡,강중원,우현수,이상훈,이재동,최도영,김건식,이두익,이윤호 대한침구의학회 2005 대한침구의학회지 Vol.22 No.6

Objectives : to evaluate the effects of Jetongdan, the newly developed herbal medicine, on the quality of life in patients with osteoarthritis of knee Methods : Placebo-controlled, randomized clinical trial on the 80 patients with osteoarthritis of the knee was fulfilled. After enrollment, they took medication as they enrolled. And they were asked to answer the questionnaires (Korean Health Assessment Questionnaire (KHAQ), Lequesne`s functional index (LFI), visual analogue scale (VAS)) and analysed with the erythrocyte sedimentation rate (ESR) at baseline, after 4 weeks and 8 weeks of medication. Results : Total KHAQ score, some categories of KHAQ like hygiene, activities were significantly improved after 8 weeks of medication. And the change of the KHAQ score was significantly correlated with the change of VAS. But LFI, VAS, ESR level was not significantly improved, and it was considered because of the short medication period and small size of study population. Conclusion : In conclusion, Jetongdan could improve the health-related quality of life in patients with osteoarthritis of knee. Further study in the large population, in long period were recommended.

퇴행성 슬관절염에 대한 제통단의 안정성과 효능 임상연구

서병관,류성룡,강중원,안경애,이상훈,최도영,김건식,이두익,이윤호,이재동 EAST-WEST MEDICAL RESEARCH INSTITUTE KYUNG HEE UNI 2005 東西醫學硏究所 論文集 Vol.2005 No.-

Objectives : In order to investigate the efficacy and safety of the newly developed herbal medicine Jetongdan, a placebo-controlled randomized clinical trial of patients with osteoarthriotis of the knee was undertaken. Methods : Data were obtained from 80 patients with OA of the knee. After the enrollment, they were asked to answer a disease-specific questionnaire (Western Ontario and McMaster Universities (WOMAC) OA index) and analyzed with the erythrocyte sedimentation rate (ESR) in order to evaluate the efficacy of Jetongdan, and analyzed for aspartate transaminase (AST) level, alanine transminase (ALT) level, blood urea mitrogen (BUN) level, and creatinine (Cr) level in order to evaluate the safety of Jetongdan. Results : The liver function and renal function did not deteriorate after treatment with Jetongdan. Composite WOMAC score and physical function subscale was improved, but pain subscale, stiffness subscale, and ESR were not improved by Jetongdan. This was possibly because the baseline characteristics of the two groups were not homogenized after randomization. Conclusions : Jetongdan could be a promising treatment option for osteoarthritis of the knee. Further study in a larger population with appropriate severity grades is recommended.

퇴행성관절염(退行性關節炎) 한방치료(韓方治療)에 대(對)한 최근(最新) 연구(硏究) 동향(動向) - 임상연구(臨床硏究) 방법론(方法論)을 중심(中心)으로 -

서병관,류성룡,이송실,허정은,백용현,이재동,최도영,조윤제,김남재,박동석,Seo, Byung-kwan,Ryu, Seong-ryong,Lee, Song-shil,Huh, Jeong-eun,Baek, Yong-hyeon,Lee, Jae-dong,Choi, Do-young,Cho, Yoon-je,Kim, Nam-jae,Park, Dong-suk 대한침구의학회 2004 대한침구의학회지 Vol.21 No.3

Objective : The aim of this study was to review systemically clinical trials on the effectiveness and safety of herbal medicines in the treatment of osteoarthritis. Methods : Computerized literature searches were carried out on seven electronic databases, and hand-searching on some chinese medical journals in library of Kyung Hee Medical Center. Trial data were extracted in a standardized, predefined manner and assessed independently. Results : 1. Thirty reports of clinical trials and two reports of meta-analyses concerning herbal medicine were collected and reviewed. Among these reports three medical herbs were applied as topical medicine and others as internal medicine. 2. The western studies established NSAIDs or placebo as their control group. Five chinese reports established formulated herb pill(Ruanshnagshenjin pill) as their control group and Six did not establish a control group at all. 3. ACR was the most highly used diagnostic criteria in the western studies while the Chinese used their official criteria established by their government or the criteria of their text books. 4. 20 reports chose the Lequesne functional index, SHAQ, WOMAC OA index, AIMS, and their own unique scoring system as the criteria of analysing the effect. Others chose clinical symptoms, articular functions, and lab finding as their criteria. 5. 7 single herbs and 19 formulated herbs were studied. Among the formulated herbs, Achyranthes japonica was studied in 10 of the studies and Angelica gigantis Radix in 8, making them the most often studied herbs among the studies.

중풍 후 강직의 침구치료에 대한 계통적 연구

서병관,백용현,박동석 대한침구의학회 2010 대한침구의학회지 Vol.27 No.6

Objectives : The aim of this systematic review was to assess the efficacy of acupuncture and its relevant modality on post-stroke muscle spasticity Methods : We included 7 randomized controlled trials(RCTs) and 1 crossover study on acupuncture on the post-stroke muscle spasticity. Articles searches were performed in various databases in October 2009. Eight studies from 38 articles met the inclusion criteria and were used to assess the quality of clinical trials by means of Jadad scale, STRICTA, CONSORT statement and cochrane-handbook for systematic reviews of interventions. Results : Electrical stimulation such as electroacupuncture and TENS on acupoints was used in five studies. Repeatition of electroacupuncture showed significant decrease of the post-stroke muscle spasticity and persistence of the effect. Only three studies were assessed high quality as the methodological assessment tool(Jadad scale) and none of the studies matched STRICTA recommendations. Conclusions : This systematic review shows that there is beneficial effects of electroacupuncture on the post-stroke muscle spasticity. Further study of large population with high methodological quality will be needed.