Background: Mild cognitive impairment (MCI) is considered an intermediate phase between normal aging and dementia. As the majority of cases of amnestic MCI (aMCI) progress to Alzheimer’s disease (AD), it is considered the prodromal stage of AD, and a treatment target for prevention of further cognitive decline. However, no medications have been shown to have symptomatic or preventive benefits in MCI. Kami-guibi-tang (KGT) is a traditional herbal formula used in Korean medicine to treat amnesia, which is reported to increase acetylcholine levels via activation of choline acetyltransferase. The objective of this study was to evaluate the efficacy and safety of KGT in patients with aMCI.Methods: This study was designed as a single-center, randomized, double-blind, placebo-controlled pilot study. Participants diagnosed with aMCI were randomized to receive either KGT or placebo granules for 24 weeks. The efficacy measure was a change in the Seoul Neuropsychological Screening Battery (SNSB) score. The safety measures included the occurrence of adverse events and abnormalities in vital signs and blood chemistry, electrocardiogram (ECG), and brain magnetic resonance imaging (MRI) findings.Results: A total of 16 patients in the KGT group and 14 patients in the placebo group were investigated in the study. The mean score of Clinical Dementia Rating-Sum of Boxes (CDR-SB) significantly improved from 1.53 (0.64) points to 1.13 (0.62) points in the KGT group (p = 0.010), whereas it worsened from 1.61 (0.88) points to 1.75 (0.94) points in the placebo group. There was a significant difference in the CDR-SB scores between the two groups after the intervention (p = 0.045). The total SNSB-D scores and the scores in the memory domain after the treatment were significantly higher than the baseline values in the KGT group, but not in the placebo group. The frequency of adverse events was not significantly different between the two groups, and there were no abnormalities in vital signs or blood test, ECG, and brain MRI findings after the intervention.Conclusions: KGT may provide a safe and effective treatment option for patients with aMCI. Further studies with a larger sample size are needed to validate the findings.Trial registration: Korean Clinical Trial Registry, ID: KCT0002407; Registered on March 30, 2017,http://cris.nih.go.kr/

Objectives: The objective of this study was to assess differences in brain responses between pressure and acupuncture stimulation at the same acupoint using functional magnetic resonance imaging (fMRI). Subjects: A total of 10 healthy right-handed volunteers were studied. Design: fMRI was performed with two different paradigms; namely, pressure and acupuncture stimulation at acupuncture points LI11 and ST36 on the left. fMRI data were analyzed using SPM2. Results: In comparison with the left LI11 pressure stimulation, both sides of the parahippocampal gyrus, cerebellum, left side of thalamus, and right side of posterior cingulate regions were more activated by the left LI11 acupuncture stimulation. In comparison with the left ST36 pressure stimulation, the secondary motor cortex, limbic system (cingulate gyrus, posterior cingulate), primary visual cortex, pons, and medulla regions were more activated by left ST36 acupuncture stimulation. In comparison with the left ST36 pressure stimulation, both side of BA 4 and BA 6 were more activated by the LI11 pressure stimulation. In comparison with the left LI11 acupuncture stimulation, left BA 6, BA 8, and anterior cingulate cortex (ACC) were more activated by the left ST36 acupuncture stimulation. Conclusions: In conclusion, brain signal activation patterns according to the stimulation methods and acupoints were observed to differ. Acupuncture stimulation activated more regions than pressure at the same acupoint. In particular, acupuncture stimulation activated the limbic system, such as the parahippocampal gyrus and ACC.

Objectives: The objective of this study was to explore the type and frequency of short-term reactions, de qi associated with acupuncture treatment, and to determine the incidence of adverse events following acupuncture treatment in Korea. Subjects and methods: This study is a retrospective and cross-sectional survey of patient reports using 1095 subjects; 585 subjects are outpatients of the East-West NEO Medical Center and the remaining 510 subjects are outpatients of the Kyung Hee Medical Center. In the period of June to November 2006, the participating subjects, who had all received acupuncture, consented and completed a single survey form. On this form, patients were asked to report their short-term reactions to the acupuncture, de qi, a patient satisfaction score (using the Visual Analogue Scale [VAS]) and any adverse events related to the acupuncture treatment. The 8 acupuncturists involved in this study were Korean medicine doctors who had more than 10 years' experience working as practitioners. Results: The average age of the 1095 subjects was 58 years old. Positive short-term acupuncture reactions were reported by 878 (80.2%) of the 1095 subjects. Seventy-five (75) (6.8%) subjects described negative short-term acupuncture reactions. The most common positive short-term acupuncture reaction was that of a “relaxed” feeling in 472 (43.1%), followed by 90 (8.2%) who acknowledged a feeling of “less pain”; 16 (1.5%) felt “energized”; 16 (1.5%) experienced “tingling” and a sensation of “Heat” or “Coldness” was reported by 10 (0.9%). Negative short-term acupuncture reactions included feelings of “pain” 37 (3.4%), tiredness 24 (2.2%), and dizziness 9 (0.8%). Traditionally, the needling sensations of de qi refer to a patient's response to treatment, such as distension, pulling, soreness, heaviness, and numbness. Some (39.7%) subjects reported de qi during needling. A number experienced “distension” 333 (30.4%), “soreness” 52(4.7%), “pulling” 22(2.0%), “heaviness” 18(1.6%), and “numbness” 10 (0.9%). Positive short-term acupuncture reactions and de qi ratings were highest in those less than 40 years of age (83/96 86.5%, 50/96 52.1%). No reaction responses to acupuncture were the highest frequency in subjects over 70 years of age (31/187, 16.6%). Patient satisfaction level using VAS was comparatively high: 72.9 ± 19.9. The only adverse events reported were bleeding in 92 (8.4%) of the participants. The majority of patients treated with acupuncture had suffered from stroke (430; 16.9%), headache (185; 16.9%), hypertension (97; 8.9%), or dizziness (85; 7.8%). Conclusions: Short-term acupuncture reactions and de qi were related to the age group. With the exception of bleeding, there were no adverse events related to the acupuncture treatment in this study. We consider acupuncture treatment to be very safe if the practitioners are well educated, trained and experienced. The number of post-treatment positive short-term acupuncture reactions was 12 times higher than that of the negative short-term reactions. Overall, subjects were comparatively satisfied with the acupuncture treatment.

Alzheimer’s disease (AD) is a leading progressive neurodegenerative disease worldwide, and its treatment is a challenging clinical problem. This review was conducted to evaluate the efficacy and safety of herbal medicine for AD treatment. The PubMed, CENTRAL, EMBASE, CNKI, OASIS, KTKP, and CiNii databases were searched until June 2020 for randomized controlled trials (RCTs) on herbal medicine for AD, and a meta-analysis of 57 RCTs was conducted. For cognitive function, herbal medicine significantly improved the Mini-Mental State Examination (MMSE) and AD Assessment Scale-Cognitive Subscale (ADAS-cog) scores compared with conventional medicine. The MMSE scores showed no significant difference between the groups treated with herbal medicine and donepezil; however, herbal medicine significantly lowered the ADAS-cog score. Acori Graminei Rhizoma-containing and Cnidii Rhizoma-containing herbal medicine significantly improved the MMSE and ADAS-cog scores compared with conventional medicine. Ginseng Radix-containing herbal medicine showed a positive, but not statistically significant, tendency toward improving the MMSE score compared with conventional medicine. Herbal medicine with conventional medicine significantly improved the MMSE, ADAS-cog, and Montreal Cognitive Assessment (MoCA) scores compared with conventional medicine, and herbal medicine with donepezil also significantly improved these scores compared with donepezil. Acori Graminei Rhizoma or Cnidii Rhizoma-containing herbal medicine with conventional medicine significantly improved the MMSE and ADAS-cog scores compared with conventional medicine. Ginseng Radix-containing herbal medicine + conventional medicine significantly improved the MMSE score, but not the ADAS-cog score, compared with conventional medicine. For behavioral and psychological symptoms of dementia, the Neuropsychiatry Inventory (NPI) score was not significantly different between herbal and conventional medicines. Herbal medicine with conventional medicine significantly improved the NPI and Behavioral Pathology in Alzheimer’s Disease Rating Scale scores compared with conventional medicine. The NPI score showed no significant difference between the groups treated with herbal medicine and placebo. Furthermore, herbal medicine with conventional medicine significantly lowered plasma amyloid beta levels compared with conventional medicine alone. Herbal medicine, whether used alone or as an adjuvant, may have beneficial effects on AD treatment. However, owing to the methodological limitations and high heterogeneity of the included studies, concrete conclusions cannot be made.

Poststroke fatigue (PSF) is reported to occur in 3072 of all patients with stroke. PSF not only is a symptom of stroke but has also been reported to adversely affect the prognosis of patients with stroke. However, no treatment has had a significant effect on PSF. In East Asian countries, several herbal medicines have been used to treat stroke, with Buyang Huanwu Tang (BHT) being the most common. This review aimed to evaluate the efficacy and safety of BHT for PSF. A literature search was conducted on MEDLINE, CENTRAL, Scopus, CiNii, CNKI, OASIS, NDSL, and KTKP databases for randomized controlled trials that evaluated the effects and safety of BHT on PSF. Six studies (n=427) were included. The overall methodological quality of these studies was relatively low. In the adjunctive BHT group, the meta-analysis indicated statistically significant improvements in the Fatigue Severity Scale score (mean difference 1.49, 95 CI [2.25, 0.73]) and total clinical efficacy rate (risk ratio 0.11, 95 CI [0.03, 0.41]) compared to those in the nonherbal group. Adverse events were only reported in one study, and no serious adverse events occurred. BHT administration might be effective in the treatment of PSF. We were unable to draw definitive conclusions owing to the limitations of the included studies. The trial is registered with CRD42019130178 in PROSPERO.