Recognition of Association Between Blood Stasis Syndrome and Traumatic Injury among Doctors of Korean Medicine:A Cross-Sectional Observation Study

Objective： To investigate the diagnostic indicators and herbal treatments for blood stasis syndrome（BSS） patients with traumatic injuries and to identify the association between BSS and traumatic injury in Korea. Methods： Two-hundred and four patients with traumatic injury were recruited from the Gangnam and Daejeon branches of Jaseng Hospital of Oriental Medicine between June 2014 and December 2014. Two independent doctors of Korean medicine（DKMs） determined the diagnosis of BSS or non-BSS based on the subjects＇ signs and symptoms. The scores assigned to BSS symptoms and DKMs＇ reasons for diagnosing BSS in patients with traumatic injury were investigated. Both medication and herbal prescription records from a 3-month period were collected for all patients diagnosed with BSS by both DKMs. Results： A total of 169 of 204（82.8%） patients received consistent diagnosis related to BSS by two DKMs. Among them, 54.4%（92 cases） were diagnosed with BSS, and 45.6%（77 cases） were not diagnosed with BSS. DKMs most frequently cited symptoms of recent traumatic injury as justifications for BSS diagnoses, and also selected pain-related indicators such as abdominal pain, sharp pain and nocturnal pain as important reasons in diagnosing BSS. In addition, an inconsistency in the pattern identification theory with respect to traumatic injury was observed. Although only 92 cases（54.4%） of patients were diagnosed with BSS, 77.6% of them were prescribed decoctions for BSS. Conclusions： DKMs considered traumatic injury could cause BSS, and utilized decoction for BSS in patients with traumatic injury without confirming a diagnosis of BSS because they assumed the main symptoms or pathologies of traumatic injury to be closely related to BSS.

Expert Opinions on the Concept of Blood Stasis in China: An Interview Study

Objective: To study various experts’ opinions on the definition and diagnosis of blood stasis in China. Methods: We e-mailed the selected experts to explain the purpose of the study and to invite them to participate and asked them to name a time for the investigator to call them. Eight experts and five organizations were interviewed in the research community investigating blood stasis in China. Results: Six main categories emerged from the interviews:(1) blood stasis concepts;(2) blood stasis-related biomarkers;(3) methods of diagnosing blood stasis;(4) drugs for promoting blood circulation and dissipating stasis;(5) blood stasis-related diseases; and(6) blood stasis-related societies. The consensus among the interviewed experts was that the definition of blood stasis is rather complicated and that there is no gold standard marker for detecting blood stasis. Conclusion: This paper acquired experts’ opinions on the definition and diagnosis of blood stasis in order to establish a modern concept of blood stasis. This paper also developed a diagnostic tool and diagnostic indices for blood stasis and identified biological indices and pathologic mechanisms related to blood stasis, which might be of great reference value in future blood stasis standardization research.

Diagnostic Indicators for Blood Stasis Syndrome Patients with Gynaecological Diseases

Objective： To investigate the important diagnostic indicators for blood stasis syndrome （BSS） in patients of childbearing age with gynaecological diseases. Methods： A partial least squared-discriminant analysis （PLS-DA） were applied to BSS symptoms data of patients with gynaecological diseases, and the diagnostic indicators used by doctors of Korean medicine （DKMs） among BSS patients with gynaecological diseases were also investigated. Results： A total of 103 patients of childbearing age with gynaecological diseases and 40 healthy controls were enrolled. Among the 103 patients, 63 （61.7%） and 40 （38.8%） were diagnosed with BSS and non-BSS, respectively, and BSS patients exhibited a more severe extent of disease. A score plot of PLS-DA showed clearly different patterns among the 3 groups. Based on the variable importance on projection of PLS-DA model, menstrual pains, dark lumps in the menstrual blood, ileocoecal tenderness and resistance, sharp pains, and sublingual varicosities were selected as the top five most important indicators. Moreover, more than 75% of DKMs chose dark lumps in menstrual blood, menstrual pain, and dark menstrual blood as the diagnostic indicators of BSS in patients with gynaecological diseases, and more than 49% of them also considered sharp pains, dark red tongue, sublingual varicosities, and tendency to bruise easily as diagnostic indicators of BSS. Conclusion： DKMs focused on menstrual symptoms and certain gynaecological symptoms to diagnose BSS patients of childbearing age with female diseases.

Standardization and Future Directions in Pattern Identification Research: International Brainstorming Session

An international brainstorming session on standardizing pattern identification（PI） was held at the Korea Institute of Oriental Medicine on October 1, 2013 in Daejeon, South Korea. This brainstorming session was convened to gather insights from international traditional East Asian medicine specialists regarding PI standardization. With eight presentations and discussion sessions, the meeting allowed participants to discuss research methods and diagnostic systems used in traditional medicine for PI. One speaker presented a talk titled ＂The diagnostic criteria for blood stasis syndrome： implications for standardization of PI＂. Four speakers presented on future strategies and objective measurement tools that could be used in PI research. Later, participants shared information and methodology for accurate diagnosis and PI. They also discussed the necessity for standardizing PI and methods for international collaborations in pattern research.

Comparative effects of artemisia vulgaris and charcoal moxa stimulating Zhongwan(CV 12) on body temperature in healthy participants:a cross-over single-blind randomized study

OBJECTIVE:To evaluate the efficacy,safety,satisfaction,discomfort and patient preference of moxa cones of artemisia vulgaris and charcoal moxa.METHODS:This comparative study of moxibustion treatment with Artemisia vulgaris and charcoal moxa cone stimulating Zhongwan(CV 12) is a cross-over single-blinded,randomized clinical trial.A total of 40 healthy subjects(24 males and 16females) participated in this study.Two subjects dropped out of the trial.Thirty-eight subjects were treated with Artemisia vulgaris and charcoal moxa cones for 30 min in a cross-over design.After treatment,the patients underwent a 30 minute waiting period,and then the temperatures at Tanzhong(CV 17),Zhongwan(CV 12) and Guanyuan(CV 4) were measured using digital infrared thermal imaging.RESULTS:After the use of Artemisia vulgaris moxa,the patients' body temperatures were slightly lowered at Tanzhong(CV 17),Zhongwan(CV 12)and Guanyuan(CV 4),but the changes were not statistically significant.After the use of charcoal moxa,the patients' body temperatures were somewhat increased at Zhongwan(CV 12) and Guanyuan(CV 4),but the changes were not statistically significant.After Artemisia vulgaris moxa use,the body temperature difference between Zhongwan(CV 12) and Guanyuan(CV 4)was significantly increased.After charcoal moxa use,the body temperature difference between Tanzhong(CV 17) and Zhongwan(CV 12) was significantly decreased in males and in the whole group.This change was caused by the difference in the moxibustion type and by gender differences.CONCLUSION:This pilot study found that moxibustion did not raise the body temperature,but temperature differences between acupoints were affected.Further large-scale randomized controlled trials are needed for the effect of moxibustion on body temperature.

Current Research and Future Directions in Pattern Identification： Results of an International Symposium

A symposium on pattern identification（PI）was held at the Korea Institute of Oriental Medicine（KIOM）on October 2,2013,in Daejeon,South Korea.This symposium was convened to provide information on the current research in PI as well as suggest future research directions.The participants discussed the nature of PI,possible research questions,strategies and future international collaborations in pattern research.With eight presentations and an extensive panel discussion,the symposium allowed participants to discuss research methods in traditional medicine for PI.One speaker presented the topic,＇Clinical pattern differentiation and contemporary research in PI.＇Two speakers presented current trends in research on blood stasis while the remaining five other delegates discussed the research methods and future directions of PI research.The participants engaged in in-depth discussions regarding the nature of PI,potential research questions,strategies and future international collaborations in pattern research.

Inter-observer Reliability of Indicators and Decision of Pattern Identification Using Diagnostic Flowchart with Traditional Korean Medicine

Objective： To evaluate the consistency of patterns and pattern identification（PI）, and the improvement in the diagnosis of blood stasis after the standard operating procedures（SOPs） were enhanced by using a diagnostic flowchart. Methods： A total of 358 subjects who were admitted by the Jaseng Hospital of Korean Medicine between June 2013 and December 2014 were included in the study. Each patient was independently diagnosed by two experts from the same department. In 2014, the SOPs included the use of a diagnostic flowchart for each indicator. Inter-observer consistency was assessed by simple percent agreement and by the kappa and AC1 statistics. Results： The improvements in inter-observer agreement for the indicators（for al patients） and PI were greater in 2014 than in 2013. In 2013, the j-value measure of agreement between the two experts ranged from ＂poor＂（κ=–0.051） to ＂good＂（κ=0.968）. The AC1 measure of agreement between the experts was generally high for the indicators and ranged from –0.010 to 0.978. In most cases, agreement was considerably lower when it was assessed by the j-values compared with the AC1 values. In 2014, the j-value measure of agreement on the indicators（for the subjects） general y ranged from poor to good, with the values ranging from –0.007 to 0.994. Moreover, the AC1 measure of agreement between the experts was general y high for al of the indicators and ranged from ＂moderate＂（AC1=0.408） to ＂excel ent＂（AC1=0.996）. Conclusions： In four examinations, there was moderate agreement between the clinicians on the PI indicators of blood stasis. To improve clinician consistency（e.g., in the diagnostic criteria used）, it is necessary to analyse the reasons for inconsistency and to improve clinician training.（Trial registration No. KCT0000916）