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NON-SURGICAL MANGEMENT OF SPINE AND JOINTS abnormalities in Korean medical center « Jasen ». President of the Korean medical center “ Jasen ” Doctor of Medical Sciences , professor Shin Chjun-Sik. Goal and Objectives .

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    1. NON-SURGICAL MANGEMENT OF SPINE AND JOINTS abnormalities in Korean medical center «Jasen» President of the Korean medical center “Jasen” Doctor of Medical Sciences, professor Shin Chjun-Sik

    2. Goal and Objectives Brief description of new constructive approaches to integrated management of intervertebral discs and joints • Demonstration of various non-surgical spine and joints management schemes, such as motion needle therapy MSAT, treatment using medicinal herbs-based drugs and apiotherapy.

    3. Outcomes On the given lecture completion: • Participants will get familiarized with four methods of integrated approach to motion system management • Participants will have the possibility to asses the efficiency of the methods presented.

    4. Integrated course of non-surgical treatment X-ray, MRI, CT, tests and etc.

    5. Characteristics of non-surgical treatment methods «Jasen»

    6. 1. Needle therapy/ acupuncture andpain management • According to the National Center of complementaryand alternative medicine (NCCAM), founded by the National Institutes of Health (NIH): • Clinical recommendations published by the American Pain Society (APS)and American College of General Practitioners in 2007, needle therapy is defined as one of the treatment methods used by complementary and alternative medicine for managing chronic spinal pains that do not respond to traditional treatment.

    7. 1. Needle therapy/ acupuncture andpain managementRandomized controlled trials

    8. 2.Needle therapy/ acupuncture andImmunity Randomized controlled trials

    9. 3. Chuna and normal biomechanics Clinical case with displacement, for which Chuna manual therapy was applied • Goal: Observation of the Chuna manual therapy effect at displacement. • Methods: To analyze statistic situation, tilt of iliac bone (PI) and that of pelvis have been measured by x-ray as well as Cobb angle and the height of the girdle of superior extremity. To asses pain degree visual analogue scale (VAS) was used. Chun therapy has been repeated 8-10 time in the course of a month. • Outcome: VAS indicators have considerably improved. X-ray of all vertebra part manifested improvement of structural imbalance. Difference in the height of the girdle of superior extremity, Cobb angle as well as dysfunction of the hip joint have obviously reduced.

    10. Complex Treatment «Jasen» Motor acupuncture+ Chuna + Natural /traditional drugs+ apitherapy

    11. Article developed jointly with the Osher research center, Harvard Medical School • “Potential resolution of integration ...- introduction of medical pluralism? In which allopathic and alternative medicine work independently from each other but on the principles of cooperation and tolerance... • Center of Korean medicine «Jasen» managed to integrate these two approaches making use of pluralistic model, in which Korean medical doctors anddoctors allopathists have clearly delineated responsibilities: Korean medicine doctors manage patients by non-surgery Korean methods: allopathists perform diagnostics and ensure urgent care” *** Published in Journal of Alternative & Complementary Medicine(Май, 2007)

    12. Cohort study of a complex “Jasen” treatment Published in the Journal of Complementary Therapies in Medicine (May 2010)

    13. Introduction Method Result Conclusion Outcomes of a complex management of intervertebral hernia by «Jasen» method Care package comprised of Korean medicine (water extracted decoction (120ml) of herbal prescription and a capsule of the dry powder (2g)), Chuna (a Korean version of spinal manipulation), acupuncture, and bee venom acupuncture (subcutaneous or intramuscular). Treatment schedule for a total of 24 weeks involved weekly clinic visits during which relevant therapies were carried out and the medicine for the following week was given. The goal of this prospective observational cohort study was to investigate therapeutic outcomes of the integrative care package for back pain with disc herniation. Figure 6. Changes of SF-36 over time. Of the 150 patients included, 128 (85.3%) completed the entire course. Treatments were well tolerated with no serious drug induced liver toxicity. Patients reported improvements in all outcome measures. At the completion of the course, VAS for pain improved by 3.29 (95% CI [2.82 to 3.77]), for sciatica 6.28 (95% CI [5.93 to 6.62]). In ODI and SF-36, significant improvements began one month after the beginning of treatment and were sustained throughout. Figure 3. Care package (Korean medicine, Chuna, acupuncture, bee venom acupuncture) Outcome measures were Visual analogue scale (VAS, 0 to 10) of back pain and radicular pain (sciatica), Oswestry Disability Index (Korean Version) and SF-36, which are assessed at baseline,4th,8th,12th,16th,20th and 24th weeks. Clinical data were obtained at baseline from a physician questionnaire and examination. Figure 1. Characteristics of Patient We selected 150 consecutive low back pain patients (18 to 60 years old) with lateral radicular pain to lower extremities diagnosed as lumbar disc herniation (protrusion~extrusion) confirmed by MRI. 92 of them (61.3%) had been previously recommended for surgical management at other hospitals. The visual analogue scale of radicular pain was above 5. Physician- Referred LBP Patients (with MRI) Self-Referred LBP Patients Table 1. Subgroup analysis of outcomes and other factors In sub-grouping by the duration of LBP, moderate group difference and time by group interaction difference were found in VAS for LBP; and so was time by group interaction different in ODI score. This may indicate different healing patterns over time among the subgroups. In subgroups organized by operation recommendation, there were significant time by group interactions for VAS for LBP. MRI Excluded (n=4034) LBP due to non-spinal or soft-tissue problems (n=2124) VAS of pain 4 or less (n=1599) Other exclusion criteria (n=311) Screened (n=4184) Figure 4. Changes of Low Back Pain and Radicular pain over time accordingto duration. (Lt : Low back pain, Rt : Radicular pain) Acute (n=34) Sub-Acute/Chronic (n=116) Did not complete treatment (n=22) Underwent operation (n=8) Dissatisfied with the treatment (n=3) Immediately improved (n=2) Lost contact (n=3) Based on the findings from the prospective observational study, wecontend it be sensible to plan a stepwise controlled study to addressmore specific questions regarding: 1) whether this package approach ismore effective than other treatments, a comparative effectiveness study;and 2) which treatment components of the package are more substantialthan others. Acknowledgements: This study was funded by the Jaseng Medical foundation, and Jongbae Park and Hyangsook Lee were supported by SRC program of KOSEF (R11-2005-014), and received consultation fee from the Jaseng Medical Foundation for carrying out the study. N=15 N=7 Medicine, Catholic University of Daegu, Daegu, Republic of Korea Completed 6-Month Treatment (n=128) Figure 5. Changes of ODI over time. Figure 2. Flow diagram of the study

    14. Motion acupunctureMSAT Motion Style Acupuncture Treatment

    15. What is MSAT? • Motion acupuncture MSAT – is a unique kind of acupuncture technique «Jasen», used for acute pain syndrome. • Immediate result is observed in cases with motion function disorders (later cervical spine and lumbar spine pathologies) • Difference from traditional acupuncture: • Needles are inserted into acupuncture points on the body, but these points are additionally stimulated by active and passive movements of certain muscle groups • Theory underpinning MSAT technique: • Propagating sensation along meridian

    16. Indications for MSAT • Pathology of intervertebral disks • Lumbar spine • Protrusionand extrusion of intervertebral disks, stenosis, degenerative disk diseases, post-surgery complications, spondylosis, spondylolisthesis. • cervical spine • Protrusionand extrusion of intervertebral disks, extension of cervical lordosis, computer vision syndrome, degenerative disk diseases • Pathology of joints • Pathology of temporomandibularjoint • osteoarthritis • Adhesive capsulitis of shoulder-joint • Degenerative disease of joints

    17. Case study№1 (H-MST)

    18. Case study №2

    19. MSAT operating principle

    20. MSAT operating principle in left joint

    21. Case study №3

    22. Chun Manual Therapy Korean manual therapy

    23. From the history of Chun 推拿 Appeared about 2700 years ago, during the Khan dynasty. Is based on HuangdiNeijing (皇帝內經) • Doh-In-Ahn-Gyo(導引按蹻) • 導: bone motion and chorda/tendon • 引:joint motion • 按: malaxationof muscles and skin • 蹻: raising hand and legs • This technique lasted as of 20th century • During Japanese colonization in Korea (1910), Korean medicine practice was prohibited. • Revival of technique – in 80s of the 20th century

    24. Chun technique Unique type of manual therapy, practiced by “Jasen” doctors • During Chun treatment manipulations the velocity and exposure tilt/angle is controlled. • In contrast to intensive technique used in chiropractic , Chun offers soft corrective exposure ensuring restoration of normal biomechanics. Ch-na(推拿) • Chu(推): ‘to push’ – correction of spine and joints by way of jolts • Na (拿): ‘pull’ – opening a joint and tension relief in surrounding tissues

    25. Natural drugs based on medicinal herbs «Jasen» GCSB-5 и Sinbarometin

    26. Sinbarometin and GCSB-5 • Substance found in the course of joint research with research institute of natural products of Seoul National University and medical faculty of the Sung KyunKwan University. • Sinbarometin – key component of all natural herbal “Jasen” drugs , GCSB-5 – herbal drug based on Sinbarometin, including:

    27. 1. 1. GCSB-5 Anti-inflammatory effect Published in Journal of Ethno-pharmacology (Май, 2010) Animal based study: Study of anti-inflammiaory effect of herbals in the lab environmental and on animals

    28. 2. GCSB-5 Neuroprotective action Neuromormorphometry environment GCSB-5 30мг/кг Muscle mass GCSB-5 100мг/кг GCSB-5 300мг/кг GCSB-5 300mg/kg groupshowed increase of the density and number of regenerated nerve cells. The group that in the space of 8 weeks took 300 mg/kg ofGCSB-5showed considerable increase of muscle mass.

    29. 3. GCSB-5 regenerating effect Histological assessment of cartilaginous tissue showed inhibition of the tissue destruction process in GCSB-5 300mg /kg group. Dyeing by hematoxylin and Eosin (H&E) Day 7 Day28 300 100 30 MIA Simulation GCSB-5 (mg/kg)

    30. Apitherapy Acupuncture with bee apitoxin

    31. What is apitherapy? • Standard dose of apitoxin • Apitoxin dose is administered subcutaneously for imitation of a bee bite but more exactly and in less quantities. • It is scientifically proved that apitoxin is effective for inflammation and pain syndrome relief when managing different vertebra and joints diseases.

    32. Effect of acupuncture with apitoxin Published in Journal of Ethno-pharmacology (September , 2009)

    33. MRT results Before and after treatment in “Jasen”

    34. Before and after treatment (F/35) June 09, 2008 In 13 months of treatment September 07, 2009

    35. Before and after treatment (M/46) December 29, 2008 In 6 months of treatment July 04, 2009

    36. Before and after treatment (M/33) August 28,2007 In 10months after treatment June 28, 2008

    37. Before and after treatment (M/32) May 05, 2008 года In 6 months of treatment November 22, 2008

    38. Before and after treatment (F/35) May 17, 2008 года In 7 months of treatment December 13, 2008

    39. Awareness-raising and training programmes for medical specialists • Duration • 1-4 weeks • Programme content • Presentation of the “Jasen” center, study tour • International clinic, in-patient unit, diagnostic unit, TPT unit and physiotherapy • Familiarization with the work of the research center “Jasen” • Review of clinical programmes • Familiarization with Korean medicine • Training in treatment technique «Jasen» • MSAT, Chuna, treatment with natural drugs, apitherapy • Visiting ambulatory unit

    40. References • B.Berman, K.Lao, G.LangenbergP, et al. Effectiveness of acupuncture as adjunctive therapy in osteoarthritis of the knee: a randomized, controlled trial. Annals of Internal Medicine. 2004;141(12):901–910. • Chung, Hwa-Jin, Hak-Sun Lee, Joon-Shik Shin, Sang-Ho Lee, Byung-Mo Park, You-SukYoun, and Sang Kook Lee. "Modulation of Acute and Chronic Inflammatory Processes by a Traditional." Journal of Ethnopharmacology 130.2 (2009): 450-459. Print. • Jang, H., H. Chung, E. Ko, J. Shin, M. Shin, M. Hong, Y. Kim, B. Min, and H. Bae. "Microarray Analysis of Gene Expression Profiles in Response to Treatment with Bee Venom in Lipopolysaccharide Activated RAW 264.7 Cells." Journal of Ethnopharmacology 121.2 (2009): 213-20. Print. • Ji-Hyun Park. Hyun-A Jeong. Seo-Young Hong. A Clinical Case Report on the Malalignment Treated by Chuna Manual Therapy. The Journal of Korea CHUNA Manual Medicine for Spine & Nerves 2010;5(2):135-149

    41. References • Manheimer E, White A, Berman B, et al. Meta-analysis: acupuncture for low back pain. Annals of Internal Medicine. 2005;142(8):651–663. • Park, Jongbae, Joonshik Shin, YoungkwonChoi, YousukYoun, Sangho Lee, Seung-Ro Kwon, Hyangsook Lee, Man-ho Kang, In-Hyuk Ha, and Imhee Shin. "Integrative Package for Low Back Pain with Leg Pain in." Complementary Therapies in Medicine 18 (2010): 78-86. Print. • Stevens, Laura, Horacio Duarte, and Jongbae Park. "Promising Implications for Integrative Medicine for Back Pain: A Profile of a Korean Hospital." The Journal of Alternative and Complementary Medicine 13.5 (2007): 481-84. Print. • Xia YQ, Zhang D, Yang CX, et al.: An approach to the effect on tumors of acupuncture in combination with radiotherapy or chemotherapy. J Tradit Chin Med 6 (1): 23-6, 1986. • Zhou RX, Huang FL, Jiang SR, et al.: The effect of acupuncture on the phagocytic activity of human leukocytes. J Tradit Chin Med 8 (2): 83-4, 1988.

    42. Thank you!