Article

Guasha-induced hepatoprotection in chronic active hepatitis B: A case study

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Abstract

Heme oxygenase-1 (HO-1) has demonstrated hepatoprotective effect in animal hepatitis models. HO-1 was also reported to be upregulated with Guasha, an ancient therapeutic technique which applies instrument assisted press-stroking to treat many disorders. We report a case on the changes of liver function, plasma HO-1 and T-helper (Th) cytokine balance in a chronic active hepatitis B carrier before and after Guasha. The patient presented with increased activities of liver enzymes (ALT and AST), indicating inflammatory damage in liver before Guasha. Forty-eight hours after receiving Guasha, the patient showed changes in a number of serum markers: a decline of liver enzymes (ALT and AST) indicating reduced chronic inflammation, an elevated plasma HO-1, and a modulation of T-helper (Th)1/Th2 balance. Guasha was shown to transiently reduce the inflammatory markers of liver injury in human, together with an enhancement of HO-1 which might be responsible for the hepatoprotective action.

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... Acute pain [2] Chills [4] Chronic pain [2,[6][7][8] Colds [2,9] Cough [5] Digestive disorders [1,6] Fevers [1,2,[4][5][6]9] Flu [2,9] Headache [1,4,5] Heatstroke [2,6,9] Musculoskeletal problems (fibromyalgia, severe strain, spasm, or injury) [1,2,6,9] Respiratory problems (asthma, bronchitis, and emphysema) [2,6,9] Seizures [4] Sore throat [5] Upper respiratory infections [1,5] Vomiting [4] ...
... Acute pain [2] Chills [4] Chronic pain [2,[6][7][8] Colds [2,9] Cough [5] Digestive disorders [1,6] Fevers [1,2,[4][5][6]9] Flu [2,9] Headache [1,4,5] Heatstroke [2,6,9] Musculoskeletal problems (fibromyalgia, severe strain, spasm, or injury) [1,2,6,9] Respiratory problems (asthma, bronchitis, and emphysema) [2,6,9] Seizures [4] Sore throat [5] Upper respiratory infections [1,5] Vomiting [4] ...
... Acute pain [2] Chills [4] Chronic pain [2,[6][7][8] Colds [2,9] Cough [5] Digestive disorders [1,6] Fevers [1,2,[4][5][6]9] Flu [2,9] Headache [1,4,5] Heatstroke [2,6,9] Musculoskeletal problems (fibromyalgia, severe strain, spasm, or injury) [1,2,6,9] Respiratory problems (asthma, bronchitis, and emphysema) [2,6,9] Seizures [4] Sore throat [5] Upper respiratory infections [1,5] Vomiting [4] ...
Article
Coining therapy is a treatment commonly used in complementary and alternative medicine. The practice has its origins in several different Asian countries. It is used to treat numerous conditions, such as chronic pain, fever, flu, headaches, heatstroke, and upper respiratory infections. Coining is performed by vigorously rubbing a rounded instrument following the application of lubricant to the affected area. Hence, patients who have undergone coining therapy frequently present with macular erythema, petechiae, and/or raised ecchymoses at the sites of treatment. The cutaneous sequelae following treatment with coining on a Vietnamese man are described. Ecchymoses caused by coining usually resolve spontaneously within one to two weeks. While coining is generally regarded as a safe practice, mild or - albeit rarely - more severe complications may occur. Therefore, this procedure is contraindicated in certain patients including those with bleeding disorders, Von Willebrand disease, or those taking antiplatelet or anticoagulant medications. Several randomized-control studies suggest coining to be an effective treatment for chronic neck and lower back pain. Immediate pain relief at the treated site may result from increased circulation; thus, the venting of heat may mitigate the effects of the inflammation and pain. However, much remains to be learned about the mechanisms of longer-term pain relief in coining therapy. The use of complementary and alternative medicine techniques such as coining has increased in the United States; therefore, clinicians' evaluation and management of their patients would benefit from an understanding of the individual's sociocultural practices and health beliefs.
... 10 However, Gua sha has never been trialed specifically in elderly subjects with cLBP. Based on previous published findings, [11][12][13] we hypothesized that Gua sha would exert anti-inflammatory effect in cLBP by upregulating the cytoprotective enzyme of heme oxygenase-1 (HO-1), 13 and increase the local microcirculation 14 by pressing and stretching of the superficial skin as well as the deep muscles. Such effects were proposed to be associated with pain reduction and improved physical mobility. ...
... The self-rated unidimensional Visual Analog Scale (VAS) consists of a 100-mm horizontal line labeled with "no pain" at score 0 and the "worst pain imaginable" at score 100, where a higher score indicates greater pain intensity. 18,19 The Hong Kong Chinese version Roland-Morris Disability Questionnaire (RMDQ) 20 (11)(12)(13)(14)(15), whereas a cut-off value of 8 was specifically established for the Hong Kong Chinese population that depression is of significant needing clinical attention if score equal to or greater than 8. 23 The Chinese version Pittsburgh Sleep Quality Index (PSQI) 24 consists of 19 items covering seven components: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime sleep efficiency. Scale score ranged 0-21 indicating poorer sleep quality with a higher score. ...
... In fact, following Gua sha, an upregulation of HO-1 was observed in healthy animal in vivo 13 as well as in blood of healthy individuals over 7 days of study period, although the increase in HO-1 were small and not significantly different over the entire study period in humans. 12 In patients with chronic disorders, instead of having an increase in HO-1, there was a decreasing trend of HO-1 after receiving Gua sha in both chronic inactive hepatitis B patients measured in previous study 11 and cLBP in the current study. These findings suggest an interaction between TNF-α and HO-1, in line with their modulatory capabilities on each other demonstrated in the previous literature. ...
Article
Objective: To address the challenges for trialing with elderly and the lacking of valid sham/placebo control, a randomized crossover pilot study is designed and its feasibility on elderly subjects is evaluated. Design: A pilot randomized crossover study was conducted with hydrocollator-based hot pack therapy as active control. Pain intensity, physical disability, depression, general health status, and salivary biomarkers were assessed as outcome measures. Results: Despite there was no significant difference observed between any outcome measures attained by the two interventions, several important differences were noted during the one-week follow-up period. The magnitudes of pain reduction (21-25% versus 16-18%) and disability improvement (45-52% versus 39-42%) were greater in the Gua sha-treated group than the hot pack group. Both treatments were shown to improve flexion, extension and bending movements of the lower back, whereas areas of improvement varied between the two interventions. Decreasing trends were observed in both tumor necrosis factor-alpha (TNF-α) and heme-oxygenase-1 (HO-1) levels following Gua sha. However, rebounds of the biomarkers were observed one week following hot pack. Furthermore, in response to Gua sha, the decrease of TNF-α was strongly correlated with the improvement of physical disability, whereas the physical disability was correlated with the VAS pain intensity. Conclusion: It demonstrated a feasible clinical trial protocol for evaluating the effectiveness of Gua sha and other therapeutic modalities. Gua sha may exhibit a more long-lasting anti-inflammatory effect relative to hot pack for pain relief and improved mobility in elderly patients with chronic low back pain.
... According to the literatures, gua sha is performed through applying repeatedly unidirectional pressured strokes on the lubricated skin surface by using a smooth-edged tool until sha appears at the scrapped region, and such skin blemishing normally takes a few days to fade. 1 The theory of Traditional Chinese Medicine (TCM) believes that illnesses are often caused by the stagnation of Qi (vital energy) and blood; the induction of sha brings the pathological force to the skin surface, through enhancing the flow of Qi and blood, illnesses are removed by following the sha resolution. 1 Experimentally, gua sha was demonstrated to enhance the surface microcirculation at the scrapping region, 2,3 and biochemical pathways were stimulated to exhibit certain health benefits. 4,5 The potential health effects of gua sha have been supported by clinical trials and case studies. [5][6][7][8][9][10][11][12][13][14] Yet, the clinical significance of gua sha and its biomechanism have not been empirically established. ...
... 4,5 The potential health effects of gua sha have been supported by clinical trials and case studies. [5][6][7][8][9][10][11][12][13][14] Yet, the clinical significance of gua sha and its biomechanism have not been empirically established. ...
... In relation to infectious diseases, the authors and team have reported a case study of active hepatitis B carrier whose inflammatory status and liver damage were remarkably improved within 7 days following a single gau sha treatment, while hepatitis B viral DNA level was not significantly changed. 5 Hence, to our best knowledge, there is no evidence available for supporting the antimicrobial activity of gua sha. Regarding the psychological effects of gua sha, a study reported the positive effects on fear avoidance associated with chronic pain. ...
Article
To conduct a community-based survey to describe the demographics, experience, and utilization variables among the users of gua sha living in Hong Kong. A total of 3209 adult respondents were surveyed by using a short Chinese questionnaire. Gua sha was found to have a one-year prevalence of 22.7% and four-week prevalence of 6.6%. The users were seen to be old of age and less educated. The majority believed that gua sha is beneficial to health, practiced in non-regular basis, and mainly employed for treating illnesses. For both male and female, the top two common illnesses to be treated were the respiratory and pain problems, which accounting for 74% of all users. Other illnesses included nervousness, heat stroke, fever, infection, dizziness, diarrhoea and vomiting, oedema, and constipation. As practiced by most respondents, unidirectional pressured stroking was applied repeatedly on the lubricated skin surface at the back region using various smooth-edged tools typically spoons. Almost all users reported the occurrence of skin blemishing and subsequently faded within 7 days after the gua sha treatment. The general population of Hong Kong was found to have high prevalence of gua sha usage. The utilization characteristics as reported by the users were generally aligned with the current scientific knowledge, in particular the treatment procedures and response. Copyright © 2014 Elsevier Ltd. All rights reserved.
... Of these 47 articles, 41 were excluded as they did not meet the inclusion criteria. Therefore, 6 eligible RCTs [34][35][36][37][38][39] involving 438 participants were included for systematic review ( Figure 1). The six included RCTs all originated in China and had a relatively small sample size. ...
... Moreover, except for one RCT [36], the duration of the interventions was 4 weeks. [34][35][36][37][38][39] included in our meta-analysis are shown in Table 1 and Table 2. ...
... The Cochrane risk-of-bias is presented in Figures 2 and 3. Two of the included trials [34,36] reported appropriate sequence-generation methods for randomization, whereas in the remaining trials [35,[37][38][39] the methods of sequence generation were not described. One of the included trials [36] conducted concealment of allocation by sealed envelopes, while three RCTs [37][38][39] used inappropriate methods. ...
Article
Objective In East Asia, Gua Sha therapy is widely used in patients with perimenopausal syndrome. The goal of this systematic review was to evaluate the available evidence from randomized controlled trials (RCTs) of Gua Sha therapy for the treatment of patients with perimenopausal syndrome. Methods Databases searched from inception until June 2017 included: PubMed, Embase, the Cochrane Central Register of Controlled Trials and four Chinese databases [WanFang Med Database, Chinese BioMedical Database, Chinese WeiPu Database, and the China National Knowledge Infrastructure (CNKI)]. Only the RCTs related to the effects of Gua Sha therapy on perimenopausal syndrome were included in this systematic review. A quantitative analysis of RCTs was employed using RevMan 5.3 software. Study selection, data extraction, and validation were performed by two independent reviewers. Cochrane criteria for risk-of-bias were used to evaluate the methodological quality of the trials. Results A total of 6 RCTs met the inclusion criteria, and most were of low methodological quality. When compared with Western medicine therapy alone, meta-analysis of 5 RCTs indicated favorable statistically significant effects of Gua Sha therapy plus Western medicine on the Kupperman Menopausal Index (KMI) Score [mean difference (MD) = -4.57, 95% confidence interval (CI) (−5.37, −3.77), p < 0.01; heterogeneity: Chi² = 29.57 p < 0.01, I² = 86%]. Moreover, study participants who received Gua Sha therapy plus Western medicine therapy showed significantly greater improvements in serum levels of follicle-stimulating hormone (FSH) [MD = −5.00, 95% CI (−9.60, −0.40), p = 0.03], luteinizing hormone (LH) [MD = −4.00, 95% CI (−7.67, −0.33), p = 0.03], and E2 [MD = −6.60, 95% CI (−12.32, −0.88), p = 0.02] compared to participants in the Western medicine therapy group, with a low heterogeneity (Chi² = 0.12, p = 0.94, I² = 0% in FSH; Chi² = 0.19 p = 0.91, I² = 0% in LH; Chi² = 0.93, p = 0.63, I² = 0% in E2). In addition, the pooled results displayed favorable significant effects of Gua Sha therapy plus the Western medicine therapy on the MENQOL scale when compared with the Western medicine therapy alone [MD = −5.13, 95% CI (−7.45, −2.81), p < 0.01] with low heterogeneity (Chi² = 0.66, p = 0.42, I² = 0%). Conclusion Preliminary evidence supported the hypothesis that Gua Sha therapy effectively improved the treatment efficacy in patients with perimenopausal syndrome. Additional studies will be required to elucidate optimal frequency and dosage of Gua Sha.
... However, a 2010 systematic review of controlled trials of Gua Sha for musculoskeletal pain conducted in China found the quality of trials was lacking (Lee et al., 2010). Since that review there have been positive randomized controlled trials for Gua Sha in the Western literature for neck pain (Braun et al., 2011) and for pain and inflammation associated with mastitis/breast engorgement (Chiu et al., 2010) in addition to case reports suggesting Gua Sha is valuable for migraine headache (Schwickert et al., 2007), postherpetic neuralgia (Nielsen, 2005) and chronic active hepatitis B where Gua Sha demonstrated a hepato-protectant effect (Chan et al., 2011). ...
... Several modes of action for Gua Sha are described in the literature. Gua Sha therapy increases surface microperfusion in treated areas by 400% following treatment (Nielsen et al., 2007) and the resulting extravasated blood in the capillary bed is associated with an up-regulation of the heme oxygenase-1 (HO-1) gene expression (Kwong et al., 2009;Chan et al., 2011). This effect, which can be measured directly after treatment, is sustained for a minimum of five days in mouse models (Kwong et al., 2009). ...
Article
Gua sha is a traditional East Asian healing technique where the body surface is press-stroked with a smooth-edged instrument to intentionally raise therapeutic petechiae. A traditional indication of Gua sha is neck pain; no data from controlled trials exist to support this claim. The researchers aimed to investigate the effectiveness of Gua sha in the symptomatic treatment of chronic neck pain. The study was designed as an open randomized controlled clinical trial. The study was set in Kliniken Essen-Mitte, Academic Teaching Hospital of the University Duisburg-Essen, Germany. Forty-eight outpatients (58.5±8.0 years; 41 female) with chronic mechanical neck pain were the subjects of the study. Patients were randomized into Gua sha (N=24) or control groups (N=24) and followed up for 7 days. Gua sha patients were treated once with Gua sha, while control patients were treated with a local thermal heat pad. Primary outcome was change of neck pain severity after 1 week as assessed by visual analog scale. Secondary outcomes included pain at motion, the neck disability index (NDI) and quality-of-life (Short-Form [36] Health Survey). Neck pain severity after 1 week improved significantly better in the Gua sha group compared with the control group (group difference -29.9 mm, 95% confidence interval: -43.3; -16.6 mm; P<0.001). Significant treatment effects were also found for pain at motion, scores on the NDI, and dimensions of quality-of-life. The treatment was safe and well tolerated. Gua sha has beneficial short-term effects on pain and functional status in patients with chronic neck pain. The value of Gua sha in the long-term management of neck pain and related mechanisms remains to be clarified.
... Additionally, two papers discuss the increase of blood flow post Gua Sha (11,12) and the expression of HO-1 post Gua Sha has been measured and discussed in two case reports. (13,14) No records related to the treatment of RLS with Gua Sha. ...
... Nevertheless, a particular interest in this case, is the reduction of RLS which is distal to the area treated, signifying a systemic effect. Though limited, a few studies have confirmed increases of HO-1 expression (13,14) post Gua Sha, remaining elevated for at least 120 hours. ...
Article
Full-text available
The patient in this case presented with chronic shoulder pain and was treated with Gua Sha. While a reduction of shoulder pain was the primary objective, the patient reported an unexpected positive outcome which was an improvement of his restless leg syndrome (RLS). The patient received Gua Sha with no other concurrent therapy. To assess pain, range of movement tests were performed before and after each treatment. Gua Sha was applied in unidirectional linear strokes with a steralised porcelain Asian soup spoon, bilaterally to the spine, over the scapulae and right posterior shoulder. Stroking was repeated in lines of 10-15cm until petechiae was fully expressed before moving onto the next area. The same treatment was given each time for a total of 4 treatments. Pre and post treatment visual analogue scales show an immediate reduction in shoulder pain. Additionally the patient noted a marked reduction in RLS which led to better quality sleep. The literature review reveals that Gua Sha has been shown to increase blood flow, tissue temperature and the expression of heme oxygense-1 (HO-1) which has anti-inflammatory and anti-oxidative actions. Not only has HO-1 been shown to remain elevated for at least 120 hours post treatment, the by-products of the catabolism of free heme molecules are carbon monoxide, bilirubin and iron. Carbon monoxide is a vasodilator and iron has been used in the treatment of RLS for decades. In this case, Gua Sha is shown to give immediate reduction in shoulder pain and we suggest that Gua Sha may have applications beyond musculoskeletal cases, including circulatory conditions such as RLS.
... However, a 2010 systematic review of controlled trials of Gua Sha for musculoskeletal pain conducted in China found the quality of trials was lacking (Lee et al., 2010). Since that review there have been positive randomized controlled trials for Gua Sha in the Western literature for neck pain (Braun et al., 2011) and for pain and inflammation associated with mastitis/breast engorgement (Chiu et al., 2010) in addition to case reports suggesting Gua Sha is valuable for migraine headache (Schwickert et al., 2007), postherpetic neuralgia (Nielsen, 2005) and chronic active hepatitis B where Gua Sha demonstrated a hepato-protectant effect (Chan et al., 2011). ...
... Several modes of action for Gua Sha are described in the literature. Gua Sha therapy increases surface microperfusion in treated areas by 400% following treatment (Nielsen et al., 2007) and the resulting extravasated blood in the capillary bed is associated with an up-regulation of the heme oxygenase-1 (HO-1) gene expression (Kwong et al., 2009;Chan et al., 2011). This effect, which can be measured directly after treatment, is sustained for a minimum of five days in mouse models (Kwong et al., 2009). ...
Article
Gua Sha is a traditional East Asian healing technique where the body surface is "press-stroked" with a smooth-edged instrument to raise therapeutic petechiae that last 2-5 days. The technique is traditionally used in the treatment of both acute and chronic neck and back pain. This study aimed to measure the effects of Gua Sha therapy on the pain ratings and pressure pain thresholds of patients with chronic neck pain (CNP) and chronic low back pain (CLBP). A total of 40 patients with either CNP or CLBP (mean age 49.23 ± 10.96 years) were randomized to either a treatment group (TG) or a waiting list control group (WLC). At baseline assessment (T1), all patients rated their pain on a 10 cm visual analog scale (VAS). Patients' pressure pain thresholds (PPT) at a site of maximal pain (pain-maximum) and an adjacent (pain-adjacent) site were also established. The treatment group then received a single Gua Sha treatment. Post-intervention measurements were taken for both groups at T2, seven days after baseline assessment (T1), using the same VAS and PPT measurements in precisely the same locations as at T1. Final analysis were conducted with 21 patients with CNP and 18 patients with CLBP. The study groups were equally distributed with regard to randomization. Patients in both the CNP and the CLBP treatment groups reported pain reduction (p < 0.05) and improved health status from their one Gua Sha treatment, as compared to the waiting list group. Pain sensitivity improved in the TG in CNP, but not in CLBP patients, possibly due to higher pressure sensitivity in the neck area. No adverse events were reported. These results suggest that Gua Sha may be an effective treatment for patients with chronic neck and low back pain. Further study of Gua Sha is warranted.
... 15 A recent study showed that scraping therapy improved muscle strength in university students, and was beneficial for healthy people as a method of recovery from fatigue. 16 Gua Sha therapy not only increases surface microperfusion, 17 but also produces an immune anti-inflammatory effect, 18 enhances liver antioxidant levels, 19 prolongs endurance time, [20][21] and increases the amount of white blood cells and neutrophils. 4 Although our pilot study showed that Gua Sha therapy was a potential recovery therapy for weightlifters, the small sample size and brief term of treatment limited the effects of the study. ...
Article
Objective: To evaluate the effect of Gua Sha therapy on weightlifting training. Methods: The sample size was calculated by conducting a pilot study. A total of 44 male weightlifters were randomly assigned to either the Gua Sha group (n = 15), sham scraping group (n = 14), or control group (n = 14). The participants in the Gua Sha group and sham scraping group received 16 sessions of Gua Sha therapy during normal weightlifting training for 8 weeks. No treatment was applied to participants in the control group. The effectiveness of Gua Sha therapy was evaluated by measuring weightlifting ability, the rating of perceived exertion (RPE) of snatch and clean and jerk (85% of 1 repetition maximum), and creatinine kinase (CK), blood urea nitrogen (BUN), and immunoglobulin A levels. Results: Gua Sha therapy treatment significantly increased weightlifting ability in participants in the Gua Sha group (P < 0.01). The RPE values of snatch and clean and jerk were significantly lower in the Gua Sha group and sham scraping groups compared with the control group (P < 0.05). CK levels were lower and immunoglobulin A levels were significantly higher in the Gua Sha group compared with sham scraping group and control group (both P < 0.05). BUN levels tended to be reduced only in the Gua Sha group. A close correlation between CK levels and the RPE was found in the Gua Sha group. Conclusion: Gua Sha therapy can facilitate weightlifting ability, reduce the RPE, and inhibit muscle injury by promoting recovery from fatigue caused by normal weightlifting training. Gua Sha therapy could be an effective treatment to complement normal weightlifting training.
... Petechiae is an indicator of blood-vessel extravasation in subcutaneous tissues. 1 Kerokan has hepatoprotective activity as it activates heme oxygenase-1. 2,3 Physical stress on skin cells and blood vessels as a result of kerokan will induce the increased synthesis of heme oxygenase-1. 3,4 Heme oxygenase-1 is a cytoprotective enzyme that catabolizes heme into the biliverdin, carbon monoxide, and ferritin. ...
Article
Full-text available
Kerokan is an alternative therapy done by rubbing and pressing the skin surface using oil and a blunt object. This treatment has a hepatoprotective effect as it increases heme oxygenase-1, an essential enzyme in heme catabolism. In hepatitis B, heme oxygenase-1 plays a vital role to fight oxidative stress. Hence the damage on liver cells can be reduced or even prevented. Damaged cells indicate by the production of aspartate aminotransferase (AST/SGOT) and alanine aminotransferase (ALT/SGPT) enzymes that accumulated in the bloodstream. This study aimed to investigate the effect of kerokan to liver function by analyzing SGOT and SGPT levels in hepatitis B patients. These were an experimental study with a pre-test post-test control group design conducted in the public health center in Palembang in October 2016. Statistical analysis used the unpaired t test and paired. The research subjects were 30 patients with inactive carrier and chronic hepatitis B. The levels of SGOT and SGPT were determined using the IFCC method. The levels of SGOT in control (19.53±3.44 U/L) and treatment group (20.46±4.53 U/L, Δ=0.93) after 24–48 hours were not statistically different (p=0.53). Also, the levels of SGPT in control (18.66±5.40 U/L) and treatment group (19.80±9.25 U/L, Δ=1.13) after 24–48 hours were also not statistically different (p=0.68) as well. In conclusion, the liver cells of inactive carrier and chronic hepatitis B patients were not damaged (necrosis) after kerokan therapy, and the levels of SGOT and SGPT were still in the normal range. EFEK KEROKAN TERHADAP FUNGSI HEPAR PASIEN HEPATITIS B Kerokan merupakan terapi alternatif yang dilakukan dengan menggosok dan menekan permukaan kulit menggunakan minyak dan benda tumpul. Pengobatan ini bersifat hepatoprotektif, yaitu meningkatkan produksi enzim heme oxygenase-1 dalam katabolisme heme. Pada hepatitis B, heme oxygenase-1 berperan penting dalam menangkal radikal bebas sehingga dapat mengurangi atau mencegah kerusakan sel hepar. Kerusakan sel hepar diindikasikan oleh produksi enzim aspartate aminotransferase (AST/SGOT) dan alanine aminotransferase (ALT/SGPT) yang terakumulasi dalam pembuluh darah. Penelitian ini bertujuan mengetahui pengaruh kerokan pada fungsi hepar dengan menganalisis kadar SGOT dan SGPT pada pasien hepatitis B. Penelitian eksperimental ini menggunakan desain pre-test post-test control group yang dilakukan di puskesmas di Palembang pada Oktober 2016. Analisis statistik menggunakan uji t berpasangan dan tidak berpasangan. Subjek penelitian meliputi 30 pasien inactive carrier dan kronik hepatitis B. Kadar SGOT dan SGPT diukur dengan menggunakan metode IFCC. Kadar SGOT pada kontrol (19,53±3,44 U/L) dan grup perlakuan (20,46±4,53 U/L; Δ=0,93) setelah 24–48 jam tidak terdapat perbedaan signifikan (p=0,53). Selain itu, kadar SGPT pada kontrol (18,66±5,40 U/L) dan grup perlakuan (19,80±9,25 U/L; Δ=1,13) setelah 24–48 jam tidak menunjukkan perbedaan signifikan (p=0,68). Simpulan, sel hepar pada pasien inactive carrier dan kronik hepatitis B tidak mengalami kerusakan setelah terapi kerokan, serta kadar SGOT dan SGPT tetap dalam kondisi normal.
... Vários modos de ação para o Gua Sha podem ser considerados na literatura para explicar o efeito observado nos sintomas dolorosos em questão. Eles inferem que a referida intervenção minimiza os efeitos diretos da dor nos nociceptores, seu entorno e as interconexões dentro da medula espinhal; aumenta a microperfusão da superfície nas áreas tratadas em 400% após o tratamento e o sangue extravasado resultante no leito capilar está associado a um regulação positiva da expressão do gene da heme oxigenase-1 (HO-1) e que a dor é reduzida através da estimulação dos sistemas serotoninérgico, noradrenérgico e opióide; (LEE et al., 2010;CHAN et al., 2011). ...
... Vários modos de ação para o Gua Sha podem ser considerados na literatura para explicar o efeito observado nos sintomas dolorosos em questão. Eles inferem que a referida intervenção minimiza os efeitos diretos da dor nos nociceptores, seu entorno e as interconexões dentro da medula espinhal; aumenta a microperfusão da superfície nas áreas tratadas em 400% após o tratamento e o sangue extravasado resultante no leito capilar está associado a um regulação positiva da expressão do gene da heme oxigenase-1 (HO-1) e que a dor é reduzida através da estimulação dos sistemas serotoninérgico, noradrenérgico e opióide; (LEE et al., 2010;CHAN et al., 2011). ...
... Research on Gua Sha therapy is mainly focus on clinical trial reports and only a few studies discussed its physiological effects and potential therapeutic mechanisms [14][15][16]. Some studies showed that scraping can improve the immune function of the body. ...
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Background: Gua Sha, an ancient Chinese treatment which produces the pressure on the skin, is used to prevent and treat cold for thousands of years. There’re evidences to approve that it can activate immune response and reduce the inflammation. However, how it has the effect on T helper 17 cells (Th17) and regulatory T cells (Treg) is poorly understood. Here, this study aims at the relationship between the pressure-stoke in the skin and pulmonary Th17 as well as Treg in PR8-infected mice. Methods: ICR mice were randomly divided into five groups. The body weight and survival rates of all groups were monitored through the experiment. At the end of experiment, lung inflammation was detected by HE staining and the expression of Matrix metalloproteinase-9 (MMP-9) was measured by immunohistochemistry. Th17 and Treg from lung tissues was analyzed by flow cytometry. esults: Our results indicated that the survival rates of prophylactic and therapeutic group respectively showed 20% and 10% though Gua Sha treatment didn’t restore the weight-loss of PR8-infected mice. What’s more important, Gua Sha remarkably inhibited inflammatory infiltration and the expression of MMP-9 of lung tissues in infected mice ( p <0.05). Finally, the ratio of Treg/Th17 from lung tissues in PR8-infected mice was significantly increased as compared with control mice while Gua Sha treatment remarkably inhibited this enhancement. All these results indicated that Gua Sha has the efficacy on reducing the pulmonary inflammation in PR8-infected mice possibly via restoring the Treg/Th17 balance. Conclusions: Our findings for the first time suggest that Gua Sha exhibits a significant inhibition of inflammatory infiltration with down-regulation of MMP-9 in lung tissues from RR8-infected mice, which might be associated with the differentiation of Th17 and Treg. Further research will be carried toward how Gua Sha functions on maintaining the homeostasis of Th17 and Treg in the lungs.
... The mechanisms of action of Gua Sha are still under debate. It has been demonstrated that Gua Sha treatment increases surface microperfusion in the treated areas by 400% [38] and that the resulting extravasated blood in the capillary bed is associated with an up-regulation of the heme oxygenase-1 (HO-1) gene expression [39,40]. In a mouse model, this immediate effect is sustained for at least five days [39]. ...
Article
Objective: To test the efficacy of Gua Sha therapy in patients with chronic low back pain. Methods: 50 patients with chronic low back pain (78% female, 49.7 ± 10.0 years) were randomized to two Gua Sha treatments (n = 25) or waitlist control (n = 25). Primary outcome was current pain intensity (100-mm visual analog scale); secondary outcome measures included function (Oswestry Disability Index), pain on movement (Pain on Movement Questionnaire), perceived change in health status, pressure pain threshold, mechanical detection threshold, and vibration detection threshold. Results: After treatment, patients in the Gua Sha group reported lower pain intensity (p < 0.001) and better overall health status (p = 0.002) compared to the waitlist group. No further group differences were found. No serious adverse events occurred. Conclusions: Gua Sha appears to be an acceptable, safe, and effective treatment for patients with chronic low back pain. Further rigorous studies are needed to confirm and extend these results.
... 4 It was shown from the result that SD rats can be selected as experimental subjects for observation of histomorphological changes after Guasha. Studies on Guasha at home and abroad study in recent years mainly focus on the biochemical index of blood, skin microcirculation, and etc., [5][6][7][8][9] but pay less attention to morphology and conjunction with morphological methods. According to HE staining, we could observe the infrastructure changes in skin tissues in Guasha area before and after Guasha at different time points, especially hair follicle, glands and stratification of skin. ...
Article
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OBJECTIVE To reveal the effects of Guasha (scraping therapy) on the histomorphology of scraped skins and on the expressions of calcitonin gene-related peptide (CGRP) and substance P (SP). METHODS 50 rats, as experimental subjects, were randomly divided into 5 groups according to different observation time points. Dorsal setae were shaved for the exposure of skin on both sides of the spine. Even reinforcing and reducing method was applied to the rats in Guasha groups on the site equivalent to bladder meridian of human body on one side of the spine, and the skin was scraped from top to bottom until rash of measles occurred. The skin tissues with rash of measles were taken down after perfusion. The corresponding sites of rats in group A were also taken down as control. The tissues were made to sections and used for immunofluorescence histochemical staining and HE staining of antibodies such as SP and CGRP. RESULTS After Guasha, there were significant differences in appearance, hair follicle and blood vessel on local skin scraped on the back of rats when compared with control; In different time points, the differences reduced. There was no significant difference in expression of CGRP and SP when compared local skin scraped on the back of rats in different time points. CONCLUSION Guasha didn't significantly change the morphology of nerve fibers inside local skin, and the histomorphology of hair follicle, blood vessel and etc. However, after Guasha they basically returned to normal level within five days.
... Clinical trials and experimental studies have demonstrated that Gua Sha could alleviate pains, 12,13 stimulate an unidentified pain-relieving biochemical pathway 14 and modulate cytokines. 15 However, the clinical significance and biomechanism of Gua Sha have not been empirically established. 16 In Jiang et al 's study, 17 compared with the model group, the level of IL-1 in serum of rats with LDH was significantly lower after Gua Sha. ...
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OBJECTIVE To investigate the analgesic effect of Gua Sha and its underlying mechanism in rats with noncompressive lumbar disk herniation induced by autologous nucleus pulposus. METHODS A rat model of noncompressive lumbar disk herniation was established and rats were randomly divided into model group, sham group, and Gua Sha group (24 in each group). Gua Sha was performed from the 5th day after the surgery, once every other day, 3 times for a course of treatment, and totally 3 courses. The thermal withdrawal latency was evaluated using the intelligent hot plate one day before the surgery, and on days 4 (the day before the treatment), 10 (the end of the first course), 16 (the end of the second course) and 22 (the end of the third course). On days 4, 10, 16 and 22, six rats in each group were picked randomly and their blood samples were drawn to assess the expression of interleukin-1β (IL-1β), interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α). RESULTS Compared to rats in the sham group, the application of nucleus pulposus to right L5 dorsal root ganglion induced prolonged thermal hyperalgesia, and up-regulated the expression of IL-1β, IL-6 and TNF-α in serum (P < 0.01). The therapy of Gua Sha attenuated thermal hyperalgesia potently, inhibited the expression of IL-1β, IL-6 and TNF-α in a time-dependent manner (P < 0.01). There were no significant differences in the thermal withdrawal latency and the expression of inflammatory cytokines between the sham and Gua Sha groups at the end of the treatment (P > 0.01). CONCLUSION The current study showed that Gua Sha might alleviate thermal hyperalgesia in rats with lumbar disc herniation induced by autologous nucleus pulposus via inhibiting the expression of proinflammatory cytokins.
Article
As one of the most important concepts in traditional Chinese medicine, cutaneous regions have a close relationship with skin in modern medicine. According to the doctrine of traditional Chinese medicine, the cutaneous regions are the corresponding projections of twelve meridians in the superficial layer of the body and play an important role in body surface-viscera correlation. The symptoms of visceral disorders will reflect on cutaneous regions and one of the major patterns of manifestation is referred visceral pain accompanied by tenderness and hyperalgesia on the body surface. On the contrary, cutaneous regions participate in the treatment of visceral disorders. As major clinical applications of the cutaneous regions hypothesis, superficial acupuncture, subcutaneous needling, massage (tuina), moxibustion, and wrist-ankle acupuncture have achieved favorable therapeutic outcomes in clinical practice. Modern researches have gained insights into the biological background of cutaneous regions, however, further studies are needed to clarify the mechanisms.
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Objective To verify the effects of scraping therapy on the weightlifting ability by measuring the subjective sensation, and changes of biomarkers. Methods Five students, who have been trained for 3 years in a sport school in China were participated in this study. A course of scraping therapy was applied to intervene during the normal 7-week of weightlifting training programme. The ability of weightlifting, the scale of rating perceived exertion and serum biochemical markers were measured before and after the intervention. Results Scraping therapy caused a significant increase in weightlifting ability (P<0.05). The level of rating perceived exertion remained stable with the increase in the training volume. Immuno-globulin A was significantly increased (P<0.05), and creatine kinase and blood urea nitrogen were significantly decreased (P<0.05). No significant changes were observed in white blood cell, neutrophil, and testosterone. Conclusion Scraping therapy may facilitate weightlifting ability mainly by decreasing weight sensation and improving serum biochemical parameters.
Article
Background: A previous case study showed that Guasha, an ancient manual therapeutic technique, could exert hepatoprotective effect in a human chronic active hepatitis B carrier (active-CHB) by modulating the liver enzymes, cytokines, and heme oxygenase-1 (HO-1). The present study serves as a control to the aforementioned case report. The controls were chronic inactive carriers (inactive-CHB) and noncarriers of hepatitis B (NCs). Besides showing a difference in biochemical markers between controls and the previously reported active-CHB case, the asymptomatic condition in both inactive- and active-CHB offers an excellent control for the patient's expectation about Guasha's efficacy. The purpose of this case study was to investigate whether hepatoprotective biochemical markers previously measured in active-CHB in response to Guasha were also present in controls. Participants and methods: Four inactive-CHB and nine NC participants were included. Each participant received a 15-minute Guasha treatment. Blood samples were obtained immediately before Guasha (day 0) and after Guasha (days 2, 5, and 7). Biochemistry values for liver function, HO-1, and T-helper (Th) cytokines were determined from blood tests. Neither the participants nor the investigator who administered Guasha were aware of the blood test results until after all data were collected for all participants. Results: In both inactive-CHB and NC participants, liver function, serum HO-1, and Th1/Th2 cytokines did not significantly differ before and after Guasha. Conclusions: In contrast to results in active-CHB patients, Guasha did not induce any significant modulation of liver enzymes, HO-1, or cytokines in inactive-CHB and NC participants. The current results suggest that a Guasha-induced hepatoprotective effect depends on the inflammatory event or clinical stage of chronic hepatitis B. Because both active and inactive carriers were completely unaware of their liver status at the time of receiving Guasha, the research protocol is effective in discounting the model that attributes the Guasha therapeutic efficacy to a placebo effect due to participants' expectations.
Article
Gua sha (press-stroking) and Baguan (cupping) are therapeutic procedures of traditional East Asian medicine (TEAM) that are also practiced in integrative clinical as well as domestic or familial settings. They may be defined as instrument assisted mechanical stimulation of the body surface that intentionally creates therapeutic petechiae and ecchymosis representing extravasation of blood in the subcutis. Blood and 'other potentially infectious material' (OPIM) can sometimes be drawn through the surface of the skin leading to potential contamination of instruments and to risk of bloodborne pathogen exposure. Neither the literature nor the current national standards of the acupuncture profession sufficiently address safety standards for Gua sha and Baguan. This paper presents the nature of the potential risks and applies current hospital safety standards as proposed protocols for Gua sha and Baguan.
Article
Till date the synthetic hepato-protective agents used in clinical practices are therapeutically non-promising and may itself lead to hepatotoxicity. Herbal medicines and their bioactives are considered to be relatively safe and have been used in the treatment of liver diseases for a long time. The 21st century has seen a paradigm shift towards therapeutic standardization of herbal drugs in hepatic disorders by evidence-based randomized controlled clinical trials to support their clinical efficacy. Even so, the specific hepato-protective clinical trial protocols for herbal medicines are not established till now. So, the efficacy of herbal medicines needs to be evaluated through rigorously designed multicentre clinical studies. In this review, we have enlightened the clinically evaluated hepatoprotective herbals and herbal formulations with respect to their status in different trial stages. Moreover, the problems and their strategic solutions during the development of clinical trial protocol for hepatoprotective herbal medicine are also addressed.
Article
"Sometimes called coining, spooning or scraping, Gua sha is defined as instrument-assisted unidirectional press stroking of a lubricated area of the body surface that intentionally creates "transitory therapeutic petechiae" representing extravasation of blood in the subcutis." Gua sha has been used for centuries in Asia, in Asian immigrant communities and by acupuncturists and practitioners of traditional East Asian medicine worldwide. With the expansion of traditional East Asian medicine, Gua sha has been used over broad geographic areas and by millions of people. It is valuable in the treatment of pain and for functional problems with impaired movement, the prevention and treatment of acute infectious illness, upper respiratory and digestive problems, and many acute or chronic disorders. Research has demonstrated Gua sha radically increases surface microperfusion that stimulates immune and anti-inflammatory responses that persist for days after treatment. The second edition expands on the history of Gua sha and similar techniques used in early Western Medicine, detailing traditional theory, purpose and application and illuminated by science that focuses its relevance to modern clinical practice as well as scholarly inquiry. This book brings the technique alive for practitioners, with clear discussion of how to do it -including correct technique, appropriate application, individualization of treatment - and when to use it, with over 50 case examples, and superb color photographs and line drawings that demonstrate the technique.
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Heme oxygenase (HO)-1 degrades heme and protects against oxidative stress, but it has not been pharmacologically induced in humans. In this randomized study of 10 healthy volunteers, hemin (3 mg/kg intravenously in 25% albumin) was shown to increase plasma HO-1 protein concentration four- to fivefold and HO-1 activity ~15-fold relative to baseline at 24 and 48 h (placebo -56.41 +/- 6.31 (baseline), 69.79 +/- 13.00 (24 h), 77.44 +/- 10.62 (48 h) vs. hemin -71.70 +/- 9.20 (baseline), 1,126.20 +/- 293.30 (24 h), 1,192.20 +/- 333.30 (48 h)) in four of five subjects as compared with albumin alone (P </= 0.03). This represents the overcoming of a fundamental hurdle to HO-1 research in humans.
Article
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Gua Sha is a traditional Chinese folk therapy that employs skin scraping to cause subcutaneous microvascular blood extravasation and bruises. The protocol for bioluminescent optical imaging of HO-1-luciferase transgenic mice reported in this manuscript provides a rapid in vivo assay of the upregulation of the heme oxygenase-1 (HO-1) gene expression in response to the Gua Sha procedure. HO-1 has long been known to provide cytoprotection against oxidative stress. The upregulation of HO-1, assessed by the bioluminescence output, is thought to represent an antioxidative response to circulating hemoglobin products released by Gua Sha. Gua Sha was administered by repeated strokes of a smooth spoon edge over lubricated skin on the back or other targeted body part of the transgenic mouse until petechiae (splinter hemorrhages) or ecchymosis (bruises) indicative of extravasation of blood from subcutaneous capillaries was observed. After Gua Sha, bioluminescence imaging sessions were carried out daily for several days to follow the dynamics of HO-1 expression in multiple internal organs.
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Heme oxygenase (HO), the rate limiting enzyme in the breakdown of heme into carbon monoxide (CO), iron and bilirubin, has recently received overwhelming research attention. To date three mammalian HO isozymes have been identified, and the only inducible form is HO-1 while HO-2 and HO-3 are constitutively expressed. Advances in unveiling signal transduction network indicate that a battery of redox-sensitive transcription factors, such as activator protein-1 (AP-1), nuclear factor-kappa B (NF-kappaB) and nuclear factor E2-related factor-2 (Nrf2), and their upstream kinases including mitogen-activated protein kinases play an important regulatory role in HO-1 gene induction. The products of the HO-catalyzed reaction, particularly CO and biliverdin/bilirubin have been shown to exert protective effects in several organs against oxidative and other noxious stimuli. In this context, it is interesting to note that induction of HO-1 expression contributes to protection against liver damage induced by several chemical compounds such as acetaminophen, carbon tetrachloride and heavy metals, suggesting HO-1 induction as an important cellular endeavor for hepatoprotection. The focus of this review is on the significance of targeted induction of HO-1 as a potential therapeutic strategy to protect against chemically-induced liver injury as well as hepatocarcinogenesis.
Article
Heme oxygenase (HO), the rate limiting enzyme in the breakdown of heme into carbon monoxide (CO), iron and bilirubin, has recently received overwhelming research attention. To date three mammalian HO isozymes have been identified, and the only inducible form is HO-1 while HO-2 and HO-3 are constitutively expressed. Advances in unveiling signal transduction network indicate that a battery of redox-sensitive transcription factors, such as activator protein-1 (AP-1), nuclear factor-kappa B (NF-kappa B) and nuclear factor E2-related factor-2 (Nrf2), and their upstream kinases including mitogen-activated protein kinases play an important regulatory role in HO-1 gene induction. The products of the HO-catalyzed reaction, particularly CO and biliverdin/bitirubin have been shown to exert protective effects in several organs against oxidative and other noxious stimuli. In this context, it is interesting to note that induction of HO-1 expression contributes to protection against liver damage induced by several chemical compounds such as acetaminophen, carbon tetrachloride and heavy metals, suggesting HO-1 induction as an important cellular endeavor for hepatoprotection. The focus of this review is on the significance of targeted induction of HO-I as a potential therapeutic strategy to protect against chemically-induced liver injury as well as hepatocarcinogenesis.
Article
Gua Sha is a therapeutic method of Traditional Chinese Medicine (TCM) widely used in Asia, particulary in the treatment of chronic pain. By use of the surface-frictioning technique (called 'Gua') petechiae and a skin rash similar to millet-seed (called 'Sha') are induced. As first observations on the application of that method have been promising, we present the case of a 72-year-old woman. The patient who suffered from chronic headaches, highly profited from Gua Sha during her 14- day inpatient multimodal treatment. This case provides first evidence that Gua Sha is effective in the treatment of headaches. Further research and clinical trials are required to corroborate that evidence.
Article
Gua sha is a traditional East Asian healing technique where the body surface is press-stroked with a smooth-edged instrument to intentionally raise therapeutic petechiae. A traditional indication of Gua sha is neck pain; no data from controlled trials exist to support this claim. The researchers aimed to investigate the effectiveness of Gua sha in the symptomatic treatment of chronic neck pain. The study was designed as an open randomized controlled clinical trial. The study was set in Kliniken Essen-Mitte, Academic Teaching Hospital of the University Duisburg-Essen, Germany. Forty-eight outpatients (58.5±8.0 years; 41 female) with chronic mechanical neck pain were the subjects of the study. Patients were randomized into Gua sha (N=24) or control groups (N=24) and followed up for 7 days. Gua sha patients were treated once with Gua sha, while control patients were treated with a local thermal heat pad. Primary outcome was change of neck pain severity after 1 week as assessed by visual analog scale. Secondary outcomes included pain at motion, the neck disability index (NDI) and quality-of-life (Short-Form [36] Health Survey). Neck pain severity after 1 week improved significantly better in the Gua sha group compared with the control group (group difference -29.9 mm, 95% confidence interval: -43.3; -16.6 mm; P<0.001). Significant treatment effects were also found for pain at motion, scores on the NDI, and dimensions of quality-of-life. The treatment was safe and well tolerated. Gua sha has beneficial short-term effects on pain and functional status in patients with chronic neck pain. The value of Gua sha in the long-term management of neck pain and related mechanisms remains to be clarified.
Article
Breast engorgement is a common problem that affects the initiation and duration of breastfeeding. Limited solutions are available to relieve the discomfort associated with breast engorgement. Thus, further investigation of methods to achieve effective relief of symptoms is critical to promote breastfeeding success. : The purpose of this study was to determine the effects of two breast care methods, that is, scraping (Gua-Sha) therapy (administered to the experimental group) and traditional breast care (i.e., massage and heating; administered to the control group). A randomized controlled trial was conducted on 54 postpartum women at a Level III medical teaching hospital. Participant inclusion criteria included postpartum breastfeeding women (a) who had an uncomplicated delivery and (b) who were experiencing breast engorgement problems. The Gua-Sha protocol selected appropriate acupoint positions, which included ST16, ST18, SP17, and CV17. Each position was lightly scraped seven times in two cycles. For the control group, we used hot packs and massage for 20 min in accordance with recommendations given in an obstetrical technique textbook. Results showed no statistical differences between the two groups at baseline. Body temperature, breast temperature, breast engorgement, pain levels, and discomforting levels were statistically different between the two groups at 5 and 30 min after intervention (p < .001). The results of generalized estimating equation analysis indicated that, with the exception of body temperature, all variables remained more significant (p < .0001) to improving engorgement symptoms in the experimental group than those in the control group, after taking related variables into account. Our findings provided empirical evidence supporting that Gua-Sha therapy may be used as an effective technique in the management of breast engorgement. By using Gua-Sha therapy, nurses can handle breast engorgement problems more effectively in primary care and hence help patients both physically and psychologically.
Article
In order to explore characteristics of clinical diseases treated by scraping therapy, summarize laws of clinical application of scraping therapy, and prospect for research direction of scraping therapy in future, collect 437 articles about scraping therapy between 1994-2007 and analyze and summarize the treated diseases and methods of scraping therapy. Results indicate that scraping therapy has been widely applied to commonly encountered diseases and frequently encountered diseases in departments of internal medicine, surgery, gynecology and pediatrics, etc. with more obvious therapeutic effects. Clinically, it can combine with acupuncture and moxibustion, cupping, massage, blood-letting puncture and other methods. In future, the studies on standardization of manipulation and standards for assessment of therapeutic effect, suitable diseases and the mechanisms of scraping therapy, and development of tools and media, etc. of scraping therapy should be strengthened.
Article
Unlabelled: Oxidative injury to hepatocytes occurs as a result of hepatitis C virus (HCV) infection and replication. Modulation of host cell antioxidant enzymes such as heme oxygenase-1 (HO-1) may be useful therapeutically to minimize cellular injury, reduce viral replication, and attenuate liver disease. In this report, we evaluated the effects of HO-1 overexpression on HCV replication and hepatocellular injury. Full-length (FL) (Con1) or nonstructural (NS) replicons (I 389 NS3-3') were transfected with complete human HO-1 sequences or empty vector for control. Cell lines overexpressing HO-1 (twofold to sixfold above basal values) or empty vector were isolated, and their HCV RNA synthesis, pro-oxidant levels, and resistance to oxidative injury were assessed. HO-1 overexpression decreased HCV RNA replication in both FL and NS replicons without affecting cellular growth or DNA synthesis. The attenuation of HCV replication was significantly reversed in both replicon systems with HO-1 small interfering RNA (siRNA) knockdown. Both FL and NS replicons that overexpress HO-1 showed reduced prooxidant levels at baseline and increased resistance to oxidant-induced cytotoxicity. HO-1 induction with hemin also markedly decreased HCV replication in both parental FL and NS replicon cell lines. Conversely, knockdown of HO-1 messenger RNA (mRNA) by siRNA in parental FL or NS replicons did not significantly affect HCV replication, suggesting that less than basal levels of HO-1 had minimal effect on HCV replication. Conclusion: Overexpression or induction of HO-1 results in decreased HCV replication as well as protection from oxidative damage. These findings suggest a potential role for HO-1 in antiviral therapy and therapeutic protection against hepatocellular injury in HCV infection.
Article
Heme Oxygenase is the rate-limiting enzyme in the degradation of heme into carbon monoxide (CO), iron and bilirubin. To date, three heme oxygenase isozymes have been identified: HO-1, HO-2 and HO-3. While HO-1 is structurally different from its counterparts, HO-2 and HO-3 are very similar (90% homology), with HO-3 being a poor heme catalyst. Of the three isozymes, HO-1 is believed to be the only inducible form. Constitutively expressed HO-2 has been identified in several organs including kidney and vascular smooth muscle, with the most abundant sources (and activity) being in the liver, brain, spleen and testes. Within the normal liver, HO-2 is constitutively expressed within hepatocytes, Kupffer cells, endothelial cells and Ito cells. Until recently, products of the HO reaction were regarded as potentially toxic waste destined only for excretion. However, this view is changing as evidence suggests that HO activity plays an important protective role against cellular stress during inflammatory diseases. Biliverdin is reduced to bilirubin, which has been shown to possess potent antioxidative properties. CO, which is produced in equimolar concentrations to biliverdin and ferrous iron during heme oxidation by HO, may function as a second messenger stimulating soluble guanylate cyclase (sGC) and regulating vascular tone in combination with the free radical gas NO. CO may also possess anti-inflammatory properties such as the capacity to inhibit platelet aggregation, or the expression of pro-inflammatory cytokines. Recently, it has been shown that CO regulates bile formation and bile flow. We review the functional role of HO in liver and the potential application of HO-1 in therapeutic approaches to the treatment of inflammation.
Article
To determine the time-course of human subcutaneous hemorrhage, heme oxygenase (HO)-1 expression and macrophage infiltration were observed using an immunohistochemical technique and semiquantitative analysis. The number of immunoreactive cells and the number of all infiltrating cells of each microscopic field were counted, and the ratio of the former to the latter was calculated as the positive cells ratio. An increase in the HO-1-positive cells ratio was observed starting at 3 h after injury, and the maximum ratio was observed 3 days after injury. The pattern of the increase in the macrophage ratio was similar to that of the HO-1-positive cells ratio in the early period after injury. Observation of serial sections revealed that the expression of HO-1 in the cells corresponded to the localization of macrophage. The present results suggest that the determination of HO-1 expression, as derived from macrophages, might be useful for the estimation of the time-course of subcutaneous hemorrhage.
Article
In the beginning, the microsomal HO system was presumed to be made of one isozymes, now known as HO-1, which was cytP450-dependent; and, was thought to be of physiological significance solely in the context of catalysis of hemoglobin heme to bile pigments and CO. A succession of discoveries including characterization of the system as an independent mono-oxygenase, identification of a second form, called HO-2, free radical quenching activity of bile pigments, analogous function of CO in cell signaling to NO, and characterization of the system as HSP32 cognates has led to such an impressive expansion in the number of reports dealing with the HO system that surpass anyone's expectation. This review is a compilation of certain older findings and recent events that together ensure placement of the HO system in the mainstream research for decades to come.
Article
No abstract. Peer Reviewed http://deepblue.lib.umich.edu/bitstream/2027.42/55941/1/21513_ftp.pdf
Article
Toll-like receptor (TLR)-4 signaling plays a key role in initiating exogenous antigen-independent innate immunity-dominated liver ischemia/reperfusion injury (IRI). Heme oxygenase (HO)-1, a heat-shock protein 32, exerts potent adaptive anti-oxidant and anti-inflammatory functions. Signal transducers and activator of transcription (STAT)-1 activation triggers interferon (IFN)-inducible protein 10 (CXCL-10), one of major products of type-1 IFN pathway downstream of TLR4. This study focuses on the role of type-1 IFN pathway in the mechanism of HO-1 cytoprotection during liver IRI. Cobalt protoporphyrin (CoPP)-induced HO-1 overexpression ameliorated liver damage in a well-defined mouse model of liver warm IRI, as evidenced by improved hepatic function (serum alanine aminotransferase levels) and liver histology (Suzuki's scores). HO-1 downregulated phospho-STAT-1 and its key product, CXCL-10. In contrast, TLR4 expression remained elevated regardless of the IRI status. To dissect the mechanism of HO-1 upon CXCL-10, we cultured RW 264.7 (macrophage) cells with exogenous rIFN-beta to stimulate CXCL-10 production via TLR4 pathway in vitro. Indeed, CoPP-induced HO-1 suppressed otherwise highly upregulated rIFN-beta-triggered CXCL-10. Moreover, consistent with our in vitro data, CoPP pretreatment diminished rIFN-beta-induced CXCL-10 production in normal mouse livers. Hepatic IRI activates TLR4 signaling in vivo to elaborate CXCL-10. HO-1 overexpression downregulates activation of STAT1 via type-1 IFN pathway downstream of TLR4, which in turn decreases CXCL-10 production. This study provides evidence for a novel mechanism by which HO-1 exerts adaptive cytoprotective and anti-inflammatory functions in the context of innate TLR4 activation.
Article
Gua Sha, therapeutic surface frictioning that intentionally raises transitory petechiae and ecchymosis, is a traditional East Asian healing technique also known as cao gio, coining, scraping, and spooning. There are case reports in Western literature but no studies on the physiological effects of Gua Sha. To study the microcirculatory effects of Gua Sha on the skin and subcutis in humans to elucidate physiological mechanisms responsible for the clinically observed pain-relieving effect of this treatment Laser Doppler imaging (LDI) was used to make sequential measurements of the microcirculation of surface tissue before and after Gua Sha treatment in 11 healthy subjects. The effect of Gua Sha treatment on the microcirculation of surface tissue was expressed as changes from baseline in arbitrary perfusion units (PU). The study was conducted at the Department of Nephrology, Unit of Circulation Research, University Hospital of Essen, Germany. Subjects were volunteers from the nursing and physician staff of the Kliniken Essen. A single Gua Sha treatment was applied to an area of each subject's back. Change in microcirculation was measured in PUs. Change in myalgia was subjectively reported and confirmed by manual palpation. Gua Sha caused a fourfold increase in microcirculation PUs at the treated area for the first 7.5 minutes following treatment and a significant increase in surface microcirculation during the entire 25 minutes of the study period following treatment (P < .001). Females showed significantly higher rates of response than males (P = .003). Each subject experienced immediate decrease in myalgia in both the site treated, in the related distal control site, and in some cases, other distal sites. Pain relief persisted to some extent up to the follow-up visit. There were no adverse reactions. Gua Sha increases microcirculation local to a treated area, and that increase in circulation may play a role in local and distal decrease in myalgia. Decrease in myalgia at sites distal to a treated area is not due to distal increase in microcirculation. There is an unidentified pain-relieving biomechanism associated with Gua Sha.
Article
Induction of heme oxygenase-1 (HO-1) has been shown to be beneficial in immune-mediated liver damage. We now investigate the effects of HO-1 induction in models of human hepatitis B virus (HBV) infection. Adenoviral transfer of an HBV 1.3 genome into wild-type mice was used as a model for acute hepatitis B. HBV transgenic animals were used as a model for chronic HBV infection. HBV replication was assessed by HBV viremia, antigenemia, and Southern blotting, liver damage was assessed by serum alanine aminotransferase activities and histopathology of liver sections. To investigate HO-1 effects on HBV replication at a molecular level, stably HBV-transfected hepatoma cells were used. HBV gene expression, protein stability, transcription, and replication were determined. HO-1 was induced by either cobalt-protoporphyrin-IX or over expressed by adenoviral gene transfer. In the acute hepatitis B model, liver injury was reduced significantly after HO-1 induction. In addition, HO-1 showed a pronounced antiviral effect, which was confirmed in stably HBV-transfected hepatoma cells and in persistently HBV replicating transgenic mice. We showed that HO-1 induction repressed HBV replication directly in hepatocytes at a posttranscriptional step by reducing stability of HBV core protein and thus blocking refill of nuclear HBV covalently closed circular (ccc)DNA. Small interfering RNA directed against HO-1 proved that this effect depended on the expression level of HO-1. Besides its hepatoprotective effect, HO-1 showed a pronounced antiviral activity in HBV infection. Therefore, induction of HO-1 might be a novel therapeutic option for inflammatory flares of hepatitis B.
Article
Gua Sha is a therapeutic method of Traditional Chinese Medicine (TCM) widely used in Asia, particularly in the treatment of chronic pain. By use of the surface-frictioning technique (called 'Gua') petechiae and a skin rash similar to millet-seed (called 'Sha') are induced. As first observations on the application of that method have been promising, we present the case of a 72-year-old woman. The patient who suffered from chronic headaches, highly profited from Gua Sha during her 14-day inpatient multimodal treatment. This case provides first evidence that Gua Sha is effective in the treatment of headaches. Further research and clinical trials are required to corroborate that evidence.
Article
The hepatitis B virus (HBV) is an enveloped, hepatotrophic, oncogenic hepadnavirus that is noncytopathic for hepatocytes. HBV infection results in a variety of outcomes that are determined by the quality, quantity, and kinetics of the host innate and adaptive immune responses. Whether HBV infection is cleared or persists as a progressive or nonprogressive liver disease is determined by both viral and host factors. Replicative intermediates can persist in the liver under immunologic control after resolution of acute or chronic hepatitis B, conferring a risk for reactivation following a course of immunosuppression or chemotherapy.
Article
Heme oxygenase-1 (HO-1) is the rate-limiting enzyme of ferroheme metabolic pathway, which has the functions of anti-oxidation, anti-inflammatory, anti-apoptosis and anti-smooth muscle hyperplasia. Furthermore, HO-1 exerts a protective action in the diseases mediated by effector T lymphocytes such as T helper (Th) 1, Th2 and Th17. In addition, regulatory T cells (Treg) control the activity of CD4+CD25- effector cells in a suppressive manner. Numerous studies indicate that the protective action of HO-1 in diseases is through CD4+CD25+ Treg. This paper will review the current research and understanding of HO-1's role in T cells-mediated immunoregulation.
Results of liver function test, HO-1 and Th1/Th2 balance before and after Guasha procedure. Changes of total bilirubin
  • Fig
Fig. 1. Results of liver function test, HO-1 and Th1/Th2 balance before and after Guasha procedure. Changes of total bilirubin, ALT, AST, ALP (top panel), HO-1 (middle panel), IFN-γ, IL-4, IL-5 and IL-10 (bottom panel).
Bioluminescence imaging of heme oxygenase-1 upregulation in the Gua Sha procedure
  • K K Kwong
  • L Kloetzer
  • K K Wong
Kwong KK, Kloetzer L, Wong KK, et al. Bioluminescence imaging of heme oxygenase-1 upregulation in the Gua Sha procedure. J Vis Exp 2009 (http://www.jove.com.ezp-prod1.hul.harvard.edu/details.stp?id=1385 doi:10.3791/1385.).