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1 Sweet 75 DOI : /KPI Sweet Received : Revised : Accepted : Key Words: Carpal tunnel sydrome, Sweet Bee Venom Pharmacopuncture, Scolopendrid Pharmacopuncture, Nerve Conduction Velocity Comparison of the Effects between Sweet Bee Venom Pharmacopuncture and Scolopendrid Pharmacopuncture on Carpal Tunnel Syndrome (Randomized, Controlled Clinical Trial) Ji-young Ku* Kyoung-hee Lee* Sung-Woo Cho** Sang-Chan Lee*** Hyoun-min Youn* Kyung-jeon Jang* Choon-ho Song* Chang-beohm Ahn* Cheol-hong Kim* *Department of Acupuncture & Moxibution College of Oriental Medicine, Dong-Eui University **Department of Oriental Rehabilitation Medicine, College of Oriental Medicine, Dong-Eui University ***Department of Neurology, Dong-Eui Hospital ABSTRACT Objectives : The purpose of this study is to compare the effects of Sweet Bee Venom Pharmacopuncture and Scolopendrid Pharmacopuncture on Carpal Tunnel Syndrome. Methods : From February to September 2010, the number of patients with Carpal Tunnel Syndrome who volunteered for this clinical study was 16 and 7 out of 16 patients complained both hands. Total 23 cases of hands were randomly divided by 2 groups. We injected Sweet Bee Venom Pharmacopuncture on PC7(Daereung) twice a week for 4weeks for experimental group(n=11), and Scolopendrid Pharmacopuncture with the same methods for control group(n=12). One case was dropped out due to itchiness of allergic response in the experimental group. Improvement of the symptoms was evaluated by Visual Analogue Scale, Pain Rating Scale, Tinel s sign, Phalen s sign and Nerve Conduction Velocity. Nerve Conduction Velocity was checked at baseline and the end of the trial and others were checked at baseline, after 2 and 4 weeks. Results : Both groups showed significant improvement in Visual Analogue Scale, Pain Rating Scale, but no significant difference between two groups. Only the control group showed significant reduction of the poitive response in the Tinel s sign and Phalen s sign. However, no groups improved in Nerve Conduction Velocity. Conclusions : These results showed that Sweet Bee Venom Pharmacopuncture and Scolopendrid Pharmacopuncture could decrease the symptoms of Carpal Tunnel Syndrome. Further studies will be required to examine more cases for the long period and use more various concentration and amount pharmacopuncture for the effect on Carpal Tunnel Syndrome. Correspondence : Cheol-hong Kim, Department of Acupuncture & Moxibution College of Oriental Medicine, Dong-Eui University, San 45-1, Yangjung 2-Dong, Busanjin-Gu, Busan, Korea, Tel Fax kmdkch@deu.ac.kr This research was supported by KPI(Korea Pharmacopuncture Institute) in 2009.

2 76 Journal of Pharmacopuncture I II ~60 70% 90% Sweet SBV SBV Visual Analog Scale VAS Pain Rating Scale PRS (Nerve Conduction Velocity, NCV) 1 IRB ) VAS 5 Tinel s sign Phalen s sign SBV 2) 1 3)

3 Sweet ml 0.5ml 2 1) screening VAS, PRS (SBV VAS, PRS (Fig.1) 2) SBV (LI11) 0.05ml mm 11mm 1ml 8mm 30guage (PC7) SBV 0.2ml 4 1) VAS 0 10 PRS PRS 2) Tinel s sign Phalen s sign 3) 8 (abductor pliicis brevis) (muscle belly) (tendon) (orthodromic)

4 78 Journal of Pharmacopuncture (Latency) (Amplitude) (Conduction Velocity) 4 SPSS version 18.0 for Win-dow (SPSS Co. USA) p-value 0.05 number(%) mean standard deviation paired t-test, Fisher s exact test t-test for independent sample McNemar PRS PRS PRS (Repeated ANCOVA) III Tinel s sign Phlaen s sign 100% 92% VAS PRS PRS (Table 1) 2 VAS, PRS VAS (p=0.000) (p=0.001) (p=0.000) 2 follow up (p=0.000) PRS (p=0.001) (p=0.003) (p=0.000) Tinel s sign Phalen s sign 10 (100%) (100%) 7 (70%) (Table 2~5) 3 VAS, PRS VAS (p=0.000) (p=0.004) (p=0.000) 2 follow up (p=0.000) PRS (p=0.003) (p=0.008) (p=0.000) Tinel s sign Phalen s sign 11 (92%) (83%) 4 (33%) (Table 2~5) 4 VAS, PRS , p value PRS PRS

5 Sweet 79 PRS PRS (Table 2~3) Tinel Phalen sign 100%-100%- 70% 92%-83%-33% (Table 4) 5 Motor nerve Amplitude Normal Limit Latency Sensory nerve Finger to Wrist Conduction Velocity (Table 6~7). IV Phalen s sign, Tinel s sign 80% 22% m/sec 70% 90% Sweet

6 80 Journal of Pharmacopuncture allergen 10,000 (phospholipase A2, hyaluronidase Bee Venom Sweet Bee Venom Sweet Bee Venom Bee Venom CT MRI :1 1:1 SBV drop out 10,000:1 pilot test IRB SBV 1 (PC7) SBV 23 SBV VAS, PRS, Tinel s sign, Phalen s sign 4 3 NCV 2 2 VAS 23 1 Drop out VAS VAS p value

7 Sweet 81 PRS p value p value gain score PRS Tinel s sign Phalen s sign 100%-100%-70% 92%-83%-33% McNemar Tinel s test Phalen s test Phalen s sign 88.9% Tinel, Phalen VAS, PRS Simpson Gilliat Sears 6 1 follow up 33 D. Rempel 8-22% 8-22% carpal tunnel release VAS, PRS, Tinel s sign, Phalen s sign SBV SBV SBV

8 82 Journal of Pharmacopuncture V SBV VAS 2. PRS 3. Tinel, Phalen s sign 4. SBV VI 1. Phalen GS. the carpal tunnel syndrome, Seven years experience in diagnosis and treatment of six hundred fifty-four hands. Bone joint surg. 1966;48(A): Department of Rehabilitation Medicine of College of Oriental Medicine. Rehabilitation Medicine of Oriental Medicine. Seoul:Jipmundang. 1995: The Korean Academy of Oriental Rehabilitation Medicine. Oriental Rehabilitation Medicine. Seoul:Koonja. 2005:83, The Korean Orthopaedic Association. Orthopaedics. Seoul : Choishin. 1997; 254, Palmer DH, Hanrahan LP. Socail and economic costs of carpal tunnel surgery. Instr Course Lect. 1995;44: Hahn SB, Kang ES, Hang HJ, Park YS. Endoscopic carpal tunnel release in carpal tunnel syndrome using the agee technique. Journal of the Korean Society for Surgery of the Hand. 2000;5(1): Lim JA, Kim SC, Kim SN, Lee SY, Moon HC. Clinical study on treatment of Carpal tunnel syndrome using Scolopendrid herbal acupuncture. The Journal of Korean Pharmacopuncture Institute. 2005;8(1): Choi CH, Song HS. Effect of Hapgok Needling and Bee Venom Acupuncture Complex Treatment on Patients with Carpal Tunnel Syndrome. The Journal of Korean Acupuncture and Moxibustion Society. 2010;27(3): Kim IH. Clinical Study on Five Cases of Carpal tunnel syndrome. The Journal of Korean Pharmacopuncture Institute. 2001;4(3): Lee BH, Yoon HI, Park JW. A Study on Efficiency of Pain Management by Questionnaire using Visual Analogue Scale in Back Pain Patients. J Korean Acad Orthop Man Phys Ther. 1995;1(1): Kim C, Kim CH, Chun SI. Clinical Value of a New Self Assessment Method of Pain. The Journal of Korean academy of Rehabilitation. 1998;22(2): Gwak JY, Cho SY, Shin AS, Lee IH, Kim NH, Kim HM, Na BJ, Park SW, Jung WS, Moon SK, Park JM, Ko CN, Cho KH, Kim YS, Bae HS. Efficacy of Bee-venom Acupuncture on Central Post Stroke Pain. The Journal of Korean Acupuncture and Moxibustion Society. 2009;26(6); Lee SY, Park KY, Lim JK. Comparison of the

9 Sweet 83 Parameters from Median Nerve Conduction Studies in the Carpal Tunnel Syndrome. Keimyung Med J. 1999;18(1): Compilation Committee of the CIBA collection of medical illustrations. The CIBA collection of medical illustrations. Seoul, Jungdam. 2000:1( ): The Korean Neurosurgical Society. Neurosurgery. Seoul: Joonnangmoonhwasha. 2005: Yoon SH, Park SK. A comparative study between clinical signs and electrodiagnostic examinations in carpal tunnel syndrome. the Journal of Chungnam colledge of Medicine. 1992;19: Park SW, Lee SH, Hur SY. Clinical Study of Conservative Treatment in the Carpal Tunnel Syndrome. The Journal of the Korean Orthopedic Association. 1985;20(5): : Science Commitee of Korean Pharmacopuncture Institute. Pharmacopuncturology. Seoul : Elsevier Korea. 2008; , Oh SW, Kim BW, An JC, Yoon HC, Park JS, Kwon KR. Clinical Analysis about Treatment of Myofascial Pain Syndrome(MPS) with Sweet Bee Venom on Hand Paresthesia based on Thoracic Outlet Syndrome. The Journal of Korean Pharmacopuncture Institute. 2010;13(2): Kim JH, Jang SH, Yoon HM, Jang KJ, Ahn CB, Kim CH, Song CH, Choi HN. The comparison of Effectiveness between Bee Venom and Sweet Bee Venom Therapy on Chronic Lower Back Pain. The Journal of Korean Pharmacopuncture Institute. 2008; 11(4) : Lee KH, Yoon HM, Ko WS, Song CH, Jang KJ, Ahn CB, Kim CH. Comparison of Treatment Effects and Allergic responses to stiff neck between Sweet Bee Venom and Bee Venom Pharmacopuncture. The Journal of Korean Pharmacopuncture Institute. 2008; 11(4): Seoul 1987; ; Kim JH, Kim SH, Song HJ, Experimental Study on Analgesic, Antinflammatory, Anticonvulsive and Toxic Action Scolopendra. The Journal of Korean Oriental Medicine. 1993;14(2): Choi SW, Lim ST, Shin JC. A Case of Patient with the Pain of Hip Adductors Treated by Scolopendrid Herbal Acupuncture. The Journal of Korean Pharmacopuncture Institute. 2006;9(1): Choi HK, SO KS, Koh KH, Park SY, Kim SN, Lee JD, Won KS, Moon HC, Kim SC. The clinical study of Scolopendrid aquacu-puncture on HIVD of lumbar spine by follow up. The Journal of Korean Acupuncture and Moxibustion Society 2003;20(3) : Hwang MR, Kwon HK, Lee HJ. The relationship between Clinical and Electrodiagnostic Findings in Carpal Tunnel Syndrome. The Journal of Korean academy of Rehabilitation. 1999;23(5): Simpson JA. Electrical signs in the diagnosis of carpal tunnel and related syndromes. J Neurol Neurosurg Psychiatry. 1956;19: Gilliat RW. Sears TA : sensory nerve action potentials in patients with peripheral nerve lesion. J Neurol Neurosurg Psychiatry. 1958;21: Kemble F. Electrodiafnosis of carpal tunnel syndrome. J Neurol Neurosurg Psychiatry. 1968;31: Kopell HP, Goodgold J. Clinical and electrodiagnostic features of carpal tunnel syndrome. Arch Phys Med. 1968;49: Lambert EH. Diagnostic value of electrical

10 84 Journal of Pharmacopuncture stimulation of motor nerve. Electroencephalography and Clinical Neurophysio-logy(suppl). 1962;22: Padua L, Padua R, Aprile I, Pasqualetti, Tonali P. Multispective follow- up of untreated carpal tunnel syndrome. Neurology 2001;56(11): Gerritsen AA, Uitdehaag BM, van Geldere D, Scholten RJ, de Vet HC, Bouter LM. Systemic review of randomized clinical trials of surgical treatment for carpal tunnel syndrome. Br J Surg 2001;88(10): Han TR. Diagnosis and Treatment of Carpal Tinnel Sundrome. The Journal of Korean EMG, Electrodiagnositic Medicine. 2003;5(1): D Rempel, B Evanoff, P C Amadio, M de Krom, G Franklin, A Franzblau, R Gray, F Gerr, M Hagberg, T Hales, J N Katz, and G Pransky. Consensus criteria for the classification of carpal tunnel syndrome in epidemiologic studies. Am J Public Health, Oct 1998; 88: Wren V. McCallister, MD, Thomas E. Trumble, MD. Decompressive Surgery Was Better Than Steroid Injection for Symptomatic and Neurophysiologic Outcomes in Carpal Tunnel Syndrome. The Journal of Bone and Joint Surgery (American). 2006;88:454.

11 Sweet 85 N= 23 randomized (After screening, Eligibility criteria) VAS, PRS, Tinel Øs sign, Phalen Øs sign NCV checked Group 1(SBV) N=11 Group 2(Scolopendrid) N=12 N=1 dropped out Because of pruritus During 2 weeks 4 injection N=10 completed During 2 weeks 4 injection N=12 completed VAS, PRS, Tinel s sign, Phalen s sign checked During 2 weeks 4 injection N=10 completed During 2 weeks 4 injection N=12 completed VAS, PRS, Tinel s sign, Phalen s sign NCV checked Fig. 1.

12 86 Journal of Pharmacopuncture Table 1. Baseline Characteristics of Patients. p value Sex(M/F) 1/9 1/ * Age * Distribution of hand (Right/Left) 5/5 7/ * The hand which uses mainly 10/0 11/ * (Right/Left) Distribution by Duration (Month) * Tinel s sign 10(100%) 11(92%) Phalen s sign 10(100%) 11(92%) VAS * PRS Values are Number or MEAN SD *using paired t-test, Fisher s exact test, P 0.05 Table 2. Change of VAS in Each Group Pre 2weeks 4weeks 12weeks Values are Number or MEAN SD Pre : primary report before 1st treatment 2weeks : report after 2weeks, 4th treatment 4weeks : report after 4weeks, 8th treatment 12weeks : report after 12weeks Table 3. Change of PRS in Each Group F P PRE week weeks Group weeks week*group Values are Number or MEAN SD Pre : primary report before 1st treatment 2weeks : report after 2weeks, 4th treatment 4weeks : report after 4weeks, 8th treatment using Repeated ANCOVA test, P 0.05

13 Sweet 87 Table 4. Positive Finding on the Physical Examination. Pre 2weeks 4weeks P tinel phalen 10(100%) 10(100%) 10(100%) 10(100%) 7(70%) 7(70%) tinel phalen 11(92%) 11(92%) 10(83%) 10(83%) 4(33%) 4(33%) 0.016* 0.016* *using McNemar test, P 0.05 Values are Number(%) Pre : primary report before 1st treatment 2weeks : report after 2weeks, 4th treatment 4weeks : report after 4weeks, 8th treatment Table 5. Comparison on Pain between Groups. p-value (p-value) (p-value) between Group 2weeks-Pre (0.000*) (0.000*) VAS 4weeks-2weeks 4weeks-Pre (0.001*) (0,000*) (0.004*) (0.000*) weeks-Pre (0.000*) (0.000*) weeks-Pre (0.001*) (0.003*) PRS 4weeks-2weeks (0.003*) (0.008*) weeks-Pre (0.000*) Values are Number or MEAN SD *using paired t-test, Fisher s exact test, P weeks-Pre : the changes during 1st treatment-4th treatment 4weeks-2weeks : the changes during 8th treatment-4th treatment 4weeks-Pre : the changes during 8th treatment-1st treatment 12weeks-Pre : the changes during 1st treatment-after 12weeks (0.000*) 0.049* Table 6. Result of Motor Nerve Conduction Study Pre 4weeks Normal Limit Latency (msec) Amplitude (mv) Values are Number or MEAN SD Pre : primary report before 1st treatment 4weeks : final report after 4weeks, 8th treatment Normal Limit by Shin J. Oh Clinical electromyography using t-test for independent sample, P 0.05

14 88 Journal of Pharmacopuncture Table 7. Result of Sensory Nerve Conduction Study Pre 4weeks Normal Limit Amplitude Palm to Wrist Finger to Wrist Conduction Velocity Palm to Wrist (msec) Finger to Wrist Values are Number or MEAN SD Pre : primary report before 1st treatment 4weeks : final report after 4weeks, 8th treatment Normal Limit by Shin J. Oh Clinical electromyography using t-test for independent sample, P 0.05

15 Sweet 89 (Appendix 1). Visual Analog Scale (Appendix 2).

139~144 ¿À°ø¾àÄ§

139~144 ¿À°ø¾àÄ§ 2 139 DOI : 10.3831/KPI.2010.13.2.139 2 Received : 10. 04. 08 Revised : 10. 04. 26 Two Case Report on Wrist Ganglion Treated with Scolopendrid Pharmacopuncture Accepted : 10. 05. 04 Key Words: Wrist Ganglion,