1Shanghai Business School, Room 612, Administrative Building, No. 123, Fengpu Avenue, Fengxian District,Shanghai 201400, China2Department of Neurology, Shuguang Hospital Affiliated to Shanghai University of TCM, No. 528, Zhang-Heng Road,Pu-Dong New Area, Shanghai 201203, China3Department of Neurology, Shanghai Seventh Hospital, Shanghai University of Traditional Chinese Medicine,Shanghai 200137, China4Department of Emergency, Shuguang Hospital Affiliated to Shanghai University of TCM, No. 528, Zhang-Heng Road,Pu-Dong New Area, Shanghai 201203, China5Department of Neurology, Hua Shan Hospital Affiliated to Fu Dan University, No. 12, Wu Lu Mu Qi Zhong Road,Shanghai 200040, China
Objective. The objective is to observe whether the traditional Chinese medicine (TCM) Nao-Xue-Shu oral liquid improves aphasiaofmixed stroke.Methods. A total of 102 patients with aphasia ofmixed stroke were divided into two groups by a single blind randommethod. The patients treated by standard Western medicine plus Nao-Xue-Shu oral liquid (𝑛 = 58) were assigned to the treatmentgroup while the remaining patients treated only by standard Western medicine (𝑛 = 58) constituted the control group. Changesin the Western Aphasia Battery (WAB), Modified Rankin Scale (mRS), National Institutes of Health Stroke Scale (NIHSS), andhemorheology parameters were assessed to evaluate the effects of the treatments. Results. Excluding the patients who dropped out,54 patients in the treatment group and 51 patients in the control group were used to evaluate the effects. Significant and persistentimprovements in the WAB score, specifically comprehension, repetition, naming, and calculating, were found in the treatmentgroup when the effects were evaluated at the end of week 2 and week 4, respectively, compared with baseline. The naming andwriting scores were also improved at the end of week 4 in this group. The comprehension and reading scores were improved at theend of week 4 in the control group compared with the baseline, but the improvements were smaller than those in the treatmentgroup. The percentages of patients at the 0-1 range of mRS were increased at the end of week 2 and week 4 in both groups, butthe improvements in the treatment group were much larger than those in the control group. Greater improvements in the NIHSSscores and the hemorheology parameters in the treatment group were also observed compared with the control group at the endof week 2 and week 4. Conclusion. Nao-Xue-Shu oral liquid formulation improved aphasia in mixed stroke patients and thus mightbe a potentially effective drug for treating stroke aphasia.
1. Introduction
Mixed stroke, also known as hemorrhagic infarction orinfarction with hemorrhage, presents as a cerebral infarc-tion combined with intracerebral hemorrhage on computedtomography (CT) brain scans [1, 2]. Current clinical cases ofmixed stroke are caused by middle cerebral artery territoryand lead to massive temporal infarction with hemorrhage.
Mixed stroke patients with brain infarction and hemorrhagehave mutual promoting and mutual transforming character-istics that often appear as epilepsy, dementia, aphasia, andother kinds of advanced neural function damage. Also, thereis a higher proportion of patients with mixed apoplexy apha-sia, including aphasia and dysarthria, or both kinds of symp-toms coexisting in patients that result in communicationdifficulties, and loss of the ability to communicate socially has
Hindawi Publishing CorporationEvidence-Based Complementary and Alternative MedicineVolume 2015, Article ID 709568, 6 pageshttp://dx.doi.org/10.1155/2015/709568
2 Evidence-Based Complementary and Alternative Medicine
a serious impact on the patient’s quality of life [3]. Westernmedicine treatment that consists of decreasing intracranialpressure and adjusting blood pressure and blood density andhemostatic measures can produce contradictory effects and,in other words, may lead to the development of ischemia andat the same time increase bleeding, and vice versa, causingcontradiction to treat it [4]. In the theory of traditionalChinese medicine (TCM), one of the integrative medicines[5] has shown that Nao-Xue-Shu oral liquid may raise 𝑄𝑖and remove blood stasis, clear pathogenic “heat” and “cool”blood (make the abnormal activity of the blood quiet stopbleeding), and eliminate phlegm [6]. In Western medicine,the oral liquid can increase cerebral blood flow, improvemicrocirculation, prolong thrombus formation, bleeding,and clotting times, and inhibit platelet aggregation, so it canpromote phagocytic function and accelerate the absorptionof blood swollen in cerebral [6] and might be an effectiveprescription in the treatment of mixed stroke [7]. For thesereasons, the aim of the present investigation was to evaluatewhether Nao-Xue-Shu oral liquid can improve the aphasia ofmixed stroke.We enrolledmixed stroke aphasia patients fromthe Department of Neurology of Shuguang Hospital affiliatedto Shanghai University of Traditional Chinese Medicineand the Department of Neurology of Hua Shan Hospitalaffiliated to Fu Dan University based on whether or not theywere taking Nao-Xue-Shu oral liquid in order to identifya reliable treatment for improving the prognosis of thepatients.
2. Subjects and Methods
2.1. Subjects. A total of 116mixed stroke patients with aphasiafrom our two hospitals were divided into a treatment group(treatment plus Nao-Xue-Shu oral liquid, 𝑛 = 58) and acontrol group (treatment without Nao-Xue-Shu oral liquid,𝑛 = 58) in a single blind fashion. Inclusion criteria forthe patients with aphasia of mixed stroke were (1) acuteonset, neural function defect syndrome caused by a localbrain blood circulation disorder, and duration of symptomsof at least 24 hours [8]; (2) diagnosis by CT and/or mag-netic resonance imaging (MRI) of the brain clearly showingcerebral infarction accompanied by cerebral hemorrhage;(3) the patient in a conscious state and with the ability tospeak and no comprehension difficulties, with or withoutdysarthria; and (4) the patient or their guardians providingsigned informed consent. Exclusion criteria for thosemeetingthe above inclusion criteria were (1) a patient with an existingconsciousness disorder; (2) cerebral hemorrhage caused byanother reason such as a tumor or brain trauma caused bycerebral infarction; (3) the existence of serious gastrointesti-nal bleeding, hemoptysis, or bloody urine; (4) the presenceof other diseases caused by vascular dementia, frontotempo-ral dementia, Parkinson’s disease (PD), Alzheimer’s disease(AD), or a central nervous system disease such as a braintumor, multiple sclerosis, encephalitis, epilepsy, normal pres-sure hydrocephalus (NPH), or other types of dementia; (5)alcohol and/or drug abuse or other known kinds of aphasiaor dementiawhich prohibit the patient fromcooperatingwiththe examiner.
The mixed stroke patients with aphasia selected included83 males and 33 females (age range, 39–87 y; mean ± SD,64.28 ± 4.74 y), and time from onset to admission was 0.5∼2.5 d (0.75 ± 1.08 d). There were 34 cases of left temporalinfarction with hemorrhage, 23 cases of right temporalleaf infarction with hemorrhage, 14 cases of left putamenhemorrhage with right basal ganglia infarction, 12 cases ofleft putamen hemorrhage with right brain stem infarction,11 cases of right basal ganglia infarction with hemorrhage inthe left caudate nucleus, 9 cases of left cerebellar hemorrhagewith right basal ganglia infarction, 8 cases of left thalamushemorrhage with infarction in the right side of the basalganglia area, and 5 cases of left basal ganglia infarction withright basal ganglia hemorrhage. No significant differences ingender, age, number of cases, duration, or types of diseasesbetween the two groups were found, and the 2 groups werecomparable (Table 1).
2.2. Treatment Methods. The control group underwent rou-tine clinical treatments andmeasures according to the guide-lines of Western medicine [9], including monitoring fluctu-ations in the electrocardiograph (ECG) and blood pressure.To control blood pressure and intracranial pressure,mannitoland/or furosemidum and citicoline were administered byintravenous infusion according to the patient’s situation.The patients in the treatment group were treated using thesame routine treatments as the control group and were alsoadministered 10mL of Nao-Xue-Shu oral liquid [6, 7] threetimes per day (Shandong Wohua Pharmaceutical PolytronTechnologies Inc.), which consists of Astragalus root,Hirudo,Acorus gramineus, Radix Achyranthis bidentatae, tree Peonybark, Rheum officinale, and Ligusticum wallichii (batch num-bers 5040504 and 5040708).The ratio formula of each herb orinsect and the craftsmanship are protected by Chinese patent,but the effective elements could pass through the blood brainbarrier to modify cerebral hemorrhage by study of cerebralhemorrhage model [10]. Patients who could not ingest theliquid orally were given it by nasal feeding. The patientsin the treatment group took Nao-Xue-Shu oral liquid for 4consecutive weeks. The clinical and laboratory parametersweremeasured before treatment (baseline), at the end ofweek2, and at the end of week 4 to evaluate the effects of treatmentin the two groups.
2.3. Assessments. (1) Western Aphasia Battery (WAB) [11] isthe main outcome measure of aphasia. The examination notonly detects fluctuations in aphasia but also assesses the useof visual spatial function, nonlinguistic intelligence abilities,spatial structure ability, ability to perform calculations, andother nonlinguistic function examinations.TheWAB test hasbeen used as a common tool in evaluating aphasia and ismin-imally influenced by race and cultural background inWesterncountries [12].The six quotients developed byweightingWABscores are as follows: comprehension, repetition, naming,reading, calculating, andwriting, with the highest score being100%.
(2) The Modified Rankin Scale (mRS) [13] is a simplifi-cation of the overall assessment of the patient’s neurologicalfunction scale. The higher the score for neural function
Evidence-Based Complementary and Alternative Medicine 3
Table 1: Background characteristics of the patients of mixed stroke with aphasia.
Group 𝑛
Gender Age (y) Educational level (𝑛) Handedness (𝑛) Aphasia type (𝑛)M F Primary Middle College or more L R Motor Receptive Mixed
Note: ∗𝑝 < 0.05 and ∗∗𝑝 < 0.01 compared with before for the same group; #𝑝 < 0.05 compared with control group at the same time.
defect, themore serious the condition; 0means nomovementdysfunction and 6 means death. After 2 and 4 weeks oftreatment, an increased percentage in the range of 0-1 of mRSwill be used as the main determinant of improvement formovement dysfunction.
(3)TheNational Institutes ofHealth Stroke Scale (NIHSS)[14] as the reference index of curative effect include con-sciousness, gaze, facial paralysis, limb activities, and so onfor a total of 11 scoring categories, with 0 points beingnormal. The higher the score of NIHSS, the more serious theneurologic deficit, NIHSS as a predictor of acute onset forstroke.
(4) Blood hemorheology as a reference index of the cura-tive effect include whole blood viscosity low shear (WBVLS),whole blood viscosity high shear (WBVHS), plasma viscosity(PV), erythrocyte sedimentation rate equation𝐾 value (ESRE𝐾 value), fibrinogen, and erythrocyte aggregation index (EAindex).
2.4. Statistics. SPSS17.0 software package was used for sta-tistical analysis of the data. Data are presented as the meanand standard deviation (−x + s) or percentage (%). Repeated-measure ANOVA was conducted to test the differencesamong changes in outcomes at baseline and at the end ofweek2 and week 4 for both groups. Differences at baseline betweenthe treatment group and control group were analyzed. A𝑝 < 0.05 was considered to indicate a statistically significantdifference.
3. Results
No significant differences in age, sex, educational level,handedness, aphasia type, baseline WAB score, mRS score,or NIHSS score, or blood parameters of hemorheology wereobserved between the treatment and control groups (Tables 1
and 2). After two weeks of treatment, there was one death inthe treatment group due to severe lung infection, while threesubjects died in the control group (one due to acute heartfailure, one due to cerebral herniation, and one due to severepulmonary infection). After 4 weeks of treatment, contactwith three subjects in the treatment group was lost after theyleft the hospital. In the control group, two patients died andcontact with two subjects was lost. Fifty-four patients in thetreatment group and 51 patients in the control group wereultimately included in the statistical analyses.
The WAB scores in both groups at the end of week 2and week 4 were better than their baseline scores. The scoresfor comprehension, repetition, reading, and calculation atthe end of week 2 and week 4 in the treatment groupwere significantly improved compared with before treatment(baseline) (𝑝 < 0.05 or 𝑝 < 0.01). These scores were muchbetter at the end of week 4 in the treatment group than inthe control group (𝑝 < 0.05). At the end of week 4, the WABscores for naming and writing were better in the treatmentgroup compared with baseline (𝑝 < 0.05), while only thecomprehension and reading scores in the control group weresignificantly improved at the end of week 4. The levels ofimprovement at the end of week 4 were worse in the controlgroup than in the treatment group (𝑝 < 0.05, Table 2).
The mRS score was significantly improved at the end ofweek 2 and week 4 in the treatment group (𝑝 < 0.05 and𝑝 < 0.01) compared with baseline, and the improvementswere markedly better than those in the control group at theend of week 4 (𝑝 < 0.01).ThemRS score only improved at theend of week 4 in the control group (𝑝 < 0.05) compared withbaseline (Figure 1, left). The number of patients with an mRSscore in the 0-1 range increased in both groups at the end ofweek 2 and week 4 (Figure 1, right), although the change wassignificantly greater in the treatment group.
4 Evidence-Based Complementary and Alternative Medicine
Table 3: Changes in hemorheology between before and after the additional treatments in the treatment and control groups.
WBVLS (mPa⋅s) WBVHS (mPa⋅s) PV (mPa⋅s) ESRE𝐾 value Fibrinogen (g/L) EA indexTreatment group (𝑛 = 54)
Note. WBVLS: whole blood viscosity low shear; WBVHS: whole blood viscosity high shear; PV: plasma viscosity; ESRE 𝐾 value: erythrocyte sedimentationrate equation𝐾 value; and EA index: erythrocyte aggregation index. ∗𝑝 < 0.05 and ∗∗𝑝 < 0.01 compared with before for the same group; #𝑝 < 0.05 comparedwith control group at the same duration.
Chan
ges o
f mRS
3
0
2
1
4
5
0-12-34-5
Treatment group
Control group
17.33% 59.28% 23.39%
38.29% 52.37% 9.3455.74% 33.17% 11.09%
18.05% 58.19% 23.76%26.58% 49.69% 23.73%
37.48% 46.33% 16.19%
BaselineWeek 2Week 4
BaselineWeek 2Week 4
Treatment groupControl group
##
Base
line
Wee
k 2
Wee
k 4
∗
∗
∗∗
%
Figure 1: Changes in the modified Rankin score (mRS) betweenbefore and after the additional treatments in the treatment andcontrol groups. Note: ∗𝑝 < 0.05 and ∗∗𝑝 < 0.01 compared withbefore for the same group; ##𝑝 < 0.01 compared with control groupat the same time.
The NIHSS scores were improved at the end of week 2and week 4 in both groups compared with their respectivebaselines, although the levels were markedly better in thetreatment group than in the control group at the end of week2 and week 4 (Figure 2).
The changes in most parameters in the blood hemorheol-ogy index in the treatment group at the end of week 4 weresignificantly different compared with baseline. The changesobserved in all six parameters of the index in the treatmentgroup were different compared with the control group at theend of week 4 (Table 3).
4. Discussion
There were more dropouts and deaths in the control groupcompared to the treatment group at the end of the study. Ourresults indicate that compared with baseline the treatmentgroup (Nao-Xue-Shu oral liquid) had improved comprehen-sion, repetition, reading, and calculating scores for aphasiaparameters at the end of week 2 and the scores for thesefactors all had improved significantly at the end of week
Chan
ges o
f NIH
SS
15
0
10
5
20
25
Treatment groupControl group
##
Baseline Week 2 Week 4
∗
∗
∗∗
Figure 2: Changes in the National Institutes of Health Stroke Scale(NIHSS) scores between before and after the additional treatmentsin the treatment and control groups. Note: ∗𝑝 < 0.05 and ∗∗𝑝 < 0.01comparedwith before for the same group; ##𝑝 < 0.01 comparedwithcontrol group at the same duration.
4 compared with the control group and their baselines(Table 2). The treatment group exhibited improvements notonly in the aphasia parameters but also in limb function,indicating that Nao-Xue-Shu oral liquid also can be usedfor treating patients with mixed stroke. After 4 weeks oftreatment, the hemodynamic level of the treatment groupimproved compared with the control group, making it moreclose to the normal range (Table 3).
Mixed stroke is a common clinical cerebrovascular dis-ease, and the patients experience acute onset and rapidprogression.The cause of the disease is often an arterial lesionin the carotid artery system of the brain region, and theinfarction area is large and often accompanied by damageto advanced brain function as the result of coma, aphasia,dementia, and epilepsy [15]. These have a serious impact onthe quality of life and safety of the patient. Explaining the
Evidence-Based Complementary and Alternative Medicine 5
mechanism of action of Nao-Xue-Shu oral liquid in terms oftraditional Chinese medicine (TCM) theory may be difficultto understand for most Western doctors. Mixed stroke inTCM is explained as “apoplexia” and an “attack on the visceraand bowels” [16], caused by a Qi deficiency, blood stasis, andphlegm.Due to theQi deficiency, the blood stasis and phlegmobstruct the internal structure of blood vessel then intertwisteach other, causing the blood stasis with phlegm to insertthe vessel in the brain, leading to infarction. The abnormalblood causes intervessel high blood pressure, and forcing theblood stasis with phlegm out of the blood vessel may breakthe vessel, leading to hemorrhage [17, 18]. In TCM theory,if blood stasis is accompanied by phlegm, it can lead to amore significantly damaged lesion in the brain [19]. This isthe mechanism that explains whymixed stroke patients oftenalso have advanced neuronal damage, including aphasia,and the two pathological phenomenons of infarction andhemorrhage can be caused simultaneously. Physiologically,cleaning and powerful Qi (Qing-yang Qi) can supply energyto the brain tomaintain its function and collect andmodulatethe blood and force it to circulate in correct way in brainblood vessels [17, 18]. If the circulation has been obstructedby the blood stasis with phlegm, the occlusion of blood vesselorifices will occur and the power of Qi will decrease; Qing-yang Qi is also like nutrition for the brain; if it cannot rise, itcan lead to the brain lack of power to speak and understandthe language and then can cause dysarthria and dysphagia.When treating this disease, we should consider three TCMpathogenic matters: Qi, blood stasis, and phlegm. First, weshould eliminate Qing-yang Qi, which can modulate bloodcirculation and control or decrease bleeding. Astragalus rootas amajor component inNao-Xue-Shu oral liquid can providea stronger Qing-yang Qi [19]. The Qi also provides energy toraise the nutrient level in blood to the brain when treatingthe infarction and improves the aphasia. In TCM, Qi canimprove circulation throughout the entire system and excretemetabolin. The other main component in the oral liquid ishirudo, a type of earthworm that has been used for more thanone thousand years in China, which can rapidly eliminateblood stasis and treat the second pathogenic condition, thatof blood stasis [20, 21], without side effect as bleeding.Other than these two components, the Nao-Xue-Shu oralliquid formulation contains 5 other TCM herbs that canhelp increase Qi, remove blood stasis and phlegm, and assistthe body to excrete the pathogenic metabolites of bloodstasis and phlegm. In fact, Nao-Xue-Shu oral liquid containstwo famous prescriptions of TCM; one is Bu-Yang-Huan-Wu decoction, which originated in the Qing Dynasty (about185 years ago) and has been used frequently to treat strokein China and Asia [22, 23]. The other is Da-Huang-Shu-Chong pill, which comes from the very famous TCM textJin-Gui-Yao-Lue (By Zhang Zhongjing, about 1700 years ago)and has been used to remove blood stasis from the body[24]. The combination of these 2 prescriptions is the mosteffective treatments in treating for mixed stroke with aphasia.Clinical pharmacological studies have confirmed that Nao-Xue-Shu oral liquid accelerates the absorption of hematomain the brain of rats, reduces edema around the hematomaaccelerating fibrinolysis and inhibiting thrombosis, increases
cerebral blood flow, and improves brain blood and oxygensupply, thereby improving blood circulation and promotingthe absorption of hematoma [25].
In this study on treating mixed stroke with aphasia, webelieve the disease is caused by 3 pathogenetic mechanisms:a deficiency of Qi, blood stasis, and phlegm. The samplesize of this study is relatively small and a single blindrandom method was used, so the treatment group mighthave experienced placebo effects and we therefore cannotdraw any definite conclusion. In TCM theory, each Chinesemedicine has its own function to modulate the body or dealwith diseases, including treating brain problems, but doctorsin China are still unable to demonstrate how the medicinepasses through the blood brain barrier (BBB). IncludingTCM herbs [26, 27], many integrative medicines such asAyurveda medicine [28], electric stimulation [29], and TaiChi quan [30] cannot confirm that they influence the nervesystem directly byWesternmedical technology, but they havebeen used in many countries for treating many diseases [5].Nao-Xue-Shu oral liquid contains a type of worm and this isanother problem since, according to ethics, it is difficult tointroduce such a treatment into foreign countries, althoughworms are frequently used in TCM treatments and TCMresearchers in China have demonstrated they are harmlessand safe. In order to validate the causes of the diseasebased on clinical data, large-scale, multicenter, double-blindrandomized control studies will be needed to verify theeffectiveness of Nao-Xue-Shu oral liquid in the treatment ofmixed stroke aphasia.
Conflict of Interests
The authors declare that there is no conflict of interestsregarding the publication of this paper.
Acknowledgment
This study was sponsored and supported by the NationalNatural Science Foundation of China (81373619).
References
[1] T. Ogawa and K. Uemura, “CT and MRI diagnosis of hemor-rhagic infarction,” Nippon Rinsho, vol. 51, supplement, pp. 800–805, 1993 (Japanese).
[2] B. R. Ott, A. Zamani, J. Kleefield, and H. H. Funkenstein, “Theclinical spectrum of hemorrhagic infarction,” Stroke, vol. 17, no.4, pp. 630–637, 1986.
[3] P. F. Finelli and F. J. DiMario Jr., “Hemorrhagic infarctionin white matter following acute carbon monoxide poisoning,”Neurology, vol. 63, no. 6, pp. 1102–1104, 2004.
[4] M. S. Pessin, C. J. Estol, F. Lafranchise, and L. R. Caplan, “Safetyof anticoagulation after hemorrhagic infarction,”Neurology, vol.43, no. 7, pp. 1298–1303, 1993.
[5] W. Pan and H. Zhou, “Inclusion of integrative medicine inclinical practice,” Integrative Medicine International, vol. 1, no.1, pp. 1–4, 2014.
[6] D. Xue, B. Suo, Y. Sun et al., “Nao-Xue-Shu liquid for hemor-rhagic stroke,” Zhong Xi Yi Jie He Xin Nao Xue Guan Bing ZaZhi, vol. 5, no. 8, pp. 690–691, 2007.
6 Evidence-Based Complementary and Alternative Medicine
[7] S. Wang, R. Song, Z. Wang et al., “The clinical study forNao-Xue-Shu liquid absorb hematoma of hemorrhagic stroke,”Zhong Xi Yi Jie He Xin Nao Xue Guan Bing Za Zhi, vol. 12, no. 4,pp. 452–453, 2014.
[8] E. C. Jauch, J. L. Saver, H. P. Adams et al., “Guidelines for theearly management of patients with acute ischemic stroke: aguideline for healthcare professionals from the American HeartAssociation/American Stroke Association,” Stroke, vol. 44, no.3, pp. 870–947, 2013.
[9] J. L. Saver and L. B. Goldstein, “The new standing guidelinecommittee policy of the american stroke association strokecouncil,” Stroke, vol. 37, no. 3, p. 753, 2006.
[10] L. Xiaoping, “The laboratory research and clinical study ofNao-Xue-Shu oral liquid,” China Journal of PharmaceuticalEconomics, vol. 6, pp. 128–130, 2012.
[11] C. M. Shewan and A. Kertesz, “Reliability and validity char-acteristics of the Western Aphasia Battery (WAB),” Journal ofSpeech and Hearing Disorders, vol. 45, no. 3, pp. 308–324, 1980.
[12] J. Horner, D. V. Dawson, A. Heyman, and A. M. Fish, “Theusefulness of the Western Aphasia Battery for differentialdiagnosis of Alzheimer dementia and focal stroke syndromes:preliminary evidence,” Brain and Language, vol. 42, no. 1, pp.77–88, 1992.
[13] G. Sulter, C. Steen, and J. De Keyser, “Use of the Barthel indexandmodified Rankin scale in acute stroke trials,” Stroke, vol. 30,no. 8, pp. 1538–1541, 1999.
[14] T. Brott, H. P. Adams Jr., C. P. Olinger et al., “Measurements ofacute cerebral infarction: a clinical examination scale,” Stroke,vol. 20, no. 7, pp. 864–870, 1989.
[15] P. M. Pedersen, H. S. Jørgensen, H. Nakayama, H. O. Raaschou,and T. S. Olsen, “Aphasia in acute stroke: incidence, determi-nants, and recovery,”Annals of Neurology, vol. 38, no. 4, pp. 659–666, 1995.
[16] D.H. Yi, Y. Li, S. X. Shao, Y.M.Xie, andY. Yuwen, “Evaluation ofthe conjoint efficacy in Chinese medicine with the longitudinallatent variable linear mixed model,” Chinese Journal of Integra-tive Medicine, vol. 19, no. 8, pp. 629–635, 2013.
[17] L. M. Yang, “[Medico-psychology in Huang di nei jing (YellowEmperor’s Inner Canon)],” Zhonghua Yi Shi Za Zhi, vol. 34, no.1, pp. 21–26, 2004 (Chinese).
[18] J. Zhu, “Textual research and explanation of “Qi-Huang”,”Zhonghua Yi Shi Za Zhi, vol. 32, no. 4, pp. 200–204, 2002.
[19] Z. Chen, L. Yuan, and G. Zhang, “The clinical and laboratoryresearch of Nao-Xue-Shu liquid in treating for vascular dis-eases,” Zhong Xi Yi Jie He Xin Nao Xue Guan Bing Za Zhi, vol.12, no. 8, pp. 1005–1006, 2014.
[20] F. von Rheinbaben, O. Riebe, J. Koehnlein, and S.Werner, “Viralinfection risks for patients using the finished product Hirudoverbana (medicinal leech),” Parasitology Research, vol. 113, no.11, pp. 4199–4205, 2014.
[21] F. LeMarrec-Croq, A. Bocquet-Garcon, J. Vizioli et al., “Calreti-culin contributes to C1q-dependent recruitment of microglia inthe leech Hirudo medicinalis following a CNS injury,” MedicalScience Monitor, vol. 20, pp. 644–653, 2014.
[22] L. H. Shaw, L. C. Lin, and T. H. Tsai, “HPLC-MS/MS analysis ofa traditional Chinese medical formulation of Bu-Yang-Huan-Wu-Tang and its pharmacokinetics after oral administration torats,” PLoS ONE, vol. 7, no. 8, Article ID e43848, 2012.
[23] Z. Lai, S. Y. Wang, X. Y. Geng, C. Q. Deng, and R. Z. Zhang,“Effects of bu yang huan wu decoction on astrocytes aftercerebral ischemia and reperfusion,” Zhongguo Zhong Yao ZaZhi, vol. 27, no. 10, pp. 763–765, 2002 (Chinese).
[24] T. Jiang and H. Fu, “Progress of experimental studies on pre-scriptions designed by Zhang Zhongjing,” Journal of TraditionalChinese Medicine, vol. 16, no. 1, pp. 55–64, 1996.
[25] X. Ai and C. Liu, “The study of cleaning volume of hematomaand protecting neuron function of hemorrhagic rat model byNao-Xue-Shu liquid,” Zhong Guo Zhong Xi Yi Jie He Xin NaoXue Guan Bing Za Zhi, vol. 11, no. 7, pp. 859–861, 2014.
[26] W. Pan, Q. Wang, S. Kwak et al., “Shen-zhi-ling oral liquidimproves behavioral and psychological symptoms of dementiain Alzheimer’s disease,” Evidence-Based Complementary andAlternative Medicine, vol. 2014, Article ID 913687, 6 pages, 2014.
[27] J. Shen, X. Chen, X. Chen, and R. Deng, “Targeting neu-rogenesis: a promising therapeutic strategy for post-stroketreatment with Chinese herbal medicine,” Integrative MedicineInternational, vol. 1, no. 1, pp. 5–18, 2014.
[28] P. Santiago Lloret, M. Veronica Rey, and O. Rascol, “Ayurvedamedicine for the treatment of Parkinson’s disease,” InternationalJournal of Integrative Medicine, vol. 1, article 6, 2013.
[29] J. Lee, J. Y. Cho, and K. W. Kim, “Rapid treatment of waistpain by nanoscale electric stimulation,” Integrative MedicineInternational, vol. 1, no. 1, pp. 19–24, 2014.
[30] F. Li, “Tai Ji Quan exercise for people with Parkinson’s diseaseand other neurodegenerative movement disorders,” Interna-tional Journal of Integrative Medicine, vol. 1, no. 4, 2013.
