Case Report

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Journal of Acupuncture Research 2025; 42:14-20

Published online January 20, 2025

https://doi.org/10.13045/jar.24.0056

© Korean Acupuncture & Moxibustion Medicine Society

Effect of a Complex Korean Medicine Treatment in a Patient with Chronic Ischemic Stroke Who Developed Neurological Complications after Posterior Lumbar Interbody Fusion: A Case Report

Shin-Hyeok Park1 , Sohae Cho1 , HyunSeung Lee2 , Jieun Kim3 , Nam Geun Cho1

1Department of Acupuncture and Moxibustion Medicine, College of Korean Medicine, Wonkwang University, Iksan, Korea
2Department of Korean Medicine, Graduate School of Wonkwang University, Iksan, Korea
3Department of Korean Medicine Rehabilitation, College of Korean Medicine, Wonkwang University, Iksan, Korea

Correspondence to : Nam Geun Cho
Department of Acupuncture and Moxibustion Medicine, College of Korean Medicine, Wonkwang University, 895 Muwang-ro, Iksan 54538, Korea
E-mail: choandle@hanmail.net

Received: October 23, 2024; Revised: October 31, 2024; Accepted: November 14, 2024

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Stroke is a considerable cause of death; patients with stroke require continuous treatment. The recovery rates dramatically decline in the chronic phase (6 months post-onset), making it difficult to achieve meaningful therapeutic effects. Posterior lumbar interbody fusion (PLIF) is used to correct deformities in spinal disorders, but it can induce chronic radiculopathy, necessitating prolonged treatment. We report the effectiveness of complex Korean medicine treatment in a patient with chronic stroke and post-PLIF complications. The patient presented with right hemiparesis, low back pain, and bilateral radiculopathy. She underwent > 100 days of treatments, including acupuncture, cupping, herbal medicine, and physiotherapy. Her right handgrip strength and hip flexion improved from grade 1+ to 2+ and from grade 2+/3- to 4/5, respectively. The score on the Korean version of the Modified Barthel Index increased from 32 to 42. Given the treatment challenges in chronic stroke with overlapping symptoms, complex Korean medicine may improve the outcomes.

Keywords Acupuncture; Case report; Complications; Spinal stenosis; Stroke; Traditional medicine

Stroke is the principal cause of mortality in South Korea. Despite the advancements in medical technology that reduce mortality rates, the number of patients requiring management for functional impairments continues to increase [1]. Stroke can be classified according to the following temporal patterns: acute phase within 7 days of onset, subacute phase within 6 months, and chronic phase thereafter. The recovery of functions, particularly motor functions, predominantly occurs during the subacute phase within the first month post-onset. In the chronic phase, the recovery rate considerably decreases, making it challenging to achieve substantial therapeutic effects through interventions [2]. Thus, the prognoses are likely to be poorer in stroke cases with accompanying similar symptomatic conditions as compared to cases with chronic stroke alone. In the present case report, we describe the case of a patient with chronic stroke who developed postoperative neurological complications after posterior lumbar interbody fusion (PLIF). PLIF is used to decompress neural elements and correct deformities via spinal segment fusion in various spinal disorders [3]. Occasionally, PLIF induces chronic lower limb radiculopathy due to nerve root retraction damage [4], requiring reoperation within 2 weeks or prolonged treatment extending over 5 months [5]. Although various treatments, including acupuncture, electroacupuncture, herbal medicine, and cupping, have been reported for stroke and post-PLIF complications separately [6,7], cases wherein these conditions occur simultaneously have not been reported. In this case report, we present the case of a patient with chronic ischemic stroke and post-PLIF neurological sequelae who achieved considerable improvements after receiving complex Korean medicine treatments.

An 85-year-old female with hyperlipidemia and a history of vertebroplasty for compression fractures (T12, L1, L2) presented to Wonkwang University Hospital on November 7, 2023, with sudden weakness in the right upper and lower limbs. Brain magnetic resonance imaging (MRI) performed on admission revealed an acute cerebral infarction in the left basal ganglia (Fig. 1). Conservative treatment was initiated. During treatment, worsening low back pain and bilateral radiculopathy necessitated lumbar spinal MRI, which revealed spondylolisthesis and spinal and foraminal stenoses at L4/5 (Fig. 2). The patient underwent PLIF on February 23, 2024 (Fig. 3). Thereafter, the patient received conservative treatment but did not experience notable improvement in symptoms, leading to treatment dissatisfaction. Consequently, Korean medicine treatment was considered necessary. Additionally, concerns about the side effects from prolonged medication use led the patient to undergo Korean medicine treatment as an alternative.

Fig. 1. Diffusion-weighted magnetic resonance images (b3000) of the brain in the transverse plane obtained on November 07, 2023.
Fig. 2. Magnetic resonance images of the lumbar spine obtained on February 21, 2024. (A) Sagittal view. (B) Transverse view at L4/5.
Fig. 3. X-ray images of the lumbar spine in a lateral view. (A) On February 21, 2024. (B) On February 26, 2024.

The patient was hospitalized for 106 days (from May 27, 2024, to September 9, 2024) at Wonkwang University Korean Medicine Hospital (Fig. 4). On the day of admission (Day 1), she reported weakness in the right upper limb and both lower limbs, low back pain, and radiating pain and numbness in both legs. The results of the manual muscle test (quantifies muscle strength on a scale of 0–5) [8] were as follows: handgrip, wrist, hip, knee, ankle, and great toe joint strengths were graded as 1+/5, 1+/5, 2+/3-, 3/5, 1/2-, and 1/2-, respectively. She required moderate assistance to roll over and maximal assistance to sit up and stand, with ambulation restricted to a wheelchair. Her Korean version of the Modified Barthel Index (K-MBI) score, which is used to assess a patient’s ability to perform activities of daily living (ADLs), was 32 [9]. Acupuncture was performed daily using needles (0.30 × 30 mm; Dongbang Medical Co., Ltd.) inserted to a depth of 10 mm and retained for 15 minutes to induce de qi at the bilateral BL23, BL25, TE5, GB34, GB39, and right EX-UE9 points. Daily cupping therapy was performed at the bilateral BL23 and BL25 points for 7 minutes. Standing frame training was conducted five times a week for 30 minutes, and functional electrical stimulation (FES) was applied for 30 minutes to the bilateral ankle dorsiflexors and right wrist extensors. Laboratory tests for the accompanying symptoms of lethargy, decreased appetite, fatigue, and head heaviness showed no specific findings, eliminating an organic cause (Table 1). Thus, the chief complaint was diagnosed as liver-kidney depletion using Korean medicine, and the patient was prescribed Dokhwalgisaeng-tang (Table 2). On Day 20, the patient reported reduced pain and numbness in the lower back and both legs. She also felt lighter but she still had discomforts on her buttocks and posterior thighs. Additional acupuncture treatments were administered daily for 10 days using needles (0.40 × 60 mm; Dongbang Medical Co., Ltd.) inserted to a depth of 30 mm and retained for 15 minutes, targeting the tender points in the buttocks. Eventually, the intensity of pain and numbness decreased. By Day 37, the patient’s muscle strength and ability to perform ADL improved, requiring only minimal assistance to roll over and moderate assistance to sit up. On Day 57, her hip flexion strength increased to grade 3+/3+, and she required minimal assistance for sitting up and moderate assistance for standing. She could briefly lift one foot off the ground with maximum support and reported increased tingling in both legs after the standing exercises. By Day 60, her K-MBI score increased to 37, and she could lift her foot up to 10 times with maximum support. On Day 71, the right handgrip strength improved to grade 2+, enabling her to perform cylindrical and spherical grasps. Her muscle strength in both lower limbs also improved, allowing her to lift her foot up to 20 times with maximum assistance. She performed bridge exercises while supporting the ankles to stabilize her trunk muscles and improve balance [10]. By Day 78, the patient reported no worsening of leg tingling after the standing exercises. On Day 90, hip flexion strength reached grade 4/5, and the K-MBI score increased to 42; the patient could walk short distances with a walker under moderate assistance (Table 3). The patient reported decreased pain and numbness in both legs. The patient was discharged on Day 106, with a final K-MBI score of 42.

Fig. 4. Timeline of the patient’s hospitalization. K-MBI, Korean version of the Modified Barthel Index.

Table 1 . Patient’s laboratory test results on Day 1 (day of admission, May 28, 2024)

Laboratory testResultReference value
White blood cell4.57 103/μL4.00–10.00 103/μL
Red blood cells3.97 106/μL3.80–5.40 106/μL
Albumin4.10 g/dL3.50–5.20 g/dL
Total protein6.47 g/dL6.40–8.30 g/dL
Aspartate aminotransferase23 IU/L< 32 IU/L
Alanine aminotransferase16 IU/L< 33 IU/L
γ-glutamyltranspeptidase13 IU/L6–42 IU/L
Alkaline phosphatase74 IU/L35–104 IU/L

Table 2 . Composition of the 1-day dose of the herbal medicine (Dokhwalgisaeng-tang) prescribed throughout the hospitalization period

Composition1-day dosage (g)*
Loranthus parasiticus Merr.16
Aralia continentalis Kitagawa, Eucommia ulmoides Oliver, Rehmannia glutinosa Liboschitz ex Steudel, Cnidium officinale Makino, Angelica gigas Nakai, Saposhnikovia divaricata Schischkin12
Chaenomeles sinensis (Thouin) Koehne, Poria cocos Wolf, Achyranthes japonica Nakai, Panax ginseng C. A. Meyer, Glycyrrhiza uralensis Fischer, Cinnamomum cassia J.Presl, Paeonia lactiflora Pallas, Crataegus pinnatifida Bunge, Gentiana macrophylla Pallas, Astragalus membranaceus Bunge, Triticum aestivum Linné (as Massa Medicata Fermentata)8
Atractylodes japonica Koidz.6

*This herbal medicine was administered orally three times daily, at 2 h postprandial, in a warm state.


Table 3 . Results of the manual muscle testing for the upper and lower limbs

AdmissionDay 30Day 37Day 57Day 71Day 90Discharge
Shoulder flexion2-/52-/52-/52-/52-/52-/52-/5
Elbow flexion2-/52-/52-/52-/52-/52-/52-/5
Wrist flexion1+/51+/51+/51+/51+/51+/51+/5
Wrist extension1+/51+/51+/51+/51+/51+/51+/5
Hand grip1+/51+/51+/51+/52+/52+/52+/5
Hip flexion2+/3-3-/33/33+/3+3+/44/54/5
Hip extension2+/3-3-/33/33/33+/3+3+/3+3+/3+
Knee flexion3/54/54/54/54/54/54/5
Knee extension3/54/54/54/54/54/54/5
Ankle dorsiflexion1/2-1/2-1+/2-1+/2-1+/2-1+/2-1+/2-
Ankle plantarflexion1/2-1/2-1+/2-1+/2-2-/2-2-/2-2-/2-
Great toe flexion1/2-1/2-1/2-1/2-1/2-1/2-1/2-
Great toe extension1/2-1/2-1/2-1/2-1/2-1/2-1/2-


During hospitalization, the K-MBI score improved from 32 at admission to 42 at discharge (an increase of 10 points). Notable improvements were observed in the “Ambulation,” “Chair/Bed transfers,” and “Bladder control” categories, which increased by 3, 5, and 2 points, respectively [11]. The numerical rating scale (NRS) measures a patient’s pain on a scale of 0 (no pain) to 10 (most severe pain) [12]. The patient’s low back pain, along with radiating pain and numbness in both legs, decreased from an NRS score of 5 at admission to 3 on Day 20 and further to 2 by Day 90. Throughout the treatment, the patient consistently took the medication prescribed by the hospital where she received the initial acute stroke treatment, with no dosage changes (Table 4). No diagnostic challenges were encountered in this case, and no adverse effects or reactions were observed during treatment.

Table 4 . Compositions, dosage, and administration of medications taken by the patient during the hospitalization period

Composition of medication1-day dosageAdministration method of the medication
Clopidogrel bisulfate 97.875 mg1 tabletQuaque die (after breakfast)
Ezetimibe 10 mg, rosuvastatin calcium 10.4 mg1 tabletQuaque die (after breakfast)
Rebamipide 150 mg1 tabletQuaque die (after breakfast)
Duloxetine hydrochloride granule 176.47 mg1 capsuleQuaque die (after dinner)
Limaprost alfadex 166.67 μg1 tabletTer in die
Pregabalin 75 mg1capsuleTer in die
Artemisia Herb isopropanol soft extract (20 → 1) 60 mg1 tabletTer in die
Acetaminophen 162.5 mg, tramadol hydrochloride 18.75 mg1 tabletTer in die
Mecobalamin 50 μg1 tabletTer in die
Benfotiamine 69.15 mg, cyanocobalamin 0.5 mg, pyridoxine hydrochloride 50 mg1 capsuleBis in die

Stroke is a chronic disease that causes severe functional impairment and poses a great burden on patients, caregivers, and communities [1]. Most recovery occurs within the first month and plateaus within 6 months [2], making aggressive rehabilitation essential. The present case study involved a 6-month post-stroke patient who faced therapeutic challenges that could delay functional recovery, including low back pain and bilateral radiculopathy, following PLIF. The patient underwent complex Korean medicine treatment, including acupuncture, cupping, herbal medicine, and FES, which reduced pain and numbness from NRS 5 to 2 and improved muscle strength from grade 1+ to 2+ in the right handgrip and from grade 2+/3- to 4/5 in hip flexion. The improvements in functional abilities greatly enhanced the patient’s ability to perform ADLs, which is clinically significant. The K-MBI score increased by 10 points, surpassing the average increase of 3.2 points seen in a study involving 1,011 patients with chronic ischemic stroke, and exceeded the minimal clinically important difference of 9.25 points, underscoring its meaningfulness [13].

The BL23 and BL25 acupuncture points are commonly used for their local analgesic effects in treating low back pain [14]. GB34 and GB39, which are part of the eight meeting points in Korean medicine for the muscle and marrow, respectively, are known to modulate the cerebral areas associated with hemiparesis [15] and improve lower limb weakness due to lumbar stenosis [16]. TE5 and EX-UE9 are used to stimulate the sensorimotor network of the central nervous system in stroke patients, enhancing connectivity and improving the motor disturbances of the hand [17,18]. In Korean medicine, the herbal medicine Dokhwalgisaeng-tang is prescribed to supplement the liver and kidney qi in patients diagnosed with liver-kidney depletion-type wilting disease, characterized by general weakness, decreased appetite, fatigue, and muscle weakness in the limbs. This prescription aims to improve functional impairments through muscular strength enhancement, regulate immune function, and alleviate pain [19]. Physical interventions, including FES and bridge and standing exercises, prevent muscle atrophy, increase strength, and improve gait [20]. Ultimately, considering the patient’s symptoms and concerns regarding the potential side effects of medication, a complex treatment centered on acupuncture as a non-pharmacological therapy was administered. Acupuncture was performed to achieve multiple therapeutic goals, including cerebral nervous system modulation, muscle strengthening, and pain relief. Additionally, other non-pharmacological therapies such as cupping and physiotherapy were used to alleviate pain and enhance muscle strength, respectively. Herbal medicine was prescribed adjunctively to address the pathological conditions based on the Korean medical diagnosis. This approach achieved comprehensive therapeutic outcomes, including ADL improvements through the achievement of specific treatment objectives, as previously described. Compared with conventional treatments, the complex Korean medicine treatment demonstrated superior efficacy, suggesting its considerable advantages in clinical practice.

The present study has several limitations. First, it did not consider psychological factors, which are important for stroke prognosis, and showed insufficient improvement in upper limb motor function. Second, as the present investigation is a single case study without a control group, the effects of the complex Korean medicine treatment cannot be generalized. Furthermore, because multiple treatments were administered simultaneously, it was unclear which treatments specifically addressed certain symptoms. Despite these limitations, the present study demonstrated that the complex Korean medicine treatments led to clinical improvement in a patient with chronic ischemic stroke requiring ongoing rehabilitation due to post-PLIF neurologic complications. This study provides a clinical case that serves as a basis for further research. Future well-controlled, large-scale studies are needed to verify the effectiveness of complex Korean medicine treatments.

Conceptualization: SHP, SC, NGC. Data curation: SHP, HSL. Formal analysis: SHP, SC, HSL. Investigation: SHP. Methodology: SHP. Visualization: SHP, HSL. Writing - original draft: SHP. Writing - review & editing: All authors.

We thank the patient for allowing us to use the medical records to report her case.

Regarding the access and use of patient medical records, informed consent was obtained from the patient at the time of admission. This study was approved by the Institutional Review Board of Wonkwang University Korean Medicine Hospital (No.: WKUIOMH-IRB-2024-14).

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Article

Case Report

Journal of Acupuncture Research 2025; 42(): 14-20

Published online January 20, 2025 https://doi.org/10.13045/jar.24.0056

Copyright © Korean Acupuncture & Moxibustion Medicine Society.

Effect of a Complex Korean Medicine Treatment in a Patient with Chronic Ischemic Stroke Who Developed Neurological Complications after Posterior Lumbar Interbody Fusion: A Case Report

Shin-Hyeok Park1 , Sohae Cho1 , HyunSeung Lee2 , Jieun Kim3 , Nam Geun Cho1

1Department of Acupuncture and Moxibustion Medicine, College of Korean Medicine, Wonkwang University, Iksan, Korea
2Department of Korean Medicine, Graduate School of Wonkwang University, Iksan, Korea
3Department of Korean Medicine Rehabilitation, College of Korean Medicine, Wonkwang University, Iksan, Korea

Correspondence to:Nam Geun Cho
Department of Acupuncture and Moxibustion Medicine, College of Korean Medicine, Wonkwang University, 895 Muwang-ro, Iksan 54538, Korea
E-mail: choandle@hanmail.net

Received: October 23, 2024; Revised: October 31, 2024; Accepted: November 14, 2024

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Stroke is a considerable cause of death; patients with stroke require continuous treatment. The recovery rates dramatically decline in the chronic phase (6 months post-onset), making it difficult to achieve meaningful therapeutic effects. Posterior lumbar interbody fusion (PLIF) is used to correct deformities in spinal disorders, but it can induce chronic radiculopathy, necessitating prolonged treatment. We report the effectiveness of complex Korean medicine treatment in a patient with chronic stroke and post-PLIF complications. The patient presented with right hemiparesis, low back pain, and bilateral radiculopathy. She underwent > 100 days of treatments, including acupuncture, cupping, herbal medicine, and physiotherapy. Her right handgrip strength and hip flexion improved from grade 1+ to 2+ and from grade 2+/3- to 4/5, respectively. The score on the Korean version of the Modified Barthel Index increased from 32 to 42. Given the treatment challenges in chronic stroke with overlapping symptoms, complex Korean medicine may improve the outcomes.

Keywords: Acupuncture, Case report, Complications, Spinal stenosis, Stroke, Traditional medicine

INTRODUCTION

Stroke is the principal cause of mortality in South Korea. Despite the advancements in medical technology that reduce mortality rates, the number of patients requiring management for functional impairments continues to increase [1]. Stroke can be classified according to the following temporal patterns: acute phase within 7 days of onset, subacute phase within 6 months, and chronic phase thereafter. The recovery of functions, particularly motor functions, predominantly occurs during the subacute phase within the first month post-onset. In the chronic phase, the recovery rate considerably decreases, making it challenging to achieve substantial therapeutic effects through interventions [2]. Thus, the prognoses are likely to be poorer in stroke cases with accompanying similar symptomatic conditions as compared to cases with chronic stroke alone. In the present case report, we describe the case of a patient with chronic stroke who developed postoperative neurological complications after posterior lumbar interbody fusion (PLIF). PLIF is used to decompress neural elements and correct deformities via spinal segment fusion in various spinal disorders [3]. Occasionally, PLIF induces chronic lower limb radiculopathy due to nerve root retraction damage [4], requiring reoperation within 2 weeks or prolonged treatment extending over 5 months [5]. Although various treatments, including acupuncture, electroacupuncture, herbal medicine, and cupping, have been reported for stroke and post-PLIF complications separately [6,7], cases wherein these conditions occur simultaneously have not been reported. In this case report, we present the case of a patient with chronic ischemic stroke and post-PLIF neurological sequelae who achieved considerable improvements after receiving complex Korean medicine treatments.

CASE REPORT

An 85-year-old female with hyperlipidemia and a history of vertebroplasty for compression fractures (T12, L1, L2) presented to Wonkwang University Hospital on November 7, 2023, with sudden weakness in the right upper and lower limbs. Brain magnetic resonance imaging (MRI) performed on admission revealed an acute cerebral infarction in the left basal ganglia (Fig. 1). Conservative treatment was initiated. During treatment, worsening low back pain and bilateral radiculopathy necessitated lumbar spinal MRI, which revealed spondylolisthesis and spinal and foraminal stenoses at L4/5 (Fig. 2). The patient underwent PLIF on February 23, 2024 (Fig. 3). Thereafter, the patient received conservative treatment but did not experience notable improvement in symptoms, leading to treatment dissatisfaction. Consequently, Korean medicine treatment was considered necessary. Additionally, concerns about the side effects from prolonged medication use led the patient to undergo Korean medicine treatment as an alternative.

Figure 1. Diffusion-weighted magnetic resonance images (b3000) of the brain in the transverse plane obtained on November 07, 2023.
Figure 2. Magnetic resonance images of the lumbar spine obtained on February 21, 2024. (A) Sagittal view. (B) Transverse view at L4/5.
Figure 3. X-ray images of the lumbar spine in a lateral view. (A) On February 21, 2024. (B) On February 26, 2024.

The patient was hospitalized for 106 days (from May 27, 2024, to September 9, 2024) at Wonkwang University Korean Medicine Hospital (Fig. 4). On the day of admission (Day 1), she reported weakness in the right upper limb and both lower limbs, low back pain, and radiating pain and numbness in both legs. The results of the manual muscle test (quantifies muscle strength on a scale of 0–5) [8] were as follows: handgrip, wrist, hip, knee, ankle, and great toe joint strengths were graded as 1+/5, 1+/5, 2+/3-, 3/5, 1/2-, and 1/2-, respectively. She required moderate assistance to roll over and maximal assistance to sit up and stand, with ambulation restricted to a wheelchair. Her Korean version of the Modified Barthel Index (K-MBI) score, which is used to assess a patient’s ability to perform activities of daily living (ADLs), was 32 [9]. Acupuncture was performed daily using needles (0.30 × 30 mm; Dongbang Medical Co., Ltd.) inserted to a depth of 10 mm and retained for 15 minutes to induce de qi at the bilateral BL23, BL25, TE5, GB34, GB39, and right EX-UE9 points. Daily cupping therapy was performed at the bilateral BL23 and BL25 points for 7 minutes. Standing frame training was conducted five times a week for 30 minutes, and functional electrical stimulation (FES) was applied for 30 minutes to the bilateral ankle dorsiflexors and right wrist extensors. Laboratory tests for the accompanying symptoms of lethargy, decreased appetite, fatigue, and head heaviness showed no specific findings, eliminating an organic cause (Table 1). Thus, the chief complaint was diagnosed as liver-kidney depletion using Korean medicine, and the patient was prescribed Dokhwalgisaeng-tang (Table 2). On Day 20, the patient reported reduced pain and numbness in the lower back and both legs. She also felt lighter but she still had discomforts on her buttocks and posterior thighs. Additional acupuncture treatments were administered daily for 10 days using needles (0.40 × 60 mm; Dongbang Medical Co., Ltd.) inserted to a depth of 30 mm and retained for 15 minutes, targeting the tender points in the buttocks. Eventually, the intensity of pain and numbness decreased. By Day 37, the patient’s muscle strength and ability to perform ADL improved, requiring only minimal assistance to roll over and moderate assistance to sit up. On Day 57, her hip flexion strength increased to grade 3+/3+, and she required minimal assistance for sitting up and moderate assistance for standing. She could briefly lift one foot off the ground with maximum support and reported increased tingling in both legs after the standing exercises. By Day 60, her K-MBI score increased to 37, and she could lift her foot up to 10 times with maximum support. On Day 71, the right handgrip strength improved to grade 2+, enabling her to perform cylindrical and spherical grasps. Her muscle strength in both lower limbs also improved, allowing her to lift her foot up to 20 times with maximum assistance. She performed bridge exercises while supporting the ankles to stabilize her trunk muscles and improve balance [10]. By Day 78, the patient reported no worsening of leg tingling after the standing exercises. On Day 90, hip flexion strength reached grade 4/5, and the K-MBI score increased to 42; the patient could walk short distances with a walker under moderate assistance (Table 3). The patient reported decreased pain and numbness in both legs. The patient was discharged on Day 106, with a final K-MBI score of 42.

Figure 4. Timeline of the patient’s hospitalization. K-MBI, Korean version of the Modified Barthel Index.

Table 1 . Patient’s laboratory test results on Day 1 (day of admission, May 28, 2024).

Laboratory testResultReference value
White blood cell4.57 103/μL4.00–10.00 103/μL
Red blood cells3.97 106/μL3.80–5.40 106/μL
Albumin4.10 g/dL3.50–5.20 g/dL
Total protein6.47 g/dL6.40–8.30 g/dL
Aspartate aminotransferase23 IU/L< 32 IU/L
Alanine aminotransferase16 IU/L< 33 IU/L
γ-glutamyltranspeptidase13 IU/L6–42 IU/L
Alkaline phosphatase74 IU/L35–104 IU/L

Table 2 . Composition of the 1-day dose of the herbal medicine (Dokhwalgisaeng-tang) prescribed throughout the hospitalization period.

Composition1-day dosage (g)*
Loranthus parasiticus Merr.16
Aralia continentalis Kitagawa, Eucommia ulmoides Oliver, Rehmannia glutinosa Liboschitz ex Steudel, Cnidium officinale Makino, Angelica gigas Nakai, Saposhnikovia divaricata Schischkin12
Chaenomeles sinensis (Thouin) Koehne, Poria cocos Wolf, Achyranthes japonica Nakai, Panax ginseng C. A. Meyer, Glycyrrhiza uralensis Fischer, Cinnamomum cassia J.Presl, Paeonia lactiflora Pallas, Crataegus pinnatifida Bunge, Gentiana macrophylla Pallas, Astragalus membranaceus Bunge, Triticum aestivum Linné (as Massa Medicata Fermentata)8
Atractylodes japonica Koidz.6

*This herbal medicine was administered orally three times daily, at 2 h postprandial, in a warm state..


Table 3 . Results of the manual muscle testing for the upper and lower limbs.

AdmissionDay 30Day 37Day 57Day 71Day 90Discharge
Shoulder flexion2-/52-/52-/52-/52-/52-/52-/5
Elbow flexion2-/52-/52-/52-/52-/52-/52-/5
Wrist flexion1+/51+/51+/51+/51+/51+/51+/5
Wrist extension1+/51+/51+/51+/51+/51+/51+/5
Hand grip1+/51+/51+/51+/52+/52+/52+/5
Hip flexion2+/3-3-/33/33+/3+3+/44/54/5
Hip extension2+/3-3-/33/33/33+/3+3+/3+3+/3+
Knee flexion3/54/54/54/54/54/54/5
Knee extension3/54/54/54/54/54/54/5
Ankle dorsiflexion1/2-1/2-1+/2-1+/2-1+/2-1+/2-1+/2-
Ankle plantarflexion1/2-1/2-1+/2-1+/2-2-/2-2-/2-2-/2-
Great toe flexion1/2-1/2-1/2-1/2-1/2-1/2-1/2-
Great toe extension1/2-1/2-1/2-1/2-1/2-1/2-1/2-


During hospitalization, the K-MBI score improved from 32 at admission to 42 at discharge (an increase of 10 points). Notable improvements were observed in the “Ambulation,” “Chair/Bed transfers,” and “Bladder control” categories, which increased by 3, 5, and 2 points, respectively [11]. The numerical rating scale (NRS) measures a patient’s pain on a scale of 0 (no pain) to 10 (most severe pain) [12]. The patient’s low back pain, along with radiating pain and numbness in both legs, decreased from an NRS score of 5 at admission to 3 on Day 20 and further to 2 by Day 90. Throughout the treatment, the patient consistently took the medication prescribed by the hospital where she received the initial acute stroke treatment, with no dosage changes (Table 4). No diagnostic challenges were encountered in this case, and no adverse effects or reactions were observed during treatment.

Table 4 . Compositions, dosage, and administration of medications taken by the patient during the hospitalization period.

Composition of medication1-day dosageAdministration method of the medication
Clopidogrel bisulfate 97.875 mg1 tabletQuaque die (after breakfast)
Ezetimibe 10 mg, rosuvastatin calcium 10.4 mg1 tabletQuaque die (after breakfast)
Rebamipide 150 mg1 tabletQuaque die (after breakfast)
Duloxetine hydrochloride granule 176.47 mg1 capsuleQuaque die (after dinner)
Limaprost alfadex 166.67 μg1 tabletTer in die
Pregabalin 75 mg1capsuleTer in die
Artemisia Herb isopropanol soft extract (20 → 1) 60 mg1 tabletTer in die
Acetaminophen 162.5 mg, tramadol hydrochloride 18.75 mg1 tabletTer in die
Mecobalamin 50 μg1 tabletTer in die
Benfotiamine 69.15 mg, cyanocobalamin 0.5 mg, pyridoxine hydrochloride 50 mg1 capsuleBis in die

DISCUSSION

Stroke is a chronic disease that causes severe functional impairment and poses a great burden on patients, caregivers, and communities [1]. Most recovery occurs within the first month and plateaus within 6 months [2], making aggressive rehabilitation essential. The present case study involved a 6-month post-stroke patient who faced therapeutic challenges that could delay functional recovery, including low back pain and bilateral radiculopathy, following PLIF. The patient underwent complex Korean medicine treatment, including acupuncture, cupping, herbal medicine, and FES, which reduced pain and numbness from NRS 5 to 2 and improved muscle strength from grade 1+ to 2+ in the right handgrip and from grade 2+/3- to 4/5 in hip flexion. The improvements in functional abilities greatly enhanced the patient’s ability to perform ADLs, which is clinically significant. The K-MBI score increased by 10 points, surpassing the average increase of 3.2 points seen in a study involving 1,011 patients with chronic ischemic stroke, and exceeded the minimal clinically important difference of 9.25 points, underscoring its meaningfulness [13].

The BL23 and BL25 acupuncture points are commonly used for their local analgesic effects in treating low back pain [14]. GB34 and GB39, which are part of the eight meeting points in Korean medicine for the muscle and marrow, respectively, are known to modulate the cerebral areas associated with hemiparesis [15] and improve lower limb weakness due to lumbar stenosis [16]. TE5 and EX-UE9 are used to stimulate the sensorimotor network of the central nervous system in stroke patients, enhancing connectivity and improving the motor disturbances of the hand [17,18]. In Korean medicine, the herbal medicine Dokhwalgisaeng-tang is prescribed to supplement the liver and kidney qi in patients diagnosed with liver-kidney depletion-type wilting disease, characterized by general weakness, decreased appetite, fatigue, and muscle weakness in the limbs. This prescription aims to improve functional impairments through muscular strength enhancement, regulate immune function, and alleviate pain [19]. Physical interventions, including FES and bridge and standing exercises, prevent muscle atrophy, increase strength, and improve gait [20]. Ultimately, considering the patient’s symptoms and concerns regarding the potential side effects of medication, a complex treatment centered on acupuncture as a non-pharmacological therapy was administered. Acupuncture was performed to achieve multiple therapeutic goals, including cerebral nervous system modulation, muscle strengthening, and pain relief. Additionally, other non-pharmacological therapies such as cupping and physiotherapy were used to alleviate pain and enhance muscle strength, respectively. Herbal medicine was prescribed adjunctively to address the pathological conditions based on the Korean medical diagnosis. This approach achieved comprehensive therapeutic outcomes, including ADL improvements through the achievement of specific treatment objectives, as previously described. Compared with conventional treatments, the complex Korean medicine treatment demonstrated superior efficacy, suggesting its considerable advantages in clinical practice.

The present study has several limitations. First, it did not consider psychological factors, which are important for stroke prognosis, and showed insufficient improvement in upper limb motor function. Second, as the present investigation is a single case study without a control group, the effects of the complex Korean medicine treatment cannot be generalized. Furthermore, because multiple treatments were administered simultaneously, it was unclear which treatments specifically addressed certain symptoms. Despite these limitations, the present study demonstrated that the complex Korean medicine treatments led to clinical improvement in a patient with chronic ischemic stroke requiring ongoing rehabilitation due to post-PLIF neurologic complications. This study provides a clinical case that serves as a basis for further research. Future well-controlled, large-scale studies are needed to verify the effectiveness of complex Korean medicine treatments.

AUTHOR CONTRIBUTIONS

Conceptualization: SHP, SC, NGC. Data curation: SHP, HSL. Formal analysis: SHP, SC, HSL. Investigation: SHP. Methodology: SHP. Visualization: SHP, HSL. Writing - original draft: SHP. Writing - review & editing: All authors.

CONFLICTS OF INTEREST

The authors have no conflicts of interest to declare.

FUNDING

None.

ACKNOWLEDGMENTS

We thank the patient for allowing us to use the medical records to report her case.

ETHICAL STATEMENT

Regarding the access and use of patient medical records, informed consent was obtained from the patient at the time of admission. This study was approved by the Institutional Review Board of Wonkwang University Korean Medicine Hospital (No.: WKUIOMH-IRB-2024-14).

Fig 1.

Figure 1.Diffusion-weighted magnetic resonance images (b3000) of the brain in the transverse plane obtained on November 07, 2023.
Journal of Acupuncture Research 2025; 42: 14-20https://doi.org/10.13045/jar.24.0056

Fig 2.

Figure 2.Magnetic resonance images of the lumbar spine obtained on February 21, 2024. (A) Sagittal view. (B) Transverse view at L4/5.
Journal of Acupuncture Research 2025; 42: 14-20https://doi.org/10.13045/jar.24.0056

Fig 3.

Figure 3.X-ray images of the lumbar spine in a lateral view. (A) On February 21, 2024. (B) On February 26, 2024.
Journal of Acupuncture Research 2025; 42: 14-20https://doi.org/10.13045/jar.24.0056

Fig 4.

Figure 4.Timeline of the patient’s hospitalization. K-MBI, Korean version of the Modified Barthel Index.
Journal of Acupuncture Research 2025; 42: 14-20https://doi.org/10.13045/jar.24.0056

Table 1 . Patient’s laboratory test results on Day 1 (day of admission, May 28, 2024).

Laboratory testResultReference value
White blood cell4.57 103/μL4.00–10.00 103/μL
Red blood cells3.97 106/μL3.80–5.40 106/μL
Albumin4.10 g/dL3.50–5.20 g/dL
Total protein6.47 g/dL6.40–8.30 g/dL
Aspartate aminotransferase23 IU/L< 32 IU/L
Alanine aminotransferase16 IU/L< 33 IU/L
γ-glutamyltranspeptidase13 IU/L6–42 IU/L
Alkaline phosphatase74 IU/L35–104 IU/L

Table 2 . Composition of the 1-day dose of the herbal medicine (Dokhwalgisaeng-tang) prescribed throughout the hospitalization period.

Composition1-day dosage (g)*
Loranthus parasiticus Merr.16
Aralia continentalis Kitagawa, Eucommia ulmoides Oliver, Rehmannia glutinosa Liboschitz ex Steudel, Cnidium officinale Makino, Angelica gigas Nakai, Saposhnikovia divaricata Schischkin12
Chaenomeles sinensis (Thouin) Koehne, Poria cocos Wolf, Achyranthes japonica Nakai, Panax ginseng C. A. Meyer, Glycyrrhiza uralensis Fischer, Cinnamomum cassia J.Presl, Paeonia lactiflora Pallas, Crataegus pinnatifida Bunge, Gentiana macrophylla Pallas, Astragalus membranaceus Bunge, Triticum aestivum Linné (as Massa Medicata Fermentata)8
Atractylodes japonica Koidz.6

*This herbal medicine was administered orally three times daily, at 2 h postprandial, in a warm state..


Table 3 . Results of the manual muscle testing for the upper and lower limbs.

AdmissionDay 30Day 37Day 57Day 71Day 90Discharge
Shoulder flexion2-/52-/52-/52-/52-/52-/52-/5
Elbow flexion2-/52-/52-/52-/52-/52-/52-/5
Wrist flexion1+/51+/51+/51+/51+/51+/51+/5
Wrist extension1+/51+/51+/51+/51+/51+/51+/5
Hand grip1+/51+/51+/51+/52+/52+/52+/5
Hip flexion2+/3-3-/33/33+/3+3+/44/54/5
Hip extension2+/3-3-/33/33/33+/3+3+/3+3+/3+
Knee flexion3/54/54/54/54/54/54/5
Knee extension3/54/54/54/54/54/54/5
Ankle dorsiflexion1/2-1/2-1+/2-1+/2-1+/2-1+/2-1+/2-
Ankle plantarflexion1/2-1/2-1+/2-1+/2-2-/2-2-/2-2-/2-
Great toe flexion1/2-1/2-1/2-1/2-1/2-1/2-1/2-
Great toe extension1/2-1/2-1/2-1/2-1/2-1/2-1/2-

Table 4 . Compositions, dosage, and administration of medications taken by the patient during the hospitalization period.

Composition of medication1-day dosageAdministration method of the medication
Clopidogrel bisulfate 97.875 mg1 tabletQuaque die (after breakfast)
Ezetimibe 10 mg, rosuvastatin calcium 10.4 mg1 tabletQuaque die (after breakfast)
Rebamipide 150 mg1 tabletQuaque die (after breakfast)
Duloxetine hydrochloride granule 176.47 mg1 capsuleQuaque die (after dinner)
Limaprost alfadex 166.67 μg1 tabletTer in die
Pregabalin 75 mg1capsuleTer in die
Artemisia Herb isopropanol soft extract (20 → 1) 60 mg1 tabletTer in die
Acetaminophen 162.5 mg, tramadol hydrochloride 18.75 mg1 tabletTer in die
Mecobalamin 50 μg1 tabletTer in die
Benfotiamine 69.15 mg, cyanocobalamin 0.5 mg, pyridoxine hydrochloride 50 mg1 capsuleBis in die

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Jan 07, 2025 Volume 42:1~130

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