title: Does guasha offer hepatoprotective effect to chronic inactive hepatitis B carriers? A built-in design to control subject expectation.
abstract: 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.
  
  
  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.
authors.affiliation: 1 Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital , Charlestown, MA.
authors.forename: Suk-tak
authors.initials: ST
authors.lastname: Chan
authors.forename: John W M
authors.initials: JW
authors.lastname: Yuen
authors.forename: Mayur-Danny I
authors.initials: MD
authors.lastname: Gohel
authors.forename: Ho-cheong
authors.initials: HC
authors.lastname: Wong
authors.forename: Chi-ping
authors.initials: CP
authors.lastname: Chung
authors.forename: Yu
authors.initials: Y
authors.lastname: Sun
authors.forename: Jia-nian
authors.initials: JN
authors.lastname: Ng
authors.forename: Rosalind
authors.initials: R
authors.lastname: Lie
authors.forename: Kenneth K
authors.initials: KK
authors.lastname: Kwong
mesh_terms: D015415:Biomarkers / Q000097:blood; D002353:Carrier State; D016207:Cytokines / Q000097:blood; D005260:Female; D051547:Heme Oxygenase-1 / Q000097:blood; D019694:Hepatitis B, Chronic / Q000628:therapy*; D006801:Humans; D008111:Liver Function Tests; D008297:Male; D008516:Medicine, Chinese Traditional; D026201:Musculoskeletal Manipulations / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D016207:Cytokines; D051547:Heme Oxygenase-1