The Practice of Korean Medicine: An Overview of Clinical Trials in Acupuncture

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By Yong-Suk Kim1, Hyungjoon Jun1, Younbyoung Chae2, Hi-Joon Park3, Bong Hyun Kim4, Il-Moo Chang4, Sung-keel Kang5 and Hye-Jung Lee2

  • 1Department of Acupuncture and Moxibustion, College of Oriental Medicine, Kangnam Korean Hospital,
  • 2Department of Oriental Medical Science, Graduate School of East-West Medical Science,
  • 3Department of Meridian and Acupuncture, College of Korean Medicine, Kyung Hee University,
  • 4Natural Products Research Institute, Seoul National University, Seoul, South Korea 
  • 5Department of Acupuncture and Moxibustion, College of Oriental Medicine, Kyung Hee University, South Korea

Introduction

Acupuncture, one of the Oriental medical therapeutic techniques inherited from ancient East Asia, is gaining popularity in the West as an alternative and complementary therapeutic intervention (1). Acupuncture is now being used in Western medicine to treat postoperative-induced and chemotherapy induced nausea and vomiting, postoperative dental pain, drug addiction, stroke rehabilitation and asthma (2). Korea has continued to develop its own unique traditional medicine throughout its long history, and has formed different types of acupuncture methods, apart from those of traditional Chinese medicine. An individualized approach based on constitutional energy traits and practical approaches applying new therapeutic modalities have been developed for treatment of disorders (3).
A large number of clinical studies using acupuncture have been performed to demonstrate its efficacy for many kinds of diseases, such as pain (headache, facial pain, neck pain, shoulder pain, lower back pain and knee pain), stroke, facial palsy
and other diseases in Korea. A wide range of control groups were used in these studies. Acupuncture and acupuncture related
therapies have been compared with various forms of control acupuncture, standard care, no treatment, baseline conditions and placebo acupuncture. These inconsistencies make the task of designing and performing systematic reviews or meta-analyses more difficult. However, non-controlled clinical trials might also be useful for the overview that they provide of what is known so far, with data that may inform future research. This review is an attempt to show a variety of applications for acupuncture treatments performed by the traditional Korean medical sector.

Clinical Studies Using Acupuncture Treatment in Korea

Acupuncture for Pain Headache

Lee and Kim (4) analyzed the effect of acupuncture treatment at trigger points in 27 patients with headache. Lee et al. (5)
compared the effect of acupuncture at trigger points with the effect of acupuncture at remote acupuncture points in patients
who were diagnosed as having tension-type headaches. A clinical study of auricular acupuncture was also done in 55 patients
with headaches (6). Clinical studies of acupuncture and auricular acupuncture for tension-type headaches were also performed (7,8) (Table 1).

Facial Pain

Temporomandibular disorder (TMD) is a musculoskeletal problem of the masticatory system and is quite commonly treated by acupuncture in the general population. It was reported that 8 and 10 cases, respectively, of TMD were treated by acupuncture (9,10). Wang et al. (11) treated by Dong-Qi acupuncture and subjectively evaluated TMD and facial pain (Table 2).

Neck Pain

Chun and Lee (12) treated patients with chronic neck pain by using electric acupuncture (0.3 · 40 mm, 3.5–12 Hz, 9 V). Kim and Lee (13) compared the group treated by both acupuncture and manipulation (chuna) treatment with the group only treated by acupuncture. A clinical study investigated the clinical applications of Oriental medical therapies including acupuncture treatment together with herbal therapy and hot pack for patients complaining of cervical pain caused by traffic accidents (14). It was reported that acupuncture treatment was effective in 50 patients with cervical pain (15). Lee and Lee
(16) treated 25 patients with neck pain with electric acupuncture together with herbal therapy, cupping therapy and hot pack. It was also reported that acupuncture was effective in treating 50 patients with herniated cervical disc (17) (Table 3).

Shoulder Pain

Forty-three patients suffering from frozen shoulder during physical exercise were treated by acupuncture, moxibustion and electric acupuncture, and evaluated with Apley scratch test. A total of 16.3% of them reported that the results of treatment
were excellent and 30.2% of them reported that they were good (18). Cho and Lee (19) showed the correlation between digital infrared thermography image (DITI) data and changes in clinical symptoms after acupuncture treatment in patients with frozen shoulder (Table 4) (Fig. 1).

Figure 1. ‘Acu-moxibustion Being Easy to Learn’, published in the Ching dynasty, 18th century. (Courtesy of Dr Kim Nam-Il, Department of Medical History, College of Oriental Medicine, Kyung Hee University, Seoul, South Korea.)

Low Back Pain

A series of 20 cases with lumbar herniated disc disease were treated by acupuncture (20). It was reported that acupuncture
and herbal medicine alleviated the symptoms of the herniation of lumbar intervertebral disc (21–25). It was also reported that
bee venom acupuncture (BVA) was beneficial for treating herniated intervertebral disc (HIVD) (26). Park et al. (27) performed
clinical studies using acupuncture and manipulation treatment on 30 HIVD patients. It was found that microcurrent electrical neuromuscular stimulation was significantly effective in decreasing the visual analog scores of patients with lower back pain (28). Park et al. (29) reported a clinical study of the stability of the lumbosacral angle of 69 patients suffering from lower back pain. The morphological changes were demonstrated by computed tomographic scan examination of acute HIVD patients who underwent Oriental medical treatment (30).
A clinical study compared acupuncture with electric acupuncture for patients with HIVD (31). Park and Lee (32) compared the effect of electric acupuncture with the effect of Dong-si acupuncture on patients with HIVD. Lee and Hwang (33) compared electric acupuncture with electric acupuncture and Saam acupuncture in HIVD patients. Yoon et al. (34) compared acupuncture at A-shi points with acupuncture on acupuncture points in HIVD patients. Chae et al. (35) compared conventional acupuncture with Eight constitution acupuncture and demonstrated that Eight constitutional acupuncture was more beneficial than conventional acupuncture for the treatment of HIVD patients.
Electric acupuncture decreased the frequency of radiating pain in lumbar spondylosis (36). Clinical studies evaluated Oriental medical treatment and manipulation therapy in patients with scoliosis (37,38). Kim (39) reported the results of 96 patients suffering from sciatica with lower back pain treated by acupuncture and herbal medicine. It was reported that acupuncture, moxibustion and herbal medicine were useful for acute back pain (40). Lee and Yin (41) also reported a clinical study of BVA on ankylosing spondylitis. Lee et al. (42) performed a clinical study on acupuncture for stable thoracolumbar vertebral fractures. It was reported that acupuncture, electric acupuncture, acupuncture at Hua-Tuo-Jia-Ji-Xue were useful for the treatment of thoracolumbar compression fracture (43–45). Han (46) treated degenerated stenosis patients (37 cases), and Kim et al. (47) evaluated the clinical results of the spondylolisthesis patients treated by Oriental medical methods.
Lee et al. evaluated acupuncture treatment for HIVD and stable compression fracture patients using DITI (48,49). Cho and Kim (50) compared the acupuncture with electric acupuncture for HIVD patients using DITI. Hur et al. (51) investigated changes in the clinical symptoms of patients with spondylolisthesis after acupuncture treatment and evaluated alterations in DITI. A clinical study also reported a relationship between cigarette smoking and the result of Oriental medical treatment for lower back pain (52). Heo and coworkers studied the treatment of lower back pain and sciatica and found some correlation in the rate of alleviation with alterations in Moire topography (53,54) (Table 5).

Knee Joint Pain

It was reported that acupuncture was useful for the treatment of degenerative arthritis of knee joints (55–57). Woo et al. (58)
evaluated the clinical effect of acupuncture on microtraumatic injuries of the knee joint. Kim and Lee compared acupuncture
with BVA for osteoarthritis (59,60). Hwang et al. (61) measured the change of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and rheumatoid arthritis (RA) factor, and the satisfactory assessment after BVA treatment in RA
patients. Hwang (62) treated RA patients with herbal acupuncture (HA) and evaluated CRP, ESR, RA factor and immunoglobulin
G and M (Table 6).

Other Painful Diseases

Electrical acupuncture stimulation was very useful to relieve pain that had not responded to various conventional medications
including nerve blocks, neurosurgical intervention and neuropolitics (63). Cho et al. (64) compared acupuncture treatment and analgesics in postthoracotomy pain control. It was reported that venesection, a therapeutic method of sucking out non-physiological blood, alleviated pain induced by blood circulation dysfunction (65). Kim et al. (66) compared acupuncture treatment with trigger point treatment in ankle sprain patients. Bang et al. (67) carried out a clinical study on patients with humeral lateral epicondylitis or tennis elbow. Seung and Ahn (68) investigated the effect of moxibustion on the immune
activity in the treatment of patients. Acupuncture treatment was very beneficial for acute gout (69). It was also demonstrated
that acupuncture at acupoints on the non-injured side were as effective as acupuncture at acupoints on the injured side in ankle sprain patients (70) (Table 7) (Fig. 2).

Figure 2. An excerpt from ‘The Simplified Diagram of Mingtang’ published in the Ming Dynasty. ‘Mingtang’ means mansion-house or hall and acupoints are called ‘the house of Qi’. This may be another correlating factor between ‘acupoint’ and ‘Mingtang’. Since ‘Mingtang’ gradually became a substitute for ‘acupoint’, the so-called ‘Mingtang diagram’ generally referred to ‘the diagram of acupoints’. (Courtesy of Dr Kim Nam-Il, Department of Medical History, College of Oriental Medicine, Kyung Hee University, Seoul, South Korea.)

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