Perspectives on Integrative Medicine

Letter

Appropriate Reporting of Acupuncture-Related Adverse Events Should be Promoted in Case Reports: Tae-Hun Kim, Jung Won Kang; Perspect Integr Med. 2025;4(1):65-66. Published online February 21, 2025; DOI: https://doi.org/10.56986/pim.2025.02.009

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Protocol

Study Protocol for a Systematic Review of the Methods and Reliability of Sham Electroacupuncture in Randomized Controlled Trials: Sung Min Lim; Perspect Integr Med. 2025;4(1):62-64. Published online February 21, 2025; DOI: https://doi.org/10.56986/pim.2025.02.008

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Abstract PDF: Background
Electroacupuncture (traditional acupuncture combined with electrical stimulation) is used to treat various medical conditions. However, the lack of standardized sham electroacupuncture options (placebo controls) poses a challenge in ensuring the validity of the results gained from randomized controlled trials (RCTs). This study presents a protocol for a systematic review to evaluate the methods and validity of sham electroacupuncture used in RCTs.
Methods
To provide evidence for establishing an optimal control model for sham electroacupuncture, a systematic review will be conducted by searching major English language electronic databases (including PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials) for studies published up to May 2024. RCTs that utilized sham electroacupuncture as a control group will be included. Two independent reviewers will screen the studies and extract the data, and the quality of the selected studies will be assessed using the Cochrane Risk of Bias Tool 2. Frequency analysis will be conducted, and to assess blinding in RCTs the Blinding Index will be reported. This systematic review protocol is registered with PROSPERO (no.: CRD42024542514).
Results
/Conclusion: This systematic review will provide a comprehensive analysis of the methods and reliability of sham electroacupuncture in RCTs and thus help identify current practices and gaps. The findings may contribute to the development of standardized sham electroacupuncture controls and improve the design RCT in the future which will facilitate treatment validation of electroacupuncture.

Short Communications

Benefits of Qigong: a 3-Months Online Course: Maria da Luz Rosário de Sousa, Maria Imaculada Lima Montebello, Érika Johnson; Perspect Integr Med. 2025;4(1):57-61. Published online February 21, 2025; DOI: https://doi.org/10.56986/pim.2025.02.007

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Abstract PDF Supplementary Material: Background
Qigong is an ancient Chinese health practice integrating slow, mindful movements, regulated breathing, and meditative awareness to promote the circulation of vital energy, and enhance overall well-being.
Methods
A prospective, longitudinal, exploratory study was carried out to investigate the effects of Qigong on the overall quality of life following a three-month online Qigong course (n = 21). Data were collected using The World Health Organization Quality of Life Brief Version questionnaire, and supplemented with self-reported measures of pain, anxiety, and sleep quality.
Results
A 10.86% improvement in the overall quality of life (from 68.44 to 75.87; p < 0.001) was observed. Physical (p = 0.003), psychological (p = 0.004), social (p = 0.046), and environmental (p = 0.001) domains also demonstrated meaningful gains, with notable increases in energy levels, daily functioning, self-esteem, and sleep quality. Over half of the participants reported marked reductions in pain severity, and anxiety, and 54.7% experienced improvements in sleep quality (ranging from 70% to 100% of baseline values). Course adherence was high, with most participants expressing satisfaction, willingness to recommend the program, and interest in continuing Qigong practice.
Conclusion
Qigong may boost physical and mental health, reduce stress and anxiety, and improve sleep quality. To corroborate these findings, large-scale, multicenter, randomized, controlled trials are necessary.

Developing of an Integrative Medicine Inpatient Care Program for Breast Cancer Patients Post-Chemotherapy: Eun-Bin Ko, Jun-Bock Jang, Deok-Sang Hwang; Perspect Integr Med. 2025;4(1):51-56. Published online February 21, 2025; DOI: https://doi.org/10.56986/pim.2025.02.006

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Abstract PDF Supplementary Material: Adjuvant chemotherapy for breast cancer (BC) has improved survival rates but often causes adverse effects such as nausea, vomiting, myelosuppression, and peripheral neuropathy, which can greatly impact patient quality of life. Integrative medicine (IM) provides adjunctive therapies to alleviate these toxicities and support immune function, yet existing clinical practice guidelines and pathways offer broad recommendations that may not sufficiently address the specific needs of post-chemotherapy BC patients. To address this gap, we developed an IM Inpatient Care Program framework for BC patients within one week of chemotherapy administration, drawing on the Korean Medicine Clinical Practice Guideline (KMCPG) for BC supportive care, an established clinical pathway, and additional guidelines focused on chemotherapy-related toxicities. The proposed inpatient model prioritizes systematic monitoring, early detection, and management of common chemotherapy-induced side effects such as neutropenia, peripheral neuropathy, gastrointestinal issues, and psychological distress. Key components include vital sign surveillance, targeted diagnostic tests (e.g., hematology, imaging), dietary and lifestyle recommendations, tailored herbal medicine prescriptions, acupuncture, moxibustion, and referral protocols for serious complications. The IM Inpatient Care Program aims to standardize treatment processes, enhance patient and clinician satisfaction, and reduce potential emergency department visits. By aligning evidence-based guidelines with real-world clinical insights, this model provides a structured approach to optimize BC patient care post-chemotherapy. Future efforts should involve implementing and evaluating the program in diverse clinical settings to refine its utility, measure outcomes, and potentially lower healthcare costs while improving quality of life for BC patients.

Original Articles

Effects of Needling Acupoint SI3 on Pressure Pain Threshold in Healthy Participants: Xiaoqin Wu, Chi Eung Danforn Lim, Shuai Zheng, Christopher Zaslawski; Perspect Integr Med. 2025;4(1):39-50. Published online February 21, 2025; DOI: https://doi.org/10.56986/pim.2025.02.005

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Abstract PDF: Background
There has been a surge in prescribing opioids for pain-related conditions and it has resulted in a prescription "opioid epidemic." It is critical for researchers and clinicians to explore nonpharmacological approaches to manage pain and mitigate the reliance on opioid analgesics. Acupuncture could be an effective therapy to modulate pain. This study examined the effects on regional pressure pain threshold (PPT) following needling of the Small Intestine 3 (SI3 -Houxi) acupoint in healthy participants.
Methods
In a randomized, three-arm cross-over design study, 32 healthy participants enrolled between November 2018 and March 2019, received 3 different acupuncture interventions, in different sequences, to the right hand at SI3: (1) SI3 without manual manipulation (SI3m-); (2) SI3 with manual needle manipulation (SI3m+); and (3) sham laser, to assess changes in PPT following the interventions. The mean change in PPT was measured at 10 different regional acupoint sites using an algometer. All PPT scores were reported as a percentage change from the mean preintervention value, the mean of the 3 PPT measurements obtained prior to receiving the intervention.
Results
The SI3m+ and SI3m- interventions for the 31 participants (drop out n=1), showed that the postintervention mean % PPT scores were significantly elevated compared to the control (sham laser; p < 0.001). The SI3m+ intervention significantly increased % PPT compared with the SI3m- intervention (p < 0.001).
Conclusion
The needling intervention was an important contributor raising regional PPT in healthy participants.

Assessing the Impact of Art Therapy on Idiopathic Parkinson’s Disease: a Mixed-Methods Practice-Based Approach: Wangjung Hur, Jungtae Leem, Hanbit Jin, Miso S. Park, Sangsoo Park, Horyong Yoo; Perspect Integr Med. 2025;4(1):28-38. Published online February 21, 2025; DOI: https://doi.org/10.56986/pim.2025.02.004

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Abstract PDF Supplementary Material: Background
Parkinson’s disease (PD) is a common degenerative brain condition worldwide. Art therapy has gained attention as a nonpharmacological, complementary, and integrative therapy, yet few studies have explored its effect on people with PD.
Methods
From May to August 2021, 9 participants diagnosed with idiopathic PD completed an art therapy program, consisting of 8 weekly sessions (60 minutes each). A mixed-method research approach combining quantitative and qualitative analyses was used to evaluate participant outcome and experience. Quantitative analysis was assessed using tests for quality of life, motor symptoms, and nonmotor symptoms. Qualitative analysis was conducted through participant responses and researcher observations.
Results
After 8 sessions of drawing-based art therapy, the total non-motor symptoms scale score, which provides a comprehensive assessment including the domains of cognition and behavior along with nonmotor symptoms in participants, significantly improved from 79.3 ± 30.9 at baseline to 59.8 ± 26.1 points after 8 weeks (p = 0.01). The unified Parkinson’s disease rating scale-I score also demonstrated significant improvement (p = 0.03). There were no reported adverse events and no participant dropout. Qualitative analysis revealed enhanced self-esteem, self-acceptance, and positive emotional expression amongst participants.
Conclusion
The art therapy conducted on the people with PD in this study improved their nonmotor symptoms and activity of daily living. Furthermore, qualitative analysis revealed the positive effect of art therapy which included improved self-esteem and self-acceptance. In the future, art therapy could be actively considered as a nonpharmacological, complementary, and integrative therapy for treating PD.

Optimized Protocols for the Isolation and Culture of Primary Neurons from Rat Cortex, Hippocampus, Spinal Cord, and Dorsal Root Ganglia: Ganchimeg Davaa, Do In Kim, Jennifer O. Buitrago, Jin Young Hong; Perspect Integr Med. 2025;4(1):16-27. Published online February 21, 2025; DOI: https://doi.org/10.56986/pim.2025.02.003

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Abstract PDF Supplementary Material: Background
The isolation and culture of primary neurons from specific regions of the rat nervous system are fundamental techniques for investigating neuronal function, development, and pathology. These tools allow the exploration of distinct neural populations and their roles in health and disease.
Methods
Protocols were optimized for dissection, isolation, and culture of primary neurons from the rat cortex, hippocampus, spinal cord, and dorsal root ganglia. Each methodology was customized to address the unique properties of the respective tissue types, focusing on key steps to enhance neuronal yield and viability whilst minimizing contamination with non-neuronal cells. The protocols incorporate refined enzymatic dissociation techniques, mechanical trituration methods, and specialized culture conditions to support neuronal survival and maturation. Additionally, essential considerations for neuronal culture such as growth medium composition, cell density used for plating, and substrate preparation were addressed.
Results
These region-specific methodologies yielded robust and reproducible outcomes, enabling the generation of reliable in vitro models of neurons from both the central and peripheral nervous systems. The optimized procedures effectively increased neuronal viability and purity, making them suitable for a wide range of neuroscience applications.
Conclusion
This comprehensive set of protocols represents a valuable resource for researchers working in neuroscience on rats. Practical approaches to isolate and culture neurons from diverse regions of the nervous system in the rat have been described. The methodologies outlined provide a strong foundation for studying neuronal populations and their significance in various physiological and pathological contexts.

Review Article

The Safety and Effectiveness of Electroacupuncture for Labor Pain Relief: a Systematic Review and Meta-Analysis: Hyein Jeong, Jiwon Heo, Hyunsuk Park, Kyeong Han Kim; Perspect Integr Med. 2025;4(1):6-15. Published online February 21, 2025; DOI: https://doi.org/10.56986/pim.2025.02.002

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Abstract PDF Supplementary Material: Background
Labor pain is among the most intense forms of pain, significantly impacting physical and psychological well-being. Although epidural anesthesia is effective, it has side effects and limited accessibility. Electroacupuncture (EA) offers a low-risk alternative. This systematic review and meta-analysis assessed the safety and effectiveness of EA in relieving labor pain and duration.
Methods
Randomized controlled trials comparing EA with standard treatments, including epidural anesthesia, were identified through database searches up to August 2024. The primary outcome was pain reduction (assessed using the visual analog scale), and the secondary outcomes were labor duration (1^st and 2^nd stages), Apgar scores, and adverse effects.
Results
In the analysis there were 10 randomized controlled trials (involving 1,498 women in labor) included in this review. EA statistically significantly improved both the level of pain and reduced labor duration compared with those women who received standard treatments (p < 0.001). Apgar scores were assessed in 3 studies and determined that the physical condition of the delivered babies was not statistically significantly different between EA and standard treatment for labor pain. Study protocol indicated the recording of adverse effects in one of the ten studies. Adverse events in that study recorded mild localized discomfort (1.89%, n = 1).
Conclusion
EA reduced labor pain and duration, and demonstrated its potential as an alternative to the conventional approaches for managing labor pain. The limited data suggest EA is likely safe, but further research is needed to confirm its safety profile.

Editorial

Empowering Acupuncture Students Through an Education in Research: Using Case Reports to Enhance Learning and Clinical Practice: Sandro Graca, Samantha J. Allen, Harriet Lansdown, Rosa N. Schnyer, Kathleen Lumiere; Perspect Integr Med. 2025;4(1):1-5. Published online February 21, 2025; DOI: https://doi.org/10.56986/pim.2025.02.001

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Abstract PDF: The current landscape of acupuncture education is marked by significant challenges including the closure of prominent schools and a decline in student enrollment. Addressing these issues requires innovative approaches that improve educational content and student engagement. Given the recognized interest in research amongst students, integration of research skills into acupuncture education is vital in the development of students into practitioners who are equipped with critical thinking. These skills enable meaningful engagement with scientific literature and facilitate the delivery of evidence-based care. Production of a case report goes beyond taking simple case histories and provides a practical bridge between theory and clinical practice by teaching students research skills (systematic data collection, detailed analysis, and critical evaluation of treatment outcomes). The work involved in case reports enhances diagnostic skills, clinical reasoning, and communication with peers and other healthcare professionals. When used in conjunction with pragmatic data sets, case reports may be used in secondary analyses that reflect real-world clinical settings in a more practical way than clinical trials providing insights into broader clinical patterns and outcomes. The integration of research-focused learning prepares students for evidence-based practice, promotes interdisciplinary communication, and supports professionalism in acupuncture through contributions to the clinical evidence base.

Letter

Research Methodology Matters: A Comment on the Newly Published Article in the Journal of Evidence-Based Medicine: Tae-Hun Kim; Perspect Integr Med. 2024;3(3):184-185. Published online October 23, 2024; DOI: https://doi.org/10.56986/pim.2024.10.009

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Case Report

Common Peroneal Nerve Entrapment Masked by Acute Lumbar Disc Herniation: Integrated Korean Medicine Treatment with Ultrasound-Guided Pharmacopuncture: Hyunsuk Park, Jinhyun Kim, Sungjae Yoo, Jung-Min Yun, Kwangchan Song; Perspect Integr Med. 2024;3(3):177-183. Published online October 23, 2024; DOI: https://doi.org/10.56986/pim.2024.10.008

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Abstract PDF

The symptoms of common peroneal nerve (CPN) entrapment are similar to the symptoms of lumbar herniated intervertebral disc. We present the successful treatment of CPN entrapment masked by acute lumbar disc herniation. A 49-year-old man presented with low back pain and numbness in his left leg. Following admission, patient history, physical examination, and radiology findings, the patient received integrated Korean medicine (KM) treatment (acupuncture, pharmacopuncture, ultrasound-guided pharmacopuncture, moxibustion and cupping, herbal medicine, and chuna therapy) for lumbar disc herniation. Outcome measures included the numeric rating scale, the European quality of life five dimensions, and the Oswestry disability index. Symptoms persisted, and CPN compression was consequently suspected. On Day 12 of 23, in addition to KM treatment, an ultrasound-guided Shinbaro2 pharmacopuncture (4 mL) was performed on the CPN entrapment site. Significant symptom relief resulted after CPN treatment on Day 12. Improvement was particularly evident in the lower leg and ankle, areas where the pain had previously been misattributed to symptoms of lumbar disc herniation. His low back pain and radiating pain to the back of the left femur started to improve from Day 20 and were mild at discharge. This case highlights the importance of considering peripheral nerve entrapment in patients presenting with symptoms similar to lumbar disc herniation. It also suggests that combining traditional KM with modern diagnostic techniques such as ultrasonography, may be beneficial in the precise location for pharmacopuncture treatment. Further studies are recommended to validate these findings and explore the broader applicability of this approach.

Citations

Citations to this article as recorded by

Differential Gene Expression Analysis in a Lumbar Spinal Stenosis Rat Model via RNA Sequencing: Identification of Key Molecular Pathways and Therapeutic Insights
Jin Young Hong, Wan-Jin Jeon, Hyunseong Kim, Changhwan Yeo, Hyun Kim, Yoon Jae Lee, In-Hyuk Ha
Biomedicines.2025; 13(1): 192. CrossRef

Protocols

A Protocol for a Bibliometric Analysis of Traditional, Complementary, and Integrative Medicine Research Preprints: Jeremy Y. Ng, Brenda Lin, Sabrina Abdella, Magdalene Abebe, Isabella Tao, Holger Cramer; Perspect Integr Med. 2024;3(3):172-176. Published online October 23, 2024; DOI: https://doi.org/10.56986/pim.2024.10.007

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Abstract PDF: Background
Traditional, complementary, and integrative medicine (TCIM) has witnessed significant growth in interest globally. Despite its popularity, TCIM research encounters numerous challenges including funding, methodological issues, and risk of bias. Preprints (scientific manuscripts openly accessible before formal peer review) present a potential solution, and understanding the characteristics and impact of TCIM preprints could offer valuable insights.
Methods
A bibliometric analysis will be conducted on all TCIM-related preprints, since inception, and posted on preprint servers with TCIM subject filters. Preprints will be sourced from servers listed in the Accelerating Science and Publication in Biology directory which allow filtering by TCIM-related categories. The preprint server and URLs, preprint server’s disciplinary scope, ownership type, screening processes, external content indexing, permanence of content, preservation of content, and comments will be extracted. The number of TCIM-related preprints yielded, and which TCIM-related term each preprint server uses will be noted. Data will be extracted from each eligible preprint: preprint server, title, DOI, preprint posted date, status of preprint, journal of final publication, final publication date, type of preprint, abstract of preprint, authors, author affiliation(s), country of corresponding author, funders, number of views, number of downloads, number of comments, number of citations, number of versions, and keywords. Descriptive statistics will be used to summarize the bibliometric characteristics, and trend analysis will identify publication patterns over time.
Conclusion
This protocol was developed for a study to identify trends in TCIM research dissemination, and contribute to a better understanding of how preprints are being used to advance the field

A Protocol for the Validation of Novel Sham Acupuncture in Patients Who Have Had a Stroke: Sung Min Lim; Perspect Integr Med. 2024;3(3):168-171. Published online October 23, 2024; DOI: https://doi.org/10.56986/pim.2024.10.006

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Graphical Abstract Abstract PDF Supplementary Material: Background
A sham control group enhances the quality of clinical trials by controlling for the placebo effect. To ensure rigorous blinding to enhance the quality of clinical trials on acupuncture treatment it is important to develop a more sophisticated sham needle. Discrepancies in perceived needling sensation and treatment expectations between patients and healthy volunteers may affect study outcomes. Thus, it may be inappropriate to generalize the findings of a sham needle validation study in healthy adults to patients who have had a stroke. Therefore, this is a protocol for a clinical trial in patients who have had a stroke to validate a newly developed sham needle to be used in double-blind trials.
Methods
Sixty-six patients who have had a stroke will be randomly assigned to the verum or sham needle group using a 1:1 ratio. As the verum and sham needles are identical in appearance, both participants and practitioners will be unaware of the needle type used for acupuncture treatment. After the acupuncture procedure, the participants will be asked whether they believe they received the verum or sham acupuncture treatment and indicate penetration, pain, and de qi sensation for each acupuncture point. A between-group comparison of needle-related adverse events will be performed.
Discussion
This double-blind randomized controlled trial will be the first study to validate a newly developed sham acupuncture needle for patients who have had a stroke. The results of this study may inform clinical trial study design for acupuncture treatment of patients who have had a stroke.

Short Communication

Robust Evidence in Integrative Medicine: Innovations, Challenges, and Future Directions: Ye-Seul Lee, Myeong Soo Lee, David Moher, In-Hyuk Ha, Jian-Ping Liu, Terje Alræk, Stephen Birch, Tae-Hun Kim, Yoon Jae Lee, Juan V.A. Franco, Jeremy Y. Ng, Holger Cramer; Perspect Integr Med. 2024;3(3):162-167. Published online October 23, 2024; DOI: https://doi.org/10.56986/pim.2024.10.005

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Graphical Abstract Abstract PDF: Integrative Medicine (IM), which includes therapies such as acupuncture, herbal medicine, yoga, and meditation, is gaining attention for managing chronic pain conditions. However, concerns about the quality of evidence supporting the use of these interventions persist. The 5th Annual Jaseng Academic conference 2024, in Seoul, South Korea, themed "Robust Evidence in Integrative Medicine: Innovations, Challenges, and Future Directions," addressed these concerns by focusing on advancements in study design, evidence synthesis, and open science practices. This conference proceeding summarizes key insights from the conference, emphasizing the role of pragmatic randomized controlled trials (pRCTs) in evaluating real-world effectiveness, and addressing the complexities involved in IM research such as sham controls. The integration of IM therapies into comprehensive pain management strategies (particularly in Korea), supported by government-backed research and policy initiatives was also discussed. Advancements in methodologies were addressed, such as bibliometric analysis, evidence mapping, and the development of clinical practice guidelines (CPGs) for integrative therapies. These methodologies offer valuable insights but face challenges due to the heterogeneity of IM interventions, and potential synergistic or antagonistic effects when combined with conventional medicine. Finally, the potential of open science to enhance transparency, reporting, and reproducibility in IM was explored, emphasizing the increased role of adherence to reporting guidelines (CONSORT and PRISMA). The future of IM research is built upon the continued efforts of refined study designs, rigorous evidence synthesis, and the integration of open science principles, for a robust and more credible evidence base.

Review Article

Trends in Clinical Research on Ultrasound-Guided Acupuncture: A Scoping Review: Sook-Hyun Lee, Yoon Jae Lee, Ju Yeon Kim, In Heo, Jae-Heung Cho, Byung-Kwan Seo, Yeoncheol Park, Jung-Hyun Kim, In-Hyuk Ha; Perspect Integr Med. 2024;3(3):152-161. Published online October 23, 2024; DOI: https://doi.org/10.56986/pim.2024.10.004

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Graphical Abstract Abstract PDF Supplementary Material

Acupuncture is widely used to reduce pain and improve function in various conditions. Despite ongoing research in ultrasound-guided acupuncture, evidence supporting efficacy remains inconclusive. This study aimed to examine Korean and international research trends, clinical efficacy, and safety of ultrasound-guided acupuncture by performing a scoping review of clinical research on ultrasound-guided acupuncture. Literature searches were conducted across 11 databases, including all clinical studies published before April 2024, without restrictions on condition/disease or type of study. Of the 2,644 identified articles, 25 studies were selected for review, mostly involving patients with musculoskeletal pain, and post-stroke sequelae. Interventions included ultrasound-guided acupuncture, warming acupuncture, dry needling, and electroacupuncture. The effectiveness of ultrasound-guided acupuncture was evaluated using pain, functional disability, and effective rate as outcome measures, and most studies reported significant improvements. This study is the first scoping review to report on trends, clinical efficacy, and safety of ultrasound-guided acupuncture. While it demonstrates potential for treating musculoskeletal disorders, post-stroke sequelae, spinal injuries, and other conditions/diseases, research on its application remains limited to specific conditions/diseases. Furthermore, substantial variations were observed in types of acupuncture, application areas, and treatment frequencies. Future research should focus on high-quality randomized controlled trials with standardized ultrasound frequencies for specific conditions/diseases.

Citations

Citations to this article as recorded by

Efficacy of ultrasound-guided pharmacopuncture: A systematic review and meta-analysis
Jinho Lee, Sook-Hyun Lee, Yoon Jae Lee, Ju Yeon Kim, In Heo, Jae-Heung Cho, Byung-Kwan Seo, Dong Kun Ko, In-Hyuk Ha
Medicine.2025; 104(11): e41733. CrossRef

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