Perspectives on Integrative Medicine

Protocols

Artificial Intelligence in the Editorial and Peer Review Process: A Protocol for a Cross-Sectional Survey of Traditional, Complementary, and Integrative Medicine Journal Editors’ Perceptions: Jeremy Y. Ng, Daivat Bhavsar, Neha Dhanvanthry, Myeong Soo Lee, Ye-Seul Lee, Tanuja M. Nesari, Thomas Ostermann, Claudia M. Witt, Linda Zhong, Holger Cramer; Perspect Integr Med. 2025;4(2):121-124. Published online June 23, 2025; DOI: https://doi.org/10.56986/pim.2025.06.008

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Abstract PDF: This research protocol outlines a cross-sectional survey study, aimed at editors from traditional, complementary, and integrative medicine (TCIM) journals, regarding their perceptions of the use of artificial intelligence (AI) in the editorial and peer review process. The survey will be sent to editors-in-chief, associate editors, and editorial board members of TCIM journals (100-150). The research involves purposive sampling via manual collection of contact details from TCIM journal websites. The survey will include sections on demographics, current use and familiarity with AI, perceived benefits and challenges, ethical concerns, and the outlook for AI in publishing. Data collection will be conducted online using SurveyMonkey whereby email invitations and follow-up reminders will be sent to potential respondents. Quantitative data will be analyzed using descriptive statistics, and for qualitative data, thematic analyses will be employed. This protocol study aimed to devise a survey which could provide insight into the acceptance and potential barriers to AI adoption in TCIM publishing from an editor’s perspective. The results of which may later guide the development of AI tools in a way that aligns with the needs and values of the TCIM research community.

A Study Protocol for Developing a Consensus-Based Reporting Guideline for Case Reports on Acupuncture-Related Adverse Events: Tae-Hun Kim, Ye-Seul Lee, Jung-Won Kang, Myeong Soo Lee, Lin Ang, Jeremy Y. Ng, Stephen Birch, Terje Alræk, Lin Yu, Yuting Duan, Zhirui Xu; Perspect Integr Med. 2025;4(2):117-120. Published online June 23, 2025; DOI: https://doi.org/10.56986/pim.2025.06.007

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Abstract PDF: Case reports play a crucial role in identifying safety concerns related to new or rare complications and adverse events (AEs) associated with therapeutic interventions. Although acupuncture is generally considered safe when performed by trained professionals, the increasing number of case reports reporting acupuncture-related AEs has raised public safety concerns. A recent systematic review of case reports from 2010 to 2023 determined that many reports lacked the essential details necessary for assessing AE causality, treatment appropriateness, and contributing risk factors. These omissions may result in misinformation, and exaggerate the potential harm of acupuncture. The CAse REport guidelines (13 items) provide general guidance to improve the clarity, completeness, and transparency of case report findings, but they do not address the unique clinical features and factors specific to acupuncture-related AEs such as defective needles, practitioner malpractice, or patient-related factors. These limitations may hinder the educational value of such reports in preventing acupuncture-related AEs. To address this gap, a consensus-based reporting guideline tailored to acupuncture-related AEs is necessary to enhance the quality, transparency, and reliability of case reports, which will ultimately contribute to improved patient care. This article outlines a protocol, and approaches, for developing a reporting guideline for acupuncture-related AEs in case reports.

Case Report

Delivery of Telemedicine to Manage Cardiac Palpitations with Herbal Medicine in a Patient with Premature Ventricular Complexes Following Catheter Ablation for Atrial Fibrillation: Jimin Kim, Hyungsun Jun, Jungtae Leem, Hyeryun Lee, Chul-Woo Ahn, Dasol Park; Perspect Integr Med. 2025;4(2):110-116. Published online June 23, 2025; DOI: https://doi.org/10.56986/pim.2025.06.006

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Abstract PDF: A patient living abroad who underwent catheter ablation for atrial fibrillation 3 years ago experienced recurrent arrhythmia symptoms 3 months ago and was diagnosed with premature ventricular complexes (PVCs) confirmed by Holter monitoring. He was advised to undergo repeat catheter ablation, however, he sought traditional Korean medicine (TKM) treatment advised via telemedicine. He reported continuous irregular heartbeats [numeric rating scale (NRS) score 10]. He was started on Yixin Tang, and by the 3^rd day of administration his symptoms of irregular heartbeats had disappeared (NRS 0) and did not return during the subsequent 320-day observation period. Pain caused by tightness in the chest and throat (NRS 8) did not show improvement despite various prescriptions; a noncardiac etiology, likely gastrointestinal, was suspected. Heart failure as measured by NT-pro BNP levels, was consistently elevated borderline, around 130 pg/mL, (possible heart failure), and on Day 320 it was normal measuring 50 pg/mL (heart failure less likely). No serious adverse events were reported following TKM treatment. This case suggests the potential value of TKM remote treatment in meeting the unmet needs of arrhythmia patients. Further research, including controlled clinical trials and development of telemedicine-specific guidelines, is warranted.

Short Communication

A Novel Hypothesis for Integrating Cupping Therapy in Spasticity Management: Bryn Hager, Faye Akin, Samuel Brant, Joshua Lopez, Camden Roth; Perspect Integr Med. 2025;4(2):103-109. Published online June 23, 2025; DOI: https://doi.org/10.56986/pim.2025.06.005

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Abstract PDF: Spasticity, a common consequence of neurological injuries, negatively affects function and quality of life. Despite the availability of pharmacological and therapeutic interventions, limitations remain in accessibility, cost, side effects, and long-term efficacy of treatments. Cupping therapy, a traditional intervention, historically used for pain relief and circulation, may offer novel benefits in reducing spasticity. In this short communication, hypothesized mechanisms are presented through which cupping therapy may modulate both central and peripheral mechanisms of spasticity, as well as clinical relevance, should this hypothesis be validated. This is not a review or evidence summary, but a conceptual hypothesis grounded in emerging evidence. We propose that cupping therapy is an underutilized, yet promising strategy in neurological rehabilitation, warranting further exploration and empirical validation. This hypothesis supports the need for controlled trials comparing cupping with standard spasticity interventions. If validated, cupping may offer a low-cost, low-risk addition to the neurorehabilitation toolkit.

Original Article

Apamin Mitigates Oxidative Stress-Induced Nucleus Pulposus Cell Death Through Regulation of Nrf2 and HO-1 Pathways: Hyunseong Kim, Hwan-Suck Chung, Hyunsu Bae; Perspect Integr Med. 2025;4(2):96-102. Published online June 23, 2025; DOI: https://doi.org/10.56986/pim.2025.06.004

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Abstract PDF: Background
Intervertebral disc degeneration is driven by the decline of nucleus pulposus (NP) cells and oxidative stress plays a key role in extracellular matrix disruption and progression of the condition. Apamin, a bioactive peptide derived from bee venom is neuroprotective and anti-inflammatory, but its effect on NP cells under oxidative stress is unknown.
Methods
Human NP cells were cultured, pretreated with apamin, and exposed to 200 μM H₂O₂ (causing oxidative stress). Reactive oxygen species (ROS) levels, disc degeneration markers, and the regulation of nuclear factor erythroid 2-related factor 2 (Nrf2) and heme oxygenase 1 (HO-1) signaling pathways were assessed using immunocytochemistry and fluorescence-activated cell sorting analysis.
Results
Apamin protected NP cell viability under oxidative stress at the optimal concentrations between 10-50 μg/mL. As a percentage relative to untreated control, apamin significantly inhibited the production of ROS (induced by H₂O₂) and the expression of Nrf2 and HO-1 (key regulators of the antioxidant response) was higher relative to the control. The expression of aggrecan and collagen Type 2 alpha 1 (essential components of the extracellular matrix) was higher relative to the control, while the expression of disc degeneration-related markers, including matrix metalloproteinases (MMPs) and a disintegrin and metalloproteinase with thrombospondin motifs (ADAMTS) was lower compared with the control.
Conclusion
In vitro, apamin protects human NP cells from oxidative stress-induced death by inhibiting levels of ROS and activating the Nrf2 and HO-1 pathways. These results suggest potential for apamin as a therapeutic antioxidant agent for intervertebral disc degeneration.

Review Articles

Evaluating the Efficacy of Warm Acupuncture and Electroacupuncture in Temporomandibular Disorder: A Narrative Review: Lisa Dal Pozzo, Secondo Scarsella, Maria Abad Arranz; Perspect Integr Med. 2025;4(2):87-95. Published online June 23, 2025; DOI: https://doi.org/10.56986/pim.2025.06.003

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Abstract PDF: Temporomandibular disorder (TMD) causes jaw pain, difficulty speaking/eating, and discomfort referred to the head, neck, and shoulders. Western treatments (anti-inflammatory drugs, opioids, muscle relaxants) may have side effects or may be unsuitable for older adults due to polypharmacy risks. Nonpharmacological options like physiotherapy and magnetic therapy are promising, but acupuncture, rooted in Traditional Chinese Medicine, has gained attention for its efficacy. Traditional Chinese medicine attributes TMD to Qi stagnation, blood stasis, and pathogenic factors (cold, wind, dampness), leading to pain and stiffness. Acupuncture reduces pain, improves jaw mobility, and decreases joint noises, and has long-term benefits and low recurrence of TMD. Techniques like warm acupuncture and electroacupuncture lower inflammation and alleviate local/distal symptoms. This review compiles studies on acupuncture’s role in TMD treatment (mono or combined therapy) and draws from Western and Chinese databases. Acupuncture offers a safe, effective alternative, particularly for patients where conventional drugs are unsuitable.

Systematic Review of Preclinical Evidence on Parenteral Administration of Schizonepeta Tenuifolia Sole Extract: Chaeheon Lee, Jihwan Choi, Ji Eun Choo, Ga Ram Yang, Hyung-Cheal Mun, Won Gun An, Cheol-Hyun Kim, Jaehyo Kim, Sangkwan Lee, Hongmin Chu; Perspect Integr Med. 2025;4(2):76-86. Published online June 23, 2025; DOI: https://doi.org/10.56986/pim.2025.06.002

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Abstract PDF: While steroids effectively control inflammation, their long-term use causes severe side effects, necessitating safer alternatives. Schizonepeta tenuifolia (S. tenuifolia) from the Lamiaceae family demonstrates potential as a natural therapeutic option through its anti-inflammatory and antiviral properties. This systematic review analyzed in vivo and in vitro studies of S. tenuifolia extract, focusing on non-oral administration routes to evaluate its therapeutic potential (n = 13). The extract effectively inhibited nuclear factor kappa-light-chain-enhancer of activated B cells and mitogen-activated protein kinase pathways, reduced inflammatory cytokine production, and showed antiviral effects. Additional benefits include wound healing and antiplatelet activity which enables targeted inflammation control without systemic immune suppression. The extract showed promise in conditions requiring targeted pathway modulation, such as inflammatory conditions needing selective cytokine inhibition, viral infections where interferon modulation is beneficial, and disorders with dysregulated mitogen-activated protein kinase signaling. These effects were achieved without the systemic immunosuppression typical of steroid treatments. While S. tenuifolia extract could serve as a safer alternative through non-oral administration routes, further research is needed to optimize extraction methods, identify key marker compounds, and determine optimal administration routes including topical administration and injectable formulations.

A Bibliometric Analysis of Studies on Meridians: Chan-Young Kwon; Perspect Integr Med. 2025;4(2):67-75. Published online June 23, 2025; DOI: https://doi.org/10.56986/pim.2025.06.001

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Abstract PDF: A meridian is a channel through which qi moves and is a key concept in traditional East Asian medicine. Meridian studies have evolved from classical functional to modern scientific investigations. This study was performed to construct, analyze, and visualize research trends in modern scientific investigations through a bibliometric analysis. The MEDLINE database was searched via PubMed. All relevant studies published up to December, 2024 were included (N = 1,446). Research on the concept of meridians has been actively reported since the early 1990s, peaking in 2015 (n = 103). Various biological basis for meridians, including the primo vascular system, have been investigated throughout this period. Co-occurrence analysis identified 3 major research clusters: clinical studies, animal experiments, and acupuncture points research. Recent studies have focused more on acupuncture points and their clinical applications, particularly in neuropsychiatric disorders, rather than fundamental meridian research. In addition, data mining has emerged as a new methodology in the field. Research collaboration was primarily occurring amongst investigators in South Korea and China (limited international cooperation). While interest in preclinical studies has declined, promising clinical applications continue to emerge. This review highlighted the need for broader international collaboration and integration of traditional concepts with modern research methodologies.

Corrigendum

Corrigendum to “Empowering Acupuncture Students Through an Education in Research: Using Case Reports to Enhance Learning and Clinical Practice” [Perspect Integr Med 2025;4(1):1-5]: Sandro Graca, Samantha J. Allen, Harriet Lansdown, Rosa N. Schnyer, Kathleen Lumiere; Perspect Integr Med. 2025;4(2):125-125. Published online March 27, 2025; DOI: https://doi.org/10.56986/pim.2025.06.011; Corrects: Perspect Integr Med 2025;4(1):1

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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.

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