Scholarly article on topic 'A Descriptive Statistical Approach to the Korean Pharmacopuncture Therapy'

A Descriptive Statistical Approach to the Korean Pharmacopuncture Therapy Academic research paper on "Animal and dairy science"

CC BY-NC-ND
0
0
Share paper
OECD Field of science
Keywords
{acupuncture / "herbal medicine" / "Korean therapy" / "literature study" / pharmacopuncture}

Abstract of research paper on Animal and dairy science, author of scientific article — Jungdae Kim, Dae-In Kang

Abstract This paper reviews trends in research related to Korean pharmacopuncture therapy. Specifically, basic and clinical research in pharmacopuncture within the last decade is summarized by introducing categorical variables for classification. These variables are also analyzed for association. This literature review is based on articles published from February 1997 to December 2008 in a Korean journal, the Journal of the Korean Institute of Herbal Acupuncture, which was renamed the Journal of the Korean Pharmacopuncture Institute in 2007. Among the total of 379 papers published in the journal during this period, 164 papers were selected for their direct relevance to pharmacopuncture research and were categorized according to three variables: medicinal materials, acupuncture points and disease. The most frequently studied medicinal materials were bee-venom pharmacopuncture (42%), followed by meridian-field pharmacopuncture (24%), single-compound pharmacopuncture (24%), and eight-principle pharmacopuncture (10%). The frequency distributions of the acupuncture points and meridians for the injection of medicinal materials are presented. The most frequently used meridian and acupuncture point was the Bladder meridian and ST36, respectively. Contingency tables are also displayed to analyze the relationship between the categorized variables. Chi-squared analysis showed a significant association between the type of pharmacopuncture and disease. The trend in research reports on Korean pharmacopuncture therapy was reviewed and analyzed using a descriptive statistical approach to evaluate the therapeutic value of this technique for future research.

Academic research paper on topic "A Descriptive Statistical Approach to the Korean Pharmacopuncture Therapy"

J Acupunct Meridian Stud 2010;3(3):141 -149

A Descriptive Statistical Approach to the Korean Pharmacopuncture Therapy

Jungdae Kim1,2, Dae-In Kang2*

biomedical Physics Laboratory for Korean Medicine, Department of Physics and Astronomy, Seoul National University, Seoul, Korea

2Pharmacopuncture Medical Research Center, Korean Pharmacopuncture Institute, Seoul, Korea

Received: Mar 18, 2010 Accepted: Jun 30, 2010

KEY WORDS:

acupuncture; herbal medicine; Korean therapy; literature study; pharmacopuncture

Abstract

This paper reviews trends in research related to Korean pharmacopuncture therapy. Specifically, basic and clinical research in pharmacopuncture within the last decade is summarized by introducing categorical variables for classification. These variables are also analyzed for association. This literature review is based on articles published from February 1997 to December 2008 in a Korean journal, the Journal of the Korean Institute of Herbal Acupuncture, which was renamed the Journal of the Korean Pharmacopuncture Institute in 2007. Among the total of 379 papers published in the journal during this period, 164 papers were selected for their direct relevance to pharmacopuncture research and were categorized according to three variables: medicinal materials, acupuncture points and disease. The most frequently studied medicinal materials were bee-venom pharmacopuncture (42%), followed by meridian-field pharmacopuncture (24%), single-compound pharmacopuncture (24%), and eight-principle pharmacopuncture (10%). The frequency distributions of the acupuncture points and meridians for the injection of medicinal materials are presented. The most frequently used meridian and acupuncture point was the Bladder meridian and ST36, respectively. Contingency tables are also displayed to analyze the relationship between the categorized variables. Chi-squared analysis showed a significant association between the type of pharmacopuncture and disease. The trend in research reports on Korean pharmacopuncture therapy was reviewed and analyzed using a descriptive statistical approach to evaluate the therapeutic value of this technique for future research.

1. I introduction

Korean traditional medicine has been developed over many centuries, and has allowed the discovery of many technologies and drugs for human health support and treatment of disease. Pharmacopuncture, or herbal acupuncture, is a new form of therapy derived from combinations of two traditional

therapeutic methods, herbal medicine and acupuncture therapy. In general, pharmacopuncture treatment is performed by injecting small amounts of extracted medicinal materials at acupuncture points or in affected areas in order to obtain combined efficacies of the acupuncture and drug. Although the first primitive trials with bee venom or herbal extractions were recorded in old medical books from

Corresponding author. Pharmacopuncture Medical Research Center, Korean Pharmacopuncture Institute, AKOM Building 4F, 26-27, Gayangdong, Gangseogu, Seoul 157-200, Korea. E-mail: dikang7@hanmail.net

©2010 Korean Pharmacopuncture Institute

the Han Dynasty of China, acupuncture with injection started in the early 1950s in China and was referred to as aqua-puncture [1,2]. Recently, phar-macopuncture therapies in Korea have developed into quite a unique and systematic framework for the diagnosis and treatment of various diseases [3].

Pharmacopuncture is mainly categorized depending on the medicinal materials used. There are four main categories: meridian-field pharmacopuncture, eight-principle pharmacopuncture, bee-venom pharmacopuncture, and single-compound pharmacopunc-ture. Each type of pharmacopuncture is described in Methods section, while more detailed information is available in the literature [3]. In short, the first full-scale study on meridian-field pharmacopuncture was introduced to the Society of Korean Oriental Medical Doctors by Nam in the 1960s [4]. Eight-principle pharmacopuncture was also developed in the 1980s with a new extraction method for medicinal materials and with diagnostic principles developed by Kim [5]. Bee-venom pharmacopuncture has been popularized following basic animal experiments and clinical studies on its effectiveness for treating pain and arthritis [6,7]. More systematic studies by many Korean traditional medical doctors and related researchers have actively been taking place since the establishment of the Korean Pharmaco-puncture Institute in 1990. Basic and clinical research conducted at this facility has been reported over the last decade in the Journal of the Korean Institute of Herbal Acupuncture [8]. As the interest in pharma-copuncture and the number of papers submitted to the Journal continue to grow, the Society of Korean Pharmacopuncture has continued to publish under the title, the Journal of the Korean Pharmaco-puncture Institute, since the second issue of 2007.

Recently, various types of research on the treatment for specific diseases have been reported. For example, the efficacy of bee-venom pharmaco-puncture for the treatment of arthritis was evaluated based on a literature search [9], and a clinical case report showed bee venom therapy to be a potential treatment modality for post-herpetic neuralgia [10]. Acupuncture plus point-injection for obstinate urticaria showed that the therapeutic effect in the treatment group was better than that in the control group [11]. Pharmacopuncture has also been a useful tool in veterinary practice. In large animals it reduces undesirable drug side effects, residues in animal consumption products, and treatment costs [12]. Most researchers have focused on specific types of pharmacopuncture for treatment of specific types of diseases. Few studies have approached pharmacopuncture as a therapeutic modality in a systematic manner to allow for a much broader view of this treatment. As a first step toward producing a more systematic study of pharmacopuncture, this

study selected and categorized articles published in the Journal of the Korean Pharmacopuncture Institute by adopting a descriptive statistical approach. These results may serve as a basis for more systematic analyses, such as a data-mining approach for a specific disease with a therapeutic method. The specifications of the selected articles were categorical, nominal variables for the type of pharmacopuncture, the disease, and the acupuncture points and meridians. Analyses of the correlation and contingency tables among the three nominal variables were conducted using the Chi-squared method, and the frequency distribution of acupuncture points and meridians are presented.

2. Materials and Methods

2.1. Description of selected articles

Articles were published from February 1997 to December 2008 in the Journal of the Korean Institute of Herbal Acupuncture (ISSN: 1226-4849). A total of 379 articles for the period are available as PDF files on the website of the Korea Institute of Science and Technology Information (http://www. koreascience.or.kr) or on the website of the Korean Pharmacopuncture Institute (http://pharmacopunc-ture.co.kr); however, most of the articles are in Korean. Not all articles were reviewed. Only articles that satisfied special criteria were selected for this study. The criteria were based on explicit and simultaneous descriptions for the types of pharmacop-uncture, disease, and injected acupuncture points. Experimental studies with healthy people and/or animals were included in the selection criteria. Approximately half the articles (164 papers) satisfied these criteria. Every selected paper was categorized and labeled according to the three nominal variables: medicinal materials (or pharmacopunc-ture), disease, and acupuncture points.

2.2. Types of pharmacopuncture

Pharmacopuncture can be divided into four types depending on the medicinal materials, diagnostic principles, and treatment methods. The types of pharmacopuncture are summarized in Table 1 and below.

2.2.1. Meridian-field pharmacopuncture

There are two kinds of meridian-field pharmaco-puncture, the Qi type and the lubrication type. The Qi types of pharmacopuncture are made from the extractions of fauna-originating medicinal materials, such as bezoar bovis, fel ursi, and moschus

Table 1 Types of pharmacopuncture and corresponding medicinal materials

Type of pharmacopuncture Medicinal materials

Meridian field Bezoar bovis, fel ursi, moschus Cervi cornu Juglandaceae seed Carthamus seed

Eight principles Mixtures of herbs

Bee venom Bee venom Sweet bee venom

Single compound Hominus placenta Scolopendrid Wild ginseng

(BUM). The lubrication types of pharmacopuncture are extracted from medicinal materials such as cervi cornu, juglandaceae seed and carthamus seed. Prescriptions for medicinal materials depend on the patient's constitution, age or disease.

2.2.2. Eight-principle pharmacopuncture

The use of the eight-principle pharmacopuncture method is based on the eight guiding principles of pattern identification/syndrome differentiation: yin and yang, exterior and interior, cold and heat, deficiency and excess [13]. Proper extractions from mixtures of many kinds of herbs are prepared according to the reason for the prescription. This method is used for the treatment of diseases such as hypertension, diabetes, gastrointestinal disease, joint sprains, lower back pain and psychosomatic diseases.

2.2.3. Bee-venom pharmacopuncture

Traditional Korean doctors have used apitoxin, or honey bee venom, as a type of pharmacopuncture. Bee venom is extracted from a honey bee by using electrical stimulation. There are approximately 40 different types of bee venom known to have antiphlogistic and pain-alleviating effects. Bee-venom therapy is effective in treating rheumatoid and degenerative arthritis, which require long-term treatment, as well as inflammatory, auto-immune, and muscular diseases [14,15]. Sweet bee venom is a more refined extract of bee venom, eliminating enzymes such as phospholipase and hyaluronidase that can trigger allergies. In order to reduce the side effects of bee venom, enzymes that had molecular weights of more than 10,000 and less than 4000 have been eliminated by using gel filtration chromatography.

2.2.4. Single-compound pharmacopuncture

Single-compound pharmacopuncture uses extracts from medicinal materials such as Hominus placenta, Scolopendrid, wild ginseng and ginger. Their efficacies have been well described in Korean oriental medical literature.

2.3. Classification of diseases

The classification of diseases followed that outlined in the literature [3], which is a different system from that used in conventional Western medicine. Table 2 shows the specific diseases that were considered in the papers selected from the Journal of the Korean Pharmacopuncture Institute.

2.4. Acupuncture points and meridians

For acupuncture nomenclature and traditional medicine terminology, we referred to the references published by the World Health Organization Regional Office for the Western Pacific [13,16]. The names of the meridians in alphabetical order are as follows: bladder (BL), conception vessel (CV), gallbladder (GB), governor vessel (GV), heart (HT), kidney (KI), large intestine (LI), liver (LR), lung (LU), pericardium (PC), small intestine (SI), spleen (SP), stomach (ST), and triple energizer (TE) meridians. Ashi points were also included separately because of their frequent occurrence in the studies. Ashi points, also known as ouch points, are acupuncture points with no specific name or definite location. Their sites are determined by tenderness or other pathological responses [13].

2.5. Descriptive statistics

The 164 selected articles were labeled according to three categorizing variables: the type of phar-macopuncture, the injected acupuncture points and meridians, and the type of disease. Based on the database, relationships between the variables are displayed within the contingency tables. Contingency tables are used to record and analyze the relationship between two categorical variables. There are several methods to quantify the measures of association between nominal variables. One is to calculate the measures of association based on the Chi-squared value [17]. Therefore, following the categorization procedure, measures of associations, such as Chi-squared, probability, Cramer's V, and contingency coefficient, were calculated for each contingency table. Additional information, such as the number of patients in clinical studies, outcome measures, and results, were also included in the database. Frequency distributions were also used for

Table 2 Diseases treated in published studies of pharmacopuncture

Category Specific disease

Lower limb disease Knee osteoarthritis, metatarsal tendinitis, pain in the popliteal region, reflex sympathetic dystrophy, pain of hip adductors, cold leg, acute ankle sprain, pes anserine bursitis, common peroneal neuropathy

Lumbar disease Lower back pain, cauda equina syndrome, herniation of intervertebral disc, lumbago pain in loin and feet, lumbar spinal stenosis, urinary incontinence, HIVD of lumbar spine patients, ruptured cervical disk

Upper limb disease Lateral epicondylitis, De Quervain's disease, lateral epicondylitis, wrist sprain, carpal tunnel syndrome, shoulder pain, radial nerve palsy, hip joint diseases, hemiplegic shoulder pain patients

Cancer-related disease Lung cancer, cancer pain, malignant melanoma, pancreatic cancer, bladder cancer

Head, face and neck disease Stiff neck, acute whiplash injury, temporomandibular disorder, transverse myelitis, Bell's palsy, peripheral facial palsy

Whole body and immune disease Rheumatoid arthritis, tardive dyskinesia, progressive muscular dystrophies, systemic lupus erythematosus, progressive muscle atrophy patient, spondylitis

Brain and cardiovascular disease Functional headache, post-stroke hemiplegic shoulder pain, headache, Klippel-Trenaunay-Weber syndrome, hypertension

Respiratory disease Asthma, pneumonia, lung disease

Gynecological disease Dysmenorrhea, oligomenorrhea, menstrual cramps

Pediatric disease Pediatric development disease, cerebral palsy syndromes

Skin disease Molluscum contagiosum, alopecia areata, herpes zoster

Urogenital disease Benign prostatic hyperplasia, swollen leg

Endocrine and metabolic disease Obesity patients

Neuropsychiatric disease Sleep pattern disturbance

Thoracoabdominal disease Chest heating

HIVD=herniation of the intervertebral disc.

tabulating the number of articles in which a specific category of a variable was counted.

3. Results

3.1. General summary of articles in the Journal of the Korean Pharmacopuncture Institute

Various kinds of articles have been published since the inaugural issue of the now Journal of the Korean Pharmacopuncture Institute in 1997. Most papers selected for this study were original research articles or clinical case studies. The proportions of the papers for basic experimental studies and human clinical studies were 36% and 64%, respectively. Most basic studies were performed using experimental animals, such as rabbits, rats, and mice. Among the clinical studies, 87% were performed with patients and the remaining 13% with healthy subjects. The total

number of patients and healthy subjects participating in the studies for the selected articles was 2479.

The selected articles were categorized depending on the medicinal materials used. The proportions of studies covering bee venom, meridian-field, single-compound and eight-principle pharmacopuncture were 42%, 24%, 24%, and 10% respectively. Among the bee venom pharmacopuncture studies, 80% used bee venom while 20% used sweet bee venom. In the case of meridian-field pharmacopuncture, most researchers studied carthamus seed (38%), followed by BUM (30%), juglandaceae seed (21%), and cervi cornu (11%). Studies on single-compound pharmacopuncture with Hominus placenta (37%), Scolopendrid (34%), and wild ginseng (29%) were more equally distributed.

The types of diseases in patients participating in clinical studies were distributed among lower limb disease (17%), back disease (17%), upper limb disease (14%), cancer-related disease (10%), head, face, and neck diseases (8%), whole body and immune

disease (8%), brain and cardiovascular disease (6%), respiratory disease (5%) and others (15%). In many clinical case reports, treatment with pharmaco-puncture was accompanied by other therapies such as needle acupuncture, herbal medications and physical therapy. More detailed information on the clinical reports, involving 40 patients or more, is summarized in Table 3 [18-29].

3.2. Associations between medicinal materials, acupuncture points and disease

The contingency table between the types of phar-macopuncture and acupuncture meridians is shown in Table 4. The numbers in the table are the number of the articles in which a specific type of pharmaco-puncture with medicinal materials was reported to have been injected at a specific acupuncture meridian. Sometimes, participants received injections at several acupuncture points and meridians in a single pharmacopuncture treatment. Therefore, the sum of the values in Table 4 is 239, larger than the number of selected articles (164). The measures of associations based on the Chi-squared method for Table 4 were Chi-squared 49.55, degrees of freedom 42, probability 0.19, and Cramer's V 0.26; the contingency coefficient was 0.41. Based on the probability result, there was no strong association between pharmacopuncture and meridians. The most frequently studied pharmacopuncture was the extraction of bee venom and injection into the stomach meridian. The contingency table between the type of pharmacopuncture and diseases, shown in Table 5, indicates that the bee-venom pharmacopuncture has been used for lower limb diseases. The measures of association based on the Chi-squared method for Table 5 were Chi-squared 22.57, degrees of freedom 9, probability 0.0072, and Cramer's V 0.39; the contingency coefficient was 0.56. A small value for the probability indicates a significant association between the type of pharmacopuncture and the disease.

3.3. Frequency distributions for meridians and acupuncture points

Frequency distributions for meridians and acupuncture points are shown in Figures 1 and 2. In a single paper, several acupuncture points or meridians may have been used for the injection of extractions from medicinal materials. In such cases, each acupuncture point was counted and added. The ordinates of the frequency-distribution graphs represent the total number of acupuncture points and meridians used for the studies in the selected articles in the Journal. These numbers were not based on the number of

patients or the number of injections in each article. The most frequently used meridians were the bladder meridian (BL), followed by the stomach meridian (ST), while the most frequently used acupuncture points were ST36, followed by BL23.

4. Discussion

The most frequently studied medicinal material, bee venom pharmacopuncture, has been used for treatment of multiple sclerosis, arthritis, pain reduction, and chronic inflammation [6,14,15]. Based on the classification of diseases shown in Table 2, lower limb diseases, such as knee osteoarthritis, were shown to be the most frequently studied diseases in the reports from the Journal of the Korean Pharmacopuncture Institute. A strong correlation between bee-venom pharmacopuncture and lower limb diseases can be seen in Table 5 (p=0.0072). The implications of the statistical quantities in association analysis are rather subjective and may not be as perceptible as the p value in usual statistical analysis [17], but these statistical quantities may be reference points for relative comparisons with future data. The correlations between the type of pharmacopuncture and the acupuncture meridians show less association compared with that between the type of pharmacopuncture and the disease. Some meridians, such as the BL line, are used with various kinds of medicinal materials, but other meridians, such as the LI and the ST, are mostly used for studies of bee venom pharmacopuncture.

This literature study shows some tendency or trend of pharmacopuncture-related research reported to the Journal of the Korean Pharmacopuncture Institute during the last decade. The limitation of this study with a heterogeneous data set is related to a reduced specificity for each medicinal material on specific injection points for the treatment of a specific disease. The growing number of data sets from every specific study will strengthen the interpretation of this analysis method, allowing pharmacopuncture to be viewed as a new treatment modality in complementary and alternative medicine. Many review papers present overviews of clinical trials of acupuncture therapies with a broader focus on the practice of Korean medicine [30]. This review paper focused on Korean pharmacopuncture-related works published in the Journal of the Korean Pharmacopuncture Institute because most such studies are reported through this journal.

Recently, interest in pharmacopuncture has been increasing domestically and internationally, with the number of English-language research articles on the subject also growing, as can be seen in the literature [31-33]. The data extracted from the articles

Table 3 Clinical pharmacopuncture therapy studies with 40 participants or more [18-29]

Reference* No. of participants Pharmacopuncture Acupoint Disease Outcome measure Comments

Jeong [18] 90 Meridian-field (Carthamus seed) BL, GB, ST Back (acute low back pain) ROM, VAS, ODI Accompanied by spiral taping therapy

Jang et al [19] 82 Eight-principle GB Brain (headache) Pain scoring Hwang-ryun-hae-dok-tang herbal acupuncture

Park et a I [20] 70 Bee-venom (sweet bee venom) Affected part Skin (molluscum contagiosum cases) Appearance observation Comparison before and after treatments

Koh et al [21] 70 Single-compound (Scolopendrid) BL, GB Back (herniation of intervertebral disc) DITI, physical test, ODI Accompanied with needle acupuncture, herbal medicine and physical therapy

Wang et al [22] 70 Bee-venom ST, Ashi Lower limb (knee osteoarthritis) Lysholm knee scoring scale Comparison before and after treatments

Kim et al [23] 49 Single-compound (Hominus placenta) CV, ST, SP Gynecology (dysmenorrhea) MMP, MSSL Comparison between treatment and saline groups

Youn et a I [24] 48 Single-compound (Hominus placenta) GB Neuropsychiatry Sleep pattern disturbance score Comparison between pharmacopuncture and needle acupuncture

Lee et al [25] 41 Bee-venom Ashi Stiff neck VAS, NDI, CEG Comparison of treatment effects and allergic responses between sweet bee venom and bee venom

Sin et al [26] 41 Eight-principle and Meridian-field (Carthamus seed) BL Peripheral facial palsy Grading paralysis on facial muscle Different pharmacopunctures used at different healing states

Lim et al [27] 40 Single-compound (Scolopendrid) Ashi Upper limb (carpal tunnel syndrome) VAS, clinical symptom Control group: needle acupuncture; treatment group: pharmacopuncture and needle acupuncture

Wei et al [28] 40 Meridian-field (Cervi Cornu) BL, Ashi Back (lumbago) VAS, ODI Accompanied with needle acupuncture, herbal medicine, physical therapy

Hur [29] 40 Eight-principle BL Pediatric (developmental disabilities) Evaluation scoring Accompanied with needle acupuncture and herbal medicine

'Articles were selected from the Journal of the Korean Institute of Herbal Acupuncture (February 1997 to February 2007) and the Journal of the Korean Pharmacopuncture Institute (June 2007 to December 2008); trefer to section 2.4. for abbreviations. VAS=visual analogue scale; ODI=Oswestry Disability Index; ROM=range of motion; DITI=digital infrared thermal imaging; MMP = measure of menstrual pain; MSSL=menstrual symptom severity list; NDI=neck disability index; CEG=clinical evaluation grade.

Table 4 Contingency table for the types of pharmacopuncture and acupuncture meridians*

Acupuncture

meridian Ashi BL CV GB GV HT KI LI LR LU PC SI SP ST TE

Pharmacopuncture

Meridian field 4 13 2 7 1 0 1 4 1 0 1 1 1 2 4

Eight principle 0 5 3 4 0 0 1 1 0 1 1 2 1 2 0

Bee venom 11 16 6 13 3 3 2 17 6 2 0 6 10 21 5

Single compound 5 14 8 5 2 0 0 3 0 1 0 1 4 9 3

'Values represent the number of reports for each type of pharmacopuncture and acupuncture meridian. BL=bladder; CV=conception vessel; GB=gallbladder; GV=governor vessel; HT=heart; KI = kidney; LI = large intestine; LR=liver; LU = lung; PC=pericardium; SI=small intestine; SP=spleen; ST=stomach; TE=triple energizer.

Table 5 Contingency table for the type of pharmacopuncture and disease*

Disease category

Lower limb Lumbar Upper limb Cancer-related

Pharmacopuncture

Meridian field 0 5 3 0

Single compound 3 3 3 2

Bee venom 11 5 5 2

Eight principle 1 0 1 4

"Values represent the number of reports for each type of pharmacopuncture and disease.

ж и с

tx си £

Г^ ^^ ^^ BL CV GB GV HT

KI LI LR LU PC SI Meridians

SP ST TE

Figure 1 Frequency distribution of meridians used for pharmacopuncture studies. Meridian names are arranged in alphabetical order. BL=bladder; CV=conception vessel; GB=gallbladder; GV=governor vessel; HT=heart; KI=kidney; LI = large intestine; LR = liver; LU = lung; PC = pericardium; SI = small intestine; SP=spleen; ST=stomach; TE = triple energizer.

published in the Journal of the Korean Pharmaco-puncture Institute are not large enough for any effect and/or efficacy of a specific pharmacopuncture therapy for a specific disease to be considered, as is common for meta analyses, systematic reviews, or the data-mining approach. However, this descriptive statistical approach may serve as a fundamental

basis for further studies on pharmacopuncture therapies through such analyses. In conclusion, the trend in basic and clinical research reports on Korean phar-macopuncture therapy was summarized by using a descriptive statistical approach and was presented to allow access for future research into the therapeutic value of pharmacopuncture.

■3 154

Acupuncture points

Figure 2 Frequency distribution of acupuncture points accessed for the study of pharmacopuncture. Acupuncture point names are arranged in order of the most frequently used points. BL=bladder; CV=conception vessel; GB = gallbladder; LI = large intestine; SP = spleen; ST=stomach.

References

1. Lee HJ. Introduction to Pharmacopuncture and Its Clinic. Seoul, Korea: Il-Chung-Sa, 1999. [In Korean]

2. Yin CS, Koh HG. The first documental record on bee venom therapy in Oriental medicine. J Korean Acupunct Moxibustion Soc 1998;15:143-7. [In Korean]

3. Science Committee of Korean Pharmacopuncture Institute. Pharmacopuncturology. Seoul, Korea: Elsevier Korea, 2008. [In Korean]

4. Nam SC. Meridian. Seoul, Korea: Hang-Lim-Seo-Won Publications, 1967. [In Korean]

5. Kim JU. Miraculous Pharmacopuncture Therapy. Seoul, Korea: Kum-Kang Publications, 1987. [In Korean]

6. Lee MS, Pittler MH, Shin BC, Kong JC, Ernst E. Bee venom acupuncture for musculoskeletal pain: a systematic review. J Pain 2008;9:289-97.

7. Yoon SY, Roh DH, Kwon YB, Kim HW, Seo HS, Han HJ, et al. Acupoint stimulation with diluted bee venom (apipuncture) potentiates the analgesic effect of intrathecal clonidine in the rodent formalin test and in a neuropathic pain model. J Pain 2009;10:253-63.

8. Lee JY, Han YJ, Kim JH, Kwon KR. Type analysis of pharma-copuncture papers published in the Journal of the Korean Institute of Pharmacopuncture. J Korean Inst Herb Acupunct 2006;9:147-54. [In Korean]

9. Lee JD, Park HJ, Chae Y, Lim S. An overview of bee venom acupuncture in the treatment of arthritis. Evid Based Complement Alternat Med 2005;2:79-84.

10. Janik J, Wania-Galicia L, Kalauokalani D. Bee stings—a remedy for postherpetic neuralgia? A case report. Reg Anesth Pain Med 2007;32:533-5.

11. Zhao Y. Acupuncture plus point-injection for 32 cases of obstinate urticaria. J Tradit Chin Med 2006;26:22-3.

12. Luna SPL, Angeli AL, Ferreira CL, Lettry V, Scognamillo-Szabo M. Comparison of pharmacopuncture, aquapuncture and acepromazine for sedation of horses. Evid Based Complement Alternat Med 2008;5:267-72.

13. World Health Organization Regional Office for the Western Pacific. WHO International Standard Terminologies on

Traditional Medicine in the Western Pacific Region. Manila, Philippines: World Health Organization Western Pacific Region, 2007.

14. Kwon YB, Lee JD, Lee HJ, Han HJ, Mar WC, Kang SK, et al. Bee venom injection into an acupuncture point reduces arthritis-associated edema and nociceptive responses. Pain 2001;90:271-80.

15. Baek YH, Huh JE, Lee JD, Choi DY, Park DS. Antinociceptive effect and the mechanism of bee venom acupuncture (api-puncture) on inflammatory pain in the rat model of collagen-induced arthritis: mediation by a2-adrenoceptors. Brain Res 2006;1073-4:305-10.

16. World Health Organization Regional Office for the Western Pacific. Standard Acupuncture Nomenclature, 2nd ed. Manila, Philippines: World Health Organization Western Pacific Region, 1993.

17. Press WH, Teukolsky SA, Vetterling WT, Flannery BP. Numerical Recipes in Fortran 77: the Art of Scientific Computing, 2nd edition. Port Chester, United Kingdom: Cambridge University Press, 1999:622-6.

18. Jeong M. Effectiveness of herbal acupuncture of Carthami semen (Honghwa) vs. its cotreatment with spiral taping for the treatment of acute low back pain: a randomized controlled trial. J Korean Inst Herb Acupunct 2002;5:25-38. [In Korean]

19. Jang HH, Lee DY, Lee SH, Kang HW, Lyu YS. Clinical studies on Hwangryunhaedoktang herbal acupuncture therapy for headaches. J Korean Inst Herb Acupunct 2003;6:52-60. [In Korean]

20. Park SH, Kim TS, Hur YJ, Kwon KR. Clinical report on the treatment of 70 Molluscum Contagiosum cases using sweet bee venom pharmacopuncture. J Korean Inst Herb Acupunct 2008;11:111-6. [In Korean]

21. Koh KH, Park SY, Choi HK, So KS, Hang WJ, Lee GM, et al. Clinical study on the treatment of HIVD of the lumbar spine using scolopendrid herbal acupuncture. J Korean Inst Herb Acupunct 2003;6:19-32. [In Korean]

22. Wang WH, Ahn KB, Lim JK, Jang HS. Clinical investigation compared with the effects of bee-venom acupuncture on

knee joints with osteoarthritis. J Korean Inst Herb Acupunct 2001;4:101-3. [In Korean]

23. Kim SM, Jang SH, Kim CH, Youn HM, Song CH, Ahn CB, et al. Effect of hominis placenta pharmacopuncture on the dys-menorrhea. J Korean Inst Herb Acupunct 2008;11:123-31. [In Korean]

24. Youn HM, Lee CW, Kim HK. Effects of the hominis placenta herbal acupuncture on sleep pattern disturbance. J Korean Inst Herb Acupunct 2005;8:5-12. [In Korean]

25. Lee KY, Youn HM, Ko WS, Song CH, Jang KJ, Ahn CB, et al. Comparison of treatment effects and allergic responses to stiff neck between sweet bee venom and bee venom phar-macopuncture. J Korean Inst Herb Acupunct 2008;11:39-48. [In Korean]

26. Sin MS, Park CJ, Choi SW, Yook TH. Clinical studies on herbal acupuncture therapy in peripheral facial palsy. J Korean Inst Herb Acupunct 2001;4:27-33. [In Korean]

27. Lim JA, Kim SC, Kim SN, Lee SY, Moon HC. Clinical study on treatment of carpal tunnel syndrome using scolopendrid herbal acupuncture. J Korean Inst Herb Acupunct 2005;8: 13-20. [In Korean]

28. Wei TS, Lee DH, Kim HS. Clinical studies about the improvement rate in managing patients who had lumbago and pain in the loin and feet with herbal-acupuncture therapy. J Korean Inst Herb Acupunct 2004;7:97-107. [In Korean]

29. Hur YJ. Clinical study on eight principle pharmacopuncture treatment of cerebral palsy syndromes. J Korean Inst Herb Acupunct 2003;6:47-51. [In Korean]

30. Kim YS, Jun H, Chae Y, Park H, Kim BH, Chang IM, et al. The practice of Korean medicine: an overview of clinical trials in acupuncture. Evid Based Complement Alternat Med 2005; 2:325-52.

31. Kim SJ, Kwon YD. Analgesic effects of Herba Chelidonii pharmacopuncture in rat model of peripheral neuropathic pain. J Altern Complement Med 2008;14:S-44.

32. Agasarov LG. Pharmacopuncture in dorsopathy treatment. J Acupunct Meridian Stud 2008;1:110-3.

33. Yook TH, Yu JS, Lee HY, Song BY, Kim LH, Roh JD, et al. Comparing the effects of distilled Rehmannia glutinosa, Wild Ginseng, and Astragali Radix pharmacopuncture with heart rate variability: a randomized, sham-controlled and doubleblind clinical trial. J Acupunct Meridian Stud 2009;2:239-47.