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Suicide is the leading cause of death worldwide, especially in South Korea. Individuals using Korean medicine (KM) clinics are common in this country, but KM doctor is not yet used in the country's suicide prevention policy. In this study, we investigated the prevalence and risk factors of passive suicidal ideation (SI) among outpatients at KM clinics, and attempted to develop a predictive model of SI through multivariate analysis. The Korea Health Panel Annual Data 2019, a nationally representative survey in South Korea, was analyzed. In this study, 1924 (weighted n:5,958,666) people aged 19 or older who used the KM outpatient service at least once in 2019 were set as study subjects. The authors calculated the weighted prevalence of passive SI and identified significant sociodemographic, physical, and mental factors using the Rao-Scott chi-square test and weighted logistic regression. A suicide risk scorecard was developed using the point to double the odds method to quantify individual risk, resulting in a score range of 0–100. We found high prevalence of passive SI among KM outpatients (7.5 %), and the annual prevalence of passive SI tended to be higher with increasing age (4.6 % in young adults, 6.7 % in middle-aged, and 12.4 % in old age). Also, the prevalence increased as stress worsened (2.0 % in hardly, 3.9 % in a little, 13.7 % in a lot, and 24.8 % in very much). By using multiple logistic regression analysis, SI risk prediction score model was developed, including basic livelihood security recipients, presence of chronic diseases, perceived stress, depression, and low quality of life. According to our findings, passive SI is not uncommon among KM outpatients. Based on current findings, the potential role of KMDs in the country's suicide prevention strategy can be discussed focusing on specific groups such as socioeconomically vulnerable groups, the elderly population, and those with physical illnesses.

Background: Traditional medicine (TM) plays a significant role in healthcare either as part of the primary healthcare system or as an adjunct to conventional medicine. This study aimed to map systematic reviews (SRs) of TM modalities across health conditions and identify gaps in the research literature to facilitate priority setting in future TM research. Methods: We searched 17 databases from January 2018 to December 2022. Reviewers in pairs independently performed the database search, screened each record for inclusion, extracted data, and performed quality assessments using the AMSTAR 2 - A Measurement Tool to Assess systematic Reviews. To be included in this evidence map, the studies had to be SRs of clinical studies that evaluated the effectiveness of a TM modalities. The included SRs were analyzed according to TM modality, ICD-11 disease classification, and health outcomes, and visualized using graphical plots. Results: We retrieved 241,509 records. After excluding duplicate records, 181,616 titles and abstracts were screened and 20,856 records were selected for full-text assessment, of which 18,137 records were further excluded. The final 2719 included SRs were primarily in adults (2591) with only 128 SRs in the pediatric population. The most commonly evaluated health conditions were diseases of the digestive system, circulatory system, and genitourinary system, with herbal medicine (n = 1867) and acupuncture (n = 471) being the most investigated TM modalities in treating these illnesses. Based on AMSTAR 2 criteria, the methodology quality of the included SRs is considerably low. Conclusion: This evidence map provides a comprehensive overview of the extent and nature of the available research onTM modalities across health conditions. It provides an initial step towards characterizing the global evidence base and outlining gaps in the existing evidence. We regard this study as laying the basis for future research of TM modalities. Registration: The protocol of this map is registered in PROSPERO (CRD42023416355).

Background: Herbal decoctions (HDs) are the oldest and most common herbal medicine formulations. Different HDs exist, and some consumers are concerned that they may become contaminated during manufacturing. Therefore, the need for a safety assessment of HDs has been raised. This study aimed to investigate the adverse events (AEs) associated with HDs by comprehensively analyzing randomized controlled trials (RCTs) using systematic reviews and meta-analyses. Methods: A systematic search was conducted on PubMed, Embase, and the Cochrane Library for articles published up to November 2022. The included RCTs compared HDs with other treatments published between 2013 and 2022, and the risk of bias was assessed using RevMan 5.4. Meta-analyses of the number of AEs associated with HDs reported in the included RCTs were also performed. Results: The systematic review included 26 RCTs, and the meta-analysis included 17 RCTs that reported AEs. The meta-analysis comparing HDs with active controls showed that both the number of AEs (14 studies; risk ratio (RR)= 0.50 cases, 95 % confidence interval (CI) [0.29, 0.88]; I2 = 42 %) and the number of patients who complained of AEs (seven studies; RR=0.51 patients, 95 % CI [0.28, 0.94]; I2 =9 %) were fewer in the HDs group than in the active control groups. Conclusion: This study showed that HDs are safer than other conventional medications based on the results of qualitative and quantitative syntheses of RCTs.

Objective: This systematic review analysed the effectiveness of mind-body modalities (MBMs) in Hwa-byung (HB). Methods: Ten electronic databases were searched. Intervention studies using MBMs for individuals with HB, published up to July 2023, were included. The methodological quality of the included studies was assessed using the Cochrane RoB and ROBINS-I tools. Meta-analysis of continuous variables was presented as mean differences (MDs) and their 95% confidence intervals (CIs). Results: Nine studies including five randomized controlled clinical trials, were included. The MBM types were meditation, relaxation, biofield therapy, art therapy, and forest-based MBM, and comprehensive HB programs. Most studies used an MBM group, with 5–6 sessions delivered during an average of 4–5 weeks. As a result of the meta-analysis, art therapy showed a statistically significantly better effect on improving the Hwa-Byung Scale (HB-S) score compared to the waitlist control (MD = −7.74; 95% CI = −9.81 to −5.66). In the before-and-after comparison, MBMs were frequently reported to have significant benefits for improving the HB-S total score (7/7, 100%), depressive mood (4/5, 80%), and state anxiety (6/8, 75%). Some methodological flaws were identified in the included studies, including the reliability of diagnosis, non-implementation of assessor blinding, and inappropriate control groups. Conclusions: This review identified potentially promising MBMs that were not previously recommended in the current HB clinical practice guidelines. In the future, high-quality clinical studies that include the use of standardized HB diagnostic criteria, homogeneous interventions, appropriate control groups, standard assessment tools such as the HB-S, and assessor blinding are needed.

Objective: In sham acupuncture-controlled acupuncture clinical trials, although sham acupuncture techniques are different from those of verum acupuncture, the same acupuncture points are often used for verum and sham acupuncture, raising the question of whether sham acupuncture is an appropriate placebo. We aimed to examine the effects of sham and verum acupuncture according to the points needled (same or different between verum and sham acupuncture) in knee osteoarthritis. Methods: Ten databases were searched to find randomized controlled clinical trials (RCTs) assessing the effects of verum acupuncture with sham acupuncture or waiting lists on knee osteoarthritis. Sham acupuncture was classified as using the same acupuncture points as those in verum acupuncture (SATV) or using sham points (SATS). A frequentist network meta-analysis (NMA) was conducted, and the certainty of evidence was evaluated. Results: A total of 10 RCTs involving 1628 participants were included. Verum acupuncture was significantly superior to SATS but not different from SATV in terms of pain reduction. Additionally, SATV was significantly superior to the waiting list. For physical function, no difference were found between verum acupuncture, SATV, and SATS. The certainty of evidence was low to moderate. Conclusion: For knee osteoarthritis, the pain reduction effect of acupuncture may differ according to the needling points of sham acupuncture, and the control group should be established according to the specific aim of the study design and treatment mechanism.

Objective: Sham acupuncture has been used as a control in acupuncture efficacy trials. However, questions have been raised about whether it is a physiologically inert placebo. We aimed to understand global research trends and provide guidance for future research by conducting a bibliometric analysis of sham acupuncture studies. Methods: Journal articles published to date related to sham acupuncture were retrieved from Web of Science on May 29, 2023. The publication year, country, keyword, author, and organization of the studies were analyzed using the available bibliometric information. Using VOSviewer software, the co-occurrence of keywords in sham acupuncture studies was visualized as a network map by cluster analysis and overlay analysis according to the publication year. Results: A total of 3428 studies were included in the analysis. Studies on sham acupuncture have been steadily increasing since 1991, with most of the studies conducted in China (1514 studies, 44.17 %), followed by the United States (789 studies, 23.02 %) and South Korea (277 studies, 8.08 %). The keywords of sham acupuncture research were classified into four clusters: evidence synthesis, pain clinical research, mechanism research, and acupressure research. Keyword analysis according to the publication year showed that evidence synthesis on sham acupuncture was recently focused on psychiatric conditions including depression and insomnia through systematic reviews, and clinical and mechanism studies on sham acupuncture were mostly conducted relatively in the past. Conclusion: This bibliometric analysis provides a comprehensive overview of the development and global trends of sham acupuncture research to date, suggesting directions for future research.

Background: Idiopathic short stature (ISS) is a common problem in children and causes many economic and social burdens. In Asian countries, East Asian traditional medicine (EATM) therapies are widely used for children with ISS. In this study, we compared and ranked various EATM therapies for the treatment of pediatric ISS using network meta-analysis. Methods: Randomized controlled trials that evaluated various EATMs for pediatric ISS were found through searching 14 electronic databases. The primary outcome was growth velocity (GV). The comparative effectiveness of the treatments was ranked based on the surface under the cumulative ranking curve (SUCRA) and the risk of bias was assessed. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations approach. Results: Fourteen studies comprising 1,066 participants were included. HM plus GH showed statistically significant superiority over other EATM therapies including acupuncture (weighted mean difference (WMD) 3.20 cm, 95% confidence interval (CI) 0.40 to 5.99) and HM (WMD 3.70 cm, 95% CI 1.41 to 5.99) for improving GV per year, although there was no difference compared with GH alone (WMD 1.18 cm, 95% CI -0.27 to 2.63). SUCRA indicated that HM plus GH was the most effective therapy for increasing GV, followed by GH, HM plus acupressure, and HM. No serious adverse events were reported. Conclusion: For the treatment of ISS, HM plus GH might have a large beneficial effect and might be a better option than EATM therapies and GH alone. However, more long-term, high-quality trials are warranted to confirm the findings. Protocol registration: PROSPERO (https://www.crd.york.ac.uk/prospero/), CRD42020187160.

Background: The significance of mindfulness meditation (MM) has increased in recent years in both clinical settings and public health. However, ways to implement MM as a disease prevention or treatment method in the elderly is still a major challenge. A comprehensive analysis of previous studies on MM programs for the elderly in Korea will help build future integrated care programs that incorporate MM. Methods: Seven international and Korean domestic electronic databases were searched to collect relevant clinical studies until May 30, 2020. Results: Sixteen articles with twelve clinical studies were included in this review. The MM program was generally offered once a week over eight weeks with a duration of between 60 and 90 min per session. The main reason for participants’ drop out was poor program compliance attributed to conflicting schedules, physical illness, or a change of mind. The program results were either positive or mixed, but the mindfulness level of the participants was improved. Conclusions: This review summarizes information obtained from previously published studies in Korea, on the design considerations, characteristics, and preliminary effectiveness of the MM program for the elderly. The findings can be used as preliminary data by future practitioners and/or researchers to design MM programs targeted toward the elderly; it could also help policymakers integrate MM-based strategies into integrated care programs to promote their mental health and well-being.

Background: Nakchim is a kind of neck pain syndrome that causes neck pain and stiffness without obvious trauma in East Asian traditional medicine. We aimed to summarize and critically evaluate the evidence regarding the efficacy and safety of acupressure on nakchim. Methods: We searched eight databases for studies published up to August 29, 2017. Clinical studies evaluating the efficacy of acupressure on nakchim were included. The acupressure methods of included studies were divided into proximal acupressure performed on acupuncture points located in neck and shoulder, and distal acupressure performed on acupuncture points located in other areas. Overall clinical effective rate (CER) and immediately cured rate (ICR), which means rate of the symptom totally resolved after one treatment session, were calculated as mean percentage with 95% confidence interval. All included studies were assessed for methodological quality. Results: Two case studies and 13 case series with 1037 participants were included, and 17 types of proximal acupuncture points and 14 types of distal acupuncture points were used. The most commonly used proximal and distal acupuncture points were GB20 and GB39, respectively. The CER in one study using both proximal and distal acupressure was 100%. The CER and ICR in studies using only proximal acupressure was 95.65% and 71.61%, respectively. The CER and ICR in studies using only distal acupressure was 99.37% and 69.08%, respectively. Eight studies performed simple acupressure technique using one acupuncture point, of which SI11, GB39, BL57, and TE3 were used. None of the studies reported adverse events. Conclusion: This review suggests that acupressure may be effective on nakchim. However, it is not conclusive due to low methodological quality and low evidence level of included studies. Keywords: Acupressure, Neck pain, Oriental medicine