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Breast cancer (BC) is the most common cancer in women and is a serious threat to women’s health. Cancer-related fatigue (CRF) is a distressing symptom in BC patients during and after chemotherapy or radiation therapy that severely affects quality of life (QoL). AT is widely used for fatigue management. However, the effect of AT on CRF is still uncertain. This study aimed to evaluate the efficacy and safety of AT in the management of CRF in patients with BC. Eleven databases were searched through June 2022. Two researchers independently performed the database search, study selection, data extraction, and risk of bias assessment. Study selection was performed based on predefined Participants, Intervention, Comparators, Outcomes, Study design (PICOS) criteria, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed when reporting the results. A meta-analysis was performed according to the Cochrane systematic review method using RevMan 5.3. A total of 12 studies including a total of 1084 participants were included. The results showed that AT had a beneficial effect compared with sham AT (n = 256, SMD = −0.26, 95% CI [−0.51, −0.01], p = 0.04, I2 = 0%) and a long-term effect on fatigue score (n = 209, MD = −0.32, 95% CI [–0.59, −0.04], p = 0.02, I2 = 0%). Meta-analysis showed that AT had a beneficial effect compared with usual care (UC) on fatigue scores (n = 238, SMD = −0.39, 95% CI [−0.66 to −0.12], p = 0.005, I2 = 0%). Of the 12 articles, 3 articles were judged as having a low risk of bias in all domains and hence were of high quality. No serious adverse effects were identified. AT is an effective and safe treatment for CRF, and AT is more effective than sham AT or UC or wait-list control (WLC). Nevertheless, the methodological quality of most of these studies was low, and the included studies/sample sizes were small, so the ability to derive decisive implications was limited. Further research is needed to confirm these findings.

We are grateful for the relevant comments by Hu et al. [...]

Although acupuncture (AT) is used in the treatment of CRF, the evidence from different systematic reviews (SRs) of AT has not yet been comprehensively evaluated. Moxibustion, which is a treatment method that is well established within Traditional East Asian Medicine, applies the heat of burning herbs towards or onto special points on the skin. Commonly, the herb Artemisia vulgaris, is used. It has been used for palliative cancer care, as well as for CRF. The aim of this overview was to evaluate the efficacy of AT and moxibustion in the management of CRF. Eleven databases were searched through for studies that were published from their dates of inception to February 2022. The study selection, the data extraction, and the assessment were performed independently by two researchers. The methodological and report quality were assessed by using the Assessment of Multiple Systematic Reviews-2 (AMSTAR-2) tool. The evidence quality was evaluated by using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Fifteen SRs on AT (n = 10) and moxibustion (n = 5) treatments for CRF were included, and they include 169 randomized controlled trials and 14,392 participants. All of the SRs that were evaluated by the AMASTAR-2 had more than one deficiency, and so all of the SRs were rated as either low or critically low. For the GRADE, 18 outcomes were rated as very-low-quality evidence, 13 as low-quality evidence, 3 as moderate-quality evidence, and 0 as high-quality evidence. Most of the SRs reached the potential benefits of AT for CRF. No serious adverse effects were identified. In conclusion, the evidence suggests that, despite the advantages of AT in terms of the improvement in and the safety of the treatment of CRF, the methodological quality of most of these studies is low, which limits our ability to draw definitive meanings. Further research of high quality is needed in order to confirm these findings.

Patients with Behçet’s disease often use complementary and alternative medicine for treating their symptoms, and herbal medicine is one of the options. This systematic review provides updated clinical evidence of the effectiveness of herbal medicine for the treatment of Behçet’s disease (BD). We searched eleven electronic databases from inception to March 2020. All randomized controlled trials (RCTs) or quasi-RCTs of BD treatment with herbal medicine decoctions were included. We used the Cochrane Handbook for Systematic Reviews of Interventions to assess the risk of bias and the grading of recommendations assessment, development and evaluation (GRADE) approach to assess the certainty of evidence (CoE). Albatross plot was also used to present the direction of effect observed. Eight studies were included. The risk of bias was unclear or low. The methodological quality was low or very low. Seven RCTs showed significant effects of herbal medicine on the total response rate (Risk ratio, RR 1.26, 95% CI 1.09 to 1.45, seven studies, very low CoE). Four RCTs showed favorable effects of herbal medicine on the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level compared with drug therapy. Herbal medicine favorably affected the ESR (MD −5.56, 95% CI −9.99 to −1.12, p = 0.01, I2 = 96%, five studies, very low CoE). However, herbal medicine did not have a superior effect on CRP. Two RCTs reported that herbal medicine significantly decreased the recurrence rate after three months of follow-up (RR 0.23, 95% CI 0.09 to 0.63, two studies, low CoE). Our findings suggest that herbal medicine is effective in treating BD. However, the included studies had a poor methodological quality and some limitations. Well-designed clinical trials with large sample sizes are needed.

Warm needle acupuncture (WA) is considered a potential intervention in the treatment of osteoarthritis (OA).To systematically evaluate the clinical efficacy and safety of WA in the treatment of OA.Systematic review and meta-analysis METHODS: Fourteen databases were searched from their inception until May 2022. Randomized controlled trials (RCTs) of WA for treating OA were identified. Study selection and data extraction were performed by two independent reviewers. The Cochrane risk of bias tool and the Grading of Recommendations Assessment, Development and Evaluation program were used to assess all included RCTs.A total of 66 RCTs met the inclusion criteria for this review. Most of the included studies had an unclear risk of bias, and the certainty of the evidence was very low. Twenty-four RCTs compared the effects of WA with those of oral drug therapies. Meta-analysis showed superior effects of WA for the total effective rate (risk ratio (RR): 1.22, 95% confidence interval (CI): 1.17 to 1.27, IWA may have some distinct advantages in the treatment of OA. However, well-designed RCTs with larger sample sizes are needed.

This review aimed to investigate the efficacy of integrative medicine (herbal medicine combined with drug therapy) in the treatment of Behcet’s disease (BD). Eleven databases were searched from their inception to 7 December 2020, for randomized control trials (RCTs) that reported the effects of integrative medicine in treating BD. The risk of bias was assessed using seven domain criteria from the Cochrane Collaboration tool. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to assess the quality of evidence. The direction of the effect is also shown in the form of an albatross plot. Sixteen trials met the inclusion criteria and were analyzed. The overall risk of bias was determined to be uncertain. The meta-analysis showed a superior response rate with herbal medicine plus drug therapy (relative risk (RR) 1.19, 95% confidence interval (CI) 1.13 to 1.25, n = 1034, p < 0.00001, I2 = 0%, low certainty of evidence (CoE)) compared to drug therapy. Integrative medicine also lowered the recurrence rate after 2 months of follow-up (RR 0.27, 95% CI 0.09 to 0.76, n = 120, p = 0.01, I2 = 0%, low CoE). The erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) level, and skin lesions were also significantly improved using integrative medicine, but equivalent effects were seen for oral ulcers, genital ulcers, and eye inflammation. Minor adverse events were reported in both groups. Our findings suggest that herbal medicine combined with drug therapy is more effective for the treatment of BD than drug therapy alone. Although the type of drug therapy used varied across the studies, integrative medicine was shown to improve the total response rate, skin lesions, the ESR, and the CRP level. However, the overall risk of bias of the studies was concerning, and the CoE was low. Information on adverse events (AEs) was also insufficient. In addition, the number of studies included for data synthesis for most outcomes was small. Future studies with rigorous RCTs may help establish the efficacy of integrative medicine in the treatment of BD.

Acupoint herbal patching (AHP) has long been used to treat patients with bronchitis in East Asia. This review assessed the efficacy and safety of AHP as a treatment for bronchitis.We performed a literature search using the 9 databases and included randomized controlled trials (RCTs) or quasi-RCTs that used AHP for bronchitis. The methodological quality of each RCT was assessed using the Cochrane Handbook version 5.3, the risk of bias tool, and Grading of Recommendations Assessment, Development and Evaluation (GRADE).Seven RCTs were included based on the inclusion criteria. All RCTs were published in China and had a high risk of bias. Three RCTs compared AHP with conventional drug therapy for the treatment of bronchitis. The meta-analysis also showed a significant improvement in treatment effectiveness (relative risk [RR] 1.28, 95% confidence interval [CI] 1.15, 1.42; P.00001; I2 = 0%). Two RCTs investigated AHP combined with conventional drug therapy versus conventional drug therapy. The meta-analysis showed that AHP was significantly more effective than conventional therapy in terms of treatment effective rate (RR 1.16, 95% CI 1.03, 1.29; P = .01; I2 = 0%). Three RCTs reported adverse events, and none reported severe adverse events.AHP appears to be more effective than conventional drug therapy alone or a placebo. Furthermore, the AHP appears to be a safe treatment option. However, due to the small number of included trials and their poor methodological quality, future studies should include larger sample sizes and well-designed RCTs.PROSPERO: CRD 42018110380.

Danggui Liuhuang (DLH) decoctions are traditional herbal medicines that are widely used for menopausal symptoms. The objective of this systematic review was to investigate evidence of the efficacy of DLH decoctions for menopausal symptoms. Fifteen databases were searched from inception until 29 May, 2020. We included randomized controlled trials (RCTs) testing any type of DLH decoction. All RCTs investigating DLH decoctions or modified DLH decoctions were included. The methodological quality of the RCTs was evaluated using Cochrane’s risk of bias assessment tool. We measured the certainty of evidence (CoE) according to the GRADE approach. A total of five RCTs met all of the inclusion criteria and were analyzed. The included RCTs had unclear risks of bias in most domains. Based on studies using the Kupperman index for the measurement of menopausal symptoms, DLH decoctions may have ameliorative effects on menopausal symptoms equivalent to those of conventional drug therapies, but we are very uncertain (MD 3.03, 95% CI −3.17 to 9.25, two studies, very low CoE). Compared with conventional drug therapies, DLH decoctions may reduce hot flashes (MD 0.17, 95% CI 0.28 to 0.06, three studies, low CoE). The difference in the response rate between treatments is very uncertain (risk ratio 1.1, 95% CI 1.07 to 1.25, three studies, very low CoE); the results may indicate that compared with drug therapy, DLH decoction therapy elicits responses in 84 more cases per 1000 cases. In conclusion, there is limited evidence that DLH decoctions improve menopausal symptoms equivalently compared with conventional drug therapies. However, the studies had unclear risks of bias, and the CoEs were very low in general. Additional large and rigorous studies are needed.

Background: The aim of this study was to undertake a systematic overview of meta-analyses and published systematic reviews to identify whether and when acupunctureand electroacupuncture are deemed efficacious treatment options for stroke and stroke-related disorders. Methods: Four databases, namely, PubMed, AMED, EMBASE, and the Cochrane Library will be searched from their inception. Two reviewers will independently perform study selection, data extraction, and assessment. This will be followed by an assessment of the methodological and report quality using the Assessment of Multiple Systematic Reviews-2 tool. Finally, the study will entail the assessment of evidence quality by employing the Grading of Recommendations Assessment, Development, and Evaluation system. Results: This overview is expected to provide data on using acupuncture for stroke and stroke-related disorders on the basis of the included systematic reviews’ qualitative and quantitative syntheses. Conclusion: This overview will assess the benefits as well as hazards of acupuncture for stroke, subsequently providing patients and practitioners with useful information and have implications for future studies on the topic. Trial registration number: Reviewregistry1263

Introduction This study aimed to investigate the perception of Korean medicine (KM) doctors regarding the treatment of degenerative lumbar spinal stenosis (LSS) and explore their opinions on the core clinical questions (CQs) of KM clinical practice guidelines (CPGs) for patients with degenerative LSS. Methods An online cross-sectional survey distributed via e-mail was conducted in December 2016. The study population included registered KM doctors (KMDs) in South Korea. The e-mail contained 13 questionnaire items regarding the doctors’ demographic characteristics and perceptions of the core CQs that should be addressed in CPGs for patients with degenerative LSS. Descriptive analyses were performed to summarize the data. Results A total of 680 KMDs responded to the survey. Kidney qi deficiency was the most commonly used diagnostic name for degenerative LSS. Acupuncture ranked first in the treatment used for degenerative LSS and in the treatment desired to be included in the development of CPG recommendations. Ojeok-san (积散, 積散, Wuji-san, Goshaku-san) was the number one herbal medicine, and 5% bee venom pharmacopuncture was the number one pharmacopuncture technique used for degenerative LSS. Drug therapy was the most selected control treatment considered appropriate to assess treatment effectiveness and safety. Pain relief was the most chosen indicator among the indicators considered reasonable to assess therapeutic effectiveness. Conclusion Results of this study are expected to inform the development of key CQs of the KM standard CPG for degenerative LSS. The involvement of KMDs in the CPG development process can help develop useful and available CPGs.

Background This study aimed to obtain the symptom, prescription and therapeutic patterns for the treatment of patients with menopausal syndrome in major Korean medicine (KM) hospitals. Methods We used a retrospective chart review of climacteric disorder and postmenopausal syndrome patients by examining medical records (ICD-10, menopausal and female climacteric states: N95.1, Menopausal and perimenopausal disorder, unspecified: N95.9) from eight university KM hospitals in South Korea. Results The main symptoms of 1,682 patients with menopausal disorders visiting 8 college-affiliated oriental medicine hospitals were hot flush, hyperhidrosis, fatigue, insomnia, and chest tightness. Guipi-tang (decoction), Siwu Guipi-tang (decoction), Qingxin Lianzi-yin (decoction), Jiawei Xiaoyao-san (powder) and Guipi Wendan-tang (decoction) were the most commonly prescribed herbal medicines for menopausal disorders. Patients were most often treated with a combination of herbal medicine and acupuncture. Conclusion Our study shows that the current prescribed herbal medicines were used for treating menopausal disorders in Korean medicine hospitals. However, the objectivity of the efficacy assessment should be studied further.

Introduction Based on a structured, rigorous methodology developed for creating evidence-based clinical practice guidelines (CPGs), the Korean Institute of Oriental Medicine and Korean Acupuncture and Moxibustion Medicine Society developed a guideline for treating acute ankle sprain using acupuncture which is part of Korean medicine (KM). Methods Using a revised Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach, the committee based these recommendations on a systematic review of randomized controlled trials on any form of acupuncture used for ankle sprains published up to July 2015. Accessible sources relating to ankle sprain were collected, and a systematic review and meta-analysis were applied to the collected data. The quality of evidence was graded, and the recommendations were drafted and then finalized after official approval. Results For this CPG, six clinical questions and recommendations that were primarily related to manual acupuncture methods were addressed. Four were related to manual acupuncture alone, of which one focused on electroacupuncture and another on pharmacopuncture. Clinical outcomes evaluated were pain reduction using a visual analogue scale (VAS) or the numeric rating scale and improved cure rates, joint position sense, kinesthesia, and range of motion. Manual acupuncture was thus recommended as grade A treatment for alleviating VAS-graded pain. Conclusions The guideline for treating ankle sprain establishes a standard procedure to ensure high-quality medical care for ankle sprain that could be applied globally to patients seeking KM. It also supports international traditional medicine research methodology. When further clinical research is conducted, this CPG can be updated, adding value to its content.

Introduction Nourishing yin is one of the most important treatment methods for skin diseases. The main conditions for which herbal prescriptions are used for nourishing yin are: skin pruritus, psoriasis, eczema, atopy, acne and alopecia. The aim of this systematic review was to identify and analyse trial data on the efficacy and safety of the nourishing yin method using herbal medicine for skin disease. Methods Eleven electronic databases were searched from their inception through until December 2016, with no language limitation. Randomised controlled trials for nourishing yin using herbal prescriptions used to treat skin disease were identified and their risk of bias of assessed. Results Of 725 of the total trials identified, 29 studies were included. Most studies had a high risk of bias. Twenty-five RCTs tested nourishing yin herbal medicines for various skin diseases compared with conventional medicines. Most showed superior response rates compared with conventional medicine, and 7 trials reported equivalent effects. The meta-analysis showed favourable effects of the nourishing yin method using herbal medicine for various skin diseases (n = 2813, RR: 1.20, 95% CI: 1.13 to 1.26, P Conclusion This review provides superior or equivalent effects of the nourishing yin method using herbal prescriptions for treating skin diseases compared with conventional medicines.

Introduction Shoulder pain is a common musculoskeletal problem and one of the highest health expenditures in Korea. This article describes the development of evidence-based Korean medicine (KM) clinical practice guidelines (CPGs) for manual acupuncture for the management of shoulder pain. Methods The CPG-KM Development Committee was provided with 12 clinical questions on manual acupuncture for the management of shoulder pain. A literature search was then conducted on seven databases (PubMed, Medline, the Cochrane Library, three Korean medical databases and one Chinese medical database). Results The final recommendations were developed by reaching official agreement on the draft using the Delphi method and the CPG-KM for shoulder pain which was approved by The Society of Korean Medicine Rehabilitation. Twelve clinical questions and eleven of the recommendations (grade A (2), B (5), C (2) and GPP (2)) were primarily related to manual acupuncture methods. A manual acupuncture treatment is recommended as grade A, to alleviate pain and improve the range of motion and shoulder joint function of an adult shoulder pain patient. An acupuncture treatment for shoulder pain should simultaneously consider local and distal acupoints. Conclusion The CPG KM for shoulder pain provides a standard procedure for the treatment process to ensure that a high quality medical service is provided globally to all patients for traditional KM, thereby supporting international traditional medicine research methodology. If additional clinical research is conducted in the future, this CPG can be updated to reflect the most up-to-date evidence.

Objectives Gan Mai Da Zao (GMDZ) decoction is widely used for the treatment of various diseases of the internal organ and of the central nervous system. The aim of this study is to investigate the effects of GMDZ decoction on neuropsychiatric disorders in an animal model. Methods We searched seven databases for randomized animal studies published until April 2015: Pubmed, four Korean databases (DBpia, Oriental Medicine Advanced Searching Integrated System, Korean Studies Information Service System, and Research Information Sharing Service), and one Chinese database (China National Knowledge Infrastructure). The randomized animal studies were included if the effects of GMDZ decoction were tested on neuropsychiatric disorders. All articles were read in full and extracted predefined criteria by two independent reviewers. Results From a total of 258 hits, six randomized controlled animal studies were included. Five studies used a Sprague Dawley rat model for acute psychological stress, post-traumatic stress disorders, and unpredictable mild stress depression whereas one study used a Kunming mouse model for prenatal depression. The results of the studies showed that GMDZ decoction improved the related outcomes. Conclusion Regardless of the dose and concentration used, GMDZ decoction significantly improved neuropsychiatric disease-related outcomes in animal models. However, additional systematic and extensive studies should be conducted to establish a strong conclusion.

Introduction Lumbar herniated intervertebral disc (HIVD) is a common chronic disease, and in Korea many patients use Korean medicine (KM) for treatment. However, KM clinical practice guideline (CPG) for HIVD remain poor. Therefore, this aim is to describe the KM approach for managing HIVD in Korea from an evidence-based medicine (EBM) perspective. Methods A systematic review was undertaken of literature focusing on key areas of KM practice aimed at managing HIVD. The evidence obtained was based on the study design and the risk of bias. Recommendations were formulated, taking the quality, quantity, and level of the evidence into consideration, as well as the likely clinical impact and the applicability of the evidence to KM practice in Korea. Preliminary CPGs were then recommended for the application of KM for the management of HIVD. After several rounds of expert consensus meetings, the final guideline was endorsed by relevant professional committees. Results The final recommendation was made based on a draft of the recommendations of the working group during the consensus process. A total of 15 recommendation statements were made regarding KM treatments for HIVD, which included acupuncture (n = 3), pharmacopuncture (n = 3), herbal medicine (n = 3), chuna (n = 2), moxibustion (n = 2), and cupping therapy (n = 2). Conclusions Following on from the above development, we sought to carry out a high-quality follow-up KM clinical study with the objective of improving HIVD patients understanding of medical treatments for the condition. Also, future research in this area will formally examine the success of the guideline’s implementation.

Background The aim of this study was to investigate the clinical practice of Korean medicine doctors (KMDs) for managing menopausal disorders. Methods We conducted a web-based questionnaire for KMDs to respond to recommendations across the three main KM domains: major symptoms of menopausal disorders, herbal prescriptions, and pattern identification. Results We received responses from 227 doctors who have treated menopausal disorders. The major pattern identifications recommended by the doctors for the pre-, peri-, and postmenopausal phases, respectively, were depression of liver energy (59.5%), kidney yin deficiency (49.8%), and kidney yin deficiency (50.7%). The most frequent herbal remedies prescribed for the pre-, peri-, and postmenopausal phases were Jiawei shaoyao-san (58.1%), Jiawei shaoyao-san (48.5%), and Jiawei guipi-decoction (37.9%), respectively. Conclusion The results of our clinical practice survey provide information on KMDs’ clinical experiences of using herbal medicines and their use of pattern identification to manage menopausal disorders.

Background This survey aimed to investigate clinicians’ perceptions and current practice patterns of Korean medicine (KM) treatment for female infertility. Methods A questionnaire on clinical practice patterns of KM treatment for female infertility was constructed and distributed to 703 KM doctors (KMDs). Results A total of 20.5% of physicians (n = 144/703) completed the survey and delivered integrative care for female infertility patients. Integrative care mainly consisted of acupuncture, herbal medicine, and moxibustion. The participants largely relied on radiological findings on ultrasonography and hormone tests for diagnosis. The most frequently prescribed herbal medication was Jogyeongjongok-tang (Tiaojing Zhongyu decoction), and the most frequently applied acupoints were SP6, CV4 and ST36. Conclusions This study provides expert opinions and information on actual clinical practice patterns of KM for treating female infertility. However, we cannot completely discount the possibility that biased selection of subjects and the low response rate limit the interpretations of the study results.

Background: Acupoint herbal patching (AHP) is widely used for symptom management in patients with acute and chronic bronchitis. The purpose of this protocol review is to evaluate the safety and efficacy of AHP for the treatment of bronchitis. Methods and analysis: This protocol of systematic review will be conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P). The databases searched will include PubMed, Embase, CENTRAL, Web of Science, 3 Korean medical databases (OASIS, Korea Med, and KMBASE), and the Chinese database China National Knowledge Infrastructure (CNKI). Randomized controlled trials (RCTs) or quasi-RCTs using AHP for bronchitis will be considered. The selection of the studies, data abstraction, and validations will be performed independently by 3 researchers. Conclusion: The conclusion of the review will provide evidence that AHP is an effective intervention in patients with bronchitis. Ethics and dissemination: As individuals were not involved, ethical approval is not required. Findings will be published in a peer-reviewed journal. This systematic review may inform the treatment of bronchitis patients in clinical practice. Registration: This systematic review has been registered with the International Prospective Register of Systematic Reviews (PROSPERO). The reference number is CRD42018110380.

Background: Most women experiencing menopause have sought out traditional treatment options to relieve their symptoms. The aim of this study, which used a web-based survey, was to investigate perceptions of Korean medicine doctors (KMDs) on managing menopausal symptoms with herbal medicines. Methods: We developed and then sent a questionnaire via email to a total 497 KMDs in obstetrics and gynecology affiliated with the Society of Korean Medicine. The questionnaire consisted of three categories and a total of 26 items focusing on major menopausal symptoms, prescriptions, pattern identification, and background characteristics. Results: Out of the 497 KMDs, we received responses from 48 doctors, a response rate of 9.7%. The most common symptoms of menopausal disorder perceived by responded KMDs were hot flashes (22.9%), sleep disorders (18.2%), systemic fatigue (12.5%), and sweating (12.0%). The herbal medicines reported to be the most effective when treating patients with menopausal disorders were Jiawei shaoyao-san (12.5%), Jiawei guipi-decoction (11.8%). The responding KMDs recommended one to two months of treatment for female menopausal disorder, using two to three doses of herbal medicine per day in combination with traditional Korean medicine (KM) therapies such as acupuncture, moxibustion, cupping, and pharmacopuncture. Conclusion: The results of this survey may provide information about doctor’s perceptions on using herbal medicines to manage patient’s menopausal symptoms. Future studies should be done with a larger sample size to overcome the limitation of this study and to examine how KM is used for treating menopausal symptoms in clinical practice. Keywords: Menopausal symptoms, Herbal medicines, Web-based survey

PURPOSE The purpose of this study was to investigate the effects of aromatherapy on sleep quality. METHODS This is a systematic review of randomized controlled trial studies (PROSPERO registration number CRD42017064519). In this study, the PICO were adults and the elderly, aromatherapy intervention, a comparative intervention with the control and placebo oil groups, and sleep. The selected articles were in English, Korean, and Chinese. RESULTS The results of the meta-analysis showed that the effect sizes of the experimental group were 1.03 (n=763, SMD=1.03, 95% CI 0.66 to 1.39) (Z=5.47, p

Blood stasis syndrome (BSS) is an important pathological condition in traditional East Asian medicine and is associated with ischemic heart disease, cerebral vascular accident, diabetes mellitus, chronic renal failure, severe traumatic injury, and dysmenorrhea. However, previous studies have been unable to reveal the clinical and biological characteristics or biological markers of BSS. We hypothesized that the heterogeneity among the manifestations of BSS or non-BSS could interfere with an analysis to describe the characteristics of BSS. In this study, male participants based on the severity of BSS-associated symptoms and signs were clustered and classified into four subgroups: BSS subgroups (1), (2), (3), and (4). Non-BSS core subgroup was redefined using manifestation cluster analysis. Biological characteristics of subgroups BSS(1) and BSS(2) belong to the range of the non-BSS core subgroup (1), whereas that of subgroups BSS(3) and BSS(4) are characterized by different biological parameters such as systemic inflammatory conditions and elevated D-dimer level. Our results suggested that patients in subgroups of BSS(3) and BSS(4) are more likely to be exposed in an inflammatory state than other BSS subgroups. We found the heterogeneity among the manifestations which could mask the characteristics of BSS and identified the clinical and biological profiles of the four BSS subgroups through comparisons of the redefined non-BSS and BSS subgroups. This finding could provide accurate diagnostic criteria and new approaches for BSS treatments in different subgroups.

Introduction Evidence based clinical practice guidelines (EB-CPGs) are recommended in order to improve the quality of healthcare. The objective of this study was to assess whether providing an EB-CPG leaflet improved the level of satisfaction of patients with shoulder pain. Methods A randomized crossover study was conducted in Gwangju Korean Medicine Hospital of Wonkwang University. Fifty participants were randomly assigned to one of two different sequences – Sequence 1: Korean medicine (KM) treatment with EB-CPG leaflet – without- EB-CPG leaflet or Sequence 2: KM treatment without EB-CPG leaflet – with EB-CPG leaflet. The washout period between the two methods was two weeks. The main outcome was patient satisfaction throughout the treatment procedure (scored on a 5-point Likert scale) that had five items: satisfaction with the KM doctor's (KMD's) explanation, understanding of the KMD's explanation, improvement in the reliability of KM, satisfaction with the treatment time, and overall satisfaction. Results The results indicated that KM treatment with the EB-CPG leaflet had a considerably greater impact in patient improvement than KM treatment with no leaflet on total patient satisfaction (P = 0.026). Patients perceived ‘reliability of KM treatments’ was higher in the KM treatment with a leaflet than in the treatment group with no leaflet (P = 0.0004). Conclusion Despite this short-term intervention, KM treatment with a leaflet that included EB-CPG information was shown to be an effective method of communication for patients being treated for shoulder pain. The efficiency of this EB-CPG-based communication tool should be further explored.

Introduction Atopic dermatitis (AD) is a type of chronic, recurrent inflammatory skin disorder that is emerging as a major healthcare problem in Korea. We aimed to develop clinical practice guidelines (CPGs) for AD and to provide recommendations for the diagnosis and management of AD on acupuncture and herbal medicine supported by both evidence and data related to the disease. Methods An expert group was convened to establish the most efficient system of clinical care based on the use of acupuncture and herbal medicine administered as part of Korean Medicine (KM) for the treatment of AD by drawing on a vast and diverse corpus of clinical data, with the goal of eventually establishing a foundation for evidence-based KM. This expert group devised a plan to publish clinical guidelines and collected and analysed currently available evidence for the development of the CPG. Results Six recommendations were developed for the treatment of AD on acupuncture and herbal medicine. Four of the recommendations were primarily related to herbal medicine, and two were related to acupuncture. Conclusion We developed CPG for AD using evidence-based medicine. This work is expected to lay the groundwork for a high-quality, follow-up clinical study on KM and to establish a foundation for a domestic KM group to assume the lead in the standardization of KM, thereby supporting international research.

IntroductionWarm needle acupuncture (WA) is widely used the treatment in the East Asian countries. However, there is no critically appraised evidence of the potential benefits and harms. The purpose of this systematic review will be to evaluate the efficacy of WA for osteoarthritis (OA).Methods and analysisElectronic databases will be searched: MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL) and AMED, 6 Korean medical databases (Korea Med, the Korean Traditional Knowledge Portal, OASIS, DBPIA, the Research Information Service System and the Korean Studies Information Service System), 3 Chinese databases (CNKI, VIP and Wanfang) and a Japanese database (CiNii Articles) will be searched from their inception. These will be searched from their inception. Selection of the studies and data extraction and validation will be performed independently by two reviewers. Randomised controlled trials (RCTs) and quasi-RCTs using WA for any type of OA will be considered. The studies will independently undertake study selection, extraction of data and assessment of study quality by two authors. Risk of bias will be assessed using the Cochrane risk of bias standards. All data synthesis and subgroup analyses will be conducted using Review Manager Software.DisseminationFindings will be published in a peer-reviewed journals. This systematic review may inform the treatment of OA patients in clinical practice.

Introduction Blood stasis is a clinical syndrome caused by an impedance or cessation of blood flow and is regarded as the cause or the result of many chronic diseases in traditional Chinese medicine (TCM). The aim of this review was to summarize definitions of blood stasis in TCM and recurring concepts regarding the physiopathology that accompany these definitions. Methods A systematic review of textbooks was performed in 5 internet bookstores (Huawen and Cathay bookshops, Taobao, Amazon, Dangdang, Baidu), 3 search engines (Google, Baidu, and Yahoo) and 2 electronic libraries (the Korea Institute of Oriental Medicine and the Beijing University of Chinese Medicine), to find unique definitions of blood stasis. The authors assessed all books, extracted unique definitions, and selected concepts of physiopathology by using the constant comparison method. Results The authors found a total of 55 textbooks. Of which, 17 was included for further analysis and identified 17 definitions of blood stasis with recurring concepts surrounding the physiopathology. These concepts were composed of 4 categories that included vascular obstruction, abnormal flow of blood, blood congestion in a viscus, and contaminated blood. Conclusion Blood stasis is still a developing concept. This information may be a valuable reference for future research seeking to standardise the concept of blood stasis.

Introduction This study aims to demonstrate the effectiveness of using clinical practice guideline (CPG) leaflets as a communication tool between doctors and patients. We will collect basic data on whether using leaflets based on traditional Korean medicine (TKM) CPGs accomplishes the goal of improving clinical decision-making for diagnosis and treatment by TKM doctors. We will also evaluate the leaflets as a communication tool in the treatment of lumbar herniated intervertebral discs (HIVDs) in terms of patient and physician satisfaction and ease of treatment. Methods and analysis We will evaluate efficacy through a comparison of satisfaction and clinical outcomes in randomly allocated groups of HIVD lumbar patients visiting the Jaseng Hospital of Korean Medicine who do or do not receive CPG-based treatment. Following the evaluation, we will make recommendations on whether to implement CPG interventions for patients selecting TKM treatment after HIVD diagnosis and the method of clinical treatment. Finally, we will evaluate the perception of and satisfaction with CPGs among TKM doctors and patients.

Introduction Facial palsy is a common disease, and Korean medicine (KM) is widely used to treat facial palsy in Korea. However, there are no Korean multidisciplinary guidelines for facial palsy; thus, guidelines that are adequate for domestic circumstances are required. Methods To establish clinical practice guidelines (CPGs), professional group formation, plans for research progress and the situation regarding CPG development were analysed. Subsequently, data from the Korean and Western medical literature regarding the CPGs for facial palsy were collected and analysed. A draft of the Korean medicine CPGs for facial palsy was then developed. After review and amendment of the guidelines by a review committee, the Korean acupuncture and moxibustion medicine society reviewed and approved the guidelines. Results In total, 24 recommendations were developed for the KM treatment of facial palsy. Six of the recommendations were primarily related to manual acupuncture and treatment methods. The other recommendations were related to electroacupuncture, thread embedding and other acupuncture techniques. Conclusion The result of this project suggests a methodology to develop CPGs that is suitable for our environment of KM but that it lacks supporting evidence; in turn, this methodology will lead to the production of evidence and recommendations for patient care in actual KM clinical settings.

Introduction Every year, more than 6 million people die from smoking-related diseases. One method used to promote smoking cessation is acupuncture. The present study aims to assess the efficacy of acupuncture for smoking cessation by conducting a review of the currently available evidence. Methods and analysis Sixteen databases will be searched for studies conducted through March 2017. We will include randomized controlled trials (RCTs) assessing acupuncture for smoking cessation. All RCTs on acupuncture or related interventions will be included. Risk of bias will be assessed using the Cochrane risk of bias assessment tool, while confidence in the cumulative evidence will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) instrument. Ethics and dissemination This systematic review will be published in a peer-reviewed journal and will also be disseminated electronically and in print. The review will be updated to inform and guide healthcare practices.

Objective This review aimed to examine the effectiveness of acupuncture for the treatment of diabetic retinopathy (DR). Methods Fourteen databases (5 English, 4 Chinese, and 5 Korean) were searched from their inception until May 20, 2020. Randomized controlled trials (RCTs) using acupuncture for DR treatment were included. The study selection and data extraction were performed by two independent reviewers. The Cochrane risk of bias tool version 2 (RoB 2.0) and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) were used to assess all the included RCTs. Results Of 864 citations, 6 RCTs met the inclusion criteria of our review. Four studies reported the beneficial effects of acupuncture with standard medication or acupuncture alone compared with standard medication or no treatment on the effective rate. Only three studies showed that acupuncture combined with standard medications significantly improved visual acuity compared to standard medication alone. None of the studies reported on adverse events. The risk of bias of the included studies was judged to be of “some concern” and was marked with a moderate and low certainty of evidence in different outcomes. Conclusion Our results suggest the potential benefit of acupuncture in treating DR. Acupuncture in the form of combined therapy with standard medication or acupuncture alone may be more effective in the treatment of DR than standard medication alone. Further rigorous clinical trials are needed to confirm these findings.

Background Radiation pneumonitis is a common and serious complication of radiotherapy. Many published randomized controlled studies (RCTs) reveal a growing trend of using herbal medicines as adjuvant therapy to prevent radiation pneumonitis; however, their efficacy and safety remain unexplored. Objective The aim of this systematic review is to evaluate the efficacy and safety of herbal medicines as adjunctive therapy for the prevention of radiation pneumonitis in patients with lung cancer who undergo radiotherapy. Methods We searched the following 11 databases: three English medical databases [MEDLINE (PubMed), EMBASE, The Cochrane Central Register of Controlled Trials (CENTRAL)], five Korean medical databases (Korean Studies Information, Research information Service System, KoreaMed, DBPIA, National Digital Science Library), and three Chinese medical databases [the China National Knowledge Database (CNKI), Journal Integration Platform (VIP), and WanFang Database]. The primary outcome was the incidence of radiation pneumonitis. The risk of bias was assessed using the Cochrane risk-of-bias tool. Results Twenty-two RCTs involving 1819 participants were included. The methodological quality was poor for most of the studies. Meta-analysis showed that herbal medicines combined with radiotherapy significantly reduced the incidence of radiation pneumonitis (n = 1819; RR 0.53, 95% CI 0.45–0.63, I2 = 8%) and the incidence of severe radiation pneumonitis (n = 903; RR 0.22, 95% CI 0.11–0.41, I2 = 0%). Combined therapy also improved the Karnofsky performance score (n = 420; WMD 4.62, 95% CI 1.05–8.18, I2 = 82%). Conclusion There is some encouraging evidence that oral administration of herbal medicines combined with radiotherapy may benefit patients with lung cancer by preventing or minimizing radiation pneumonitis. However, due to the poor methodological quality of the identified studies, definitive conclusion could not be drawn. To confirm the merits of this approach, further rigorously designed large scale trials are warranted.

Background: Integrative medicine is claimed to improve symptoms of lupus nephritis. No systematic reviews have been performed for the application of integrative medicine for lupus nephritis on patients with systemic lupus erythematosus (SLE). Thus, this review will aim to evaluate the current evidence on the efficacy of integrative medicine for the management of lupus nephritis in patients with SLE. Methods and analyses: The following electronic databases will be searched for studies published from their dates of inception February 2018: Medline, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL), as well as 6 Korean medical databases (Korea Med, the Oriental Medicine Advanced Search Integrated System [OASIS], DBpia, the Korean Medical Database [KM base], the Research Information Service System [RISS], and the Korean Studies Information Services System [KISS]), and 1 Chinese medical database (the China National Knowledge Infrastructure [CNKI]). Study selection, data extraction, and assessment will be performed independently by 2 researchers. The risk of bias (ROB) will be assessed using the Cochrane ROB tool. Dissemination: This systematic review will be published in a peer-reviewed journal and disseminated both electronically and in print. The review will be updated to inform and guide healthcare practice and policy. Trial registration number: PROSPERO 2018 CRD42018085205

Supplemental Digital Content is available in the text, Background: Bojungikki-tang, a herbal medicine for strengthening the digestive system, has been widely used in East Asian countries since the Yuan Dynasty in China. Moreover, Bojungikki-tang has reportedly exhibited anti-allergy effects in many clinical trials. This systematic review will assess the effectiveness and safety of Bojungikki-tang for allergic rhinitis (AR). Methods and analysis: Eleven databases, including Asian databases, will be searched for studies conducted through October 2017. We will include randomized controlled trials (RCTs) assessing Bojungikki-tang for AR. The risk of bias will be evaluated using the Cochrane risk of bias assessment tool, and confidence in the cumulative evidence will be evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) instrument. Ethics and dissemination: This systematic review will be published in a peer-reviewed journal and will also be disseminated electronically and in print. The review will be updated to inform and guide health care practices. Registration: The protocol for this systematic review has been registered in PROSPERO (https://www.crd.york.ac.uk/PROSPERO) under number CRD42017068993.

Background: Acupuncture is claimed to improve the lower urinary tract symptoms (LUTS). Currently, no systematic reviews are performed for acupuncture on LUTS in patients with Parkinson's diseases (PD). This review aims to evaluate the current evidence on the efficacy of acupuncture for the management of LUTS in PD. Methods and analyses: Eleven databases will be searched from their inception. These include PubMed, AMED, EMBASE, the Cochrane Library, 6 Korean medical databases, and 1 Chinese medical database. Study selection, data extraction, and assessment will be performed independently by 2 researchers. Risk of bias will be assessed with the Cochrane risk of bias assessment tool. Ethics and dissemination: Ethical approval will not be required, given that this protocol is for a systematic review. The systematic review will be published in a peer-reviewed journal and disseminated both electronically and in print. The review will be updated to inform and guide healthcare practice and policy. Trial registration number: PROSPERO 2018 CRD42018083857

Introduction The blood stasis pattern in Chinese and Korean traditional Medicine is characterised by stagnation, including extravasated blood and sluggish blood circulation or viscous or congested blood, all of which may become pathogenic factors. Blood stasis is associated with chronic and incurable disease, such as pain, infertility, cancer and health reducing conditions caused by stress, which are not relieved with modern medicine. The aim of the study is to establish a modern concept of blood stasis, develop diagnostic tools and diagnostic indices for blood stasis, identify biological indices related to blood stasis. Methods This community-based, multi-centre trial is designed as an observational study. Data will be collected in order to standardise blood stasis diagnosis in Korea. Patients will be admitted to one of the following 7 hospitals participating in this study: Kyung Hee Oriental Medical Centre, Kyung Hee University Oriental Hospital at Gangdong, Wonkwang Oriental Medical Hospital, Jaseng Hospital of Oriental Medicine, Cha Medical Centre, Pusan National University Korean Medicine Hospital and Dongguk University Ilsan Oriental Hospital. A total of 1400 participants will be recruited through local advertising and doctor referrals from hospitals. At each site, 200–280 participants will be recruited. Ethics and dissemination All of the research aims, the study design, and the specific methods in this study have been approved by the Institutional Review Boards (IRB) of all seven of the participating hospitals. Additionally, the study was approved by the IRB of the Korean Institute of Oriental Medicine. Trial registration CRIS No. KCT 0000916