Implementation strategy for introducing a clinical skills examination to the Korean Oriental Medicine Licensing Examination: a mixed-method modified Delphi study

PURPOSE

This study investigated the validity of introducing a clinical skills examination (CSE) to the Korean Oriental Medicine Licensing Examination through a mixed-method modified Delphi study

METHODS

A 3-round Delphi study was conducted between September and November 2022. The expert panel comprised 21 oriental medicine education experts who were officially recommended by relevant institutions and organizations. The questionnaires included potential content for the CSE and a detailed implementation strategy. Subcommittees were formed to discuss concerns around the introduction of the CSE, which were collected as open-ended questions. In this study, a 66.7% or greater agreement rate was defined as achieving a consensus.

RESULTS

The expert panel’s evaluation of the proposed clinical presentations and basic clinical skills suggested their priorities. Of the 10 items investigated for building a detailed implementation strategy for the introduction of the CSE to the Korean Oriental Medicine Licensing Examination, a consensus was achieved on 9. However, the agreement rate on the timing of the introduction of the CSE was low. Concerns around 4 clinical topics were discussed in the subcommittees, and potential solutions were proposed.

CONCLUSION

This study offers preliminary data and raises some concerns that can be used as a reference while discussing the introduction of the CSE to the Korean Oriental Medicine Licensing Examination.

Distribution of licensed acupuncturists and educational institutions in the United States at the start of 2018

This study was conducted to identify the approximate number and density of actively licensed acupuncturists, as well as the number of schools in acupuncture and oriental medicine (AOM) by January 1, 2018 in the United States (U.S.). We contacted the appropriate department governing acupuncturists, such as the Board of Acupuncture or Board of Medicine, etc. in each state and U.S. territories, to collect the data. We also conducted online license information searches in order to collect the most accurate numbers of licensed acupuncturists, especially for those states in which a board could not be reached. We found that the number of actively licensed acupuncturists as of January 1, 2018 in the U.S. was 37,886. The ten states with the largest number of acupuncturists (28,452 or 75.09% of the U.S. total), in order by total, included California, New York, Florida, Colorado, Washington, Oregon, Texas, New Jersey, Maryland and Massachusetts. The number of practitioners was greater than 1000 for each of these states. Among them, the largest three were California (12,135; 32.03%), New York (4438; 11.71%) and Florida (2705; 7.13%). These three states accounted for more than half of the overall total. The number of total licensed acupuncturists has increased 257% since 1998. The overall acupuncturist density in the U.S. - measured as number of acupuncturists per 100,000 - was 11.63 (total number of licensed acupuncturists: 37,886, divided by the total population: 325,719,178 at the start of 2018). There were 20 states with an acupuncturist density of more than 10 per 100,000 population. Hawaii (52.82) was the highest, followed by Oregon (34.88), Vermont (30.79), California (30.69) and then New Mexico (30.27). There were 62 active, accredited AOM schools which altogether offered 100 programs: 32 master degrees in Acupuncture, 53 master degrees in Oriental medicine, 13 postgraduate doctorate degrees and 2 entry-level doctorate degrees. Among these active accredited schools, institutions in the West and East Coast states comprised 77.42% of the national total. California, Florida, and New York represented 41.94%. There were 48 jurisdictions (47 States and the District of Columbia) with acupuncture practice laws in place. States without acupuncture laws included Alabama, Oklahoma and South Dakota. The data suggests that acupuncture profession has steadily grown in the United States.

Clinical effects of acupressure on neck pain syndrome (nakchim): a systematic review

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.

Anti-inflammatory effects of traditional mixed extract of medicinal herbs (MEMH) on monosodium urate crystal-induced gouty arthritis

Korean oriental medicine prescription is widely used for the treatment of gouty diseases. In the present study, we investigated anti-inflammatory effects of modified Korean herbal formulation, mixed extract of medicinal herbs (MEMH), and its modulatory effects on inflammatory mediators associated with gouty arthritis. Both in vitro and in vivo studies were carried out to assess the anti-inflammatory efficacy of MEMH on monosodium urate (MSU) crystals-induced gouty inflammation. MSU crystals stimulated human chondrosarcoma cell line, SW1353, and human primary chondrocytes were treated with MEMH in vitro. The expression levels of pro-inflammatory mediators and metalloproteases were analyzed. The effect of MEMH on NFκB signaling pathway in SW1353 cells was examined. Effect of MEMH on the mRNA expression level of pro-inflammatory mediators and chemotactic factor from human monocytic cell line, THP-1, was also analyzed. The probable role of MEMH in the differentiation process of osteoblast like cells, SaOS-2, after MSU treatment was also observed. To investigate the effects of MEMH in vivo, MSU crystals-induced ankle arthritic model was established. Histopathological changes in affected joints and plasma levels of pro-inflammatory mediators (IL-1β and TNFα) were recorded. MEMH inhibited NFκB signaling pathway and COX-2 protein expression in chondrocytes. MSU-induced mRNA expressions of pro-inflammatory mediators and chemotactic cytokines were suppressed by MEMH. In MSU crystals-induced ankle arthritic mouse model, administration of MEMH relieved inflammatory symptoms and decreased the plasma levels of IL-1β and TNFα. The results indicated that MEMH can effectively inhibit the expression of inflammatory mediators in gouty arthritis, demonstrating its potential for treating gouty arthritis.

Distribution of licensed acupuncturists and educational institutions in the United States in early 2015

In recent decades, acupuncture has been used more widely and extensively in the United States (U.S.). However, there have been no national surveys or analyses reported in academic journals on the number of practicing or licensed acupuncturists. This study was conducted to identify the approximate number of licensed acupuncturists active in 2015. The Board of Acupuncture or Board of Medicine in each state or U.S. territory was contacted to collect data. Online license information searching was also performed in order to get accurate numbers of licensed acupuncturists for those states in which a board was unable to be contacted. The study found that the number of licensed acupuncturists in 2015 in the U.S. was 34,481. Of this, more than 50% were licensed in three states alone: California (32.39%), New York (11.89%) and Florida (7.06%). The number of licensed acupuncturists increased 23.30% and 52.09%, compared to the year 2009 (n = 27,965) and 2004 (n = 22,671), respectively; increasing about 1,266 per year. There were 62 and 10 accredited acupuncture institutions providing master and doctoral degrees, respectively. The West Coast comprised 51.39% of degree granting programs, while the East Coast comprised 29.17%; together the coastal states housed more than 80% of all programs, with the remainder sprinkled across the southern (9.72%), northern (8.33%), and the middle/central states (1.39%). Forty-four states and the District of Columbia regulated acupuncture practice by law at the time of data collection. Acupuncture continues to be a quickly growing profession in the U.S.

Japanese traditional herbal medicine reduces use of pregabalin and opioids for pain in patients with lumbar spinal canal stenosis: a retrospective cohort study

Background

There has been an increase in the number of Japanese patients with lumbar spinal canal stenosis (LSCS) who complain of chronic pain or motor disturbance in the lower back or extremities. These patients are often treated with anti-convulsive drugs, opioids, antidepressants, acetaminophen, or nonsteroidal anti-inflammatory drugs, all of which can cause side effects. For this reason, Japanese traditional herbal medicine (Kampo) is of interest, because it produces fewer adverse reactions. The aim of this retrospective cohort study was to analyze the effects of Kampo in patients with LSCS.

Findings

A total of 151 patients with LSCS were divided into two groups based on treatment with (n = 111, group K) and without (n = 40, group N) Kampo. Use of pregabalin and opioids decreased significantly in group K (p < 0.001). The hazard ratio for opioid discontinuation was 0.220 (p = 0.004) for group N vs. group K, while that for pregabalin and antidepressants discontinuation were 0.589 (p = 0.202) and 0.509 (p = 0.377), respectively. The mean duration of hospital visits and treatment did not differ between the groups, but the number of dropouts was significantly higher in group N (p < 0.0001). The hazard ratio for patient dropout was 4.118 (p = 0.001) for group N vs. group K.

Conclusions

Kampo led to discontinuation of opioid use for pain in patients with LSCS, and patients who were treated with Kampo were more likely to continue treatment.

Empirical versus Etiological Approaches in Oriental Medical Research

Although Oriental medicine, by nature, may be considered an etiology-based approach to healing, its role in modern research is primarily empirical. The absolute dependence on symptomatic presentation to establish acupuncture point selection goes against the grain of traditional Oriental methods, which emphasize pulse, tongue, and other diagnostic tools to determine the overall biological and psychological conditions of the patient. Recently introduced diagnostic methods in Oriental medical research indicate a potential shift from empirically to etiologically centered designs. This article reviews current mainstream approaches to efficacy trial designs and proceeds with the analysis of newer research models, such as a constitutional approach spearheaded in Korea by the field of four-constitutional medicine.

Long-term Treatment with Oriental Medicinal Herb Artemisia princeps Alters Neuroplasticity in a Rat Model of Ovarian Hormone Deficiency

Artemisia princeps (AP) is a flowering perennial used as a traditional medicine and dietary supplement across East Asia. No study has yet assessed its effects on synaptic plasticity in hippocampus and much less in a model of ovarian hormone deficiency. We examined the influence of chronic oral AP ethanol extract treatment in ovariectomized rats on the induction of long-term depression in a representative synapse (CA3-CA1) of the hippocampus. Ovariectomized rats demonstrated lower trabecular mean bone mineral densities than sham, validating the establishment of pathology. Against this background of pathology, AP-treated ovariectomized rats exhibited attenuated long-term depression (LTD) in CA1 relative to water-treated controls as measured by increased field excitatory post-synaptic potentials (fEPSP) activation averages over the post-stimulation period. While pathological significance of long-term depression (LTD) in ovariectomized rats is conflicting, that AP treatment significantly affected its induction offers justification for further study of its influences on plasticity and its related disorders.

A single case study: treating migraine headache with acupuncture, chinese herbs, and diet

Background:

Acupuncture is an often sought-out treatment modality for migraine. The World Health Organization lists headache as one of the several conditions treated effectively by acupuncture.

Case Description:

This single case reports on a 32-year-old woman who presented with a 10-year history of migraine.

Methods:

The patient was treated with acupuncture, dietary modifications, and Chinese herbal medicine enemas over a course of 2 months.

Results:

The patient experienced pain relief that resulted in several months without any migraine.

Conclusion:

This article may aid in expanding practitioners’ treatment options to include a more diverse set of modalities such as Chinese herbal enemas. More research is needed to investigate the role of Oriental medicine and Chinese herbal enemas in the treatment of pain conditions.

A novel taping therapy for chronic insomnia: a report on two cases

OBJECTIVES

Here, we report two cases of chronic insomnia treated satisfactorily by re-using of patients' bioelectricity.

PATIENTS

First was a 46 years old male who had taken drugs for several years and depression drug for one year. He had heart beat and felt pressure pain on almost of chest. Second was a 64 years old male who had taken drugs for one year. In spite of the medication, he could not sleep at all and had glint eyes.

INTERVENTIONS

Method of treatment is to put the medical tape (Chimsband) on acupoints and pressure pain points in the chest, which can be traced down by finger pressing examination.

RESULTS

In the first case, the patient escaped from the medications after three weeks. Following seven weeks, depression was reduced remarkably. In the second case, the glint of eyes returned to normal after two treatments. After three treatments, the sleeping time was lengthened to 4h.

CONCLUSIONS

First, pressing chest can be used for tracing neurological symptoms; second, when the bioelectricity of the patient reacts to Chimsband, the symptoms could be ameliorated; third, there is a relationship between treating the neurological symptoms such as insomnia and attenuating pressure pain.