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Journal of Acupuncture Research 2024; 41(1): 1-16

Published online February 29, 2024

https://doi.org/10.13045/jar.2023.00325

© Korean Acupuncture & Moxibustion Medicine Society

Clinical Research Trends on Compression Fracture Treatment Using Traditional Korean Medicine: A Case Study Review

Jeong-Du Roh1 , Jung Won Byun1 , Soo Min Ryu1 , You Jin Heo2 , Song Choi3 , Eun Yong Lee2 , Cham Kyul Lee2 , Na Young Jo1

1Department of Acupuncture and Moxibustion Medicine, Jecheon Hospital of Korean Medicine, Semyung University, Jecheon, Korea
2Department of Acupuncture and Moxibustion Medicine, Chungju Hospital of Korean Medicine, Semyung University, Chungju, Korea
3Department of Internal Korean Medicine, Mokpo Korean Medicine Hospital, Dongshin University, Mokpo, Korea

Correspondence to : Jeong-Du Roh
Department of Acupuncture and Moxibustion Medicine, Jecheon Hospital of Korean Medicine, Semyung University, 65 Semyeong-ro, Jecheon 27136, Korea
E-mail: wsrohmio@hanmail.net

Received: November 17, 2023; Revised: December 29, 2023; Accepted: January 9, 2024

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

This review examined and analyzed clinical research trends in the treatment of compression fractures in traditional Korean medicine using case studies. Accordingly, 5 web databases were searched using relevant Korean and English terms. Based on predefined exclusion and inclusion criteria, 16 case studies were selected, analyzed, and classified according to the journal, publication year, participants, chief complaints, affected vertebrae, treatment and evaluation methods, and improvement. The case studies reported various treatment methods, including acupuncture, herbal medicine, physical therapy, cupping, moxibustion, and band training. All 16 case studies reported the use of combination therapy. All 23 cases reported in these case studies demonstrated improvement in chief complaints, and none reported any side effects.

Keywords Acupuncture; Case reports; Compression fracture; Herbal medicine

Vertebral compression fractures occur because of axial loading or biomechanical issues and are characterized by a collapse of the anterior part of the vertebral body [1]. The etiology of vertebral compression fractures includes trauma or weakened bone conditions, such as osteoporosis or cancer metastasis [2]. In younger adults, the incidence of spine injuries due to significant trauma, such as industrial or car accidents, is high [3]. Among older adults, the incidence of secondary fractures due to minor external forces, such as falls during daily activities, particularly under osteoporotic conditions, is high [4]. Typical symptoms of compression fractures include restricted range of spinal motion and pain. Spinal nerve compression can lead to radiating pain, and intercostal nerve irritation can induce muscle spasms [5]. Moreover, compression fractures may lead to psychological disorders and chronic thoracolumbar kyphosis [6-8]. Treatment typically includes nonsurgical methods, such as bed rest and thoracolumbar braces, based on the degree of fracture, with an emphasis on pain relief and prevention of further fractures [2]. According to the Korean Statistical Office, individuals aged ≥ 75 years comprised 7.3% of the overall population in 2022; however, it is projected to increase to 10.7%, 18.1%, and 30.7% in 2030, 2040, and 2070, respectively [9]. Considering that osteoporotic vertebral compression fractures occurred most frequently in patients aged ≥ 70 years (45%) from 2012 to 2016 [10], the prevalence of compression fractures is expected to steadily increase. Several studies on the use of traditional Korean medicine for compression fracture treatment in South Korea have been conducted, with some reporting favorable outcomes. However, comprehensive research that examines various therapeutic approaches for compression fractures is lacking. Therefore, this study reviewed the current therapeutic approaches and their effects on compression fractures from a South Korean perspective. Furthermore, this study aimed to contribute to the knowledge of treatment and research on compression fractures.

1. Data and web search sources

Five domestic databases were used to search for clinical studies conducted in Korea on traditional Korean medicine treatments for compression fractures published between January 1, 2000, and July 31, 2023: the Korean Studies Information Service System, Research Information Sharing Service, Korean Medical Database, Science On, Database Periodical Information Academic, and Traditional Medicine Information Portal (Oasis). The literature search used the following keywords: “compression fracture,” “Korean medicine,” “acupuncture,” and “herbal medicine.”

2. Data selection

Titles, abstracts, and full texts of the articles extracted via the database search were reviewed to select studies that described traditional Korean medicine treatments for compression fractures. Patients with compression fractures were defined as those diagnosed using imaging examinations, regardless of sex, age, or race. Reviews, randomized controlled trials, simple clinical process analysis studies, and case reports that focused on the treatment of accompanying symptoms rather than pain caused by compression fractures were excluded. Because the research focused on compression fractures as a single condition, studies that involved fractures in other areas, those that combined compression fractures with disk herniation, or those that discussed various symptoms due to electric shock, including compression fractures, were excluded. The database search generated 126 studies; of the 126 studies, 91 duplicate studies were excluded, and from the remaining 35 studies, 19 that met the aforementioned exclusion criteria were excluded. Finally, 16 studies were selected for analysis.

3. Data analysis

The 16 included studies (Tables 1, 2) [11-26] were classified according to the journal and year of publication, patient information, intervention, evaluation methods, and treatment results.

Table 1 . Patient information

Authors (y)JournalPatient information
Sex/ageChief complaintsAffected vertebraeTreatment duration (d)
Han and Lee (2002) [11]JKCMM/29LBP and dorsalgiaT12, L210
Lee et al. (2004) [12]JOPPM/58Right LBP (L3–L4 stenosis and right iliac crest line) and radiating pain (lower extremity traction and tingling)L215
Seo et al. (2005) [13]Journal of the Jeahan Oriental Medical AcademyF/44Nuchal pain, bilateral hand numbness, and LBPT131
Eom et al. (2005) [14]JKCMF/72LBP and referred pain on the lateral side of the gluteal femoral region, constipation, and urinary inadequacyL1, L226
Jang et al. (2005) [15]JKCMM/74LBP: lower extremity pain (anterior, sitting position, uncomfortable when standing, and unable to walk)L451
Lee et al. (2006) [16]Journal of the Society of Spine and Joint in Korean MedicineF/52LBP (worse on the left side, worsens with movement and at night, dysfunction of joint movements, and difficulty with walking and changing positions)T1048
Jo et al. (2009) [17]JKMRF/83LBP, coccydynia, gluteal pain, left foot pain, anterior discomfort, dysfunction of joint movements, and gait disorderT12, L119
Yang et al. (2009) [18]JCMMF/62LBP, bilateral lower limb muscle atrophy, inability to walk, facial edema, and skin inflammationL372
Han et al. (2011) [19]JCMMF/78
F/79
F/88
LBP: pain that seems to migrate all over the superolateral surface of the middle to right gluteal area of the lower lumbar region, which worsens when sitting or walking; however, pain is alleviated when supine
LBP: generalized pain in the lower lumbar region and severe pain when rising from the supine position
LBP: bilateral iliac crest pain, worsens when changing posture, difficulty with standing or sitting; however, pain alleviated upon lying down
Recent L1, old T12, L4
L1
Acute T12, old L4
29
22
22
Kim et al. (2017) [20]JKMRM/56
F/48
F/56
LBP
LBP
Dorsalgia
L2
L1, L2
T7
19
25
21
Hong et al. (2017) [21]JKMRM/39
F/63
M/30
M/30
Right facial pain, nuchal pain, right scapula to shoulder joint pain, chest pain, LBP, dizziness, and nausea
Headache, nuchal pain, and LBP
LBP and right gluteal pain
Abdominal pain, left rib pain, LBP, and left knee pain
L2
L1
L2, L3, L5
L3
25
23
22
19
Lee et al. (2018) [22]JARF/35Severe LBP on the right sideT11–L5 (7 vertebral bodies)27
Kim et al. (2019) [23]JIKMM/60LBP, right groin pain, and bilateral leg pain and numbnessMalignant L4 and L5
Benign L1 and L2
25
Lee et al. (2021) [24]JIKMF/76LBP and bilateral leg numbnessL351
Shin et al. (2022) [25]Journal of the Society of Spine and Joint in Korean MedicineF/75LBP, pelvic pain, and bilateral leg numbnessL426
Lee et al. (2022) [26]JSKMCPF/80Right leg hypersensitivity to cold, right gluteal pain, LBP, and right foot numbnessL3, T1224

JKCM, Journal of Korea CHUNA Manual Medicine; JOPP, Korean Journal of Oriental Physiology and Pathology; JKMR, Journal of Korean Medicine Rehabilitation; JCMM, Journal of Korea CHUNA Manual Medicine for Spine and Nerves; JAR, Journal of Acupuncture Research; JIKM, Journal of Korean Oriental Internal Medicine; JSKMCP, Journal of Korean Medicine and Clinical Pharmacopuncture; M, male; F, female; LBP, low back pain; L, lumbar vertebra; T, thoracic vertebra.


Table 2 . Interventions, evaluation, and results

Author (y)InterventionEvaluationResult/score
AcupunctureHerbal medicineOthers
Han and Lee (2002) [11]1. Burning acupuncture:
- After inserting the needle approximately 20 mm between the spinous processes, heat it over a direct flame for 2–3 min.
- Every alternate day for 4 times.
Paejangtang1. Physical therapy- Manual therapy: abdominal area.
2. Microwave: abdominal area.
3. Cupping: once/day.
VAS, ODI, and DITIVAS 6 → 0
ODI 22 → 42
Difference in DITI between both iliac crests 0.34 → 0.08
Lee et al. (2004) [12]1. Sa-am acupuncture:
- SP3, L9 Bo, LI11 Sa, Young-Su-Bo-Sa, and Gu-Ryuk-Bo-Sa on the right side.
- Once/day, R: 15–20 min.
2. Pharmacopuncture (Carthami-Flos):
- Acupoints around the fracture site.
- Once/day, D: 0.05 cc × 8–10 points.
GamigungguitangPain index, classification methods such as Chae’s method [27] and QVASPain index 9 → 2
Grade III → I
(Appendix 1)
Excellent (Appendix 2)
QVAS 9 → 2
Seo et al. (2005) [13]1. General acupuncture:
- GV14, EX-B2, G20, GV16, LI11, TE5, SI3, L9, and SP3.
- Once/day, R: 30 min.
2. Pharmacopuncture (SweetBV 10,000:1 → 4,000:1 → 2,000:1):
- GV14, EX-B2, and G20, at the tenderness site.
- 2–3 times/week, D: 0.05 mL/point.
1st Gamiseogyeong-tang
2nd Whuallak-tang
3rd GamiSamul-tang
4th Sokyungsoonkisan-hap-Ssanghwa-tang
5th Gamissanghwa-tang
6th Sokyungsoonkisan
1. Physical therapy:
- TENS, ICT, ultrasound, and manual therapy, each once/day.
- Hot pack every 6 h.
2. Taping:
- Tape the splenius capitis and trapezius and attach it in a star-shaped manner to the first thoracic vertebra, and maintain for 48 h.
3. Moxibustion:
- Three multiportions on the abdomen and lumbar region in the prone position, once/day.
4. Cupping:
- At the site of tenderness.
- Dry or wet cupping, once/day.
VAS, ROM, and classification methods such as Chae’s method [27]VAS 10 → 2
Extension 30 → 45, lateral bending 30/20 → 30/30
Rotation 10/10 → 60/60
Grade III → I
(Appendix 1)
Eom et al. (2005) [14]1. Sa-am acupuncture (first half of treatment):
- Kidney and large intestine toxifying acupuncture.
- Twice/day, R: 20–30 min.
2. General acupuncture (second half of treatment):
- B23, B24, B25, B26, B20, B21, and B17 at the site of tenderness.
- If flank pain is present, TE6 and G34, twice/day, R: 20–30 min.
1st JihwangBaekho-tang
2nd Moktongdaean-tang
3rd Yukmijihwang-tang-gami
1. Physical therapy:
- ICT, TENS once/day.
2. Moxibustion:
- Indirect tool to improve urination (big moxibustion) CV6 and CV4, twice/day.
3. Cupping:
- Dry cupping in the area of lumbar drainage, once/day.
- 20 days postinjury.
VAS, ROM, and classification methods such as Chae’s method [27]VAS unspecified before treatment → upon discharge (at rest VAS 3, with movement VAS 6)
Grade IV → I
(Appendix 1)
ROM unmeasurable →flexion 70°, extension 10°, lateral bending 20°/20°, rotation 30°/20°
Jang et al. (2005) [15]1. General acupuncture:
- BL23, GV3, B60, L9, G30, ST36, B40, and GB41.
- A-shi points.
- Twice/day, R: 20 min.
1st Extract-Gamihwalheol-tang
2nd Extract-Samchulkunbi-tang
1. Physical therapy:
- ICT, hot pack.
- Once/day, R: 30 min.
2. Therapeutic exercise:
- Lower spine exercises during Goldthwait’s exercise, knee joint extension and elevation exercises, and pelvic tilt exercises during Calliet’s exercise.
- 5 times/set, 6 sets/day.
3. Band training:
- Wrap a band around both knees, maintain the ankle joint at 90°, and raise one leg until the highest angle possible.
- Start on day 5 of hospitalization, ten times/set, 3 sets/day.
ODI, VAS, ROM, SLR test (T), Bragard T, Lasegue T, Patrick T, Milgram T, Valsalva T, dorsiflexion, and plantar flexionODI 46 → 21
VAS 8 → 2
Flexion 60° → 70°
Extension 10° → 20°
Lateral bending 20°/20° → 20°/20°
Rotation 25°/25° → 30°/30°
SLR T −/− → −/−
Bragard T −/− → −/−
Lasegue T −/− → −/−
Patrick T −/− → −/−
Milgram T 2° → 20°
Valsalva T −/− → −/−
Dorsiflexion −/− → +/+
Plantar flexion ++/++ → ++/++
Lee et al. (2006) [16]1. Dong-si acupuncture:
- R: 30 min, 2 times/day.
- am: Yeonggol, Daebaek, Biik, Okhwa, Jungbaek, Habaek, Junggeun, Jeongjong, Bokwon, Sogol.
- pm: Tonggwan, Tongsan, Tongchun, Shimmun, Sahwajung, Sahwawae, Ganmun, Jangmun, Sangsamhwang, Mokyeom, Hachunhwang.
2. Pharmacopuncture (Sweet BV, 2,000:1):
- EX-B2 and A-shi points on T10–11 and T11–L1.
- 2–3 times/week, D: start from 0.1 cc, until 1 cc.
1st Whuallak-tang
2nd Gucheokbogol-tang
3rd Jaeumgeonbi-tang
4th Boshinikdok-tang
5th Dokwhal-tang
6th Sayuktanggagami
VAS and classification methods such as Chae’s method [27]VAS 9 → 3
Grade IV → I
(Appendix 1)
Jo et al. (2009) [17]1. General acupuncture:
- EX-B2 around the A-shi points.
- Bilateral B23, B25, B26, B50, and B60.
- Once/day, R: 15 min.
2. Pharmacopuncture (Jungsongouhyul):
- Around the fracture site.
- Once/day, D: 0.1–0.2 cc × 8–10 points.
1st Doinseunggi-tang
2nd Gyejibokryeong-hwan
Classification methods such as Chae’s method [27], VAS, and ODIGrade IV → I
(Appendix 1)
VAS 10 → 1
ODI 52 → 16
Yang et al. (2009) [18]1. Sa-am acupuncture:
- Once/day, Young-Su-Bo-Sa.
- Lung toxifying acupuncture: Sp3, L9 Bo, H8, L10 Sa.
- Alcoholic phlegm acupuncture: Sp3, L9 Bo, Liv1, Sp1 Sa.
2. Pharmacopuncture (Jungsongouhyul):
- Around both sides of B23, B24, and B25.
- Once/day, D: 1 mL/6 points.
1st Yukgunja-ga-Euiiin
2nd Ssanghwa-tang-gami
Stages of motor weakness, VAS, and changes in chief complaintsChange in motor weakness (Appendix 3)
Grade 2 → Grade 5
VAS 10 → 1
Changed chief complaints (Appendix 4)
Han et al. (2011) [19]1. General acupuncture:
- A-shi points, once/day, R: 15 min.
2. Pharmacopuncture (Jungsongouhyul):
- A-shi points, once/1–2 days.
Case 1: 1st Danggwisu-san, 2nd Chungungyukgye-tang, 3rd Tong shun-san
Case 2: 1st Cheongpa-jeon H, 2nd Tong shun-san
Case 3: 1st Baekpa-jeon, 2nd Tong shun-san
VASCase 1: VAS 10 → 2
Case 2: VAS 10 → 3
Case 3: VAS 10 → 3
Kim et al. (2017) [20]1. General acupuncture:
- B23, B24, B25, B26, B50, and B60.
- Depending on the area of injury or pain: B16, B17, and B18.
- Twice/day, R: 10 min.
2. Burning acupuncture:
- Place the needle at a depth of 15–20 mm at 0.30–50 mm in the concave area between the injured EX-B2 and spinous processes and apply heat, once/day.
- Case 1: 6 times, EX-B2 at GV4 and L2–L3.
- Case 2: 8 times, EX-B2 at GV5 and GV4 and L1–L3.
- Case 3: 7 times, GV10, GV9, and GV8.
1. Physical therapy:
- Hot pack twice/day.
2. Moxibustion:
- Indirect moxa cone moxibustion between the EX-B2 and spinous processes.
- Once/day, 6 days/week.
NRS and ODICase 1: NRS 8 → 5
ODI 60 → 55
Case 2: NRS 7 → 5
ODI 62 → 55
Case 3: NRS 10 → 5
ODI 64 → 55
Hong et al. (2017) [21]1. General acupuncture:
- B23, B24, B25, B26, B51, B52, B40, GB34, and B60.
- R: 15 min.
2. Pharmacopuncture (Hwangryunhaedok-tang):
- The fracture site is the interspinous ligament between the spinous processes and B23, B24, B25, and B26.
- 7 times/week, D: 0.1 cc at each point.
Danggwisu-san1. Physical therapy:
- For the treatment of muscles and ligaments of bilateral or affected lumbar and hip– sacroiliac joints - microwave, R: 5 min.
- TENS R: 10 min.
- Electromagnetic field therapy: R: 10 min.
- Hot pack R: 10 min.
VAS and PFWDCase 1: VAS 6 → 3
PFWD 30 m → 450 m
Case 2: VAS 6 → 3
PFWD 30 m → 450 m
Case 3: VAS 7 → 5
PFWD 45 m → 420 m
Case 4: VAS 9 → 4
PFWD 30 m → 420 m
Lee et al. (2018) [22]1. General acupuncture:
- EX-B2 near the site of the patient’s LBP and the quadratus lumborum.
- Twice/day
- Additional treatment for indigestion was administered, when necessary, at LI4, LR3, CV12, and ST36.
1st Keoseup-hwalhyeol-jitong-tang
2nd Nokyong-kunbi tang
NRS, EQ-5D, ODI, and blood test (ESR, CRP, and PTH-C)NRS 7 → 5
EQ-5D -0.121 → 0.677
ODI 93.33 → 86.67
ESR 41 mm/h → no results
CRP 0.43 mg/dL → no results
PTH-C 102.5 pg/mL → no results
Kim et al. (2019) [23]1. General acupuncture:
- B23, B40, SP6, and GB39. B26, B24, S34, and SP10.
- Twice/day, R: 15 min.
2. Pharmacopuncture (Shinbaro):
- At the point of tenderness.
- Around 2 times/day, D: 0.2–0.3 mL/point, 1 mL.
1st Dansambohyel-tang
2nd Dangguibohyel-tang
3rd Cheongpa-jeon H
4th Yukkongbaro-hwan
5th Jaseng-Ko
6th Jeobgol
1. Physical therapy:
- Manual therapy: relaxes the iliopsoas and quadratus lumborum.
2. Cupping:
- A-shi point, dry or wet cupping.
ODI, NRS, and blood testODI 44 → 22
NRS (leg) 4 → 3
NRS (LBP) 6 → 4
CRP 15.08 → 0.2 mg/dL
ESR 140 → 53 mm/h
Lee et al. (2021) [24]1. General acupuncture:
- B15, SI11, B23, B52, and A-shi points.
- Twice/day, R: 15 min.
2. Pharmacopuncture (Shinbaro):
- L2/3, L3/4 both EX-B2 and the A-shi point.
- D: twice/day, 1 cc/point.
1st Cheongpa-jeon H
2nd Chungwoongbaro-hwan
3rd Jeobgol
4th Bojungikgi-tang
NRS, ROM, ODI, and EQ-5DNRS 7 → 3
Flexion 30° → 60°
Extension 0° → 10°
Lateral bending 10°/30° → 30°/45°
Left/right rotation 10°/30° → 30°/45°
ODI 51.11 → 22.22
EQ-5D 0.506 → 0.677
Shin et al. (2022) [25]1. General acupuncture:
- B23, B24, B25, B26, B40, B60, and GB34.
- Twice/day, R:15 min.
2. Pharmacopuncture (Hwangryunhaedok-tang):
- Interspinous ligament at the fracture site.
- Once/day, D: 1 cc/day.
Danggwisu-sanNRS, ODI, and PFWDNRS 9 → 4
ODI 57 → 24
PFWD uncheckable → 500 m
Lee et al. (2022) [26]1. General acupuncture and electroacupuncture:
- Waist and gluteal area.
- Twice/day, R: 15 min, 3 Hz.
2. Pharmacopuncture (Hwangryunhaedok-tang):
- S35, GB34, GB39, B56, B57, SP9, SP6, and LR4.
- Once/day, D: 0.25 cc/point, 2 cc.
1st Yeong-gangchulgamtang
2nd Saeyeok-tang
3rd Gagambogol-hwan
1. Moxibustion:
- Big moxibustion, CV12 for wiwanbimin (abdominal distension), twice/day, R: 20 min.
2. Cupping:
- Dry cupping, once/day, R: 5 min, 4 cups.
- Lower back and right gluteus.
Coldness diary and drawing, noncontact thermometer
PSQI-K, and EQ-5D
Coldness diary and drawing
(Appendix 5, 6)
Skin temperature at 4 acu points increased
PSQI 9 → 9
Hypnagogic state
60 min → 30 min
EQ-5D 0.423 →
−0.056

VAS, visual analog scale; ODI, Oswestry Disability Index; DITI, digital infrared thermal imaging; R, retaining time; D, injection dose; QVAS, quadruple visual analog scale; TENS, transcutaneous electrical nerve stimulation; ICT, interferential current therapy; ROM, range of motion; SLR, straight leg raise; NRS, numerical rating scale; PFWD, pain-free walking distance; LBP, low back pain; EQ-5D, European quality of life-5 dimensions scale; ESR, erythrocyte sedimentation rate; CRP, C-reactive protein; PTH-C, parathyroid hormone–C terminal; PSQI-K, Korean version of the Pittsburgh sleep quality index.


1. Classification according to the journal

The 16 included studies comprised the following: 3 each from the Journal of Korean Medicine Rehabilitation and Journal of Korea CHUNA Manual Medicine; 2 each from the Journal of Korea CHUNA Manual Medicine for Spine and Nerves, Journal of Korean Oriental Internal Medicine, Journal of the Society of Spine and Joint in Korean Medicine; and 1 each from the Korean Journal of Oriental Physiology and Pathology, Journal of Jeahan Oriental Medical Academy, Journal of Acupuncture Research, Journal of Sports Korean Medicine and Clinical Pharmacopuncture (Table 1).

2. Classification according to the year of publication

One case study each was published in 2002, 2004, 2006, 2011, 2018, 2019, and 2021; 3 in 2005; and 2 each in 2009, 2017, and 2022 (Table 1).

3. Classification according to the clinicodemographic characteristics of the study participants

1) Sex and age

In the 16 included studies, 23 cases were identified (8 males and 15 females); 1 patient was in their 20s, 4 were in their 30s, 2 were in their 40s, 4 were in their 50s, 3 were in their 60s, 6 were in their 70s, and 3 were in their 80s (Table 1).

2) Chief complaints

Among the chief complaints reported by the patients, lumbago or low back pain was the most frequent (n = 22), followed by radiating pain and leg pain (n = 6) (Table 1).

3) Affected vertebrae

In 20 cases, the distinction between old and recent fractures was not considered, particularly among compound fractures. Among these, L2 fractures were the most frequent (n = 9), followed by L1 fractures (n = 8) (Fig. 1).

Fig. 1. Affected vertebrae.

4) Treatment duration

Although some studies specified the treatment duration, others did not. Because all study participants were inpatients, for studies that did not specify the treatment duration, the length of hospitalization was considered the treatment duration. Treatment duration varied from 10 to 72 days. In particular, 5 patients were treated for 10–20 days, 13 were treated for 20–30 days, and 5 were treated for < 30 days (Table 1).

4. Analysis of the interventions

In the 16 studies, various traditional Korean medicine treatments, including acupuncture and herbal medicine, were administered. Acupuncture therapy was administered in all 16 studies; herbal medicine was used in 15 studies; physical therapy was used in 7 studies; cupping therapy was administered in 5 studies; moxibustion was used in 4 studies; and kinesio taping, band training, and therapeutic exercise were used in 1 study each. In all studies, ≥ 2 of these treatments were administered concurrently.

1) Acupuncture

Acupuncture, pharmacopuncture, sa-am, fire, Dong’s method, and electroacupuncture techniques were used. Although in only 3 studies, one acupuncture technique was used, other studies combined ≥ 2 acupuncture techniques. Eom et al. [14] performed sa-am acupuncture at treatment initiation and subsequently shifted to body acupuncture.

Acupuncture was performed in 12 studies. The reported treatment durations were 15 minutes in 7 studies and 10, 20, 20–30, and 30 minutes in 1 study each. However, 1 study did not specify the treatment duration. Among these studies, acupuncture was performed twice/day and once/day in 8 and 3 studies, respectively, whereas 1 study did not specify the treatment frequency. The most commonly used acupoint was BL23 (8 studies) (Table 3).

Table 3 . Frequency of used acupoints

FrequencyAcupoints
8BL23
6BL26
5BL24, BL25, and BL60
4BL40
3GB34
2LU9, BL17, BL50, BL52, and ST36
1GV3, GV14, GV16, GB20, GB30, GB39, GB41, LI11, TE5, TE6, SI3, SI11, SP3, SP6, SP10, ST34, BL15, BL16, BL18, BL20, BL21, CV12, LR3, and LI14


Pharmacopuncture was performed in 11 studies. The herbal remedies used in pharmacopuncture included Hwangryunhaedok-tang and Jungseongaehyeol, which were used in 3 studies each. Sinbaro and sweet BV were used in 2 studies each. Carthami-Flo was used in 1 study. Four of the 11 studies provided specific acupoints for the pharmacopuncture: GV14, EX-B2, and GB20 in the study by Seo et al. [13]; B23, B24, and B25 in the study by Yang et al. [18]; BL23, BL24, BL25, and BL26 in the study by Hong et al. [21]; and S35, GB34, GB39, BL56, BL57, SP9, SP6, and LR4 in the study by Lee et al. [26]. In other studies, pharmacopuncture was administered at A-shi points around the fracture site or between the spinous processes of the injured area without acupuncture point specification. The procedures were performed once/day in 5 studies, 2–3 times/week in 2 studies, twice/day in 1 study, once every 1–2 days in 1 study, and approximately twice/day in 1 study.

Fire acupuncture was performed in 2 studies. Han and Lee [11] used disposable stainless steel needles measuring 0.40 × 80 mm. The needles were inserted to a depth of approximately 20 mm and subsequently heated with a direct flame for 2–3 minutes until the needle became red-hot and the patient sensed the heat. This procedure was performed every alternate day for 4 sessions. In the study by Kim et al. [20], fire acupuncture was performed on 3 patients. Needles measuring 0.30 × 50 mm were inserted between the spinous processes and Ex-B2 associated with the injured area to a depth of 15–20 mm. A flame lighter positioned 1 cm away from the skin was used to heat the needle. However, unlike that in Han and Lee [11] study, fire acupuncture was not immediately administered. Instead, acupuncture, moxibustion, and physical therapy were initiated first, and when improvement was slow, fire acupuncture was introduced. This treatment was performed once/day and was continued for 6–8 sessions, depending on the patient’s condition. The specific acupuncture points varied among patients, with treatment performed at points, such as EX-B2 between L2–L3, GV4, and GV5 and EX-B2 between L1–L3, GV10, GV9, and GV8.

In 3 studies, sa-am acupuncture was performed. Lee et al. [12] initiated treatment with sa-am acupuncture. They used the acupuncture points SP3 and LU9 for tonification (strengthening) and LI11 for draining. The Young-Su-Bo-Sa and Gu-Ryuk-Bo-Sa techniques were applied, and the treatment was administered on the right side every day.

Eom et al. [14] initially performed sa-am acupuncture; however, it was later switched to acupuncture. For sa-am acupuncture, kidney and large intestine toxifying acupunctures were used, with treatment administered twice/day. Yang et al. [18] performed sa-am acupuncture once/day. They employed a specific technique termed “Young-Su-Bo-Sa” for lung tonification, using the acupoints SP3 and LU9 for tonification and HT8 and LU10 for draining. Furthermore, the authors employed alcoholic phlegm acupuncture techniques with the acupoints SP3 and LU9 for tonification and LR1 and SP1 for draining.

Lee et al. [16] used Dong’s acupuncture technique; the morning treatment focused on alleviating low back pain, whereas the afternoon treatment focused on the liver, heart, and kidney, with Dong’s acupoints adjusted based on the symptoms. In the study by Lee et al. [26], only electrical acupuncture was performed, in which stimulation was applied at 3 Hz for 15 minutes.

2) Herbal medicine

Herbal medicine was used in 15 studies and 20 cases. Various formulations, totaling 39 prescriptions, were used, including decoctions, powders, pills, extracts, and capsules. These included 4 types of pills: Chungwoongbaro-hwan, Gagambogol-hwan, Yukkongbaro-hwan, and Gyejibokryeong-hwan; 2 types of powders: Gamihwalheol-tang and Samchulkunbi-tang; an extract, Jaseng-Ko; and a capsule, Jeobgol. Furthermore, 31 types of decoctions were prescribed. Although 7 patients used a single decoction throughout the treatment period, 13 switched their herbal medicine based on the treatment duration. Danggwisu-san was used most frequently (6 cases), followed by Tong shun-san and Cheongpa-jeon (3 cases each).

3) Moxibustion

Moxibustion was performed in 4 studies. Seo et al. [13] performed Dabonggu once/day, with 3 pricks each on the nuchal and lumbar regions. Eom et al. [14] performed indirect moxibustion twice/day on CV6 and CV4 to enhance diuresis. Kim et al. [20] performed indirect Aejugu at Ex-B2 and between the spinous processes around the injured areas, once/day, 6 times/week. Lee et al. [26] applied Shingigu to the CV12 area to treat chest congestion symptoms.

4) Cupping

Cupping was reported in 5 studies. In the study by Han and Lee [11], the form or location of cupping was unspecified; however, it was reported that cupping was performed once/day. In the study by Eom et al. [14], dry cupping was performed once/day on the lumbar back-shu points 20 days after injury. In the studies by Seo et al. [13] and Kim et al. [23], dry and wet cupping techniques were combined at A-shi points. Although Seo et al. [13] performed cupping once/day, Kim et al. [23] did not specify the frequency. Lee et al. [26] performed dry cupping once/day for 5 minutes on the lower back and right gluteal area using 4 cups.

5) Other therapies

Physical therapy was reported in 7 studies. Hot packs were used in 4 studies, whereas manual therapy, interferential current therapy, and transcutaneous electrical nerve stimulation were each used in 3 studies. Microwave therapy was used in 2 studies, and ultrasound and electromagnetic field therapy were each used in 1 study. Seo et al. [13] used kinesio tape for taping therapy. Taping was performed on the splenius capitis and trapezius, and a star-shaped tape was applied at the first thoracic vertebra. In the study by Jang et al. [15], band training and therapeutic exercises were administered. Band training started on day 5 of hospitalization, initially using heavy resistance bands and subsequently transitioning to extra heavy resistance bands from day 32 of hospitalization. Therapeutic exercises primarily focused on strengthening the lumbar spinal muscles and were based on the back pain rehabilitation program exercises of Song and Lim [27].

5. Analysis of the evaluation methods

The most commonly used evaluation tool for assessing the subjective intensity of pain was the visual analog scale (9 studies), followed by the Oswestry Disability Index (ODI) (7 studies). The ODI is a multiple-choice patient-completed questionnaire and comprises ten items related to various aspects of daily life. Each item describes the level of disability in activities of daily living on a scale of 0–5 in 6 statements. This method evaluates the functional outcomes of low back pain. The numerical rating scale and range of motion were used in 5 and 4 studies, respectively. The European quality of life-5 dimensions scale (EQ-5D) was used in 3 studies. It is a widely used tool for assessing the health-related quality of life. It comprises 5 objective questions related to exercise ability, self-care, daily activities, pain, and anxiety, each answered on a point scale ranging from “no problem at all” to “extreme problems.” Blood tests and pain-free walking distance were used in 2 studies each. Blood tests focused on C-reactive protein levels and the erythrocyte sedimentation rate. Furthermore, in the study by Kim et al. [23], the parathyroid hormone–C terminal level was used for evaluation because the vertebral compression fracture reported in this study was caused by postpartum osteoporosis. Kim and Chae’s [28] classification method was used in 5 studies. It categorized the degree of pain and functional limitation to objectively assess the severity of a patient’s condition in 4 stages (Appendix 1). Furthermore, it included another classification method to objectively evaluate patient condition at discharge (Appendix 2). In the study by Han and Lee [11], the temperature difference between both iliac crests was measured using digital infrared thermal imaging to assess progress. Motor weakness stage (Appendix 3) and change in chief complaints (Appendix 4) were reported in 1 study each. A noncontact thermometer and tools, such as a coldness diary (Appendix 5) and a coldness drawing (Appendix 6), were used to assess the improvements in cold sensation. Lee et al. [26] used the Korean version of the Pittsburgh Sleep Quality Index to evaluate sleep quality.

6. Analysis of improvement

In most cases, improvements in the chief complaints reported by patients could be observed through the respective assessment criteria (Table 2).

Because the 16 case studies included inpatients, observations were made only during their hospitalization period. Therefore, whether symptoms worsened after discharge or other complications occurred remains unknown. Thus, studies involving long-term follow-up based on imaging tests for compression rate, kyphotic angle, and pain intensity are recommended. The study by Lee et al. [22] is noteworthy because although improvements in cold sensation were observed, according to the EQ-5D assessment, the quality of life obviously deteriorated. Compression fractures can have a psychological impact; therefore, future research should address the improvement in physical issues and the long-term quality of life through traditional Korean medicine treatments. Case studies must provide specific information to enable other researchers to replicate the study. Some studies did not specify the form or location of cupping, and except for the study by Kim et al. [20], the composition of moxibustion was not specified in the studies that applied it. The duration and frequency of acupuncture were not mentioned in 2 studies. Lee et al. [12] used the term “pain index” without clearly defining it. Therefore, future research should provide clearer descriptions and specify details, such as frequency, location, and treatment methods. This study analyzed case reports; therefore, all patients did not undergo the same conditions. This study covered only a limited sample size of 23 individuals. Furthermore, no comparisons were made between the group of patients with compression fractures who received Korean medicine treatment and those who did not. Although this study revealed the potential of various types of Korean medicine treatments and their effects on compression fractures, conclusively asserting significant effectiveness is difficult. Therefore, it is hoped that future research will address the limitations mentioned earlier and conduct follow-up studies for a more comprehensive understanding.

This study analyzed case studies on various traditional Korean medicine treatments, including acupuncture, herbal medicine, moxibustion, cupping, and physical, taping, and exercise therapies, for treating compression fractures. No side effects were reported, and most patients reported symptom improvement. From the results of this review, the possibility of Korean medicine in treating patients with compression fractures has been confirmed because it had a significant effect on the patients’ symptoms and pain assessment scales.

Conceptualization: JWB. Formal analysis: JWB. Investigation: JWB. Methodology: JWB. Supervision: NYJ. Writing – original draft: JWB. Writing – review & editing: All authors.

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Article

Review Article

Journal of Acupuncture Research 2024; 41(1): 1-16

Published online February 29, 2024 https://doi.org/10.13045/jar.2023.00325

Copyright © Korean Acupuncture & Moxibustion Medicine Society.

Clinical Research Trends on Compression Fracture Treatment Using Traditional Korean Medicine: A Case Study Review

Jeong-Du Roh1 , Jung Won Byun1 , Soo Min Ryu1 , You Jin Heo2 , Song Choi3 , Eun Yong Lee2 , Cham Kyul Lee2 , Na Young Jo1

1Department of Acupuncture and Moxibustion Medicine, Jecheon Hospital of Korean Medicine, Semyung University, Jecheon, Korea
2Department of Acupuncture and Moxibustion Medicine, Chungju Hospital of Korean Medicine, Semyung University, Chungju, Korea
3Department of Internal Korean Medicine, Mokpo Korean Medicine Hospital, Dongshin University, Mokpo, Korea

Correspondence to:Jeong-Du Roh
Department of Acupuncture and Moxibustion Medicine, Jecheon Hospital of Korean Medicine, Semyung University, 65 Semyeong-ro, Jecheon 27136, Korea
E-mail: wsrohmio@hanmail.net

Received: November 17, 2023; Revised: December 29, 2023; Accepted: January 9, 2024

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

This review examined and analyzed clinical research trends in the treatment of compression fractures in traditional Korean medicine using case studies. Accordingly, 5 web databases were searched using relevant Korean and English terms. Based on predefined exclusion and inclusion criteria, 16 case studies were selected, analyzed, and classified according to the journal, publication year, participants, chief complaints, affected vertebrae, treatment and evaluation methods, and improvement. The case studies reported various treatment methods, including acupuncture, herbal medicine, physical therapy, cupping, moxibustion, and band training. All 16 case studies reported the use of combination therapy. All 23 cases reported in these case studies demonstrated improvement in chief complaints, and none reported any side effects.

Keywords: Acupuncture, Case reports, Compression fracture, Herbal medicine

INTRODUCTION

Vertebral compression fractures occur because of axial loading or biomechanical issues and are characterized by a collapse of the anterior part of the vertebral body [1]. The etiology of vertebral compression fractures includes trauma or weakened bone conditions, such as osteoporosis or cancer metastasis [2]. In younger adults, the incidence of spine injuries due to significant trauma, such as industrial or car accidents, is high [3]. Among older adults, the incidence of secondary fractures due to minor external forces, such as falls during daily activities, particularly under osteoporotic conditions, is high [4]. Typical symptoms of compression fractures include restricted range of spinal motion and pain. Spinal nerve compression can lead to radiating pain, and intercostal nerve irritation can induce muscle spasms [5]. Moreover, compression fractures may lead to psychological disorders and chronic thoracolumbar kyphosis [6-8]. Treatment typically includes nonsurgical methods, such as bed rest and thoracolumbar braces, based on the degree of fracture, with an emphasis on pain relief and prevention of further fractures [2]. According to the Korean Statistical Office, individuals aged ≥ 75 years comprised 7.3% of the overall population in 2022; however, it is projected to increase to 10.7%, 18.1%, and 30.7% in 2030, 2040, and 2070, respectively [9]. Considering that osteoporotic vertebral compression fractures occurred most frequently in patients aged ≥ 70 years (45%) from 2012 to 2016 [10], the prevalence of compression fractures is expected to steadily increase. Several studies on the use of traditional Korean medicine for compression fracture treatment in South Korea have been conducted, with some reporting favorable outcomes. However, comprehensive research that examines various therapeutic approaches for compression fractures is lacking. Therefore, this study reviewed the current therapeutic approaches and their effects on compression fractures from a South Korean perspective. Furthermore, this study aimed to contribute to the knowledge of treatment and research on compression fractures.

MATERIALS AND METHODS

1. Data and web search sources

Five domestic databases were used to search for clinical studies conducted in Korea on traditional Korean medicine treatments for compression fractures published between January 1, 2000, and July 31, 2023: the Korean Studies Information Service System, Research Information Sharing Service, Korean Medical Database, Science On, Database Periodical Information Academic, and Traditional Medicine Information Portal (Oasis). The literature search used the following keywords: “compression fracture,” “Korean medicine,” “acupuncture,” and “herbal medicine.”

2. Data selection

Titles, abstracts, and full texts of the articles extracted via the database search were reviewed to select studies that described traditional Korean medicine treatments for compression fractures. Patients with compression fractures were defined as those diagnosed using imaging examinations, regardless of sex, age, or race. Reviews, randomized controlled trials, simple clinical process analysis studies, and case reports that focused on the treatment of accompanying symptoms rather than pain caused by compression fractures were excluded. Because the research focused on compression fractures as a single condition, studies that involved fractures in other areas, those that combined compression fractures with disk herniation, or those that discussed various symptoms due to electric shock, including compression fractures, were excluded. The database search generated 126 studies; of the 126 studies, 91 duplicate studies were excluded, and from the remaining 35 studies, 19 that met the aforementioned exclusion criteria were excluded. Finally, 16 studies were selected for analysis.

3. Data analysis

The 16 included studies (Tables 1, 2) [11-26] were classified according to the journal and year of publication, patient information, intervention, evaluation methods, and treatment results.

Table 1 . Patient information.

Authors (y)JournalPatient information
Sex/ageChief complaintsAffected vertebraeTreatment duration (d)
Han and Lee (2002) [11]JKCMM/29LBP and dorsalgiaT12, L210
Lee et al. (2004) [12]JOPPM/58Right LBP (L3–L4 stenosis and right iliac crest line) and radiating pain (lower extremity traction and tingling)L215
Seo et al. (2005) [13]Journal of the Jeahan Oriental Medical AcademyF/44Nuchal pain, bilateral hand numbness, and LBPT131
Eom et al. (2005) [14]JKCMF/72LBP and referred pain on the lateral side of the gluteal femoral region, constipation, and urinary inadequacyL1, L226
Jang et al. (2005) [15]JKCMM/74LBP: lower extremity pain (anterior, sitting position, uncomfortable when standing, and unable to walk)L451
Lee et al. (2006) [16]Journal of the Society of Spine and Joint in Korean MedicineF/52LBP (worse on the left side, worsens with movement and at night, dysfunction of joint movements, and difficulty with walking and changing positions)T1048
Jo et al. (2009) [17]JKMRF/83LBP, coccydynia, gluteal pain, left foot pain, anterior discomfort, dysfunction of joint movements, and gait disorderT12, L119
Yang et al. (2009) [18]JCMMF/62LBP, bilateral lower limb muscle atrophy, inability to walk, facial edema, and skin inflammationL372
Han et al. (2011) [19]JCMMF/78
F/79
F/88
LBP: pain that seems to migrate all over the superolateral surface of the middle to right gluteal area of the lower lumbar region, which worsens when sitting or walking; however, pain is alleviated when supine
LBP: generalized pain in the lower lumbar region and severe pain when rising from the supine position
LBP: bilateral iliac crest pain, worsens when changing posture, difficulty with standing or sitting; however, pain alleviated upon lying down
Recent L1, old T12, L4
L1
Acute T12, old L4
29
22
22
Kim et al. (2017) [20]JKMRM/56
F/48
F/56
LBP
LBP
Dorsalgia
L2
L1, L2
T7
19
25
21
Hong et al. (2017) [21]JKMRM/39
F/63
M/30
M/30
Right facial pain, nuchal pain, right scapula to shoulder joint pain, chest pain, LBP, dizziness, and nausea
Headache, nuchal pain, and LBP
LBP and right gluteal pain
Abdominal pain, left rib pain, LBP, and left knee pain
L2
L1
L2, L3, L5
L3
25
23
22
19
Lee et al. (2018) [22]JARF/35Severe LBP on the right sideT11–L5 (7 vertebral bodies)27
Kim et al. (2019) [23]JIKMM/60LBP, right groin pain, and bilateral leg pain and numbnessMalignant L4 and L5
Benign L1 and L2
25
Lee et al. (2021) [24]JIKMF/76LBP and bilateral leg numbnessL351
Shin et al. (2022) [25]Journal of the Society of Spine and Joint in Korean MedicineF/75LBP, pelvic pain, and bilateral leg numbnessL426
Lee et al. (2022) [26]JSKMCPF/80Right leg hypersensitivity to cold, right gluteal pain, LBP, and right foot numbnessL3, T1224

JKCM, Journal of Korea CHUNA Manual Medicine; JOPP, Korean Journal of Oriental Physiology and Pathology; JKMR, Journal of Korean Medicine Rehabilitation; JCMM, Journal of Korea CHUNA Manual Medicine for Spine and Nerves; JAR, Journal of Acupuncture Research; JIKM, Journal of Korean Oriental Internal Medicine; JSKMCP, Journal of Korean Medicine and Clinical Pharmacopuncture; M, male; F, female; LBP, low back pain; L, lumbar vertebra; T, thoracic vertebra..


Table 2 . Interventions, evaluation, and results.

Author (y)InterventionEvaluationResult/score
AcupunctureHerbal medicineOthers
Han and Lee (2002) [11]1. Burning acupuncture:
- After inserting the needle approximately 20 mm between the spinous processes, heat it over a direct flame for 2–3 min.
- Every alternate day for 4 times.
Paejangtang1. Physical therapy- Manual therapy: abdominal area.
2. Microwave: abdominal area.
3. Cupping: once/day.
VAS, ODI, and DITIVAS 6 → 0
ODI 22 → 42
Difference in DITI between both iliac crests 0.34 → 0.08
Lee et al. (2004) [12]1. Sa-am acupuncture:
- SP3, L9 Bo, LI11 Sa, Young-Su-Bo-Sa, and Gu-Ryuk-Bo-Sa on the right side.
- Once/day, R: 15–20 min.
2. Pharmacopuncture (Carthami-Flos):
- Acupoints around the fracture site.
- Once/day, D: 0.05 cc × 8–10 points.
GamigungguitangPain index, classification methods such as Chae’s method [27] and QVASPain index 9 → 2
Grade III → I
(Appendix 1)
Excellent (Appendix 2)
QVAS 9 → 2
Seo et al. (2005) [13]1. General acupuncture:
- GV14, EX-B2, G20, GV16, LI11, TE5, SI3, L9, and SP3.
- Once/day, R: 30 min.
2. Pharmacopuncture (SweetBV 10,000:1 → 4,000:1 → 2,000:1):
- GV14, EX-B2, and G20, at the tenderness site.
- 2–3 times/week, D: 0.05 mL/point.
1st Gamiseogyeong-tang
2nd Whuallak-tang
3rd GamiSamul-tang
4th Sokyungsoonkisan-hap-Ssanghwa-tang
5th Gamissanghwa-tang
6th Sokyungsoonkisan
1. Physical therapy:
- TENS, ICT, ultrasound, and manual therapy, each once/day.
- Hot pack every 6 h.
2. Taping:
- Tape the splenius capitis and trapezius and attach it in a star-shaped manner to the first thoracic vertebra, and maintain for 48 h.
3. Moxibustion:
- Three multiportions on the abdomen and lumbar region in the prone position, once/day.
4. Cupping:
- At the site of tenderness.
- Dry or wet cupping, once/day.
VAS, ROM, and classification methods such as Chae’s method [27]VAS 10 → 2
Extension 30 → 45, lateral bending 30/20 → 30/30
Rotation 10/10 → 60/60
Grade III → I
(Appendix 1)
Eom et al. (2005) [14]1. Sa-am acupuncture (first half of treatment):
- Kidney and large intestine toxifying acupuncture.
- Twice/day, R: 20–30 min.
2. General acupuncture (second half of treatment):
- B23, B24, B25, B26, B20, B21, and B17 at the site of tenderness.
- If flank pain is present, TE6 and G34, twice/day, R: 20–30 min.
1st JihwangBaekho-tang
2nd Moktongdaean-tang
3rd Yukmijihwang-tang-gami
1. Physical therapy:
- ICT, TENS once/day.
2. Moxibustion:
- Indirect tool to improve urination (big moxibustion) CV6 and CV4, twice/day.
3. Cupping:
- Dry cupping in the area of lumbar drainage, once/day.
- 20 days postinjury.
VAS, ROM, and classification methods such as Chae’s method [27]VAS unspecified before treatment → upon discharge (at rest VAS 3, with movement VAS 6)
Grade IV → I
(Appendix 1)
ROM unmeasurable →flexion 70°, extension 10°, lateral bending 20°/20°, rotation 30°/20°
Jang et al. (2005) [15]1. General acupuncture:
- BL23, GV3, B60, L9, G30, ST36, B40, and GB41.
- A-shi points.
- Twice/day, R: 20 min.
1st Extract-Gamihwalheol-tang
2nd Extract-Samchulkunbi-tang
1. Physical therapy:
- ICT, hot pack.
- Once/day, R: 30 min.
2. Therapeutic exercise:
- Lower spine exercises during Goldthwait’s exercise, knee joint extension and elevation exercises, and pelvic tilt exercises during Calliet’s exercise.
- 5 times/set, 6 sets/day.
3. Band training:
- Wrap a band around both knees, maintain the ankle joint at 90°, and raise one leg until the highest angle possible.
- Start on day 5 of hospitalization, ten times/set, 3 sets/day.
ODI, VAS, ROM, SLR test (T), Bragard T, Lasegue T, Patrick T, Milgram T, Valsalva T, dorsiflexion, and plantar flexionODI 46 → 21
VAS 8 → 2
Flexion 60° → 70°
Extension 10° → 20°
Lateral bending 20°/20° → 20°/20°
Rotation 25°/25° → 30°/30°
SLR T −/− → −/−
Bragard T −/− → −/−
Lasegue T −/− → −/−
Patrick T −/− → −/−
Milgram T 2° → 20°
Valsalva T −/− → −/−
Dorsiflexion −/− → +/+
Plantar flexion ++/++ → ++/++
Lee et al. (2006) [16]1. Dong-si acupuncture:
- R: 30 min, 2 times/day.
- am: Yeonggol, Daebaek, Biik, Okhwa, Jungbaek, Habaek, Junggeun, Jeongjong, Bokwon, Sogol.
- pm: Tonggwan, Tongsan, Tongchun, Shimmun, Sahwajung, Sahwawae, Ganmun, Jangmun, Sangsamhwang, Mokyeom, Hachunhwang.
2. Pharmacopuncture (Sweet BV, 2,000:1):
- EX-B2 and A-shi points on T10–11 and T11–L1.
- 2–3 times/week, D: start from 0.1 cc, until 1 cc.
1st Whuallak-tang
2nd Gucheokbogol-tang
3rd Jaeumgeonbi-tang
4th Boshinikdok-tang
5th Dokwhal-tang
6th Sayuktanggagami
VAS and classification methods such as Chae’s method [27]VAS 9 → 3
Grade IV → I
(Appendix 1)
Jo et al. (2009) [17]1. General acupuncture:
- EX-B2 around the A-shi points.
- Bilateral B23, B25, B26, B50, and B60.
- Once/day, R: 15 min.
2. Pharmacopuncture (Jungsongouhyul):
- Around the fracture site.
- Once/day, D: 0.1–0.2 cc × 8–10 points.
1st Doinseunggi-tang
2nd Gyejibokryeong-hwan
Classification methods such as Chae’s method [27], VAS, and ODIGrade IV → I
(Appendix 1)
VAS 10 → 1
ODI 52 → 16
Yang et al. (2009) [18]1. Sa-am acupuncture:
- Once/day, Young-Su-Bo-Sa.
- Lung toxifying acupuncture: Sp3, L9 Bo, H8, L10 Sa.
- Alcoholic phlegm acupuncture: Sp3, L9 Bo, Liv1, Sp1 Sa.
2. Pharmacopuncture (Jungsongouhyul):
- Around both sides of B23, B24, and B25.
- Once/day, D: 1 mL/6 points.
1st Yukgunja-ga-Euiiin
2nd Ssanghwa-tang-gami
Stages of motor weakness, VAS, and changes in chief complaintsChange in motor weakness (Appendix 3)
Grade 2 → Grade 5
VAS 10 → 1
Changed chief complaints (Appendix 4)
Han et al. (2011) [19]1. General acupuncture:
- A-shi points, once/day, R: 15 min.
2. Pharmacopuncture (Jungsongouhyul):
- A-shi points, once/1–2 days.
Case 1: 1st Danggwisu-san, 2nd Chungungyukgye-tang, 3rd Tong shun-san
Case 2: 1st Cheongpa-jeon H, 2nd Tong shun-san
Case 3: 1st Baekpa-jeon, 2nd Tong shun-san
VASCase 1: VAS 10 → 2
Case 2: VAS 10 → 3
Case 3: VAS 10 → 3
Kim et al. (2017) [20]1. General acupuncture:
- B23, B24, B25, B26, B50, and B60.
- Depending on the area of injury or pain: B16, B17, and B18.
- Twice/day, R: 10 min.
2. Burning acupuncture:
- Place the needle at a depth of 15–20 mm at 0.30–50 mm in the concave area between the injured EX-B2 and spinous processes and apply heat, once/day.
- Case 1: 6 times, EX-B2 at GV4 and L2–L3.
- Case 2: 8 times, EX-B2 at GV5 and GV4 and L1–L3.
- Case 3: 7 times, GV10, GV9, and GV8.
1. Physical therapy:
- Hot pack twice/day.
2. Moxibustion:
- Indirect moxa cone moxibustion between the EX-B2 and spinous processes.
- Once/day, 6 days/week.
NRS and ODICase 1: NRS 8 → 5
ODI 60 → 55
Case 2: NRS 7 → 5
ODI 62 → 55
Case 3: NRS 10 → 5
ODI 64 → 55
Hong et al. (2017) [21]1. General acupuncture:
- B23, B24, B25, B26, B51, B52, B40, GB34, and B60.
- R: 15 min.
2. Pharmacopuncture (Hwangryunhaedok-tang):
- The fracture site is the interspinous ligament between the spinous processes and B23, B24, B25, and B26.
- 7 times/week, D: 0.1 cc at each point.
Danggwisu-san1. Physical therapy:
- For the treatment of muscles and ligaments of bilateral or affected lumbar and hip– sacroiliac joints - microwave, R: 5 min.
- TENS R: 10 min.
- Electromagnetic field therapy: R: 10 min.
- Hot pack R: 10 min.
VAS and PFWDCase 1: VAS 6 → 3
PFWD 30 m → 450 m
Case 2: VAS 6 → 3
PFWD 30 m → 450 m
Case 3: VAS 7 → 5
PFWD 45 m → 420 m
Case 4: VAS 9 → 4
PFWD 30 m → 420 m
Lee et al. (2018) [22]1. General acupuncture:
- EX-B2 near the site of the patient’s LBP and the quadratus lumborum.
- Twice/day
- Additional treatment for indigestion was administered, when necessary, at LI4, LR3, CV12, and ST36.
1st Keoseup-hwalhyeol-jitong-tang
2nd Nokyong-kunbi tang
NRS, EQ-5D, ODI, and blood test (ESR, CRP, and PTH-C)NRS 7 → 5
EQ-5D -0.121 → 0.677
ODI 93.33 → 86.67
ESR 41 mm/h → no results
CRP 0.43 mg/dL → no results
PTH-C 102.5 pg/mL → no results
Kim et al. (2019) [23]1. General acupuncture:
- B23, B40, SP6, and GB39. B26, B24, S34, and SP10.
- Twice/day, R: 15 min.
2. Pharmacopuncture (Shinbaro):
- At the point of tenderness.
- Around 2 times/day, D: 0.2–0.3 mL/point, 1 mL.
1st Dansambohyel-tang
2nd Dangguibohyel-tang
3rd Cheongpa-jeon H
4th Yukkongbaro-hwan
5th Jaseng-Ko
6th Jeobgol
1. Physical therapy:
- Manual therapy: relaxes the iliopsoas and quadratus lumborum.
2. Cupping:
- A-shi point, dry or wet cupping.
ODI, NRS, and blood testODI 44 → 22
NRS (leg) 4 → 3
NRS (LBP) 6 → 4
CRP 15.08 → 0.2 mg/dL
ESR 140 → 53 mm/h
Lee et al. (2021) [24]1. General acupuncture:
- B15, SI11, B23, B52, and A-shi points.
- Twice/day, R: 15 min.
2. Pharmacopuncture (Shinbaro):
- L2/3, L3/4 both EX-B2 and the A-shi point.
- D: twice/day, 1 cc/point.
1st Cheongpa-jeon H
2nd Chungwoongbaro-hwan
3rd Jeobgol
4th Bojungikgi-tang
NRS, ROM, ODI, and EQ-5DNRS 7 → 3
Flexion 30° → 60°
Extension 0° → 10°
Lateral bending 10°/30° → 30°/45°
Left/right rotation 10°/30° → 30°/45°
ODI 51.11 → 22.22
EQ-5D 0.506 → 0.677
Shin et al. (2022) [25]1. General acupuncture:
- B23, B24, B25, B26, B40, B60, and GB34.
- Twice/day, R:15 min.
2. Pharmacopuncture (Hwangryunhaedok-tang):
- Interspinous ligament at the fracture site.
- Once/day, D: 1 cc/day.
Danggwisu-sanNRS, ODI, and PFWDNRS 9 → 4
ODI 57 → 24
PFWD uncheckable → 500 m
Lee et al. (2022) [26]1. General acupuncture and electroacupuncture:
- Waist and gluteal area.
- Twice/day, R: 15 min, 3 Hz.
2. Pharmacopuncture (Hwangryunhaedok-tang):
- S35, GB34, GB39, B56, B57, SP9, SP6, and LR4.
- Once/day, D: 0.25 cc/point, 2 cc.
1st Yeong-gangchulgamtang
2nd Saeyeok-tang
3rd Gagambogol-hwan
1. Moxibustion:
- Big moxibustion, CV12 for wiwanbimin (abdominal distension), twice/day, R: 20 min.
2. Cupping:
- Dry cupping, once/day, R: 5 min, 4 cups.
- Lower back and right gluteus.
Coldness diary and drawing, noncontact thermometer
PSQI-K, and EQ-5D
Coldness diary and drawing
(Appendix 5, 6)
Skin temperature at 4 acu points increased
PSQI 9 → 9
Hypnagogic state
60 min → 30 min
EQ-5D 0.423 →
−0.056

VAS, visual analog scale; ODI, Oswestry Disability Index; DITI, digital infrared thermal imaging; R, retaining time; D, injection dose; QVAS, quadruple visual analog scale; TENS, transcutaneous electrical nerve stimulation; ICT, interferential current therapy; ROM, range of motion; SLR, straight leg raise; NRS, numerical rating scale; PFWD, pain-free walking distance; LBP, low back pain; EQ-5D, European quality of life-5 dimensions scale; ESR, erythrocyte sedimentation rate; CRP, C-reactive protein; PTH-C, parathyroid hormone–C terminal; PSQI-K, Korean version of the Pittsburgh sleep quality index..


RESULTS

1. Classification according to the journal

The 16 included studies comprised the following: 3 each from the Journal of Korean Medicine Rehabilitation and Journal of Korea CHUNA Manual Medicine; 2 each from the Journal of Korea CHUNA Manual Medicine for Spine and Nerves, Journal of Korean Oriental Internal Medicine, Journal of the Society of Spine and Joint in Korean Medicine; and 1 each from the Korean Journal of Oriental Physiology and Pathology, Journal of Jeahan Oriental Medical Academy, Journal of Acupuncture Research, Journal of Sports Korean Medicine and Clinical Pharmacopuncture (Table 1).

2. Classification according to the year of publication

One case study each was published in 2002, 2004, 2006, 2011, 2018, 2019, and 2021; 3 in 2005; and 2 each in 2009, 2017, and 2022 (Table 1).

3. Classification according to the clinicodemographic characteristics of the study participants

1) Sex and age

In the 16 included studies, 23 cases were identified (8 males and 15 females); 1 patient was in their 20s, 4 were in their 30s, 2 were in their 40s, 4 were in their 50s, 3 were in their 60s, 6 were in their 70s, and 3 were in their 80s (Table 1).

2) Chief complaints

Among the chief complaints reported by the patients, lumbago or low back pain was the most frequent (n = 22), followed by radiating pain and leg pain (n = 6) (Table 1).

3) Affected vertebrae

In 20 cases, the distinction between old and recent fractures was not considered, particularly among compound fractures. Among these, L2 fractures were the most frequent (n = 9), followed by L1 fractures (n = 8) (Fig. 1).

Figure 1. Affected vertebrae.

4) Treatment duration

Although some studies specified the treatment duration, others did not. Because all study participants were inpatients, for studies that did not specify the treatment duration, the length of hospitalization was considered the treatment duration. Treatment duration varied from 10 to 72 days. In particular, 5 patients were treated for 10–20 days, 13 were treated for 20–30 days, and 5 were treated for < 30 days (Table 1).

4. Analysis of the interventions

In the 16 studies, various traditional Korean medicine treatments, including acupuncture and herbal medicine, were administered. Acupuncture therapy was administered in all 16 studies; herbal medicine was used in 15 studies; physical therapy was used in 7 studies; cupping therapy was administered in 5 studies; moxibustion was used in 4 studies; and kinesio taping, band training, and therapeutic exercise were used in 1 study each. In all studies, ≥ 2 of these treatments were administered concurrently.

1) Acupuncture

Acupuncture, pharmacopuncture, sa-am, fire, Dong’s method, and electroacupuncture techniques were used. Although in only 3 studies, one acupuncture technique was used, other studies combined ≥ 2 acupuncture techniques. Eom et al. [14] performed sa-am acupuncture at treatment initiation and subsequently shifted to body acupuncture.

Acupuncture was performed in 12 studies. The reported treatment durations were 15 minutes in 7 studies and 10, 20, 20–30, and 30 minutes in 1 study each. However, 1 study did not specify the treatment duration. Among these studies, acupuncture was performed twice/day and once/day in 8 and 3 studies, respectively, whereas 1 study did not specify the treatment frequency. The most commonly used acupoint was BL23 (8 studies) (Table 3).

Table 3 . Frequency of used acupoints.

FrequencyAcupoints
8BL23
6BL26
5BL24, BL25, and BL60
4BL40
3GB34
2LU9, BL17, BL50, BL52, and ST36
1GV3, GV14, GV16, GB20, GB30, GB39, GB41, LI11, TE5, TE6, SI3, SI11, SP3, SP6, SP10, ST34, BL15, BL16, BL18, BL20, BL21, CV12, LR3, and LI14


Pharmacopuncture was performed in 11 studies. The herbal remedies used in pharmacopuncture included Hwangryunhaedok-tang and Jungseongaehyeol, which were used in 3 studies each. Sinbaro and sweet BV were used in 2 studies each. Carthami-Flo was used in 1 study. Four of the 11 studies provided specific acupoints for the pharmacopuncture: GV14, EX-B2, and GB20 in the study by Seo et al. [13]; B23, B24, and B25 in the study by Yang et al. [18]; BL23, BL24, BL25, and BL26 in the study by Hong et al. [21]; and S35, GB34, GB39, BL56, BL57, SP9, SP6, and LR4 in the study by Lee et al. [26]. In other studies, pharmacopuncture was administered at A-shi points around the fracture site or between the spinous processes of the injured area without acupuncture point specification. The procedures were performed once/day in 5 studies, 2–3 times/week in 2 studies, twice/day in 1 study, once every 1–2 days in 1 study, and approximately twice/day in 1 study.

Fire acupuncture was performed in 2 studies. Han and Lee [11] used disposable stainless steel needles measuring 0.40 × 80 mm. The needles were inserted to a depth of approximately 20 mm and subsequently heated with a direct flame for 2–3 minutes until the needle became red-hot and the patient sensed the heat. This procedure was performed every alternate day for 4 sessions. In the study by Kim et al. [20], fire acupuncture was performed on 3 patients. Needles measuring 0.30 × 50 mm were inserted between the spinous processes and Ex-B2 associated with the injured area to a depth of 15–20 mm. A flame lighter positioned 1 cm away from the skin was used to heat the needle. However, unlike that in Han and Lee [11] study, fire acupuncture was not immediately administered. Instead, acupuncture, moxibustion, and physical therapy were initiated first, and when improvement was slow, fire acupuncture was introduced. This treatment was performed once/day and was continued for 6–8 sessions, depending on the patient’s condition. The specific acupuncture points varied among patients, with treatment performed at points, such as EX-B2 between L2–L3, GV4, and GV5 and EX-B2 between L1–L3, GV10, GV9, and GV8.

In 3 studies, sa-am acupuncture was performed. Lee et al. [12] initiated treatment with sa-am acupuncture. They used the acupuncture points SP3 and LU9 for tonification (strengthening) and LI11 for draining. The Young-Su-Bo-Sa and Gu-Ryuk-Bo-Sa techniques were applied, and the treatment was administered on the right side every day.

Eom et al. [14] initially performed sa-am acupuncture; however, it was later switched to acupuncture. For sa-am acupuncture, kidney and large intestine toxifying acupunctures were used, with treatment administered twice/day. Yang et al. [18] performed sa-am acupuncture once/day. They employed a specific technique termed “Young-Su-Bo-Sa” for lung tonification, using the acupoints SP3 and LU9 for tonification and HT8 and LU10 for draining. Furthermore, the authors employed alcoholic phlegm acupuncture techniques with the acupoints SP3 and LU9 for tonification and LR1 and SP1 for draining.

Lee et al. [16] used Dong’s acupuncture technique; the morning treatment focused on alleviating low back pain, whereas the afternoon treatment focused on the liver, heart, and kidney, with Dong’s acupoints adjusted based on the symptoms. In the study by Lee et al. [26], only electrical acupuncture was performed, in which stimulation was applied at 3 Hz for 15 minutes.

2) Herbal medicine

Herbal medicine was used in 15 studies and 20 cases. Various formulations, totaling 39 prescriptions, were used, including decoctions, powders, pills, extracts, and capsules. These included 4 types of pills: Chungwoongbaro-hwan, Gagambogol-hwan, Yukkongbaro-hwan, and Gyejibokryeong-hwan; 2 types of powders: Gamihwalheol-tang and Samchulkunbi-tang; an extract, Jaseng-Ko; and a capsule, Jeobgol. Furthermore, 31 types of decoctions were prescribed. Although 7 patients used a single decoction throughout the treatment period, 13 switched their herbal medicine based on the treatment duration. Danggwisu-san was used most frequently (6 cases), followed by Tong shun-san and Cheongpa-jeon (3 cases each).

3) Moxibustion

Moxibustion was performed in 4 studies. Seo et al. [13] performed Dabonggu once/day, with 3 pricks each on the nuchal and lumbar regions. Eom et al. [14] performed indirect moxibustion twice/day on CV6 and CV4 to enhance diuresis. Kim et al. [20] performed indirect Aejugu at Ex-B2 and between the spinous processes around the injured areas, once/day, 6 times/week. Lee et al. [26] applied Shingigu to the CV12 area to treat chest congestion symptoms.

4) Cupping

Cupping was reported in 5 studies. In the study by Han and Lee [11], the form or location of cupping was unspecified; however, it was reported that cupping was performed once/day. In the study by Eom et al. [14], dry cupping was performed once/day on the lumbar back-shu points 20 days after injury. In the studies by Seo et al. [13] and Kim et al. [23], dry and wet cupping techniques were combined at A-shi points. Although Seo et al. [13] performed cupping once/day, Kim et al. [23] did not specify the frequency. Lee et al. [26] performed dry cupping once/day for 5 minutes on the lower back and right gluteal area using 4 cups.

5) Other therapies

Physical therapy was reported in 7 studies. Hot packs were used in 4 studies, whereas manual therapy, interferential current therapy, and transcutaneous electrical nerve stimulation were each used in 3 studies. Microwave therapy was used in 2 studies, and ultrasound and electromagnetic field therapy were each used in 1 study. Seo et al. [13] used kinesio tape for taping therapy. Taping was performed on the splenius capitis and trapezius, and a star-shaped tape was applied at the first thoracic vertebra. In the study by Jang et al. [15], band training and therapeutic exercises were administered. Band training started on day 5 of hospitalization, initially using heavy resistance bands and subsequently transitioning to extra heavy resistance bands from day 32 of hospitalization. Therapeutic exercises primarily focused on strengthening the lumbar spinal muscles and were based on the back pain rehabilitation program exercises of Song and Lim [27].

5. Analysis of the evaluation methods

The most commonly used evaluation tool for assessing the subjective intensity of pain was the visual analog scale (9 studies), followed by the Oswestry Disability Index (ODI) (7 studies). The ODI is a multiple-choice patient-completed questionnaire and comprises ten items related to various aspects of daily life. Each item describes the level of disability in activities of daily living on a scale of 0–5 in 6 statements. This method evaluates the functional outcomes of low back pain. The numerical rating scale and range of motion were used in 5 and 4 studies, respectively. The European quality of life-5 dimensions scale (EQ-5D) was used in 3 studies. It is a widely used tool for assessing the health-related quality of life. It comprises 5 objective questions related to exercise ability, self-care, daily activities, pain, and anxiety, each answered on a point scale ranging from “no problem at all” to “extreme problems.” Blood tests and pain-free walking distance were used in 2 studies each. Blood tests focused on C-reactive protein levels and the erythrocyte sedimentation rate. Furthermore, in the study by Kim et al. [23], the parathyroid hormone–C terminal level was used for evaluation because the vertebral compression fracture reported in this study was caused by postpartum osteoporosis. Kim and Chae’s [28] classification method was used in 5 studies. It categorized the degree of pain and functional limitation to objectively assess the severity of a patient’s condition in 4 stages (Appendix 1). Furthermore, it included another classification method to objectively evaluate patient condition at discharge (Appendix 2). In the study by Han and Lee [11], the temperature difference between both iliac crests was measured using digital infrared thermal imaging to assess progress. Motor weakness stage (Appendix 3) and change in chief complaints (Appendix 4) were reported in 1 study each. A noncontact thermometer and tools, such as a coldness diary (Appendix 5) and a coldness drawing (Appendix 6), were used to assess the improvements in cold sensation. Lee et al. [26] used the Korean version of the Pittsburgh Sleep Quality Index to evaluate sleep quality.

6. Analysis of improvement

In most cases, improvements in the chief complaints reported by patients could be observed through the respective assessment criteria (Table 2).

DISCUSSION

Because the 16 case studies included inpatients, observations were made only during their hospitalization period. Therefore, whether symptoms worsened after discharge or other complications occurred remains unknown. Thus, studies involving long-term follow-up based on imaging tests for compression rate, kyphotic angle, and pain intensity are recommended. The study by Lee et al. [22] is noteworthy because although improvements in cold sensation were observed, according to the EQ-5D assessment, the quality of life obviously deteriorated. Compression fractures can have a psychological impact; therefore, future research should address the improvement in physical issues and the long-term quality of life through traditional Korean medicine treatments. Case studies must provide specific information to enable other researchers to replicate the study. Some studies did not specify the form or location of cupping, and except for the study by Kim et al. [20], the composition of moxibustion was not specified in the studies that applied it. The duration and frequency of acupuncture were not mentioned in 2 studies. Lee et al. [12] used the term “pain index” without clearly defining it. Therefore, future research should provide clearer descriptions and specify details, such as frequency, location, and treatment methods. This study analyzed case reports; therefore, all patients did not undergo the same conditions. This study covered only a limited sample size of 23 individuals. Furthermore, no comparisons were made between the group of patients with compression fractures who received Korean medicine treatment and those who did not. Although this study revealed the potential of various types of Korean medicine treatments and their effects on compression fractures, conclusively asserting significant effectiveness is difficult. Therefore, it is hoped that future research will address the limitations mentioned earlier and conduct follow-up studies for a more comprehensive understanding.

CONCLUSION

This study analyzed case studies on various traditional Korean medicine treatments, including acupuncture, herbal medicine, moxibustion, cupping, and physical, taping, and exercise therapies, for treating compression fractures. No side effects were reported, and most patients reported symptom improvement. From the results of this review, the possibility of Korean medicine in treating patients with compression fractures has been confirmed because it had a significant effect on the patients’ symptoms and pain assessment scales.

AUTHOR CONTRIBUTIONS

Conceptualization: JWB. Formal analysis: JWB. Investigation: JWB. Methodology: JWB. Supervision: NYJ. Writing – original draft: JWB. Writing – review & editing: All authors.

CONFLICTS OF INTEREST

The authors have no conflicts of interest to declare.

FUNDING

None.

ETHICAL STATEMENT

This research did not involve any human or animal experiment.

Fig 1.

Figure 1.Affected vertebrae.
Journal of Acupuncture Research 2024; 41: 1-16https://doi.org/10.13045/jar.2023.00325

Table 1 . Patient information.

Authors (y)JournalPatient information
Sex/ageChief complaintsAffected vertebraeTreatment duration (d)
Han and Lee (2002) [11]JKCMM/29LBP and dorsalgiaT12, L210
Lee et al. (2004) [12]JOPPM/58Right LBP (L3–L4 stenosis and right iliac crest line) and radiating pain (lower extremity traction and tingling)L215
Seo et al. (2005) [13]Journal of the Jeahan Oriental Medical AcademyF/44Nuchal pain, bilateral hand numbness, and LBPT131
Eom et al. (2005) [14]JKCMF/72LBP and referred pain on the lateral side of the gluteal femoral region, constipation, and urinary inadequacyL1, L226
Jang et al. (2005) [15]JKCMM/74LBP: lower extremity pain (anterior, sitting position, uncomfortable when standing, and unable to walk)L451
Lee et al. (2006) [16]Journal of the Society of Spine and Joint in Korean MedicineF/52LBP (worse on the left side, worsens with movement and at night, dysfunction of joint movements, and difficulty with walking and changing positions)T1048
Jo et al. (2009) [17]JKMRF/83LBP, coccydynia, gluteal pain, left foot pain, anterior discomfort, dysfunction of joint movements, and gait disorderT12, L119
Yang et al. (2009) [18]JCMMF/62LBP, bilateral lower limb muscle atrophy, inability to walk, facial edema, and skin inflammationL372
Han et al. (2011) [19]JCMMF/78
F/79
F/88
LBP: pain that seems to migrate all over the superolateral surface of the middle to right gluteal area of the lower lumbar region, which worsens when sitting or walking; however, pain is alleviated when supine
LBP: generalized pain in the lower lumbar region and severe pain when rising from the supine position
LBP: bilateral iliac crest pain, worsens when changing posture, difficulty with standing or sitting; however, pain alleviated upon lying down
Recent L1, old T12, L4
L1
Acute T12, old L4
29
22
22
Kim et al. (2017) [20]JKMRM/56
F/48
F/56
LBP
LBP
Dorsalgia
L2
L1, L2
T7
19
25
21
Hong et al. (2017) [21]JKMRM/39
F/63
M/30
M/30
Right facial pain, nuchal pain, right scapula to shoulder joint pain, chest pain, LBP, dizziness, and nausea
Headache, nuchal pain, and LBP
LBP and right gluteal pain
Abdominal pain, left rib pain, LBP, and left knee pain
L2
L1
L2, L3, L5
L3
25
23
22
19
Lee et al. (2018) [22]JARF/35Severe LBP on the right sideT11–L5 (7 vertebral bodies)27
Kim et al. (2019) [23]JIKMM/60LBP, right groin pain, and bilateral leg pain and numbnessMalignant L4 and L5
Benign L1 and L2
25
Lee et al. (2021) [24]JIKMF/76LBP and bilateral leg numbnessL351
Shin et al. (2022) [25]Journal of the Society of Spine and Joint in Korean MedicineF/75LBP, pelvic pain, and bilateral leg numbnessL426
Lee et al. (2022) [26]JSKMCPF/80Right leg hypersensitivity to cold, right gluteal pain, LBP, and right foot numbnessL3, T1224

JKCM, Journal of Korea CHUNA Manual Medicine; JOPP, Korean Journal of Oriental Physiology and Pathology; JKMR, Journal of Korean Medicine Rehabilitation; JCMM, Journal of Korea CHUNA Manual Medicine for Spine and Nerves; JAR, Journal of Acupuncture Research; JIKM, Journal of Korean Oriental Internal Medicine; JSKMCP, Journal of Korean Medicine and Clinical Pharmacopuncture; M, male; F, female; LBP, low back pain; L, lumbar vertebra; T, thoracic vertebra..


Table 2 . Interventions, evaluation, and results.

Author (y)InterventionEvaluationResult/score
AcupunctureHerbal medicineOthers
Han and Lee (2002) [11]1. Burning acupuncture:
- After inserting the needle approximately 20 mm between the spinous processes, heat it over a direct flame for 2–3 min.
- Every alternate day for 4 times.
Paejangtang1. Physical therapy- Manual therapy: abdominal area.
2. Microwave: abdominal area.
3. Cupping: once/day.
VAS, ODI, and DITIVAS 6 → 0
ODI 22 → 42
Difference in DITI between both iliac crests 0.34 → 0.08
Lee et al. (2004) [12]1. Sa-am acupuncture:
- SP3, L9 Bo, LI11 Sa, Young-Su-Bo-Sa, and Gu-Ryuk-Bo-Sa on the right side.
- Once/day, R: 15–20 min.
2. Pharmacopuncture (Carthami-Flos):
- Acupoints around the fracture site.
- Once/day, D: 0.05 cc × 8–10 points.
GamigungguitangPain index, classification methods such as Chae’s method [27] and QVASPain index 9 → 2
Grade III → I
(Appendix 1)
Excellent (Appendix 2)
QVAS 9 → 2
Seo et al. (2005) [13]1. General acupuncture:
- GV14, EX-B2, G20, GV16, LI11, TE5, SI3, L9, and SP3.
- Once/day, R: 30 min.
2. Pharmacopuncture (SweetBV 10,000:1 → 4,000:1 → 2,000:1):
- GV14, EX-B2, and G20, at the tenderness site.
- 2–3 times/week, D: 0.05 mL/point.
1st Gamiseogyeong-tang
2nd Whuallak-tang
3rd GamiSamul-tang
4th Sokyungsoonkisan-hap-Ssanghwa-tang
5th Gamissanghwa-tang
6th Sokyungsoonkisan
1. Physical therapy:
- TENS, ICT, ultrasound, and manual therapy, each once/day.
- Hot pack every 6 h.
2. Taping:
- Tape the splenius capitis and trapezius and attach it in a star-shaped manner to the first thoracic vertebra, and maintain for 48 h.
3. Moxibustion:
- Three multiportions on the abdomen and lumbar region in the prone position, once/day.
4. Cupping:
- At the site of tenderness.
- Dry or wet cupping, once/day.
VAS, ROM, and classification methods such as Chae’s method [27]VAS 10 → 2
Extension 30 → 45, lateral bending 30/20 → 30/30
Rotation 10/10 → 60/60
Grade III → I
(Appendix 1)
Eom et al. (2005) [14]1. Sa-am acupuncture (first half of treatment):
- Kidney and large intestine toxifying acupuncture.
- Twice/day, R: 20–30 min.
2. General acupuncture (second half of treatment):
- B23, B24, B25, B26, B20, B21, and B17 at the site of tenderness.
- If flank pain is present, TE6 and G34, twice/day, R: 20–30 min.
1st JihwangBaekho-tang
2nd Moktongdaean-tang
3rd Yukmijihwang-tang-gami
1. Physical therapy:
- ICT, TENS once/day.
2. Moxibustion:
- Indirect tool to improve urination (big moxibustion) CV6 and CV4, twice/day.
3. Cupping:
- Dry cupping in the area of lumbar drainage, once/day.
- 20 days postinjury.
VAS, ROM, and classification methods such as Chae’s method [27]VAS unspecified before treatment → upon discharge (at rest VAS 3, with movement VAS 6)
Grade IV → I
(Appendix 1)
ROM unmeasurable →flexion 70°, extension 10°, lateral bending 20°/20°, rotation 30°/20°
Jang et al. (2005) [15]1. General acupuncture:
- BL23, GV3, B60, L9, G30, ST36, B40, and GB41.
- A-shi points.
- Twice/day, R: 20 min.
1st Extract-Gamihwalheol-tang
2nd Extract-Samchulkunbi-tang
1. Physical therapy:
- ICT, hot pack.
- Once/day, R: 30 min.
2. Therapeutic exercise:
- Lower spine exercises during Goldthwait’s exercise, knee joint extension and elevation exercises, and pelvic tilt exercises during Calliet’s exercise.
- 5 times/set, 6 sets/day.
3. Band training:
- Wrap a band around both knees, maintain the ankle joint at 90°, and raise one leg until the highest angle possible.
- Start on day 5 of hospitalization, ten times/set, 3 sets/day.
ODI, VAS, ROM, SLR test (T), Bragard T, Lasegue T, Patrick T, Milgram T, Valsalva T, dorsiflexion, and plantar flexionODI 46 → 21
VAS 8 → 2
Flexion 60° → 70°
Extension 10° → 20°
Lateral bending 20°/20° → 20°/20°
Rotation 25°/25° → 30°/30°
SLR T −/− → −/−
Bragard T −/− → −/−
Lasegue T −/− → −/−
Patrick T −/− → −/−
Milgram T 2° → 20°
Valsalva T −/− → −/−
Dorsiflexion −/− → +/+
Plantar flexion ++/++ → ++/++
Lee et al. (2006) [16]1. Dong-si acupuncture:
- R: 30 min, 2 times/day.
- am: Yeonggol, Daebaek, Biik, Okhwa, Jungbaek, Habaek, Junggeun, Jeongjong, Bokwon, Sogol.
- pm: Tonggwan, Tongsan, Tongchun, Shimmun, Sahwajung, Sahwawae, Ganmun, Jangmun, Sangsamhwang, Mokyeom, Hachunhwang.
2. Pharmacopuncture (Sweet BV, 2,000:1):
- EX-B2 and A-shi points on T10–11 and T11–L1.
- 2–3 times/week, D: start from 0.1 cc, until 1 cc.
1st Whuallak-tang
2nd Gucheokbogol-tang
3rd Jaeumgeonbi-tang
4th Boshinikdok-tang
5th Dokwhal-tang
6th Sayuktanggagami
VAS and classification methods such as Chae’s method [27]VAS 9 → 3
Grade IV → I
(Appendix 1)
Jo et al. (2009) [17]1. General acupuncture:
- EX-B2 around the A-shi points.
- Bilateral B23, B25, B26, B50, and B60.
- Once/day, R: 15 min.
2. Pharmacopuncture (Jungsongouhyul):
- Around the fracture site.
- Once/day, D: 0.1–0.2 cc × 8–10 points.
1st Doinseunggi-tang
2nd Gyejibokryeong-hwan
Classification methods such as Chae’s method [27], VAS, and ODIGrade IV → I
(Appendix 1)
VAS 10 → 1
ODI 52 → 16
Yang et al. (2009) [18]1. Sa-am acupuncture:
- Once/day, Young-Su-Bo-Sa.
- Lung toxifying acupuncture: Sp3, L9 Bo, H8, L10 Sa.
- Alcoholic phlegm acupuncture: Sp3, L9 Bo, Liv1, Sp1 Sa.
2. Pharmacopuncture (Jungsongouhyul):
- Around both sides of B23, B24, and B25.
- Once/day, D: 1 mL/6 points.
1st Yukgunja-ga-Euiiin
2nd Ssanghwa-tang-gami
Stages of motor weakness, VAS, and changes in chief complaintsChange in motor weakness (Appendix 3)
Grade 2 → Grade 5
VAS 10 → 1
Changed chief complaints (Appendix 4)
Han et al. (2011) [19]1. General acupuncture:
- A-shi points, once/day, R: 15 min.
2. Pharmacopuncture (Jungsongouhyul):
- A-shi points, once/1–2 days.
Case 1: 1st Danggwisu-san, 2nd Chungungyukgye-tang, 3rd Tong shun-san
Case 2: 1st Cheongpa-jeon H, 2nd Tong shun-san
Case 3: 1st Baekpa-jeon, 2nd Tong shun-san
VASCase 1: VAS 10 → 2
Case 2: VAS 10 → 3
Case 3: VAS 10 → 3
Kim et al. (2017) [20]1. General acupuncture:
- B23, B24, B25, B26, B50, and B60.
- Depending on the area of injury or pain: B16, B17, and B18.
- Twice/day, R: 10 min.
2. Burning acupuncture:
- Place the needle at a depth of 15–20 mm at 0.30–50 mm in the concave area between the injured EX-B2 and spinous processes and apply heat, once/day.
- Case 1: 6 times, EX-B2 at GV4 and L2–L3.
- Case 2: 8 times, EX-B2 at GV5 and GV4 and L1–L3.
- Case 3: 7 times, GV10, GV9, and GV8.
1. Physical therapy:
- Hot pack twice/day.
2. Moxibustion:
- Indirect moxa cone moxibustion between the EX-B2 and spinous processes.
- Once/day, 6 days/week.
NRS and ODICase 1: NRS 8 → 5
ODI 60 → 55
Case 2: NRS 7 → 5
ODI 62 → 55
Case 3: NRS 10 → 5
ODI 64 → 55
Hong et al. (2017) [21]1. General acupuncture:
- B23, B24, B25, B26, B51, B52, B40, GB34, and B60.
- R: 15 min.
2. Pharmacopuncture (Hwangryunhaedok-tang):
- The fracture site is the interspinous ligament between the spinous processes and B23, B24, B25, and B26.
- 7 times/week, D: 0.1 cc at each point.
Danggwisu-san1. Physical therapy:
- For the treatment of muscles and ligaments of bilateral or affected lumbar and hip– sacroiliac joints - microwave, R: 5 min.
- TENS R: 10 min.
- Electromagnetic field therapy: R: 10 min.
- Hot pack R: 10 min.
VAS and PFWDCase 1: VAS 6 → 3
PFWD 30 m → 450 m
Case 2: VAS 6 → 3
PFWD 30 m → 450 m
Case 3: VAS 7 → 5
PFWD 45 m → 420 m
Case 4: VAS 9 → 4
PFWD 30 m → 420 m
Lee et al. (2018) [22]1. General acupuncture:
- EX-B2 near the site of the patient’s LBP and the quadratus lumborum.
- Twice/day
- Additional treatment for indigestion was administered, when necessary, at LI4, LR3, CV12, and ST36.
1st Keoseup-hwalhyeol-jitong-tang
2nd Nokyong-kunbi tang
NRS, EQ-5D, ODI, and blood test (ESR, CRP, and PTH-C)NRS 7 → 5
EQ-5D -0.121 → 0.677
ODI 93.33 → 86.67
ESR 41 mm/h → no results
CRP 0.43 mg/dL → no results
PTH-C 102.5 pg/mL → no results
Kim et al. (2019) [23]1. General acupuncture:
- B23, B40, SP6, and GB39. B26, B24, S34, and SP10.
- Twice/day, R: 15 min.
2. Pharmacopuncture (Shinbaro):
- At the point of tenderness.
- Around 2 times/day, D: 0.2–0.3 mL/point, 1 mL.
1st Dansambohyel-tang
2nd Dangguibohyel-tang
3rd Cheongpa-jeon H
4th Yukkongbaro-hwan
5th Jaseng-Ko
6th Jeobgol
1. Physical therapy:
- Manual therapy: relaxes the iliopsoas and quadratus lumborum.
2. Cupping:
- A-shi point, dry or wet cupping.
ODI, NRS, and blood testODI 44 → 22
NRS (leg) 4 → 3
NRS (LBP) 6 → 4
CRP 15.08 → 0.2 mg/dL
ESR 140 → 53 mm/h
Lee et al. (2021) [24]1. General acupuncture:
- B15, SI11, B23, B52, and A-shi points.
- Twice/day, R: 15 min.
2. Pharmacopuncture (Shinbaro):
- L2/3, L3/4 both EX-B2 and the A-shi point.
- D: twice/day, 1 cc/point.
1st Cheongpa-jeon H
2nd Chungwoongbaro-hwan
3rd Jeobgol
4th Bojungikgi-tang
NRS, ROM, ODI, and EQ-5DNRS 7 → 3
Flexion 30° → 60°
Extension 0° → 10°
Lateral bending 10°/30° → 30°/45°
Left/right rotation 10°/30° → 30°/45°
ODI 51.11 → 22.22
EQ-5D 0.506 → 0.677
Shin et al. (2022) [25]1. General acupuncture:
- B23, B24, B25, B26, B40, B60, and GB34.
- Twice/day, R:15 min.
2. Pharmacopuncture (Hwangryunhaedok-tang):
- Interspinous ligament at the fracture site.
- Once/day, D: 1 cc/day.
Danggwisu-sanNRS, ODI, and PFWDNRS 9 → 4
ODI 57 → 24
PFWD uncheckable → 500 m
Lee et al. (2022) [26]1. General acupuncture and electroacupuncture:
- Waist and gluteal area.
- Twice/day, R: 15 min, 3 Hz.
2. Pharmacopuncture (Hwangryunhaedok-tang):
- S35, GB34, GB39, B56, B57, SP9, SP6, and LR4.
- Once/day, D: 0.25 cc/point, 2 cc.
1st Yeong-gangchulgamtang
2nd Saeyeok-tang
3rd Gagambogol-hwan
1. Moxibustion:
- Big moxibustion, CV12 for wiwanbimin (abdominal distension), twice/day, R: 20 min.
2. Cupping:
- Dry cupping, once/day, R: 5 min, 4 cups.
- Lower back and right gluteus.
Coldness diary and drawing, noncontact thermometer
PSQI-K, and EQ-5D
Coldness diary and drawing
(Appendix 5, 6)
Skin temperature at 4 acu points increased
PSQI 9 → 9
Hypnagogic state
60 min → 30 min
EQ-5D 0.423 →
−0.056

VAS, visual analog scale; ODI, Oswestry Disability Index; DITI, digital infrared thermal imaging; R, retaining time; D, injection dose; QVAS, quadruple visual analog scale; TENS, transcutaneous electrical nerve stimulation; ICT, interferential current therapy; ROM, range of motion; SLR, straight leg raise; NRS, numerical rating scale; PFWD, pain-free walking distance; LBP, low back pain; EQ-5D, European quality of life-5 dimensions scale; ESR, erythrocyte sedimentation rate; CRP, C-reactive protein; PTH-C, parathyroid hormone–C terminal; PSQI-K, Korean version of the Pittsburgh sleep quality index..


Table 3 . Frequency of used acupoints.

FrequencyAcupoints
8BL23
6BL26
5BL24, BL25, and BL60
4BL40
3GB34
2LU9, BL17, BL50, BL52, and ST36
1GV3, GV14, GV16, GB20, GB30, GB39, GB41, LI11, TE5, TE6, SI3, SI11, SP3, SP6, SP10, ST34, BL15, BL16, BL18, BL20, BL21, CV12, LR3, and LI14

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JAR
Feb 29, 2024 Vol.41 No.1, pp. 1~73

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