Acupotomy is a type of acupuncture where a scalpel-shaped needle (miniscalpel needle) is used to exfoliate adhesion sites or relax entrapment regions. This miniscalpel-shaped needle is called “Chimdo” in Korean, which means “blade-shaped acupuncture” [1]. Acupotomy is administered for various conditions/diseases, including those which are musculoskeletal, neurological, or metabolic in nature [2-4]. In China, several retrospective medical record analyses of acupotomy usage have been conducted to determine the therapeutic effects of acupotomy, and to identify the conditions/diseases that are primarily treated with acupotomy procedures [5,6]. The study by Ai et al [5] showed that in a single hospital’s orthopedic clinic, the application of acupotomy for treating spinal conditions/diseases such as disc herniation, was 1.5 times higher than for joint conditions/diseases. A review of the research trends of acupotomy showed that lumbar conditions/diseases had the highest number of reports of treatment, followed by cervical, ankle, and shoulder conditions/diseases [7]. The number of studies on acupotomy has increased. It was reported in 2010 by Zhang et al [8], that the number of published acupotomy studies increased from 7 in 1989 to 1,880 in 2006. However, few studies have attempted to determine the range of applicability of acupotomy and the characteristics of patients who have undergone acupotomy. In this regard, we report the current status of acupotomy treatment at a single Korean Medicine Clinic in Korea and the patients’ condition/disease codes used from August 2017 to December 2019. This descriptive study examined the demographic characteristics, frequency of acupotomy, and disease codes of patients.

A total of 551 patients were treated with acupotomy from August 2017 to December 2019; the average age was 52 ± 14.26 years and 49.9% were male. The average number of acupotomy sessions per patient was 8.47 (Table 1). Altogether, 45.91% of the acupotomy treatments were applied to the spinal regions, of which 60.01% were in the lumbar region (Table 2). The next most common regions were the head, scalp, face, shoulder, and knee regions. Of the total number of patients, 49 (8.89%) were treated with Chuna therapy in parallel with acupotomy.

The frequency of condition/disease codes for patients receiving acupotomy treatment was similar to patients receiving Korean medicine treatments. The codes related to conditions/diseases of the lumbar spinal area were used most frequently. However, differences were observed between males and females. The 5^th most frequently used code in males was the sequelae of cerebrovascular conditions/diseases which did not appear in the most frequently used code for women. However, in women, tinnitus and headache codes were observed on the 8^th and 9^th usage which did not appear in the most frequently used code for men (Table 3).

The mean age of the patients was 52 years; however, 32.85% were over 60 years old. The oldest patient was 84 years old. The chief complaints were dizziness, lumbar spinal stenosis, and Dupuytren’s contracture. The youngest patient was 16 years old. Her chief complaint was muscle contraction in the pelvic region.

Each patient received acupotomy treatment 8.47 times on average. The patient who received the greatest number of acupotomy sessions underwent treatment 113 times for the sequelae of stroke. The 2^nd highest number of sessions was 92 times, for the treatment of stroke. Of the patients, 27% received acupotomy more than 10 times, and 4% received only 1 session.

This study aimed to report the demographic characteristics, frequency of acupotomy, and primary diagnosis of patients who received acupotomy treatment. According to previous studies conducted in China, acupotomy is mainly used to treat cervical spinal conditions/diseases [5,6]. In the study by Ai et al [5], 34% of patients had a cervical spinal condition/disease, 15.9% had lumbar spinal disc herniation, and 9.09% had lumbar spine stenosis. Zhang et al reported 56.41% of patients had a cervical spinal condition/disease, and 17.94% had a lumbar spinal condition/disease [6]. However, these studies had several limitations in that some studies analyzed fewer than 300 patients, and some studies were conducted before 2000. Therefore, these studies may not be applicable to Korean medicine clinics today.

The results of this study are similar to those of previous studies that analyzed the frequency of condition/disease codes for acupuncture or other Korean medicine treatments [9-11]. The study by Kim et al [9] analyzed the characteristics of patients who received acupuncture treatment in a single center and identified that 54.5% of the patients received acupuncture for a spinal condition/diseases, this was followed by acupuncture treatment for shoulder, hip, and knee pain. In the study by Lee et al [10], which also identified acupuncture and pharmacopuncture treatment patterns in a single hospital, they confirmed that acupuncture treatment was most frequently administered for lumbar spinal conditions/diseases such as intervertebral disc disorder amongst both inpatients and outpatients. In Korea, the most frequently used condition/disease code in Korean Medicine Clinics in 2017 indicated thoracic pain, followed by low back pain, myalgia, ankle sprains, and shoulder conditions/diseases [11]. Conversely, ankle conditions/diseases were lower at the 6^th most frequently used condition/disease code used by the patients in this current study who had received acupotomy at least once from August 2017 to December 2019 at a single Korean Medicine Clinic.

To our knowledge, this is the 1st study to report the age distribution of patients who received acupotomy. It has been conf irmed that acupotomy is frequently performed in elderly people over 60 years of age. Moreover, as reported in Chinese studies, acupotomy treatment is performed mainly in patients with spinal conditions/diseases [5,6]. The difference between the existing acupuncture treatment patterns and previous acupuncture treatment patterns is that acupotomy is used more frequently for facial, scalp, and cervical spinal conditions/diseases. Previous studies have shown that the most frequently reported conditions/disease codes in acupuncture are those denoting shoulder and knee joint conditions/diseases, followed by spinal conditions/disease [10,11]. However, according to the results of this current study, acupotomy was mainly used to treat upper cervical vertebral conditions/diseases, followed by head and scalp region and facial conditions/diseases.

This study had several limitations. Firstly, this was a descriptive, retrospective analysis study in 1 Korean Medicine Clinic in Seoul. Therefore, it did not include information on the patients’ symptom improvements, and the results from this study may not be nationally applicable. Secondly, the primary diagnosis KCD codes were analyzed but did not consider the secondary codes. In this regard, further studies are needed to determine the clinical outcomes of patients who receive acupotomy treatment. It is important to determine the safety of acupotomy in elderly patients because patients over 60 years of age undergo acupotomy more frequently than those under 30 years. In the future, it is necessary to evaluate the treatment site, treatment method, and objective improvement evaluations.

This was the 1st analysis of acupotomy treatment patterns in Korea. Acupotomy is primarily administered for the treatment of spinal conditions/diseases, especially those involving the lumbar region. Future studies are required to determine the clinical outcome and safety of patients who receive acupotomy treatment.