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J Acupunct Meridian Stud 2016;9(2):49e57

Available online at www.sciencedirect.com

Journal of Acupuncture and Meridian Studies


journal homepage: www.jams-kpi.com

REVIEW ARTICLE

Herbal Acupuncture for the Treatment


of Obesity
Min-Ho Nam 1,y, Seung-Wook Lee 2,y, Hyun-Young Na 2,
Jeong-Hwa Yoo 2, Sun-Ho Paik 2, Kwang Seok Ahn 1,
Young-Min Ahn 2, Se-Young Ahn 2, Seung-Hoon Choi 3,*,
Byung-Cheol Lee 2,*

1
Department of Pathology, College of Korean Medicine, Kyung Hee University, Seoul, South Korea
2
Department of Internal Medicine, College of Korean Medicine, Kyung Hee University,
Seoul, South Korea
3
Department of Medicine Consilience, Dankook University, Yongin, South Korea

Available online 3 October 2015

Received: May 26, 2015 Abstract


Revised: Sep 3, 2015 Obesity is the state of excessive body fat accumulation and is mainly caused by consuming more
Accepted: Sep 9, 2015 calories than are burned through physical activity. Herbal acupuncture (HA), also known as
pharmacopuncture, has been increasingly used in clinics of Korean medical to alleviate
KEYWORDS obesity. This review analyzed four clinical studies and 16 animal studies on the effectiveness
herbal acupuncture; of HA as a treatment for obesity. Clinical evidence suggests that various kinds of HA might
obesity; be beneficial for treating obesity; however, further investigations with well-designed, evi-
pharmacopuncture dence-based, randomized clinical trials are needed. Animal studies support the idea that HA
might be beneficial for the treatment of obesity and provide possible mechanisms, such as
anti-inflammation, antioxidation, modulating lipid metabolism and so on, to explain the effect
of HA on obesity. This review, based on the evidence collected, suggests that HA could have a
beneficial effect for alleviating obesity by modulating inflammation, oxidative stress, lipid
metabolism, leptin, and the insulin signal.

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.
* Corresponding authors.
E-mail: choish@dankook.ac.kr (S.-H. Choi), hydrolee@korea.com (B.-C. Lee).
y
These authors equally contributed to this work.

pISSN 2005-2901 eISSN 2093-8152


http://dx.doi.org/10.1016/j.jams.2015.09.002
Copyright 2015, Medical Association of Pharmacopuncture Institute.
50 M.-H. Nam et al.

1. Introduction diet, electroacupuncture, herbal therapy, and exercise


education, both groups showed significant decreases in BMI,
Obesity is a serious and rapidly growing public health BW, and WC. However, the HA group showed greater re-
problem in most countries around the world. Obesity is the ductions in BW (1.86  1.65 kg vs. 0.94  2.47 kg,
state of excessive body fat accumulation, which is mainly p < 0.05), BMI (0.76  0.67 kg/m2 vs. 0.34  1.06 kg/m2,
caused by consuming more calories, especially fatty and p < 0.05), and WC (3.30  2.12 inch vs.
sugary foods, than one burns off through physical activity; 1.09  1.32 inch, p < 0.05), than the control group.
therefore, many behavioral lifestyle interventions have Another study [9] investigated the therapeutic effects of
been suggested [1]. Most of them have shown positive re- HA using the Bigiheo (Piqixu, spleen qi deficiency) decoc-
sults in short-term weight loss. However, the majority of tion on waistehip ratio, nonfat mass, WC, and BMI in
patients failed to maintain the weight loss for more than a women. In this study, spleen qi deficiency was regarded as a
few years [2]. In addition, the use of Western antiobesity critical inclusion criterion; however, the study did not
drugs has been limited by side effects such as negative include a detailed protocol. After 3 weeks of treatment,
mood changes, suicidal thoughts, and gastrointestinal or the HA group showed more significant decreases in WC
cardiovascular complications [3]. Therefore herbal medi- (3.36  2.53 cm vs. 4.58  2.54 cm, p < 0.05) and
cine and acupuncture can provide an alternative therapy abdominal fat (3.19  6.79% vs. 5.22  1.20%, p < 0.05)
for this medical challenge. Recent clinical trials using than the control group. In terms of abdominal nonfat mass
herbal medicine and acupuncture have reported possible and BMI, common interventions (diet, behavioral therapy,
therapeutic value in treating obesity, despite controversy electroacupuncture, auricular acupuncture, herbal medi-
caused by small sample sizes and low-quality methodolo- cine, exercise education) showed significant effects, and
gies [4]. The combined treatment of herbal medicine and HA did not show any additional effects.
acupuncture also showed greater efficacy in reducing
weight than a nonpharmacological control [5]. (2) Effects on reducing visceral adipose tissue
Herbal acupuncture (HA), a type of acupuncture also
known as pharmacopuncture, acupuncture point injection, One clinical study showed efficacy in reducing visceral
acupoint injection, or point injection therapy, is a modern adipose tissue. Lee et al [10] designed a clinical trial with
adjunctive Korean medicine technique that injects natural HA using the Sobieum (Xiaofeiyin) decoction. They
herbs or biologic substances into acupuncture points to recruited 40 women with obesity and assigned them
promote, maintain, or restore health and prevent disease randomly into two groups. Computed tomography (CT) and
[6]. To this point, it has primarily been applied to resolve bioelectrical impedance analysis (BIA) were used for
pain-related diseases such as rheumatoid arthritis [7]. outcome evaluation. Both the HA and control groups
Here, we review recent progress in HA with a special showed a significant decrease in BW, WC, BMI, body fat
focus on its efficacy, safety, and possible therapeutic value mass, and total, visceral, and superficial subcutaneous fat
in treating obesity. tissue because of the basal interventions applied to both
groups. Deep subcutaneous fat tissue area
(6.17  13.78 cm2 vs. 5.50  12.13 cm2, p < 0.05) was
2. Clinical studies of HA and obesity the only outcome that showed a significant difference be-
tween the two groups.
2.1. Efficacy By analyzing the data with Pearsons correlation,
visceral fat area was significantly correlated with total fat
Four clinical studies have dealt with the efficacy of HA reduction only in the HA group (0.600 vs. 0.406, p < 0.01),
on people with obesity. All of the studies used different which means that HA using Sobieum is effective at reducing
herbal decoctions, acupoints, and doses for specified ef- visceral fat. Visceral adiposity is a marked feature of aging
fects on obesity (Table 1). and other prominent risk factors associated with obesity
such as insulin resistance [11], which is highly correlated
(1) Effects on losing body weight with obesity and diabetes. This clinical study suggests that
HA using Sobieum could be useful in obesity treatment,
The practical purpose of HA therapy on people with especially with diabetes.
obesity is losing weight. Two clinical studies showed sig-
nificant beneficial effects in reducing body weight (BW) and (3) Effects on metabolic rate
waist circumference (WC). Kim et al [8] examined whether
or not HA using Ephedra sinica and Aconitum carmichaelii Lee et al [12] tested whether HA using the Bangkih-
had therapeutic effects on 70 volunteers with body mass wangkitang (Fangjihuangqitang) decoction is effective
index (BMI) greater than 25. Persons with a body weight against obesity. Interestingly, this study showed an increase
greater than 120 kg, underlying disease (liver cirrhosis, in energy expenditure without body weight loss. The au-
renal failure, severe diabetes mellitus with complications, thors recruited 31 female volunteers with a BMI over 25 and
etc.), and those taking obesity-inducing drugs were divided them into two groups. They evaluated BMI, per-
excluded. Twenty-four patients in the HA group and 28 in- centage of body fat, skeletal muscle mass, basal metabolic
dividuals in the control group with normal saline injection rate, total cholesterol, triglycerides, high-density lipopro-
were randomly assigned and analyzed. Because both groups tein cholesterol, low-density lipoprotein cholesterol, blood
underwent other common interventions together, such as urea nitrogen, creatinine, aspartate transaminase, and
Herbal Acupuncture for the Treatment of Obesity
Table 1 Summary of clinical studies reviewed in this review.
Study Country Numbers allocated Mean age Inclusion Description of intervention Outcome Study design Main findings
(language) (numbers analyzed) (y)  SD criteria measures
[dropout rate] (range)
Kim Korea HA: (24)[d] HA: BMI  25 HA decoction: Ephedra sinica BMI RCT HA group showed a
et al [8] (Korean) CTL: (28)[d] 43.42  11.18 & Aconitum carmichaeli BW single-blind significant decrease in
(20e68) Acupoint: ST25, CV4, CV6, WC BMI, BW, WC than CTL
CTL: GB26 group.
46.57  13.37 Dose: 0.5 mL for each
(20w68) acupoint
Treatment: twice a wk for 5
wk.
(Normal saline was injected
for CTL group.)
Dietary therapy,
electroacupuncture therapy,
herbal therapy, exercise
education were applied
equally in both groups.
Lee Korea HA: 16 (16)[0] NA (16e35) BMI  25 HA decoction: BMI, percentage of - BMI & percentage of body
et al [12] (Korean) CTL: 15 (15)[0] Female Bangkihwangkitang decoction body fat, skeletal fat were significantly
Acupoint: BL23, BL52, ST25 muscle mass, basal decreased in both groups.
Dose: 0.2 mL for each metabolic rate, Skeletal muscle mass &
acupoint TC, TG, HDL, LDL, basal metabolic rate had
Treatment: 8 times for 3 wk BUN, Creatinine, significantly increased in
(No injection was performed AST, ALT only HA group.
for CTL group.)
Dietary therapy,
physiotherapy, colonic
irrigation, auricular
acupuncture therapy, &
electrostimulation therapy
were applied equally in both
groups.
(continued on next page)

51
52
Table 1 (continued )
Study Country Numbers allocated Mean age Inclusion Description of intervention Outcome Study design Main findings
(language) (numbers analyzed) (y)  SD criteria measures
[dropout rate] (range)
Cha [9] Korea HA: 21 (21)[0] HA: 35.5 Female HA decoction: Bigiheo WHR, WC, non-fat d HA group showed a
(Korean) CTL: 21 (21)[0] CTL: 36.5 Spleen qi decoction mass, BMI significantly greater
deficiency Acupoint: 9 to 10 acupoints decrease in WHR & WC.
syndrome including CV12, CV10, CV4, Change of non-fat mass,
ST25 BMI showed no significant
Dose: 0.2 mL for each difference between two
acupoint groups.
Treatment: twice a wk for  3
wk.
(No injection was performed
for CTL group.)
Dietary therapy, behavioral
therapy, electroacupuncture
therapy, auricular
acupuncture therapy, herbal
therapy, exercise education
were applied equally in both
groups
Lee Korea HA: 20 (18)[2] NA (20e55) BMI  25 HA decoction: Sobieum BW, WC, body fat RCT BW, WC, BMI, body fat
et al. [10] (Korean) CTL: 20 (18)[2] WC  85 decoction mass, total fat single-blind mass, total fat area,
Pre-menopausal Acupoint: No-specific area, visceral fat visceral fat area,
women acupoint. Abdomen. area, &superficial subcutaneous
Dose: 4 mL subcutaneous fat fat area were significantly
Treatment: twice a wk for 6 area, blood decreased in both groups.
wk. pressure, FBS, TC, Deep subcutaneous fat
(Normal saline was injected TG, HDL, FFA, area was decreased
for CTL group.) KEAT-26, BPAQ, significantly only in the HA
Dietary therapy (1,200 kcal/ SRRS, SRI, BDI, SES group.
d), physical therapy (30 min Only HA group showed a
walking, 3 times a wk) were significant correlation
prescribed for both groups. between visceral fat area
& total fat area reduction.
ALT Z alanine transaminase; AST Z aspartate transaminase; BDI Z Beck Depression Inventory; BL Z bladder; BMI Z body mass index; BPAQ Z Baecke Physical Activity Questionnaire;
BUN Z blood urea nitrogen; CTL Z control; CV Z conception vessel; FBS Z fasting blood sugar; FFA Z free fatty acid; GB Z gall bladder; HA Z herbal acupuncture; HDL Z high-density

M.-H. Nam et al.


lipoprotein cholesterol; KEAT-26 Z the Korean version of Eating Attitude Test-26; LDL Z low-density lipoprotein cholesterol; NA Z not attained; RCT Z randomized clinical trial;
SD Z standard deviation; SES Z Self Esteem Scale; SRI Z Stress Response Inventory; SRRS Z Social Readjustment Rating Scale; ST Z stomach; TC Z total cholesterol; TG Z triglyceride;
WC Z waist circumference; WHR Z waist-hip ratio.
Herbal Acupuncture for the Treatment of Obesity 53

alanine transaminase. Except for skeletal muscle mass and Lee et al [12] applied HA using Bangkihwangkitang to
basal metabolic rate, HA did not show any significant su- obesity treatment. Bangkihwangkitang is a composition of
periority compared to the control group. The HA group Stephania tetrandra, Astragalus membranaceus, Atractylis
showed significantly higher skeletal muscle mass koreana, Glycyrrhiza uralensis, and Zingiber officinale.
(39.03  5.24 kg vs. 34.41  4.12 kg, p < 0.05) and basal This decoction has been known to dispel dampness and
metabolic rate (1,458  135.2 kcal vs. 1,346  130.7 kcal, tonify the spleen; therefore, it has long been used for
p < 0.05) than the control group at the end of the study. treating obesity in traditional Korean medicine.
Because the low quality of this study indicates low reli- HA using the Bigiheo decoction [9] was used to tonify
ability, additional studies are needed to evaluate the spleen qi. This decoction is composed of Panax ginseng,
therapeutic effect of HA using Bangkihwangkitang. Astragalus membranaceus, Dioscorea batatas, Atractylodes
japonica, Poria cocos, Citrus unshiu, Zizyphus jujube, and
Glycyrrhiza uralensis.
2.2. Acupoint selection According to traditional Korean medical theories,
obesity can be caused by phlegm dampness, spleen defi-
Clinical studies have used acupoints ST25, CV4, CV6, ciency, stomach heat, liver depression, and kidney defi-
CV10, CV12, GB26, BL23, and BL52. ST25 and CV4 were used ciency [4]. Bangkihwangkitang and Bigiheo herbal
in three [8,9,12] and two [8,9] studies, respectively, and decoctions are both known to tonify qi and spleen function.
each of the other points was used once. ST25, which is on In particular, Astragalus membranaceus, used in both de-
the stomach meridian and on the abdomen, is a frequently coctions, is known to boost spleen qi and improve obesity
used acupoint for various gastrointestinal track disorders. and insulin resistance [29,30]. In human studies, herbal
Like ST25, the other acupoints are all on the abdominal decoctions were preferred to a single herb. Combinations
region, with the exceptions of BL23 and BL52. BL23 and of multiple herbs hinder mechanism studies of HA. In spite
BL52 are well known for dealing with endocrinological dis- of this limitation, many of the herbs used for HA therapy
orders. In the study by Lee et al [12], HA treatment on BL23 have already been proven to have antiobesity effects in
and BL52 showed increased metabolic rate. previous studies.
Due to the possibility of identifying multiple patterns for
a single disease in traditional Korean medicine, applied 2.4. Safety issues
acupoints and herbal decoctions vary. The clinical studies
we reviewed also used various acupoints and herbal de-
Safety issues of HA have to be discussed in two aspects.
coctions. Therefore, it is difficult to conclude that HA using
One is adverse events induced by needling, and the other is
any specific acupoints or kinds of herbs has a beneficial
events caused by herbs. In this review, none of the four
effect in treating obesity.
papers reported any adverse events from HA.
Finally, none of the studies we reviewed evaluated Deqi
Acupuncture is known to be a safe intervention in the
sensation. Even though little evidence supports the rela-
hands of skilled physicians. A prospective investigation re-
tionship between acupuncture efficacy and Deqi so far,
ported only 7.10% occurrence of nonserious adverse events
Deqi has been broadly accepted as a critical concept for
and 0.006% occurrence of serious events among 97,733
acupuncture efficacy [13]. If studies evaluated Deqi
cases [31]. In 16 studies on acupuncture treatment for
sensation in HA treatment, it would be safer to conclude
obesity, only six reported side effects such as skin bruises
that HA therapy is effective as a kind of acupuncture
and redness. More serious complications have been rarely
therapy.
reported, for example abscess formation and cardiac tam-
ponade, but those were limited to elderly immunocom-
2.3. Herbs promised patients and those with severe diabetes [4].
Even though HA did not raise any safety issues in the four
clinical studies and herbal medicine is also known to be a
Kim et al [8] used HA composed of Ephedra sinica and
relatively safe treatment throughout its long history, HA is
Aconitum carmichaelii. Both herbs are widely used for
not completely free from the possibility of toxicity or
tonifying yang and dissipating cold that hinders energy
adverse effects. For instance, Ephedra sinica and Aconitum
expenditure. Lee et al [10] used Sobieum HA, which in-
carmichaelii are notorious for their side effects of palpi-
cludes Platycodon grandiflorum, Ephedra sinica, Morus
tation, nausea, vomiting, breathing problems, etc.
alba, Liriope platyphylla, Scutellaria baicalensis, and
Although no adverse events occurred in the four clinical
Prunus armeniaca. Sobieum is a decoction known to boost
studies, these herbs should be used in a proper dose and
the lipolysis of adipose tissue and inhibit lipid absorption in
under the supervision of skilled physicians.
the intestine [14]. In this review, two studies used Ephedra
sinica, which is well known for its antiobesity effect, as
demonstrated in many human and animal studies [15e18]. 2.5. Limitations
Because Ephedra sinica has side effects such as heart pal-
pitations and dyspepsia [19], combination with other drugs Because all the studies used basal interventions such as
would be helpful. In this regard, Sobieum contains not only dietary therapy, physical therapy, and exercise education
Ephedra sinica but also other herbs with antiobesity po- for both HA and control groups, accurate evaluation of HA
tential, such as Platycodon grandiflorum [20e23], Morus efficacy was difficult. Primary outcomes were not consis-
alba [24,25], Liriope platyphylla [26], and Scutellaria bai- tent between studies; therefore, direct comparison be-
calensis [27,28]. tween various kinds of HA is impractical. Moreover, the
54 M.-H. Nam et al.

sample sizes of the four studies were too small to gener- [42]. Therefore, several studies suggest that reducing
alize. Despite these limitations, HA treatment of obesity oxidative stress or increasing antioxidants might be bene-
does seem to be beneficial. ficial in treating obesity [43].
Several pieces of experimental evidence suggest that HA
can increase antioxidants such as SOD, GSH-Px, and cata-
3. Experimental evidence
lase in obese mice. HA using extracts of Prunella vulgaris,
Chrysanthemum indicum, Radix puerariae [37], Radix
Recent experimental studies support the idea that HA ginseng [44], and Phaseolus angularis [45] significantly in-
has beneficial effects in treating obesity. HA using various creases SOD, GSH-Px, and catalase levels in mice with
herb extracts was shown to be effective for weight loss and obesity and reduces body weight and body fat. HA using the
lowering blood glucose and blood lipids. Those therapeutic extract of Lumbricus [38] increases SOD and catalase levels
effects were caused by multi-faceted mechanisms, such as but not GSH-Px with reduced body weight.
anti-inflammatory effects, antioxidative effects, and mod-
ulation of lipid metabolism. The experimental evidence
(3) Effects on modulating lipid metabolism
could provide a mechanistic understanding of the effects of
HA on obesity.
In physiological conditions, adiponectin is exclusively
secreted by adipocytes and activates adenosine
3.1. Efficacy monophosphate-activated protein kinase (AMPK). In turn,
activation of AMPK inactivates acetyl-CoA carboxylase
(1) Anti-inflammatory effect (ACC) by phosphorylation and blocks transformation of
acetyl-CoA into malonyl-CoA. Therefore, carnitine palmi-
Obesity and inflammation are associated with each toyltransferase 1 (CPT1) is activated, prompting adequate
other. Obesity induces a chronic, low-grade inflammatory mitochondrial fatty acid oxidation. However, AMPK phos-
response initiated by excess nutrients in metabolic cells phorylation also activates peroxisome proliferator-
[32]. This inflammation, also called metaflammation, activated receptor (PPAR)-a, which leads to the oxidation
generally causes insulin resistance through inflammatory of fatty acids and decreasing triglycerides [46].
kinases, c-Jun N-terminal kinases (JNK), IkB kinase (IKK), However, in obese conditions, increased adiposity leads
and protein kinase R (PKR), which can aggravate obesity to low plasma levels of adiponectin production, resulting in
[32]. Since the first study showing overexpression of tumor decreased AMPK activity. Inactivation of AMPK reduces
necrosis factor-alpha (TNF-a) in the adipose tissue of mice PPAR-a activity and phosphorylation of ACC [46], inducing
with obesity [33], many subsequent studies have provided a hyperglycemia [47].
link between obesity and chronic inflammation. In addition Several reports suggest that abnormal lipid metabolism
to TNF-a, several other inflammatory mediators and cyto- in obese animal models can be recovered by HA treatment.
kines, such as interleukin (IL)-1b and IL-6, are reportedly HA using Rhizoma Atractylodis [48] and Artemisia capil-
increased in obese conditions [34]. laries [49] was reported to boost AMPK phosphorylation,
Many studies have suggested that acupuncture might thus inhibiting the synthesis of fatty acids and promoting
improve inflammatory conditions by regulating several pro- their oxidation. Adiponectin [36,50,51] and PPAR-g [36],
or anti-inflammatory mediators [35]. Not only acupuncture, which are critical for regulating fatty acid storage and
but also HA is supported as a potent anti-inflammatory glucose metabolism [44], were also shown to be increased
therapy for obesity as evidenced by several experiments by HA treatment. Moreover, HA treatment with Artemisia
[36e40]. HA was shown to be effective in reducing TNF-a, capillaries was effective in increasing CPT1, which was
IL-1b, and/or IL-6 in mice with obesity using extracts of followed by AMPK phosphorylation [49]. Apolipoprotein B,
Prunella vulgaris, Chrysanthemum indicum, Radix puerar- overproduction of which leads to insulin resistance and
iae [37], Radix ginseng [36], and Lumbricus [38] on BL11 obesity [52,53], was reduced by HA using Phaseolus angu-
and ST36, BL18 and LI11, and ST36 and CV12, respectively. laris [45].
One in vitro study showed that mixed extracts of Radix Taken together, the evidence suggests that acupoint
Ginseng, musk, Ursi Fel, and Bovis Calculus inhibited injection of herbal extracts might modulate systemic lipid
inducible nitric oxide synthase, cyclooxygenase-2, and nu- metabolism. However, HA treatment is profoundly depen-
clear factor-kappa B expression induced by lipopolysac- dent on the kinds of herbal extracts used; therefore, it is
charide in the 3T3-L1 cell line, which is consistent with the difficult to conclude that most HA used to treat obesity is
in vivo effect of weight loss [36]. working on the lipid metabolism. Most studies show only
one or two pieces of the whole metabolism picture. Further
(2) Antioxidative effect studies should investigate the beneficial effects of using HA
to modulate lipid metabolism with other extracts.
In obese conditions, as fat tissue increases, adipocytes
generate increasing levels of oxidative stress, such as (4) Effects on insulin signal
reactive oxygen species (ROS), that induce secretion of
inflammatory molecules [41]. Oxidative stress leads to in- It is well known that insulin resistance commonly co-
sulin resistance, which again aggravates obesity [41]. exists with obesity and that the two conditions aggravate
Simultaneously with ROS production, antioxidants such as each other [54]. Hyperinsulinemia is thought to be a result
superoxide dismutases (SOD), glutathione (GSH), gluta- of obesity and insulin resistance. However, a recent study
thione peroxidase (GSH-Px), and catalase are decreased
Herbal Acupuncture for the Treatment of Obesity 55

reported that hyperinsulinemia drives obesity and its respectively, are also known to tonify the qi of the spleen
complications [55]. Keeping insulin levels low is critical to and stomach. ST40, on the stomach meridian, is a repre-
maintaining energy expenditure in white adipose tissue; sentative acupoint for treating phlegm, which is another
therefore, reducing insulin levels is beneficial in treating major cause of obesity [46]. Even though the evidence
obesity [55]. shows that HA has beneficial effects for treating obesity,
clinical and experimental research has used dissimilar
(5) Effect on leptin acupoint selection. In future studies, the mechanism of
frequently used acupoints in clinics needs to be studied
Several studies suggest that HA is beneficial for reducing experimentally.
serum insulin levels and insulin resistance. Using the herb
extracts of Rhizoma Atractylodis [48] or Artemisia capil- 3.3. Herbal medicine
laries [49] at BL23 or BL20, respectively, was especially
effective for reducing both serum insulin levels and insulin A variety of herbs were used in HA to treat obesity. Most
resistance. HA using mixed extracts of Radix Ginseng, experimental studies used a single herb to confirm its ef-
musk, Ursi Fel, and Bovis Calculus at BL20 was also re- fects. Because several different etiologies can cause
ported to reduce serum insulin levels [36]. obesity, medicinal herbs with various efficacies were used.
Leptin, a key hormone of obesity produced by adipo- To resolve dampness in the spleen and stomach, re-
cytes, inhibits hunger [38]. Obesity is characterized by low searchers chose Rhizoma atractylodis [48], Artemisia cap-
leptin sensitivity among neurons in the arcuate nucleus of illaries [49], Semen Coicis [60], and Eugenia caryophyllata
the hypothalamus and increased serum leptin levels [36]. [51], whereas to digest accumulated food, extracts of
Therefore, regulating leptin levels and leptin sensitivity is Semen Raphani [56], Fructus Crataegi [58], and Fructus
thought to be pivotal for treating obesity [45]. Hordei [61] were injected into the acupoints. To tonify qi
Three experimental studies investigated whether HA and blood, researchers used Radix Glycyrrhiza [62], Radix
exhibits a significant effect in reducing serum leptin levels. Ginseng [36,44], Radix Astragali, and Angelica gigas [59],
Consistent with the clinical effects of HA, HA with Prunella and they used Eriobotryae Folium [50], Prunella vulgaris,
vulgaris, Chrysanthemum indicum, Radix puerariae [37], Chrysanthemum indicum, Radix puerariae, Phaseolus
and Phaseolus angularis [45] was also reported to reduce angularis [37], and Lumbricus [38] to clear the heat of the
serum leptin levels in parallel with its weight loss effect. spleen and stomach. Many of these extracts have previously
However, HA using Eriobotryae folium did not decrease been reported to have beneficial effects on treating obesity
leptin levels [50]. Those results imply that the therapeutic [50]. However, acupoint injection of extracts is different
mechanism of HA could be dependent on the herbs. In from oral administration; therefore, the mode of action
future studies, leptin sensitivity should be considered as a still needs to be elucidated in further studies.
more important factor in determining improvement of
obesity rather than plasma levels of leptin.
4. Conclusion

3.2. Acupoint selection In this article, we reviewed four clinical studies and 16
animal studies on the therapeutic effects of HA for obesity.
Obesity is a medical condition characterized by excess All of the clinical studies showed that various kinds of HA
body weight and body fat. As mentioned above, it has been have significant benefits for treating obesity. The thera-
conceptualized in various ways, such as a spleen deficiency peutic effect might come through anti-inflammatory and
with dampness encumbrance, spleen-stomach dampness- antioxidative action or the modulation of lipid metabolism
heat, liver qi depression, spleen-kidney yang deficiency, or insulin and leptin signals, as investigated in in vivo and
dual deficiency of qi and blood, and food accumulation. in vitro studies. Taking all the evidence together, we sug-
Based on those patterns of obesity conceptualized by gest that HA could be a therapeutic option for treating
traditional Korean medical theories, various acupoints have obesity. Further clinical and experimental studies with
been applied to improve obese conditions in humans and standardized methodologies should be conducted to test
animals. the efficacy of HA.
Unlike the clinical studies, which mainly used acupunc-
ture points on the abdomen, experimental research used Disclosure statement
more challenging points, such as those located on the lower
limbs and back. Those acupuncture points are known to The authors declare that they have no conflicts of in-
modulate the digestive system (BL20 [36,49,56,57], BL21 terest and no financial interests related to the material of
[58], ST36 [37,38,45,59], ST40 [60], SP9 [60], LI11 [44,45], this manuscript.
CV12 [38,59]), control liver qi (BL18 [44]), affect the brain
(BL11 [37]), or modulate the endocrine system (BL23 [48]).
Those acupoints were previously reported to be effective Acknowledgments
for ameliorating obesity by acupuncture stimulation [49].
BL20 and BL21, on the bladder meridian, have a potent This study was supported by the Traditional Korean
effect for modulating the spleen and stomach. ST36, SP9, Medicine R&D program funded by the Ministry of Health &
LI11, and CV12, located on the stomach meridian, spleen Welfare through the Korea Health Industry Development
meridian, large intestine meridian, and conception vessel, Institute (KHIDI) (HI13C0700).
56 M.-H. Nam et al.

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