Perspectives on Integrative Medicine

Most viewed articles are from the articles published in 2021 during the last three month.

Review Article

Shoulder Pain and the Potential Role of Acupuncture: A Narrative Review of Clinical Practice and Treatment Guidelines: Stephen Birch, Myeong Soo Lee, Tae-Hun Kim, Terje Alraek; Perspect Integr Med. 2022;1(1):3-9. Published online September 22, 2022; DOI: https://doi.org/10.56986/pim.2022.09.002

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The potential use of acupuncture for shoulder pain of various etiologies and whether clinicians make recommendations about the use of acupuncture was examined. Shoulder pain is a common clinical problem. What is the level of evidence and how often is acupuncture recommended for shoulder pain? A manual and database (PubMed) search of review articles of related clinical trials and guidelines was performed. The evidence for effectiveness of acupuncture treatment of different types of shoulder pain was weak. However, there are some studies, with a weak to moderate level of evidence, on shoulder pain (across nine subtypes of shoulder pain). Acupuncture is safe and may be a cost-effective treatment for shoulder pain. There were 131 statements recommending the use of acupuncture for shoulder pain across 12 subtypes of shoulder pain. The most common statements were for non-specific ‘shoulder pain.’ There were 11 statements against the use of acupuncture for shoulder pain and three subtypes of shoulder pain. The level of evidence in studies of acupuncture treatment for shoulder pain is low, therefore, further research is needed. Recommendations for the use of acupuncture for shoulder pain are increasing but lag behind those for other pain problems such as low back pain.

Citations

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A Review of Key Research and Engagement in 2022
John McDonald, Sandro Graca, Claudia Citkovitz, Lisa Taylor-Swanson
Journal of Integrative and Complementary Medicine.2023; 29(8): 455. CrossRef

Editorial

Best Evidence for Best Care: Nicola Robinson; Perspect Integr Med. 2023;2(3):139-141. Published online October 23, 2023; DOI: https://doi.org/10.56986/pim.2023.10.001

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Graphical Abstract PDF

Review Article

Clinical Research on Pharmacopuncture in Korea: A Scoping Review: Me-riong Kim, Seong Min Lee, Yoon Jae Lee, In-Hyuk Ha; Perspect Integr Med. 2023;2(1):8-23. Published online February 21, 2023; DOI: https://doi.org/10.56986/pim.2023.02.003

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Graphical Abstract Abstract PDF Supplementary Material

This scoping review was performed as an update on the effects and safety of pharmacopuncture clinical research for the treatment of multiple indications in Korea. Nine electronic databases were searched to identify comparative clinical studies and clinical practice guidelines on Korean pharmacopuncture from inception to December 31, 2022. In vivo and in vitro studies, and case reports were excluded. There were 226 studies identified, including randomized controlled trials, retrospective comparison observational studies, and single-subject crossover designs, of which 17 focused on clinical safety profiles. Most studies pertained to rehabilitation medicine, especially for musculoskeletal (n = 129) and nervous system disorders (n = 35). The evidence supported treatment of neoplasms, obesity, and stroke sequelae. Adverse events of pharmacopuncture were mostly mild and temporary, and occurred more frequently with bee venom compared with herb-derived solutions. Thirty-five clinical practice guidelines including recommendations on pharmacopuncture were included. To the best of our knowledge, this is the first scoping review of clinical pharmacopuncture use in Korea, and our findings support its use in clinical practice and research. Considering the diverse clinical applications of pharmacopuncture, additional pragmatic trials are required to further strengthen the evidence base and develop standard research methodology in Korean medicine.

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The effect of integrative Korean medicine treatment on symptomatic lumbar facet joint cysts: A case series
Hee-seung Choi, Yoon Jae Lee, Dae-Hyun Hahm, Hyangsook Lee, In-Hyuk Ha
EXPLORE.2023;[Epub] CrossRef
A Pragmatic Randomized Controlled Trial on the Effectiveness and Safety of Pharmacopuncture for Chronic Lower Back Pain
Kyoung Sun Park, Changnyun Kim, Joo Won Kim, Sang‐Don Kim, Jee Young Lee, Yoon Jae Lee, Jinho Lee, Min Ji Kim, Young Eun Choi, Changsop Yang, Chang-Hyun Han, In-Hyuk Ha
Journal of Pain Research.2023; Volume 16: 2697. CrossRef
Long-Term Follow-Up of Inpatients with Rotator Cuff Tear Who Received Integrative Korean Medicine Treatment: A Retrospective Analysis and Questionnaire Survey
Dong-Hwi Yoo, Jae-Yong Choi, Sang-Gun Lee, Ki-Won Choi, Han-Bin Park, Ho Kim, Hyunwoo Cho, Sang Don Kim, Doori Kim, Yoon Jae Lee, Kyoung Sun Park, In-Hyuk Ha
EXPLORE.2023;[Epub] CrossRef

Original Articles

Effectiveness of the Korean Medicine-Based Postnatal Healthcare Program: A Retrospective Observational Study: Joohee Seo, Doeun Lee, Hansong Park, Inae Youn, Jungtae Leem, Minjung Park; Perspect Integr Med. 2023;2(2):117-125. Published online June 23, 2023; DOI: https://doi.org/10.56986/pim.2023.06.006

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Graphical Abstract Abstract PDF Supplementary Material: Background
Insufficient postpartum care can negatively affect mothers’ health. The aim of the Korean Medicine-based Postnatal Healthcare Program (KMPHP) is to prevent and treat Sanhupung by rapid intervention in postpartum care.
Methods
A retrospective study was conducted using data from 37 postpartum women who participated in the KMPHP between April 2019 and April 2020. The women had received at least one type of Korean medicine treatment (herbal medicine, acupuncture, electroacupuncture, pharmacoacupuncture, or Chuna manual therapy) for at least one session. General characteristics were collected from the medical records, and postpartum symptoms (taken from a questionnaire) were investigated. Outcome measures included pain intensity, quality of life (QoL), and postpartum depression.
Results
The effectiveness of the KMPHP was determined using the paired-sample Wilcoxon test and significant improvements in the scores were observed using the Korean version of the Edinburgh Postnatal Depression Scale (from 8 to 5, p < 0.01), EuroQol-5 Dimension-5L (from 0.82 to 0.83, p = 0.02), and EuroQol Visual Analog Scale (from 70 to 80, p < 0.01). The womens’ pain scores (Numeric Rating Scale) reduced from 4 to 3 after treatment, but the difference was not significant. As a result of analyzing the effects of each intervention, herbal medicine show a significant effect on womens’ depression, QoL and pain, and non-pharmacological intervention showed synergistic effects with herbal medicine.
Conclusion
Korean medicine-based interventions may be effective in the management of postpartum health by improving mothers’ emotional status, QoL, as well as reducing pain.

Contributing Factors in the Decision to Study Korean Medicine and Satisfaction with the College Experience: A Quantitative Nationwide Study: HyunSeok Kim, Hyunho Kim, Joohyun Lee, Hwimun Kim; Perspect Integr Med. 2023;2(3):173-181. Published online October 23, 2023; DOI: https://doi.org/10.56986/pim.2023.10.005

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Graphical Abstract Abstract PDF Supplementary Material: Background
The practice of Korean medicine (KM) taught at KM colleges has equal legal rights and responsibilities as Western medicine in South Korea. To date, no research has been conducted on the factors which influence college students in their choice to study KM and satisfaction with the course.
Methods
Content validity and face validity tests were conducted while developing the questionnaires. Research was conducted amongst all KM colleges in South Korea and of the 744 premedical KM 2^nd year students, 420 participated. Analysis was performed on how much the mean values changed between the items and sub-items. Factors were also correlated with the students’ satisfaction and willingness to reenter KM colleges.
Results
The means of stable incumbency items were the highest of all the items, while items concerning experience of chronic disease had the lowest mean values. For enrollment, the latent value that most questionnaire items were changed positively by was interest in KM. Items related to students’ choice or KM doctor status were closely tied to students’ current satisfaction with their choice to enroll at a KM college, rather than their college entrance examination scores.
Conclusion
Identifying which factors are considered before entering KM college and during the course can help students to be more satisfied with their academic progress. To satisfy the KM students, educators should focus on providing both qualified clinical training and guidance to enter diverse career fields. This study highlights factors that can be applied to college curriculum or subject teaching.

Editorial

Integration of Acupuncture into UK Healthcare - A NICE Perspective: Why is Acupuncture Now Recommended for Chronic Pain but not for Back Pain or Osteoarthritis: Mike Cummings; Perspect Integr Med. 2023;2(1):3-7. Published online February 21, 2023; DOI: https://doi.org/10.56986/pim.2023.02.002

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Abstract PDF

In April 2021, the National Institute for Health and Care Excellence (NICE) published a guideline on chronic pain (NG193) with a recommendation to consider a single course of acupuncture treatment in patients with chronic primary pain. This positive recommendation came after the NICE guideline on low back pain and sciatica (NG59) announced in November 2016, that acupuncture treatment did not work for back pain, having previously recommended it in 2009 (CG88). This article attempts to explain this apparent contradiction in recommendations by tracing the history of acupuncture debates in the NICE guidelines over the last 2 decades.

Citations

Citations to this article as recorded by

A Review of Key Research and Engagement in 2022
John McDonald, Sandro Graca, Claudia Citkovitz, Lisa Taylor-Swanson
Journal of Integrative and Complementary Medicine.2023; 29(8): 455. CrossRef

Guideline

ACURATE: A Guide for Reporting Sham Controls in Trials Using Acupuncture: Ye-Seul Lee, Song-Yi Kim, Hyangsook Lee, Younbyoung Chae, Myeong Soo Lee; Perspect Integr Med. 2023;2(2):100-106. Published online June 23, 2023; DOI: https://doi.org/10.56986/pim.2023.06.004

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Abstract PDF: This paper presents the Acupuncture Controls gUideline for Reporting humAn Trials and Experiments (ACURATE) checklist, an extension of The Consolidated Standards for Reporting of Trials (CONSORT) and to be used along with STandards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA) when both real and sham acupuncture needles are used in the study. This checklist focuses on a clear depiction of sham needling procedures to enhance replicability and enable a precise appraisal. We encourage researchers to use ACURATE in trials and reviews involving sham acupuncture to assist reporting of sham acupuncture procedures and the related components.

Review Articles

Expanding the Scope of Manual Medicine Through Research, Academic Exchange, and Healthcare Coverage: A Summary of Two International Conferences: Seung Min Kathy Lee, Su-Bin Han, Boyd Buser, Kendi Hensel, Brian Kim, William Mayo, Nicola Robinson, Byung-Cheul Shin, Daniel Williams, Joon-Shik Shin, Me-riong Kim, In-Hyuk Ha, Jinho Lee, Lawrence Prokop; Perspect Integr Med. 2022;1(1):10-16. Published online September 22, 2022; DOI: https://doi.org/10.56986/pim.2022.09.003

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Abstract PDF: In Korea, Chuna was officially included in the Korean national health insurance (NHI) system in 2019. In the US, osteopathic manipulative treatment has been part of conventional healthcare since 1966. Since there are few countries that provide manual therapy in mainstream healthcare, academic exchange between experts in Chuna therapy on an international stage is essential; to date there has been a conference in 2018 and 2019, both of which were held in Korea. This review presents a summary of these conference proceedings. There were 13 keynote speakers including doctors of Korean medicine, osteopathic physicians, and policymakers. In the 1^st conference, seven speakers shared their knowledge on the history of Chuna, policies, and the current body of evidence for using Chuna and osteopathic manipulative treatment of various conditions. In the following year, six speakers also included novel Chuna techniques, similarities and differences, and explored the possibilities for collaborations moving forward. Previous to these two international conferences, the last national conference was held in Korea in 2008. The timing of these two international conferences has proved significant due to the inclusion of Chuna in Korean national health insurance in 2019, and helped to provide guidance in expanding the scope of manual medicine.

An Umbrella Review of Systematic Reviews for Chuna (or Tuina) Manual Therapy on Musculoskeletal Disorders: Doori Kim, Gil Geun Baek, Byung-Cheul Shin; Perspect Integr Med. 2023;2(3):142-154. Published online October 23, 2023; DOI: https://doi.org/10.56986/pim.2023.10.002

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Graphical Abstract Abstract PDF Supplementary Material: Background
To provide clinicians with reliable evidence an umbrella review of systematic reviews (SRs) on Chuna manual therapy (CMT) for musculoskeletal disorders was performed to synthesize important outcomes.
Methods
There were eight databases (Cochrane, EMBASE, MEDLINE, CNKI, KMBASE, KISS, Scienceon, and OASIS) searched as well as the international database Prospective Register of Systematic Reviews in health and social care until August 2023. SRs of randomized controlled trials involving patients with musculoskeletal conditions, limited to interventions explicitly labeled as “Chuna” or “Tuina” in English, Chinese, or Korean language were retrieved. Two reviewers independently conducted selection and data extraction, and SR quality was assessed using A Measurement Tool to Assess Systematic Reviews tool (low, medium, or high quality).
Results
This review included 32 SRs, categorized by cervical (n = 4), thoracolumbar (n = 7), upper extremity (n = 5), lower extremity (n = 9), and other musculoskeletal disorders (n = 7). Quality assessments determined that three SRs were of “high” quality, two were “low” quality, and the remaining SRs were of “medium” quality. CMT was consistently reported to demonstrate superior outcomes: an effective rate was observed in 17 of 19 SRs, CMT was effective at reducing pain in 12 of the 16 SRs, and functional outcomes of CMT were observed in 8 of 12 SRs. No serious adverse events were reported.
Conclusion
CMT may be a safe and effective treatment for various musculoskeletal disorders based on the limited number of studies and the low quality of included SRs.

Short Communication

The Mazzanti AcuOsteo Method^®: Pathology and Treatment with Acupuncture and Osteopathy of the Musculoskeletal Pain of The Upper and Lower Limbs: Umberto Mazzanti; Perspect Integr Med. 2023;2(2):126-130. Published online June 23, 2023; DOI: https://doi.org/10.56986/pim.2023.06.007

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Graphical Abstract Abstract PDF: Musculoskeletal pain is one of the most frequent reasons for consultations in my clinic. In my experience of 35 years, acupuncture, and osteopathy are effective techniques in the treatment of musculoskeletal pain of the upper and lower limbs. Pain reported by the patient often affects a widespread area around the joint and is usually associated with some stiffness. The aim of acupuncture is to restore the local circulation of Qì and Blood, inducing an analgesic and anti-inflammatory effect, along with myofascial detensioning. The aim of the osteopathic manipulative treatment is to return joints to their normal position and restore restricted joint motion. The Mazzanti AcuOsteo Method is a newly patented method which uses the synergistic combination of using points for acupuncture, cupping or bleeding, and osteopathy to maximize effectiveness of treatment for musculoskeletal pain.

Review Articles

Effectiveness and Safety of Low-Level Laser Treatment for Lumbar Disc Herniation: A Systematic Review and Meta-Analysis: Sang Jun Lee, Seung Jin Noh, Jeong Rock Kim, Kyung Bok Park, Sae-rom Jeon, Yejin Hong, Dongwoo Nam; Perspect Integr Med. 2023;2(3):155-163. Published online October 23, 2023; DOI: https://doi.org/10.56986/pim.2023.10.003

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Graphical Abstract Abstract PDF Supplementary Material: Background
Low-level laser treatment (LLLT) is used to treat low back pain (LBP) however, its effects on lumbar disc herniation (LDH) remain unclear. The safety and effectiveness of LLLT for LDH was determined using a systematic review of randomized clinical trials.
Methods
Studies on LLLT in adults with LDH were identified from 12 worldwide databases. A risk of bias assessment and a meta-analysis with categorization according to the type of control used (inactive, active, or add-on) was performed. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation.
Results
The quantitative analyses included five studies. LLLT was significantly more effective at treating LDH [leg pain visual analog scale (VAS) mean difference (MD): -1.90, 95% confidence interval (CI): -2.01, -1.80, I2 80%; LBP VAS MD: -0.79, 95% CI: -0.87, -0.71, I2 80%] than inactive controls (placebo or sham). The quality of the evidence ranged from “low” to “very low.” As an add-on to usual care, LLLT significantly improved pain intensity and disability compared with usual care (leg pain VAS MD: -2.52, 95% CI: -2.65, -2.40, I2 97%; LBP VAS MD: -1.47, 95% CI: -1.58, -1.36; Oswestry Disability Index MD: -4.10, 95% CI: -4.55, -3.65, I2 6%). However, the quality of the evidence ranged from “moderate” to “low.”
Conclusion
LLLT significantly improved outcomes compared with the inactive controls, but was not more effective than usual care for LDH. In combination with usual care, LLLT was significantly more effective than usual care alone highlighting the potential of LLLT.

A Scoping Review of Clinical Research on Motion Style Acupuncture Treatment: Doori Kim, Yoon Jae Lee, In-Hyuk Ha; Perspect Integr Med. 2023;2(2):65-76. Published online June 23, 2023; DOI: https://doi.org/10.56986/pim.2023.06.001

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Graphical Abstract Abstract PDF

This scoping review was conducted to examine the concept of Motion style acupuncture treatment (MSAT), use in clinical practice, its effectiveness, and safety. A literature review of clinical study treatment methods combining acupuncture and movement therapy was performed using PubMed. Of 2,096 studies retrieved, 22 were included in this review. There were 12 randomized controlled trials, and all 22 studies were published in China and Korea, mostly, within the last 3 years. There were five studies concerning local acupoints and 17 studies regarding needling at distal acupoints, and the level of risk of the procedure was “high” in eight studies and “moderate” in 14 studies. The study participants were patients with musculoskeletal pain, and many studies reported significant improvements in pain and functional disability outcomes following treatment using MSAT. For conclusion, MSAT refers to a treatment method in which a patient performs active/passive movements under the supervision of a physician with the acupuncture needle retained at the insertion site. However, there are a limited number of MSAT studies, and various treatment types and related terms are mixed. Further studies, classification of the types of MSAT using a well-established classification system, and a clearer definition of the MSAT concept are needed.

Citations

Citations to this article as recorded by

Effectiveness and Safety of Progressive Loading–Motion Style Acupuncture Treatment for Acute Low Back Pain after Traffic Accidents: A Randomized Controlled Trial
Seung-Yoon Hwangbo, Young-Jun Kim, Dong Guk Shin, Sang-Joon An, Hyunjin Choi, Yeonsun Lee, Yoon Jae Lee, Ju Yeon Kim, In-Hyuk Ha
Healthcare.2023; 11(22): 2939. CrossRef

Minimum Clinically Important Difference for Nonsurgical Interventions for Spinal Diseases: Choosing the Appropriate Values for an Integrative Medical Approach: Ye-Seul Lee, Sungmin Lee, Yoon Jae Lee, In-Hyuk Ha; Perspect Integr Med. 2023;2(2):86-99. Published online June 23, 2023; DOI: https://doi.org/10.56986/pim.2023.06.003

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Graphical Abstract Abstract PDF Supplementary Material: The minimal clinically important difference (MCID) plays a crucial role in the design and interpretation of clinical trials, as it helps in distinguishing between statistically significant and clinically meaningful outcomes. This scoping review aims to collate and appraise the current research concerning the validation of MCIDs for surgical and nonsurgical measures for spine disorders. Two databases of MEDLINE (PubMed and EMBASE) were searched. There were 1,590 studies retrieved and 79 were selected as eligible for review. Measurement tools such as the Oswestry Disability Index, Neck Disability Index, Numeric Rating Scale, and Visual Analogue Scale were assessed by regions and interventions. A total of 24 studies identified MCIDs on nonsurgical interventions, and 55 studies identified MCIDs on surgical interventions. The range of MCIDs varied greatly depending on study population, specific interventions, calculation methods, and outcomes. This scoping review emphasizes the complexity and variability in determining MCIDs for musculoskeletal or neurodegenerative spinal diseases, influenced by several factors including the intervention type, measurement tool, patient characteristics, and disease severity. Given the wide range of reported MCIDs, it is crucial to consider the specific context when interpreting these values in clinical and research settings. To select an appropriate MCID value for comparison in a clinical trial, careful consideration of the patient group, intervention, assessment tools, and primary outcomes is necessary to ensure that the chosen MCID aligns with the research question at hand.

Protocol

Effectiveness and Safety of Duantengyimu-tang for Rheumatoid Arthritis: A Protocol for a Systematic Review and Meta-Analysis: Gyoungeun Park, Jeong-Hyun Moon, Eun-Jung Kim, Won-Suk Sung; Perspect Integr Med. 2023;2(2):134-137. Published online June 23, 2023; DOI: https://doi.org/10.56986/pim.2023.06.009

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Abstract PDF: Background
Per-oral pharmacological medication is a representative treatment for rheumatoid arthritis (RA), and has improved over several guidelines. However, limitations of long-term use of these medications including adverse events, led to the introduction and utilization of complementary and alternative treatments for RA. Several herbal medicine decoctions have been reported to be effective and safe; a recent study introduced Duantengyimu-tang (DTYMT). Regardless of the pharmacological effects of the DTYMT components, there are concerns about its safety. Therefore, this systematic review (SR) will focus on the effectiveness and safety of DTYMT treatment for RA.
Methods
Searches for randomized controlled trials using DTYMT treatment for RA will be performed using multiple electronic databases, manual searches, and emails (if necessary). A summary will be written using data on outcome measurements of the study participants, interventions, adverse events, and risk of bias in the studies. The primary outcomes will be disease activity scores including effective rate, tender joints, swollen joints, and morning stiffness. The secondary outcomes will include adverse events and blood tests for RA (erythrocyte sedimentation rate, C-reactive protein, and rheumatoid factors). This SR will use Review Manager software to perform a meta-analysis, the Cochrane Collaboration “risk of bias” tool, and determine the quality of evidence using the Grades of Recommendation, Assessment, Development, and Evaluation method.
Results
This SR will investigate the clinical effectiveness and safety of DTYMT treatment in patients with RA.
Conclusion
This SR aims to be informative for patients and clinicians in clinical practice, researchers, and policymakers in managing RA.

Original Article

Current Status of Korean Medicine Treatment for Post-acute COVID-19 Syndrome: A Survey of Korean Medicine Doctors: Doori Kim, Seo-Hyun Park, Won-Suk Sung, Eun-Jung Kim; Perspect Integr Med. 2022;1(1):34-44. Published online September 22, 2022; DOI: https://doi.org/10.56986/pim.2022.09.006

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Abstract PDF Supplementary Material: Background
The applicability of Korean medicine (KM) treatments for post-acute COVID-19 syndrome were investigated.
Methods
A cross-sectional, web-based survey of Korean medical doctors (KMDs) was conducted in June 2022. The 25-item questionnaire comprised of five parts: basic characteristics, prescribed post-COVID-19 KM treatments, treatment effect in patients with post-acute COVID-19 syndrome, patient satisfaction, and awareness and utilization of the relevant KM Clinical Practice Guideline by the KMDs.
Results
In total, 1,063 completed questionnaires were collected, and 822 were analyzed. The most common symptoms in patients with post-acute COVID-19 syndrome treated by KMDs was weakness and fatigue (84.3%). Herbal decoctions (39.2%) and herbal powder (not covered by medical insurance; 25.8%) were primarily used. Among the KMDs, 95% (n = 781) responded that KM treatments, particularly herbal decoctions (82.6%) and herbal powder (not covered by medical insurance; 46.8%), were effective. Overall, 92.6% (n = 761) of KMD participants answered that the patients were satisfied with KM treatments, mostly due to symptomatic improvement (60.8%). The primary reason for dissatisfaction was the burden of cost for patients (78.4%). The main reasons for low uptake of KM services by patients with post-acute COVID-19 syndrome were lack of publicity and administrative issues such as no health insurance coverage.
Conclusion
KM is highly applicable for post-acute COVID-19 syndrome. Health policies supporting the use of KM for post-acute COVID-19 syndrome are recommended.

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