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
Accepted: Sep 9, 2015
KEYWORDS
herbal acupuncture;
obesity;
pharmacopuncture
Obesity is the state of excessive body fat accumulation and is mainly caused by consuming more
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
obesity. This review analyzed four clinical studies and 16 animal studies on the effectiveness
of HA as a treatment for obesity. Clinical evidence suggests that various kinds of HA might
be beneficial for treating obesity; however, further investigations with well-designed, evi-
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://
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* 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
1. Introduction
Obesity is a serious and rapidly growing public health
problem in most countries around the world. Obesity is the
state of excessive body fat accumulation, which is mainly
caused by consuming more calories, especially fatty and
sugary foods, than one burns off through physical activity;
therefore, many behavioral lifestyle interventions have
been suggested [1]. Most of them have shown positive re-
sults in short-term weight loss. However, the majority of
patients failed to maintain the weight loss for more than a
few years [2]. In addition, the use of Western antiobesity
drugs has been limited by side effects such as negative
mood changes, suicidal thoughts, and gastrointestinal or
cardiovascular complications [3]. Therefore herbal medi-
cine and acupuncture can provide an alternative therapy
for this medical challenge. Recent clinical trials using
herbal medicine and acupuncture have reported possible
therapeutic value in treating obesity, despite controversy
caused by small sample sizes and low-quality methodolo-
gies [4]. The combined treatment of herbal medicine and
acupuncture also showed greater efficacy in reducing
weight than a nonpharmacological control [5].
Herbal acupuncture (HA), a type of acupuncture also
known as pharmacopuncture, acupuncture point injection,
acupoint injection, or point injection therapy, is a modern
adjunctive Korean medicine technique that injects natural
herbs or biologic substances into acupuncture points to
promote, maintain, or restore health and prevent disease
[6]. To this point, it has primarily been applied to resolve
pain-related diseases such as rheumatoid arthritis [7].
Here, we review recent progress in HA with a special
focus on its efficacy, safety, and possible therapeutic value
in treating obesity.
2. Clinical studies of HA and obesity
2.1. Efficacy
Four clinical studies have dealt with the efficacy of HA
on people with obesity. All of the studies used different
herbal decoctions, acupoints, and doses for specified ef-
fects on obesity (Table 1).
(1) Effects on losing body weight
The practical purpose of HA therapy on people with
obesity is losing weight. Two clinical studies showed sig-
nificant beneficial effects in reducing body weight (BW) and
waist circumference (WC). Kim et al [8] examined whether
or not HA using Ephedra sinica and Aconitum carmichaelii
had therapeutic effects on 70 volunteers with body mass
index (BMI) greater than 25. Persons with a body weight
greater than 120 kg, underlying disease (liver cirrhosis,
renal failure, severe diabetes mellitus with complications,
etc.), and those taking obesity-inducing drugs were
excluded. Twenty-four patients in the HA group and 28 in-
dividuals in the control group with normal saline injection
were randomly assigned and analyzed. Because both groups
underwent other common interventions together, such as
M.-H. Nam et al.
diet, electroacupuncture, herbal therapy, and exercise
education, both groups showed significant decreases in BMI,
BW, and WC. However, the HA group showed greater re-
ductions in BW (1.86  1.65 kg vs. 0.94  2.47 kg,
p < 0.05), BMI (0.76  0.67 kg/m2 vs. 0.34  1.06 kg/m2,
p < 0.05), and WC (3.30  2.12 inch vs.
1.09  1.32 inch, p < 0.05), than the control group.
Another study [9] investigated the therapeutic effects of
HA using the Bigiheo (Piqixu, spleen qi deficiency) decoc-
tion on waistehip ratio, nonfat mass, WC, and BMI in
women. In this study, spleen qi deficiency was regarded as a
critical inclusion criterion; however, the study did not
include a detailed protocol. After 3 weeks of treatment,
the HA group showed more significant decreases in WC
(3.36  2.53 cm vs. 4.58  2.54 cm, p < 0.05) and
abdominal fat (3.19  6.79% vs. 5.22  1.20%, p < 0.05)
than the control group. In terms of abdominal nonfat mass
and BMI, common interventions (diet, behavioral therapy,
electroacupuncture, auricular acupuncture, herbal medi-
cine, exercise education) showed significant effects, and
HA did not show any additional effects.
(2) Effects on reducing visceral adipose tissue
One clinical study showed efficacy in reducing visceral
adipose tissue. Lee et al [10] designed a clinical trial with
HA using the Sobieum (Xiaofeiyin) decoction. They
recruited 40 women with obesity and assigned them
randomly into two groups. Computed tomography (CT) and
bioelectrical impedance analysis (BIA) were used for
outcome evaluation. Both the HA and control groups
showed a significant decrease in BW, WC, BMI, body fat
mass, and total, visceral, and superficial subcutaneous fat
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
the only outcome that showed a significant difference be-
tween the two groups.
By analyzing the data with Pearsons correlation,
visceral fat area was significantly correlated with total fat
reduction only in the HA group (0.600 vs. 0.406, p < 0.01),
which means that HA using Sobieum is effective at reducing
visceral fat. Visceral adiposity is a marked feature of aging
and other prominent risk factors associated with obesity
such as insulin resistance [11], which is highly correlated
with obesity and diabetes. This clinical study suggests that
HA using Sobieum could be useful in obesity treatment,
especially with diabetes.
(3) Effects on metabolic rate
Lee et al [12] tested whether HA using the Bangkih-
wangkitang (Fangjihuangqitang) decoction is effective
against obesity. Interestingly, this study showed an increase
in energy expenditure without body weight loss. The au-
thors recruited 31 female volunteers with a BMI over 25 and
divided them into two groups. They evaluated BMI, per-
centage of body fat, skeletal muscle mass, basal metabolic
rate, total cholesterol, triglycerides, high-density lipopro-
tein cholesterol, low-density lipoprotein cholesterol, blood
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
alanine transaminase. Except for skeletal muscle mass and
basal metabolic rate, HA did not show any significant su-
periority compared to the control group. The HA group
showed significantly higher skeletal muscle mass
(39.03  5.24 kg vs. 34.41  4.12 kg, p < 0.05) and basal
metabolic rate (1,458  135.2 kcal vs. 1,346  130.7 kcal,
p < 0.05) than the control group at the end of the study.
Because the low quality of this study indicates low reli-
ability, additional studies are needed to evaluate the
therapeutic effect of HA using Bangkihwangkitang.
2.2. Acupoint selection
Clinical studies have used acupoints ST25, CV4, CV6,
CV10, CV12, GB26, BL23, and BL52. ST25 and CV4 were used
in three [8,9,12] and two [8,9] studies, respectively, and
each of the other points was used once. ST25, which is on
the stomach meridian and on the abdomen, is a frequently
used acupoint for various gastrointestinal track disorders.
Like ST25, the other acupoints are all on the abdominal
region, with the exceptions of BL23 and BL52. BL23 and
BL52 are well known for dealing with endocrinological dis-
orders. In the study by Lee et al [12], HA treatment on BL23
and BL52 showed increased metabolic rate.
Due to the possibility of identifying multiple patterns for
a single disease in traditional Korean medicine, applied
acupoints and herbal decoctions vary. The clinical studies
we reviewed also used various acupoints and herbal de-
coctions. Therefore, it is difficult to conclude that HA using
any specific acupoints or kinds of herbs has a beneficial
effect in treating obesity.
Finally, none of the studies we reviewed evaluated Deqi
sensation. Even though little evidence supports the rela-
tionship between acupuncture efficacy and Deqi so far,
Deqi has been broadly accepted as a critical concept for
acupuncture efficacy [13]. If studies evaluated Deqi
sensation in HA treatment, it would be safer to conclude
that HA therapy is effective as a kind of acupuncture
therapy.
2.3. Herbs
Kim et al [8] used HA composed of Ephedra sinica and
Aconitum carmichaelii. Both herbs are widely used for
tonifying yang and dissipating cold that hinders energy
expenditure. Lee et al [10] used Sobieum HA, which in-
cludes Platycodon grandiflorum, Ephedra sinica, Morus
alba, Liriope platyphylla, Scutellaria baicalensis, and
Prunus armeniaca. Sobieum is a decoction known to boost
the lipolysis of adipose tissue and inhibit lipid absorption in
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].
Because Ephedra sinica has side effects such as heart pal-
pitations and dyspepsia [19], combination with other drugs
would be helpful. In this regard, Sobieum contains not only
Ephedra sinica but also other herbs with antiobesity po-
tential, such as Platycodon grandiflorum [20e23], Morus
alba [24,25], Liriope platyphylla [26], and Scutellaria bai-
calensis [27,28].
53
Lee et al [12] applied HA using Bangkihwangkitang to
obesity treatment. Bangkihwangkitang is a composition of
Stephania tetrandra, Astragalus membranaceus, Atractylis
koreana, Glycyrrhiza uralensis, and Zingiber officinale.
This decoction has been known to dispel dampness and
tonify the spleen; therefore, it has long been used for
treating obesity in traditional Korean medicine.
HA using the Bigiheo decoction [9] was used to tonify
spleen qi. This decoction is composed of Panax ginseng,
Astragalus membranaceus, Dioscorea batatas, Atractylodes
japonica, Poria cocos, Citrus unshiu, Zizyphus jujube, and
Glycyrrhiza uralensis.
According to traditional Korean medical theories,
obesity can be caused by phlegm dampness, spleen defi-
ciency, stomach heat, liver depression, and kidney defi-
ciency [4]. Bangkihwangkitang and Bigiheo herbal
decoctions are both known to tonify qi and spleen function.
In particular, Astragalus membranaceus, used in both de-
coctions, is known to boost spleen qi and improve obesity
and insulin resistance [29,30]. In human studies, herbal
decoctions were preferred to a single herb. Combinations
of multiple herbs hinder mechanism studies of HA. In spite
of this limitation, many of the herbs used for HA therapy
have already been proven to have antiobesity effects in
previous studies.
2.4. Safety issues
Safety issues of HA have to be discussed in two aspects.
One is adverse events induced by needling, and the other is
events caused by herbs. In this review, none of the four
papers reported any adverse events from HA.
Acupuncture is known to be a safe intervention in the
hands of skilled physicians. A prospective investigation re-
ported only 7.10% occurrence of nonserious adverse events
and 0.006% occurrence of serious events among 97,733
cases [31]. In 16 studies on acupuncture treatment for
obesity, only six reported side effects such as skin bruises
and redness. More serious complications have been rarely
reported, for example abscess formation and cardiac tam-
ponade, but those were limited to elderly immunocom-
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
relatively safe treatment throughout its long history, HA is
not completely free from the possibility of toxicity or
adverse effects. For instance, Ephedra sinica and Aconitum
carmichaelii are notorious for their side effects of palpi-
tation, nausea, vomiting, breathing problems, etc.
Although no adverse events occurred in the four clinical
studies, these herbs should be used in a proper dose and
under the supervision of skilled physicians.
2.5. Limitations
Because all the studies used basal interventions such as
dietary therapy, physical therapy, and exercise education
for both HA and control groups, accurate evaluation of HA
efficacy was difficult. Primary outcomes were not consis-
tent between studies; therefore, direct comparison be-
tween various kinds of HA is impractical. Moreover, the
54
sample sizes of the four studies were too small to gener-
alize. Despite these limitations, HA treatment of obesity
does seem to be beneficial.
3. Experimental evidence
Recent experimental studies support the idea that HA
has beneficial effects in treating obesity. HA using various
herb extracts was shown to be effective for weight loss and
lowering blood glucose and blood lipids. Those therapeutic
effects were caused by multi-faceted mechanisms, such as
anti-inflammatory effects, antioxidative effects, and mod-
ulation of lipid metabolism. The experimental evidence
could provide a mechanistic understanding of the effects of
HA on obesity.
3.1. Efficacy
(1) Anti-inflammatory effect
Obesity and inflammation are associated with each
other. Obesity induces a chronic, low-grade inflammatory
response initiated by excess nutrients in metabolic cells
[32]. This inflammation, also called metaflammation,
generally causes insulin resistance through inflammatory
kinases, c-Jun N-terminal kinases (JNK), IkB kinase (IKK),
and protein kinase R (PKR), which can aggravate obesity
[32]. Since the first study showing overexpression of tumor
necrosis factor-alpha (TNF-a) in the adipose tissue of mice
with obesity [33], many subsequent studies have provided a
link between obesity and chronic inflammation. In addition
to TNF-a, several other inflammatory mediators and cyto-
kines, such as interleukin (IL)-1b and IL-6, are reportedly
increased in obese conditions [34].
Many studies have suggested that acupuncture might
improve inflammatory conditions by regulating several pro-
or anti-inflammatory mediators [35]. Not only acupuncture,
but also HA is supported as a potent anti-inflammatory
therapy for obesity as evidenced by several experiments
[36e40]. HA was shown to be effective in reducing TNF-a,
IL-1b, and/or IL-6 in mice with obesity using extracts of
Prunella vulgaris, Chrysanthemum indicum, Radix puerar-
iae [37], Radix ginseng [36], and Lumbricus [38] on BL11
and ST36, BL18 and LI11, and ST36 and CV12, respectively.
One in vitro study showed that mixed extracts of Radix
Ginseng, musk, Ursi Fel, and Bovis Calculus inhibited
inducible nitric oxide synthase, cyclooxygenase-2, and nu-
clear factor-kappa B expression induced by lipopolysac-
charide in the 3T3-L1 cell line, which is consistent with the
in vivo effect of weight loss [36].
(2) Antioxidative effect
In obese conditions, as fat tissue increases, adipocytes
generate increasing levels of oxidative stress, such as
reactive oxygen species (ROS), that induce secretion of
inflammatory molecules [41]. Oxidative stress leads to in-
sulin resistance, which again aggravates obesity [41].
Simultaneously with ROS production, antioxidants such as
superoxide dismutases (SOD), glutathione (GSH), gluta-
thione peroxidase (GSH-Px), and catalase are decreased
M.-H. Nam et al.
[42]. Therefore, several studies suggest that reducing
oxidative stress or increasing antioxidants might be bene-
ficial in treating obesity [43].
Several pieces of experimental evidence suggest that HA
can increase antioxidants such as SOD, GSH-Px, and cata-
lase in obese mice. HA using extracts of Prunella vulgaris,
Chrysanthemum indicum, Radix puerariae [37], Radix
ginseng [44], and Phaseolus angularis [45] significantly in-
creases SOD, GSH-Px, and catalase levels in mice with
obesity and reduces body weight and body fat. HA using the
extract of Lumbricus [38] increases SOD and catalase levels
but not GSH-Px with reduced body weight.
(3) Effects on modulating lipid metabolism
In physiological conditions, adiponectin is exclusively
secreted by adipocytes and activates adenosine
monophosphate-activated protein kinase (AMPK). In turn,
activation of AMPK inactivates acetyl-CoA carboxylase
(ACC) by phosphorylation and blocks transformation of
acetyl-CoA into malonyl-CoA. Therefore, carnitine palmi-
toyltransferase 1 (CPT1) is activated, prompting adequate
mitochondrial fatty acid oxidation. However, AMPK phos-
phorylation also activates peroxisome proliferator-
activated receptor (PPAR)-a, which leads to the oxidation
of fatty acids and decreasing triglycerides [46].
However, in obese conditions, increased adiposity leads
to low plasma levels of adiponectin production, resulting in
decreased AMPK activity. Inactivation of AMPK reduces
PPAR-a activity and phosphorylation of ACC [46], inducing
hyperglycemia [47].
Several reports suggest that abnormal lipid metabolism
in obese animal models can be recovered by HA treatment.
HA using Rhizoma Atractylodis [48] and Artemisia capil-
laries [49] was reported to boost AMPK phosphorylation,
thus inhibiting the synthesis of fatty acids and promoting
their oxidation. Adiponectin [36,50,51] and PPAR-g [36],
which are critical for regulating fatty acid storage and
glucose metabolism [44], were also shown to be increased
by HA treatment. Moreover, HA treatment with Artemisia
capillaries was effective in increasing CPT1, which was
followed by AMPK phosphorylation [49]. Apolipoprotein B,
overproduction of which leads to insulin resistance and
obesity [52,53], was reduced by HA using Phaseolus angu-
laris [45].
Taken together, the evidence suggests that acupoint
injection of herbal extracts might modulate systemic lipid
metabolism. However, HA treatment is profoundly depen-
dent on the kinds of herbal extracts used; therefore, it is
difficult to conclude that most HA used to treat obesity is
working on the lipid metabolism. Most studies show only
one or two pieces of the whole metabolism picture. Further
studies should investigate the beneficial effects of using HA
to modulate lipid metabolism with other extracts.
(4) Effects on insulin signal
It is well known that insulin resistance commonly co-
exists with obesity and that the two conditions aggravate
each other [54]. Hyperinsulinemia is thought to be a result
of obesity and insulin resistance. However, a recent study
Herbal Acupuncture for the Treatment of Obesity
reported that hyperinsulinemia drives obesity and its
complications [55]. Keeping insulin levels low is critical to
maintaining energy expenditure in white adipose tissue;
therefore, reducing insulin levels is beneficial in treating
obesity [55].
(5) Effect on leptin
Several studies suggest that HA is beneficial for reducing
serum insulin levels and insulin resistance. Using the herb
extracts of Rhizoma Atractylodis [48] or Artemisia capil-
laries [49] at BL23 or BL20, respectively, was especially
effective for reducing both serum insulin levels and insulin
resistance. HA using mixed extracts of Radix Ginseng,
musk, Ursi Fel, and Bovis Calculus at BL20 was also re-
ported to reduce serum insulin levels [36].
Leptin, a key hormone of obesity produced by adipo-
cytes, inhibits hunger [38]. Obesity is characterized by low
leptin sensitivity among neurons in the arcuate nucleus of
the hypothalamus and increased serum leptin levels [36].
Therefore, regulating leptin levels and leptin sensitivity is
thought to be pivotal for treating obesity [45].
Three experimental studies investigated whether HA
exhibits a significant effect in reducing serum leptin levels.
Consistent with the clinical effects of HA, HA with Prunella
vulgaris, Chrysanthemum indicum, Radix puerariae [37],
and Phaseolus angularis [45] was also reported to reduce
serum leptin levels in parallel with its weight loss effect.
However, HA using Eriobotryae folium did not decrease
leptin levels [50]. Those results imply that the therapeutic
mechanism of HA could be dependent on the herbs. In
future studies, leptin sensitivity should be considered as a
more important factor in determining improvement of
obesity rather than plasma levels of leptin.
3.2. Acupoint selection
Obesity is a medical condition characterized by excess
body weight and body fat. As mentioned above, it has been
conceptualized in various ways, such as a spleen deficiency
with dampness encumbrance, spleen-stomach dampness-
heat, liver qi depression, spleen-kidney yang deficiency,
dual deficiency of qi and blood, and food accumulation.
Based on those patterns of obesity conceptualized by
traditional Korean medical theories, various acupoints have
been applied to improve obese conditions in humans and
animals.
Unlike the clinical studies, which mainly used acupunc-
ture points on the abdomen, experimental research used
more challenging points, such as those located on the lower
limbs and back. Those acupuncture points are known to
modulate the digestive system (BL20 [36,49,56,57], BL21
[58], ST36 [37,38,45,59], ST40 [60], SP9 [60], LI11 [44,45],
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
for ameliorating obesity by acupuncture stimulation [49].
BL20 and BL21, on the bladder meridian, have a potent
effect for modulating the spleen and stomach. ST36, SP9,
LI11, and CV12, located on the stomach meridian, spleen
meridian, large intestine meridian, and conception vessel,
55
respectively, are also known to tonify the qi of the spleen
and stomach. ST40, on the stomach meridian, is a repre-
sentative acupoint for treating phlegm, which is another
major cause of obesity [46]. Even though the evidence
shows that HA has beneficial effects for treating obesity,
clinical and experimental research has used dissimilar
acupoint selection. In future studies, the mechanism of
frequently used acupoints in clinics needs to be studied
experimentally.
3.3. Herbal medicine
A variety of herbs were used in HA to treat obesity. Most
experimental studies used a single herb to confirm its ef-
fects. Because several different etiologies can cause
obesity, medicinal herbs with various efficacies were used.
To resolve dampness in the spleen and stomach, re-
searchers chose Rhizoma atractylodis [48], Artemisia cap-
illaries [49], Semen Coicis [60], and Eugenia caryophyllata
[51], whereas to digest accumulated food, extracts of
Semen Raphani [56], Fructus Crataegi [58], and Fructus
Hordei [61] were injected into the acupoints. To tonify qi
and blood, researchers used Radix Glycyrrhiza [62], Radix
Ginseng [36,44], Radix Astragali, and Angelica gigas [59],
and they used Eriobotryae Folium [50], Prunella vulgaris,
Chrysanthemum indicum, Radix puerariae, Phaseolus
angularis [37], and Lumbricus [38] to clear the heat of the
spleen and stomach. Many of these extracts have previously
been reported to have beneficial effects on treating obesity
[50]. However, acupoint injection of extracts is different
from oral administration; therefore, the mode of action
still needs to be elucidated in further studies.
4. Conclusion
In this article, we reviewed four clinical studies and 16
animal studies on the therapeutic effects of HA for obesity.
All of the clinical studies showed that various kinds of HA
have significant benefits for treating obesity. The thera-
peutic effect might come through anti-inflammatory and
antioxidative action or the modulation of lipid metabolism
or insulin and leptin signals, as investigated in in vivo and
in vitro studies. Taking all the evidence together, we sug-
gest that HA could be a therapeutic option for treating
obesity. Further clinical and experimental studies with
standardized methodologies should be conducted to test
the efficacy of HA.
Disclosure statement
The authors declare that they have no conflicts of in-
terest and no financial interests related to the material of
this manuscript.
Acknowledgments
This study was supported by the Traditional Korean
Medicine R&D program funded by the Ministry of Health &
Welfare through the Korea Health Industry Development
Institute (KHIDI) (HI13C0700).
56 M.-H. Nam et al.

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