Korean Herbal Medicine and Pharmacopuncture: Evidence and Safety

Two different practices

Korean herbal medicine means herbal prescriptions given by Korean medicine doctors, one of several modalities alongside acupuncture, moxibustion, cupping and manual therapy. [1] Pharmacopuncture, also called herbal acupuncture, is a newer practice that combines acupuncture with injection of herbal medicine into acupuncture points. [2] It was first officially introduced to the Korean medicine community in 1967. [2] The wider tradition is in Traditional Korean Medicine.

We give no recipes, doses or preparation steps for either practice. Herbal prescriptions and injections are matters for a licensed clinician.

Traditional framing

The Donguibogam, Korea's foundational medical text, included prescriptions with herbs known by their local names, and also recorded prescriptions using heavy metals, which a review of the book says can cause poisoning. [3] Prescriptions in Korean medicine are traditionally chosen by pattern and sometimes by Sasang type; these are traditional frameworks, not tested categories. See Sasang constitutional medicine.

What research shows: herbal medicine

Korean herbal formulas are many, and each needs its own evidence. We found studies on single formulas and on safety, not a review of "Korean herbal medicine" overall. Proper evidence not found for the category as a whole.

One example is Bojungikgi-tang for persistent allergic rhinitis, tested against placebo in a randomized, double-blind phase II trial. Symptom scores improved more in the herbal group than the placebo group, but the difference was not statistically significant, and no serious adverse effects were observed. [4] That is insufficient evidence of benefit from one small trial; it is not a recommendation.

What research shows: pharmacopuncture

A systematic review of Korean randomized trials included 29 studies with 1,211 participants. [2] Pooled results from two obesity trials showed more reduction in weight, waist circumference and body mass index than saline injections, and trials in musculoskeletal conditions suggested added pain relief. [2] But the authors concluded it is difficult to recommend pharmacopuncture as an evidence-based treatment because of methodological flaws and small samples. [2] Median group sizes were 17 and 18, and the authors say the included trials were mostly of poor quality, so data are likely overestimated. [2]

Evidence label: promising but limited. Pharmacopuncture is injected, so side effects are related to both the needle and the herb. Only five of the studies reported adverse events; the mild ones included pain during injection, bruising and redness, as well as nausea and itching in one trial. [2] A protocol for a review of pharmacopuncture's safety says that its safety has not been thoroughly assessed yet. [5] We did not find a completed safety review.

Safety: the liver

A systematic review of herb-induced liver injury in Korea found 97 cases in 31 reports. [6] Most injuries were hepatocellular, and Polygoni Multiflori (39.2 percent) and Dictamnus dasycarpus (37.1 percent) were the most frequent agents. [6] The authors note that herbs are generally regarded as safe because of extensive clinical use, but the potential for toxicity has become an important medical issue. [6] Cases come from published reports, so they show that harm occurs, not how often. In a 2023 national survey, liver function tests were the most common blood test used by Korean medicine doctors, and 58.68 percent of respondents named monitoring herb-induced liver injury as a purpose. [7]

Warning signs such as yellow skin or eyes, dark urine, severe tiredness or upper-right abdominal pain need prompt medical care. See liver safety and supplements.

Safety: interactions, products and heavy metals

Some herbs can decrease or increase the effects of medicines. [8] Bring a written list of everything you take. [8] Mineral and metal-containing preparations can carry lead, mercury or arsenic risk; see heavy metals in traditional medicines and adulteration and undeclared drugs. For shared concepts with Chinese herbal practice, see Chinese herbal medicine.

Who should check first

Ask a clinician or pharmacist before any herbal prescription if you are pregnant or breastfeeding, have liver or kidney disease, are a child, are older and taking several medicines, or are due for surgery. Never stop a prescribed medicine for an herbal one. Pharmacopuncture is an injection; ask whether the practitioner is licensed to give it and how needles and preparations are kept sterile. See talking to your doctor about traditional healing.

Regulation

In South Korea, Korean medicine doctors hold their own license. [1] We did not find a readable official source on how herbal products or pharmacopuncture solutions are regulated, so we make no statement about it. In the United States, practitioner requirements vary by state and discipline. [9]