Types and Doses of Pharmacopuncture for Lumbar Disc Herniation: a scoping review of clinical studies.

Researchers reviewed 63 studies to understand how pharmacopuncture—a treatment combining acupuncture with injectable herbal or natural substances—is being used for lumbar disc herniation, a condition causing lower back pain, leg pain, and muscle weakness. The team looked at what types of substances practitioners inject, how much they use, and where they place the injections. They found that bee venom was the most commonly studied substance, used in 34 studies, followed by Shinbaro (a Korean herbal formula) in 29 studies. Other injectable substances were rarely studied. The amount injected varied widely, from as little as 0.04 cc to as much as 6.00 cc, though 1.00 cc was most typical. Practitioners injected these substances at various locations including the skin surface near the affected disc, painful trigger points, muscles, traditional acupuncture points, and facet joints in the spine. This review is important because it shows there's currently no standardized approach to this treatment—different practitioners use different substances, amounts, and injection sites. The researchers hope their findings will help develop consistent treatment protocols so patients can receive more predictable care. If you're considering pharmacopuncture for disc herniation, seek a qualified acupuncturist with specialized training in injection techniques and appropriate licensing in your jurisdiction.

This scoping review analyzed 63 clinical studies (case reports, retrospective studies, and RCTs) examining pharmacopuncture applications for lumbar disc herniation through September 2024. Data sources included domestic Korean databases (RISS, SCIENCE ON, OASIS) and PubMed. Bee venom pharmacopuncture was most frequently studied (n=34), followed by Shinbaro (n=29), with all other formulations appearing in fewer than four studies each. Dosing ranged from 0.04-6.00 cc per injection point, with 1.00 cc being most common. Injection sites included intradermal administration at disc levels, Ah-Shi points, tender points, muscular sites, classical acupoints, and facet joints. Significant variation exists in injection protocols based on substance type and anatomical location. No effect sizes or outcomes were reported in this review. Clinical takeaway: Current evidence lacks standardization in pharmacopuncture protocols for LDH, highlighting the need for consensus guidelines regarding substance selection, dosing parameters, and injection site protocols to optimize clinical outcomes and reproducibility.