Effects of Acupuncture Treatment Alone and in Combination With Japanese Kampo Medicines on Reduced Dietary Intake During Hospitalization: A Single-Center Case Series

Abstract

Background: Malnutrition leads to various consequences, including prolonged hospital stays and an increased risk of readmission. Insufficient dietary intake often necessitates interventions such as parenteral or enteral nutrition, further extending the duration of hospitalization. Studies suggest that acupuncture may enhance appetite; however, its direct impact on dietary intake remains unclear. In this study, we aimed to evaluate the effects of acupuncture alone and in combination with Japanese Kampo medicines on reduced dietary intake and related blood parameters to clarify this relationship.

Methods: This single-center, retrospective observational study was conducted at the Japanese Red Cross Kumamoto Hospital, an acute care facility in Japan, and included all hospitalized patients who received acupuncture treatment for reduced dietary intake from February 1, 2020, to January 31, 2023. Reduced dietary intake was defined as an average intake of less than 50% during the seven days prior to the initiation of acupuncture treatment. The treatment sessions lasted 20-30 minutes, with interventions performed once daily, five times per week (Monday to Friday, excluding Japanese holidays). Japanese Kampo medicines were prescribed by attending physicians in the course of routine medical care. The rate of daily change in dietary intake percentage from seven days before to seven days after acupuncture treatment, changes in blood parameters (total lymphocyte count, hemoglobin, albumin, and prealbumin levels), and treatment safety were evaluated. The change in dietary intake percentage before and after acupuncture treatment was analyzed using a paired t-test.

Results: Of 80 patients who received acupuncture during the study period, 64 were ultimately included in the analysis. Of these, 21 (33%) were male patients and 43 (67%) were female patients, with a mean age of 75.0 ± 12.7 years. The daily dietary intake rate increased from -1.08% before acupuncture to 1.93% after treatment. Similar trends were observed for individual meals, with breakfast intake rising from -1.46% to 2.09%, lunch from -1.67% to 1.53%, and dinner from -0.70% to 2.22%. The cause of reduced dietary intake was not clearly identified. Rikkunshito (TJ-43) was the most commonly co-administered Japanese Kampo medicine (31.7%). The most frequently used acupoints included ST36 (54 patients), SP6 (35 patients), CV12 (33 patients), SP9 (29 patients), SP3 (26 patients), and KI3 (20 patients). No significant adverse events were observed.

Conclusions: Dietary intake significantly improved following acupuncture treatment alone and in combination with Japanese Kampo medicines. These findings suggest that the observed improvements in dietary intake may be attributable to these interventions rather than to natural recovery. There were limitations to the study methods, and future studies with prospective, high-quality research designs will be necessary.

Keywords: acupuncture; enteral nutrition; hospitalization; japanese kampo medicine; malnutrition.

Figure 1. Method to calculate the dietary intake rate percentage

The amount of staple food and side dishes consumed at breakfast, lunch, and dinner was recorded using a 10-point scale for each component. The maximum total score for the three meals was 60 points. The sum was divided by 60 and multiplied by 100 to calculate the daily dietary intake percentage (maximum 100%).

Figure 2. Flow diagram of the trial

Patients excluded from analysis comprised of those receiving ongoing enteral nutrition or lacking dietary intake percentage data for the three days before and after acupuncture treatment. These exclusions were necessary as it was not possible to calculate the rate of daily change in dietary intake percentage for these cases.

Figure 3. Classification of reasons for hospitalization

The horizontal axis indicates the number of cases for each diagnostic category leading to hospital admission.

Figure 4. Rate of change in dietary intake before and after acupuncture treatment

Box plots representing changes in (A) overall daily intake, (B) breakfast, (C) lunch, and (D) dinner. The vertical axis indicates the percentage change. The box edges indicate the 25th and 75th percentiles, the whiskers represent the 10th and 90th percentiles, and the line within each box shows the median value.

Figure 5. Frequency of combined Japanese Kampo medicine usage

The horizontal axis represents the number of cases for each Kampo formulation. Formulation manufacturers are indicated as follows: (a) Kracie Pharmaceutical Co. Ltd., Tokyo, Japan; (b) Sanwa Shoyaku Co. Ltd., Wakayama, Japan; (c) Kotaro Pharmaceutical Co. Ltd., Osaka, Japan.

Figure 6. Frequency of acupoint usage

The horizontal axis represents the number of cases. The group of 14 acupoints includes CV22, ST9, ST21, BL10, BL17, BL23, BL60, GB20, TE4, LV4, Hx-HN1, Ex-B7, shenmen (auricular acupoint), and sympathetic (auricular acupoint). The group of 21 acupoints includes CV23, LU1, LU7, LU9, ST25, SI13, BL2, BL25, BL57, PC7, TE5, TE23, GB1, GB34, GB37, GB42, GB43, Ex-HN3, Ex-B2, brainstem point (YNSA), and basic D point (YNSA). YNSA: Yamamoto new scalp acupuncture