# Bee Venom Acupuncture in Traditional Korean Medicine: A Review of Clinical Practice Guidelines
## 2 General Characteristics of BVA-Related Recommendations in TKM-CPGs  
A search of the National Clearinghouse for Korean Medicine (NCKM, nikom.orkr/nckm) database was conducted in January 2025 and identified a total of 347 CPGs. Among these, 100 were guidelines developed in Korea. Further assessment revealed that 52 of these 100 guidelines were developed with verified quality control processes, following standardized manuals [22; 23]. Of these 52 guidelines, 18 included recommendations for BVA therapy. We finally verified the 30 specific BVA recommendations in the selected 18 CPGs (Figure 1). The 18 CPGs included in this review encompassed a wide range of clinical conditions (Table 1). Musculoskeletal disorders were the most frequently represented, including chronic low back pain [24], cervical pain [25], shoulder pain [26], knee osteoarthritis [27], lumbar herniated intervertebral disc [28], ankle strain [29], carpal tunnel syndrome [30], rheumatoid arthritis [31], degenerative arthritis of hip and phalangeal joints [32], and temporomandibular joint disorder [33]. Furthermore, CPGs for the postoperative syndromes following spinal, shoulder, or knee surgery [34] and traffic accident injury specified with whiplash-associated disorders I and II [35] were also considered as musculoskeletal conditions. The CPGs addressing neurological diseases were also included, such as stroke [36] and facial nerve palsy [37]. Additionally, there were the CPGs covering other diseases, including tension-type headache [38], cancer-accompanying symptoms [39], prostatic hypertrophy [40], and gout [41]. These 18 CPGs recommended BVA as a standalone treatment or in combination with other therapeutic methods. The details on combined therapies are summarized in the subsequent section for BVA treatment regimens. Figure 1: Study workflow to identify recommendations for bee venom acupuncture therapy in clinical practice guidelines of traditional Korean medicine. Abbreviations. AGREE, Appraisal of Guidelines for Research and Evaluation; CPG, clinical practice guideline; GRADE, Grading of Recommendations, Assessment, Development and Evaluations; NCKM, National Clearinghouse for Korean Medicine. \begin{table}
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Most of the CPGs relied on primary studies conducted in Korea. For example, the guidelines for ankle sprain [29], carpal tunnel syndrome [30], cervical pain [25], chronic low back pain [24], degenerative arthritis [32], and gout [41] exclusively used Korean studies. Some CPGs incorporated studies from both Korea and China, such as facial nerve palsy [37], rheumatoid arthritis [31], and temporomandibular joint disorder [33]. Only the CPG for knee osteoarthritis included a multinational randomized controlled trial (RCT) [27]. Age-related conditions for BVA therapy were recommended, with most guidelines applicable to general adults without specifying age ranges. However, the guideline for traffic accident injury specifically addressed adults aged 19-70 years old for BVA therapy [35]. Disease or symptom specifications of BVA recommendations were also presented. For acute conditions, BVA was recommended for acute ankle sprain [29] and acute gout [41]. Chronic conditions included chronic ankle sprain [29], chronic and nonspecific low back pain [24], and chronic tension-type headache [38]. The CPG for post-surgical care recommended BVA for patients in rehabilitation periods after lumbar surgery, total knee arthroplasty, and rotator cuff operations [34]. Neurological conditions such as facial palsy (including idiopathic cases with or without post-auricular pain) [37] and stroke-related symptoms (motor disability, shoulder pain, and spasticity) [36] were also addressed. Other specifications for BVA included cancer-related pain [39], degenerative arthritis of the hip and phalangeal joints [32], and benign prostatic hyperplasia without acute urinary retention [40]. Gender-specific recommendations were absent in the included CPGs. Most guidelines did not differentiate between males and females.