# Bee Venom Acupuncture in Traditional Korean Medicine: A Review of Clinical Practice Guidelines
## 1 Introduction  
Bee venom (BV), a complex mixture of biologically active substances secreted by honeybees (_Apis mellifera_), has been used for centuries in traditional medicine for its therapeutic properties [1]. It contains peptides such as melittin, apamin, adolapin, and mast cell degranulating peptide, along with various enzymes, notably phospholipase A\({}_{2}\) and hyaluronidase. Melittin exhibits potent anti-inflammatory, cytolytic, and antimicrobial properties, primarily by disrupting cellular membranes, while apamin has significant neurological effects by selectively blocking calcium-dependent potassium channels. Additionally, phospholipase A\({}_{2}\) contributes anti-inflammatory, immune-modulatory, and antiviral effects by hydrolyzing membrane phospholipids, and hyaluronidase facilitates venom diffusion and enhancestissue permeability by degrading extracellular matrix components, collectively broadening BV's therapeutic potential [2; 3]. This natural compound has been applied in various forms, including acupuncture and topical applications, to treat multiple conditions such as arthritis, rheumat, back pain, and skin diseases [4]. Modern research has revealed that BV possesses potent anti-inflammatory and analgesic properties [5; 6], supporting its potential application in treating various inflammatory conditions. In clinical practice, bee venom acupuncture (BVA) is employed across a spectrum of pain conditions [7], primarily within musculoskeletal and neuropathic contexts. For musculoskeletal pain, BVA has demonstrated effectiveness in alleviating low back pain, shoulder pain, and osteoarthritis [4; 8; 9]. Beyond its use in musculoskeletal disorders, BVA has shown promising effects for neurological and oncological conditions. A systematic review indicated the potential benefits of BVA in managing post-stroke shoulder pain [10]. Furthermore, BV and its primary component, melittin (MEL), have shown anticancer effects against various malignancies, including hepatocellular carcinoma, prostate cancer, melanoma, and lung cancer, by inhibiting cancer cell growth, inducing apoptosis, and suppressing tumor metastasis [11; 12]. These diverse applications of BV highlight potential as a therapeutic agent across multiple medical domains [13]. Clinical practice guidelines (CPGs) are systematically developed statements to assist practitioners and patients in making decisions about appropriate health care for specific clinical circumstances [14]. These guidelines play a crucial role in evidence-based medicine by synthesizing the best available evidence and expert consensus to provide recommendations for clinical practice [15]. CPGs serve as essential tools for standardizing treatment approaches, improving patient outcomes, and ensuring evidence-based decision-making in clinical practice. They aim to improve the quality of patient care, reduce inappropriate variation in practice, promote efficient use of resources, and identify knowledge gaps that require further research [16]. The development of CPGs in traditional Korean medicine (TKM) has evolved significantly. While initial TKM-CPG development was primarily led by academic societies, subsequent efforts, mainly through national research and development projects funded by the Ministry of Health and Welfare (MoHW) in the Republic of Korea, have emphasized validated evidence conforming to international standards. These initiatives have resulted in developing numerous TKM-CPGs across various clinical problems, with globally standardized methodologies including Grading of Recommendations, Assessment, Development and Evaluations (GRADE) and Appraisal of Guidelines for Research and Evaluation (AGREE) II assessments, promoting evidence-based medical services in TKM [17]. Despite growing evidence supporting BVA's therapeutic potential, systematic analyses of its clinical application remain limited.