Abstract Background: The main points of focus of bibliometric analysis of acupuncture treatment of diseases include pain (headache, low back pain), insomnia, and knee osteoarthritis, for example. In this paper, we analyze the frontiers, hotspots, and research trends of acupuncture over the past 30 years and compare them for each of three 10-year periods. Methods: All the studies on acupuncture research in three different periods (1990–1999, 2000–2009, 2010–2019) were collected from the Web of Science database. The evolution of the research, hotspots, and trends in acupuncture were explored intuitively by analyzing the frequency, betweenness centrality, and subject word clustering of the three periods. Results: (1) 1990–1999, the main content relating to research was the mechanism of research of acupuncture treatment of pain. Naloxone was the high-frequency subject word, and centrality included, for example, the spinal cord, enkephalin, smoking cessation, and detoxification. The results of keyword cluster analysis showed that the main research content included capsaicin-induced neurogenic edema, chemical dependency treatment, afferent fiber, and sufferers from xerostomia. (2) 2000–2009, during this stage, the frequency of keywords appeared in new research content such as randomized controlled trials of acupuncture and low back pain, but pain still dominated the main research content. From the perspective of intermediary centrality, along with the rise in randomized controlled trials, there were many important meta-analyses, as well as the management of acupuncture treatment. The main elements of the keyword cluster analysis included, for example, systematic review, randomized controlled pilot study, add-on therapy, brief overview, and ovarian morphology. (3) 2010–2019, during this period, compared with the previous two stages, there was increased frequency of keywords, a growth in clinical randomized controlled trials, and distribution of centrality was evident in the emergence of acupuncture in care, osteoarthritis treatment, and breast cancer research. The keyword clustering covered, for example, neural specificity, inflammatory reaction, chronic pain, sleep pattern, and consort statement. Conclusion: This article summarizes the trend of development of acupuncture from 1990 to 2019 and compares the main research categories and hotspots in each of three different 10-year periods within this span, thereby helping elucidate the research direction within the field.

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Traditional Chinese Medicine
Bibliometric analysis of acupuncture research through the Web of
Science database from 1990 to 2019
Yan-Qing Zhao1, #, *
, Li Huang1, #
1
Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200062, China.
#
Yan-Qing Zhao and Li Huang are co-first authors for this paper.
*Corresponding to: Yan-Qing Zhao. Putuo Hospital, Shanghai University of Traditional Chinese Medicine, No. 164 Lanxi
Road, Putuo District, Shanghai 200062, China. E-mail: zhaoyanqing1983@126.com.
Highlights
This study summarizes the trend of development of acupuncture research from 1990 to 2019 and compares
the main research categories and hotspots in different time periods: 1990–1999, 2000–2009 and 2010–2019.
Tradition
Dating from before 168 B.C.E., the earliest existing acupuncture literature Moxibustion Classic of Foot and
Arm Eleven Channels and Moxibustion Classic of Yin Yang Eleven Channels (unknown author) discussed
the method of locating the 11 meridians in the human body, moxibustion methods, and indications for these
meridians. There are many studies on acupuncture theory and clinical treatment in the Yellow Emperor’s
Classic of Internal Medicine (unknown author, from 99 B.C.E. to 26 B.C.E.), which marks the formation of
acupuncture theory. In 1979, the World Health Organization recommended acupuncture and moxibustion
treatments for 43 kinds of diseases. On October 24, 2018, the United States signed the H.R.6 Act and
included acupuncture and moxibustion in its federal medical insurance program.

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Abstract
Background: The main points of focus of bibliometric analysis of acupuncture treatment of diseases include pain
(headache, low back pain), insomnia, and knee osteoarthritis, for example. In this paper, we analyze the frontiers,
hotspots, and research trends of acupuncture over the past 30 years and compare them for each of three 10-year
periods. Methods: All the studies on acupuncture research in three different periods (1990–1999, 2000–2009,
2010–2019) were collected from the Web of Science database. The evolution of the research, hotspots, and trends
in acupuncture were explored intuitively by analyzing the frequency, betweenness centrality, and subject word
clustering of the three periods. Results: (1) 1990–1999, the main content relating to research was the mechanism of
research of acupuncture treatment of pain. Naloxone was the high-frequency subject word, and centrality included,
for example, the spinal cord, enkephalin, smoking cessation, and detoxification. The results of keyword cluster
analysis showed that the main research content included capsaicin-induced neurogenic edema, chemical
dependency treatment, afferent fiber, and sufferers from xerostomia. (2) 2000–2009, during this stage, the
frequency of keywords appeared in new research content such as randomized controlled trials of acupuncture and
low back pain, but pain still dominated the main research content. From the perspective of intermediary centrality,
along with the rise in randomized controlled trials, there were many important meta-analyses, as well as the
management of acupuncture treatment. The main elements of the keyword cluster analysis included, for example,
systematic review, randomized controlled pilot study, add-on therapy, brief overview, and ovarian morphology. (3)
2010–2019, during this period, compared with the previous two stages, there was increased frequency of keywords,
a growth in clinical randomized controlled trials, and distribution of centrality was evident in the emergence of
acupuncture in care, osteoarthritis treatment, and breast cancer research. The keyword clustering covered, for
example, neural specificity, inflammatory reaction, chronic pain, sleep pattern, and consort statement. Conclusion:
This article summarizes the trend of development of acupuncture from 1990 to 2019 and compares the main
research categories and hotspots in each of three different 10-year periods within this span, thereby helping
elucidate the research direction within the field.
Keywords: Acupuncture, Research categories, Research hotspots, Pain, Naloxone, Bibliometric analysis
Author contributions:
Yan-Qing Zhao conceived the study; Li Huang downloaded and organized the data; Yan-Qing Zhao and Li
Huang conducted the data analysis; Yan-Qing Zhao and Li Huang wrote the manuscript. All the authors have
read and approved the final version of manuscript.
Competing interests:
The authors declare no conflicts of interest.
Acknowledgments:
The study was funded by Budget Project of Shanghai University of Traditional Chinese Medicine (No.
2019WK118).
Abbreviations:
LLR, log-likelihood ratio; MI, mutual information; RCTs, randomized controlled trials; P6, pericardium 6; fMRI,
functional magnetic resonance imaging.
Citation:
Zhao YQ, Huang L. Bibliometric analysis of acupuncture research through the Web of Science database from
1990 to 2019. Tradit Med Res. 2021; 6(1): 9. doi: 10.12032/TMR20201023203.
Executive editor: Rui-Wang Zhao.
Submitted: 12 July 2020, Accepted: 08 September 2020, Online: 29 October 2020.
© 2021 By Authors. Published by TMR Publishing Group Limited. This is an open access article under the CC-BY
license (http://creativecommons.org/licenses/BY/4.0/).

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Background
Acupuncture is becoming increasingly favored by
people worldwide, and it is now a popular
supplementary and alternative therapeutic method in
many countries. Dating from before 168 B.C.E., the
earliest existing acupuncture literature Moxibustion
Classic of Foot and Arm Eleven Channels and
Moxibustion Classic of Yin Yang Eleven Channels
(unknown author) discussed the method of locating the
11 meridians in the human body, moxibustion methods,
and indications for these meridians. There are many
articles on acupuncture theory and clinical treatment in
the Yellow Emperor’s Classic of Internal Medicine
(unknown author, from 99 B.C.E. to 26 B.C.E.), which
marks the formation of acupuncture theory.
Subsequently, the A-B Classic of Acupuncture and
Moxibustion (written by Huangfu Mi from 256 to 260
C.E.) played a connecting role in the development of
acupuncture and moxibustion. After the development
of each dynasty in ancient China, it became more and
more perfect. With the development of science and
technology, acupuncture and moxibustion are no
longer limited to the development of medicine in
China, and their therapeutic effects have been
recognized worldwide. In 1979, the World Health
Organization recommended the use of acupuncture and
moxibustion in treatment of 43 kinds of diseases. In
April 2009, the Canadian health care system officially
incorporated acupuncture and moxibustion. On
October 24, 2018, the United States signed the H.R.6
Act and included acupuncture and moxibustion in the
federal medical insurance program. These things are of
great significance for the global popularization of
acupuncture and moxibustion. The aim of this study is
to clearly understand the development of acupuncture
research over the past 30 years.
Bibliometric analysis is a scientific method for
studying publications on a given topic [1], and it is a
widely used quantitative method for assessing the
knowledge structure and development context of
various research fields. It has been employed in
assessing the productivity of institutions, studying
national and international cooperation, and examining
the hot spots and frontiers of research in specific fields.
CiteSpace is one of the more commonly used pieces of
visualization analysis software.
The global popularization of acupuncture has led to
a gradual increase of research on acupuncture
(including literature research). Bibliometric analysis of
acupuncture incorporates statistics on the scientific
research output of different countries. Studies include
an analysis of the current status of global and Brazilian
acupuncture studies from 2000 to 2014 [2], a
bibliometric analysis of randomized controlled trials
(RCTs) of acupuncture in Korea [3], and a 1988–2017
analysis of acupuncture literature in Taiwan [4]. These
studies greatly facilitate understanding of the trends of
acupuncture research in different regions.
Secondly, it is a bibliometric analysis of
acupuncture treatment about different diseases. For
example, Liang YD [5] utilized CiteSpace software to
analyze the literature on acupuncture treatment of low
back pain over the past 20 years, Lee IS [6] used
VOSviewer software to analyze the literature on
acupuncture treatment of pain over the past 20 years,
and Pei W [7] carried out a bibliometric analysis of
acupuncture treatment for insomnia. Studies such as
these can enable scholars to understand the frontiers
and hotspots in this field both accurately and quickly.
In the current study, we use CiteSpace software to
carry out a visual analysis of the knowledge map of the
acupuncture research in the Web of Science database
between 1990 and 2019. Through comparison of the
keywords of the research literature, we aim to identify
the frontiers, hotspots, and research trends in each time
node to clarify the sources and evolution of literature
on acupuncture research.
Materials and methods
Source of literature
We first searched the Web of Science database using
the English keywords: “acupuncture” OR
“acupuncture therapy” OR “acupuncture, ear” OR
“acupuncture points” OR “acupuncture analgesia”.
Second, to avoid omitting research literature, we use,
“acupuncture” to search for synonyms in the MeSH
database and the subject word database in PubMed,
and then we merged the final data. The link to the
synonyms’ database is as follows: https://
www.ncbi.nlm.nih.gov/mesh/?term=acupuncture. Next,
is Web of Science database settings: “select database”
setting is “Web of Science core collection”. [8] The
data were retrieved on April 15, 2020, and the data for
the periods 1990–1999, 2000–2009, 2010–2019 were
compared and analyzed.
Analysis software
The version of CiteSpace analysis software used was
5.2.R1, this was invented by Professor Chen Chaomei
from the Computer and Information Science
Department of Drexel University in the United States.
It can be used to analyze the structure, laws and
distribution of scientific knowledge [9].
Download and import of data
The results retrieved by using subject words were
exported, the file format was “plain text”. We used
CiteSpace software to remove duplicates and create a
unique record, which we then analyzed.
Statistical methods
We conducted keyword analysis of all the acupuncture
research literature, keyword frequency identifies the

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core keywords, and betweenness centrality is an
indicator of the importance of nodes in the network
used to discover and measure the significance of the
literature. Keyword clustering analysis produces a
keyword co-occurrence network that can reflect both
the current research hotspots in a certain field and the
hotspots have been generated in the past. The purpose
is to analyze hotspots, trends, and knowledge structure
to measure the main research hotspots in a field.
CiteSpace software uses Q and silhouette to measure
the clarity of clustering. In general, Q > 0.3 means that
the divided community structure is significant; when
the S value is 0.7, clustering is highly efficient and
convincing.
Parameter setting
The parameter settings of the CiteSpace software are
“time slicing”, which is set to “from 1990 to 1999,
from 2000 to 2009, from 2010 to 2019” and “#years
per slice: 1, 2, 1”, “node types” select “keyword”,
“pruning” selects “pathfinder” and “pruning the
merged network”.
Results
We conducted the co-occurrence analysis of keywords
for three different time nodes to identify the sources of
literature on acupuncture research. In addition to
discovering the hot spots of acupuncture research in
different periods, we must explore the differences
between them.
The first stage (1990–1999)
In the first stage (1990–1999) we identified 936
articles, of which 927 remained after sorting them for
repetition. We used the CiteSpace software to obtain
the intermediary centrality of the acupuncture research
keywords at this stage and create the diagram of the
clustering of keywords [4]. The clustering analysis
graph included 196 nodes and 372 connections, with a
density value of 0.0195. The top five keywords
identified by keyword frequency distribution were
“acupuncture”, “pain”, “analgesia”,
“electroacupuncture”, and “rat”. The top five values of
intermediary centrality were “mechanism”, “smoking”,
“placebo”, “alternative medicine”, and “spinal cord”.
Table 1 shows the specific statistical results.
Using CiteSpace software, we clustered the
keywords of the acupuncture research, and we
obtained 14 categories of acupuncture research:
“capsaicin-induced neurogenic edema”, “systematic
review”, “chemical dependency treatment”, “Chinese
medicine”, “afferent fiber”, “enkephalin-like material”,
“eye acupuncture”, “cerebrovascular disease”,
“acupuncture”, “brain catecholamine content”, and
“xerostomia sufferer”. The specific statistical results
are shown in Table 2 and Figure 1.
Figure 1 Cluster analysis of keywords in
acupuncture research from 1990 to 1999. Nodes of
different colors represent different clusters, and the
combination of symbols and numbers represents the
keywords’ study of similar categories; different color
block areas represent different research categories,
different keywords constitute these categories, and the
size of the color block area has no special meaning.
Burst is used to reflect hotspots within a certain time
node. The red bar indicates both the duration of the
citation explosion and the start and end years of the
citation explosion; that is, the red bar represents some
frequently cited keywords, and the green bar represents
rarely cited keywords [10]. The hotspot of acupuncture
research between 1990 and 1999 was identified as
“naloxone”, and the frontier was identified as the
research on “therapy”. The specific results are shown
in Figure 2 below.
Figure 2 Burst diagram of acupuncture research
from 1990 to 1999. The red bar indicates both the
duration of the citation explosion and the start and end
years of the citation explosion; the longer the red band,
the longer the maintenance time of the hot spot on this
kind of research, indicating that it is a hot spot in this
field; the closer the band to the right, the more recent
the study.

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Table 1 Frequency of keywords and centrality distribution of acupuncture research from 1990 to 2019
Different time periods Keyword Frequency Keyword Centrality
1990–1999
Acupuncture 254 Mechanism 0.48
Pain 68 Smoking 0.47
Analgesia 57 Placebo 0.46
Electroacupuncture 40 Alternative medicine 0.42
Rat 30 Spinal cord 0.41
Naloxone 23 Enkephalin 0.37
Placebo 18 Plasma 0.36
Stimulation 17 Detoxification 0.35
Spinal cord 15 Behavior 0.29
Beta endorphin 12 Substance P 0.27
2000–2009
Acupuncture 778 Electroacupuncture 0.87
Pain 277 Placebo 0.75
Electroacupuncture 250 Analgesia 0.67
Stimulation 233 Pain 0.59
Placebo 118 Clinical trial 0.54
Randomized controlled
trial
113 Acupuncture 0.53
Low back pain 112 United States 0.53
Trial 108 Medicine 0.47
Rat 106 Blood flow 0.45
Therapy 106 Meta-analysis 0.42
2010–2019
Acupuncture 1,896 Low back pain 0.98
Electroacupuncture 698 Care 0.75
Pain 517 Complementary 0.71
Stimulation 367 fMRI 0.67
Randomized controlled
trial
362 Pain 0.66
Management 335 Stimulation 0.62
Complementary 279 Osteoarthritis 0.62
Therapy 269 Breast cancer 0.59
Trial 235 Rat 0.54
Quality of life 223 Knee 0.53
fMRI, functional magnetic resonance imaging. Frequency represents the number of times that keywords appear in
all research literature. Centrality is an index to measure the importance of nodes in the network; the greater the
centrality value (represented by the purple circle), the more prominent it is in the network, and the larger is the
purple circle; CiteSpace uses this index to find and measure the significance of documents, and it utilizes purple
circles to mark such documents.

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Table 2 Keyword clustering analysis of acupuncture research in 1990–2019
Different time
periods
Cluster
ID
Size Silhouette Mean (y) Label (LLR) top terms (p-level) Label (MI) terms
1990–1999
0 28 0.654 1996 Capsaicin-induced neurogenic edema Long-term pilot study
1 23 0.952 1996 Systematic review Cocaine abuse
2 17 0.854 1995 Chemical dependency treatment Cocaine abuse
3 16 0.998 1995 Chinese medicine Chinese medicine
4 14 0.818 1991 Afferent fiber Afferent fiber
5 14 0.892 1992 Enkephalin-like material Cocaine abuse
6 14 0.945 1994 Eye acupuncture Cocaine abuse
7 12 0.922 1998 Cerebrovascular disease Cocaine abuse
8 12 0.976 1998 Acupuncture Systematic review
9 12 0.951 1997 Brain catecholamine content Cocaine abuse
10 9 0.945 1995 Xerostomia sufferer Systematic review
11 8 0.971 1992 Chronic skin disease Systematic review
12 4 0.952 1997 Acupuncture point P6 Systematic review
13 4 0.983 1996 Skin resistance response Systematic review
2000–2009
0 15 0.857 2001 Systematic review Nicotine-induced behavioral sensitization
1 13 0.941 2002 Delayed onset muscle soreness Polycystic ovary syndrome
2 12 0.906 2000 Acupuncture treatment Nicotine-induced behavioral sensitization
3 11 0.888 2001 Pediatric pain patients experience Nicotine-induced behavioral sensitization
4 11 0.895 2001 Brief overview Nicotine-induced behavioral sensitization
5 9 0.927 2001 Pediatric pain patients experience Nicotine-induced behavioral sensitization
6 8 0.829 2003 Induced ischemic pain Nicotine-induced behavioral sensitization
7 8 0.976 2000 Ovarian morphology Nicotine-induced behavioral sensitization
8 8 0.815 2002 Add-on therapy Nicotine-induced behavioral sensitization
9 6 0.936 2002 Randomized controlled pilot study Nicotine-induced behavioral sensitization
2010–2019
0 15 0.948 2011 Neural specificity Polycystic ovary syndrome
1 14 0.984 2012 Inflammatory reaction Urinary tract disease
2 13 0.773 2010 Chronic pain Polycystic ovary syndrome
3 13 0.870 2012 Sleep pattern Evaluating intense rehabilitative therapy
4 12 0.847 2012 Consort statement Polycystic ovary syndrome
5 12 0.967 2012 Receptor-positive breast cancer Polycystic ovary syndrome
6 11 0.832 2012 Controlled clinical trial Polycystic ovary syndrome
7 9 0.947 2011 Adaptive coping strategies Polycystic ovary syndrome
8 9 0.979 2013 Auricular acupuncture Polycystic ovary syndrome
9 5 0.957 2010 Nurse-led supportive care Polycystic ovary syndrome
10 4 0.950 2010 Progesterone level Systematic review
LLR, log-likelihood ratio; MI, mutual information; P6, pericardium 6. Cluster ID represents cluster number; size represents the
number of members in the cluster; silhouette is an index measuring the homogeneity of the cluster members, the larger the value, the
higher the similarity of the cluster members; mean (y) represents the median value of the publication year of the cluster. The words
extracted by term frequency-inverse document frequency emphasize the mainstream of research, whereas the words extracted from
LLR and MI emphasize the research characteristics, the larger the LLR, the more representative the cluster category. MI is used mainly
to represent the relationship between terms and categories in text mining, and it does not consider the frequency of feature words.

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The second stage (2000–2009)
In the second stage (2000–2009), we identified 2,461
articles, of which 2,430 remained after duplicates were
eliminated. We used the CiteSpace software to obtain
the intermediary centrality of the acupuncture research
keywords at this stage and create the diagram of the
clustering of keywords. The cluster analysis graph
contained 105 nodes and 107 connections, with a
density value of 0.0196. The top five keywords in
terms of frequency distribution were “acupuncture”,
“pain”, “electroacupuncture”, “stimulation” and
“placebo”. The popular keywords during this period
were from studies on acupuncture treatment of pain.
The top five keywords in respect of centrality were
“electroacupuncture”, “placebo”, “analgesia”, “pain”
and “clinical trial”. The clinical research into pain was
a considerable research node. Table 1 shows the
specific statistical results.
We clustered the keywords of the acupuncture
studies and obtained 10 categories of acupuncture
research: “systematic review”, “delayed onset muscle
soreness”, “acupuncture treatment”, “pediatric pain
patients” “experience”, “brief overview”, “induced
ischemic pain”, “ovarian morphology”, “add-on
therapy” and “randomized controlled pilot study”. The
specific statistical results are shown in Table 2 and
Figure 3.
Figure 3 Cluster analysis of keywords in
acupuncture research from 2000 to 2009. Nodes of
different colors represent different clusters, and the
combination of symbols and numbers represents the
keywords’ study of similar categories; different color
block areas represent different research categories,
different keywords constitute these categories, and the
size of the color block area has no special meaning.
Burst analysis identified the hot spot of acupuncture
research between 2000 and 2009 as being “chronic
pain”, and the frontier was “women”. Figure 4 shows
the specific results.
Figure 4 Burst diagram of acupuncture research
from 2000 to 2009. The red bar indicates both the
duration of the citation explosion and the start and end
years of the citation explosion; the longer the red band,
the longer the maintenance time of the hot spot on this
kind of research, indicating that it is a hot spot in this
field; the closer the band is to the right, the more recent
the study.
The third stage (2010–2019)
In the third stage (2010–2019), we identified 5,174
articles, of which 5,064 remained after the duplicates
were removed. We used the CiteSpace software to
obtain the centrality of the acupuncture research
keywords at this stage and create the diagram of the
analysis of the clustering of the keywords. The cluster
analysis graph contained 119 nodes and 127
connections, with a density value of 0.0181. The top
five keywords in terms of frequency distribution were
“acupuncture”, “electroacupuncture”, “pain”,
“stimulation” and “randomized controlled trial”. The

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popular keywords in this stage of the research are
constantly appearing growth trend on the basis of the
first two time periods. The top five keywords in terms
of centrality were “low back pain”, “care”,
“complementary”, “functional magnetic resonance
imaging (fMRI)” and “pain”. Acupuncture research on
low back pain is a newly emerging and important node.
Table 1 shows the specific statistical results.
We clustered and analyzed the acupuncture research
keywords in this stage and identified 11 categories:
“neural specificity”, “inflammatory reaction”, “chronic
pain”, “sleep pattern”, “consort”, “statement”,
“receptor-positive breast cancer”, “controlled clinical
trial”, “adaptive coping strategies”, “auricular
acupuncture”, “nurse-led supportive care” and
“progesterone level”. Table 2 and Figure 5 show the
specific statistical results.
Figure 5 Cluster analysis of keywords in
acupuncture research from 2010 to 2019. Nodes of
different colors represent different clusters, and the
combination of symbols and numbers represents the
keywords’ study of similar categories; different color
block areas represent different research categories,
different keywords constitute these categories, and the
size of the color block area has no special meaning.
Burst analysis identified the hot spot of acupuncture
research between 2010 and 2019 as being the “disease”
study of acupuncture treatment. The research frontier
was the study of “receptor”. Figure 6 shows the
specific results.
Discussion
Bibliometrics is a cross-science of quantitative analysis
that all knowledge carriers using mathematical and
statistical methods [11]. With the advancement of
science and technology, bibliometrics provides a
reliable method for researchers to deeply understand
the research in this field. We have applied co-citation
analysis and co-word analysis to studying the
keywords of acupuncture research in the Web of
Science database to identify, summarize, and compare
the trends and characteristics of acupuncture research
in different time periods and determine the similarities
and differences in acupuncture research during the
different periods.
Figure 6 Burst diagram of acupuncture research
from 2010 to 2019. The red bar indicates both the
duration of the citation explosion and the start and end
years of the citation explosion; the longer the red band,
the longer the maintenance time of the hot spot on this
kind of research, indicating that it is a hot spot in this
field; the closer the band to the right, the more recent
the study.
Centrality and frequency comparison
There were important studies in the three time periods,
including a study of acupuncture treatment of pain and
RCTs study. The difference is that another
high-frequency keyword was naloxone from 1990 to
1999, related studies have shown endogenous opioids

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are involved in the acupuncture-mediated antipyretic
effect [12], and the centrality also includes spinal cord,
enkephalin, smoking cessation, detoxification, etc. The
main studies include clinical trials of the effect of
acupuncture on smoking cessation and in
detoxification in substance abusers. Waite [13] and
others have shown that simple ear acupuncture
treatment is effective in helping smokers quit smoking.
Brewington [14] reviewed the research literature on
the use of acupuncture in relieving withdrawal
symptoms in drug abusers and showed that
acupuncture can help people quit drugs and help
detoxify alcoholics who have entered a period of
abstinence. A randomized controlled trial of
acupuncture treatment of low back pain appeared in
2000–2009. From the perspective of intermediary
centrality, with the increase of RCTs, there have also
been many important meta-analyses, as well as the
management of acupuncture treatment. In 2010–2019,
in addition to the increasing frequency of appearance
of keywords year by year, some new study keywords
appeared, including “care”, “osteoarthritis”, and
“breast cancer”.
Comparison of keyword cluster analysis
The same point is that the research category shared
between 1990–1999 and 2000–2009 is systematic
review, the difference is that the systematic review in
1990–1999 mainly focuses on acupuncture treatment
of osteoarthritis [15] and temporomandibular joint
function obstacles [16], recurrent headaches [17], acute
and chronic low back pain [18], neck pain [19], etc.,
and the results of the research require in-depth
evaluation and verification of high-quality clinical
research. The systematic review in 2000–2009 was not
limited to diseases such as pain, but included insomnia
[20], depression [21], primary dysmenorrhea [22],
menopause [23], Alzheimer’s disease [24], and chronic
fatigue syndrome [25]. Comparison of the similarities
and differences between 2000–2009 and 2010–2019,
shows that researchers have begun to pay attention to
clinical RCTs in both periods. RCTs during 2000–2009
focused mainly on postmenopausal hot flashes [26],
childhood asthma [27], and rhinitis [28], and the
pattern appearing in 2010–2019 showed that the
number of RCTs had grown rapidly during this stage
and that the types of acupuncture treatment had
expanded still further. For example, thread
acupuncture treatment of chronic rotator cuff diseases
[29], acupuncture treatment of subjective cognitive
decline in the elderly [30], and the use of acupuncture
combined with selective serotonin reuptake inhibitors
to improve the clinical symptoms and quality of life of
patients with depression have emerged [31]. Moreover,
in the use of acupuncture to treat pain, instead of being
limited to simple primary pain, research on pain
induced by acupuncture intervention diseases has
begun to appear; such research includes the use of ear
acupuncture treatment in relieving neuropathic pain
caused by spinal cord injury [32] and acute needling
with silver needles and warm acupuncture for
treatment of lumbosacral disc herniation in adults [33].
In addition, there have also been randomized
controlled studies in areas such as post-operative
complications of acupuncture treatment; laser
stimulation of BL10, BL11, GB34 acupoints to prevent
vomiting after strabismus surgery [34]; and
perioperative disease prevention, such as the use of
electroacupuncture stimulation for elderly patients
with coronary heart disease. The cardioprotective [35]
effects of acupuncture seen during the perioperative
period have greatly enriched RCTs of acupuncture
treatment of diseases.
The remaining difference lies in the differences in
the content of the categories of the respective studies.
1990–1999. keyword cluster analysis identified 14
main categories at this stage, mainly including as
follows. (1) Capsaicin-induced neurogenic edema:
Ceccherelli [36] studied the effect of deep acupuncture
on capsaicin-induced edema. Although both deep and
shallow thorns were effective, only the deep thorn on
the opposite side exhibited a certain therapeutic effect,
indicating that the therapeutic effect of the deep thorn
is greater than that of the shallow thorn. (2) Chemical
dependency treatment: Brumbaugh [37] used
acupuncture and moxibustion to relieve acute
symptoms of drug withdrawal. This is expected to
become an effective alternative therapy for drug abuse.
(3) Afferent fiber: Okada [38] found that local
application of the capsaicin selective conduction block
method detected afferent fibers that may be involved in
the suppression of open mouth reflexes. (4)
Xerostomia sufferer: Dawidson [39, 40] studied the
mechanism of effect of acupuncture on saliva secretion
and found that increased release of calcitonin
gene-related peptide and the increase of vasoactive
intestinal peptide may be factors affecting the flow of
saliva in acupuncture treatment. (5) Brain
catecholamine content: Toriizuka [41] found that
acupuncture plays an important role in improving
memory in aging and/or lowering the immune
response after menopause. (6) Enkephalin-like material:
Bing [42] studied the effect of acupuncture on the
activity of enkephalin neurons in the spinal cord. The
findings revealed that acupuncture can induce
enkephalin in the spinal cord Abnormal activation of
neurons. (7) Skin resistance response: Liao [43] found
that acupuncture can cause vasoconstriction, thereby
reducing the blood flow to the skin and increasing
sweating. These are skin resistance reactions and they
are the main observation indicators of deh-chi. (8)
Acupuncture point pericardium 6 (P6): Schlager [44]
conducted a randomized double-blind
placebo-controlled study to determine the incidence of
vomiting after laser-stimulated P6 decreased
significantly. (9) Cerebrovascular disease: Chen [45]

10. ARTICLE
10
doi: 10.12032/TMR20201023203
Submit a manuscript: https://www.tmrjournals.com/tmr
analyzed the use of acupuncture to treat hemiplegia
after stroke and found that it can not only play a
therapeutic role but also prevent cerebrovascular
accidents.
2000–2009. The keyword cluster analysis involved 11
main categories, details of some of which are as
follows. (1) Add-on therapy: Karst [46] used a
randomized single-blind placebo control study to
examine the therapeutic effect of acupuncture on 34
patients with alcoholism and found a better effect on
the withdrawal symptoms on the 14th day. (2) Brief
overview: Mittleman [47] provided an overview of
neurophysiology, bioelectricity, and humoral effects,
and then briefly summarized the mechanism of
acupuncture treatment for diseases. (3) Ovarian
morphology: Manneras [48] studied the effect of
electroacupuncture and physical exercise on mRNA
expression of sympathetic markers in adipose tissue of
female rats and in ovarian morphology and found that
the occurrence of polycystic ovary syndrome was due
to increased sympathetic nerve activity. And exercise
can achieve this process by regulating the sympathetic
nerve outflow to adipose tissue and ovaries. (4)
Pediatric pain patients experience: Kemper [49]
described the experience of acupuncture treatment in
children with chronic pain through a retrospective case
study. The analysis showed that 70% of children and
59% of parents believed that acupuncture treatment
can improve symptoms, but in-depth prospective
research is required to quantify the costs and effects of
treatment. Huebscher [50] conducted a prospective
randomized controlled study of the effect of
acupuncture on the symptoms and muscle function of
22 patients with delayed onset muscle soreness. (5)
Acupuncture treatment: Ahsin [51] found that
acupuncture can significantly reduce pain, stiffness,
and disability, and that the related physiological
changes caused by the treatment exceeded the placebo
effect. Chae [52] studied the use of acupuncture and
moxibustion in treating Parkinson’s disease and used
fMRI technology to explore the neural mechanism of
the effect of acupuncture on motor function in
Parkinson’s disease patients. The findings revealed
that acupuncture therapy can improve the condition of
Parkinson’s disease patients through the basal
ganglia-thalamic cortical circuit motor function.
2010–2019. The keyword clustering analysis involved
11 main research categories, details of some of which
are as follows. (1) Neural specificity: Xue [53] verified
the nerve specificity of the block-based general linear
model method by acupuncture treatment for the
gallbladder 40. The findings revealed that the
block-based general linear model method is prone to
error and is not suitable for analysis of the neural
response pattern caused by acupuncture. Bai [54] used
brain fMRI technology to study the nerve specificity of
stimulation of acupuncture point P6 in 36 healthy
subjects and found evidence that that the specific
invasion of the cerebellar hypothalamus and island
process after P6 acupuncture has a sedative effect in
the treatment of vomiting. (2) Inflammatory reaction:
Li [55] conducted randomized controlled animal
experiments to examine the effect of acupuncture on
the expression of NF-kB (nuclear factor-kB), ICAM-1
(intercellular adhesion molecule-1), VCAM-1
(vascular cell adhesion molecule-1), mRNA, and
protein in the brain tissue of rats with cerebral
ischemia-reperfusion injury. The findings revealed that
acupuncture can pass through the frontal lobe and the
parietal cortex, and other proteins are expressed to
improve nerve function. (3) Chronic pain: the study of
chronic pain involves two main areas. The first is
chronic pain in different parts of the body, mainly
involving RCTs of acupuncture treatment of chronic
low back pain [56], chronic neck pain [57], chronic
migraine [58], chronic shoulder pain [59], and other
diseases. The second are is pain caused by disease,
which mainly includes chronic hemophilia pain [60],
chronic knee pain caused by osteoarthritis [61], and
chronic prostatitis-chronic pelvic pain syndrome [62];
these are the main areas of chronic pain research at this
stage. (4) Sleep pattern: research is mainly focused on
the effects of acupuncture on the sleep patterns in
insomnia [63], moderate obstructive sleep apnea [64],
and intestinal colic [65]. (5) Consort statement: it is
mainly reflected in the use of the CONSORT statement
and the STRICTA standard for the quality assessment
of RCT that acupuncture treatment of diseases [66–69].
The quality of these RCTs of acupuncture treatment of
related diseases is unsatisfactory, and they all need
further improvement. (6) Receptor-positive breast
cancer: Walker [70] compared acupuncture and
venlafaxine treatment in 50 breast cancer patients with
vasomotor symptoms. Studies have shown that both
treatments can significantly reduce patients’ hot
flashes, depressive symptoms, and other adverse
quality of life symptoms. (7) Adaptive coping
strategies: Bussing [71] used a questionnaire survey to
assess whether there are differences in social
demographic data, adaptive coping strategies, and
attitudes toward such therapies between users of
acupuncture and homeopathy. The findings revealed
that people using acupuncture are more pragmatic and
that the expected scientific background of the selected
treatment tends to be more obvious. (8) Nurse-led
supportive care: Lim [72] studied the changes in the
symptoms of 42 patients with incurable cancer after
either acupuncture or nurse-led supportive care. The
findings showed that acupuncture may be helpful for
the treatment of advanced incurable diseases because
there are no side effects and good tolerance. Moreover,
the therapeutic effect was also prominent, and
nurse-led supportive care had a greater impact after a
final period of acupuncture treatment for six weeks;
thus, it is worth continuing to study this in depth. (9)
Progesterone level: Fu [73] showed that acupuncture

11. Traditional Medicine Research
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doi: 10.12032/TMR20201023203
can improve certain aspects of cholesterol
crystal-induced endometrial receptivity in rats during
implantation, thereby promoting good reproduction in
female rats.
Burst test comparison. The research hotspots in the
three time periods evolved from the influence of
naloxone on acupuncture analgesia and acupuncture
treatment of chronic pain to placebo-controlled trials
of acupuncture treatment of various diseases. In
addition, the research frontier has transited from the
macro level of acupuncture treatment for female
diseases to the micro level of receptor research.
Conclusion
In summary, analyzing the hot spots of acupuncture
research in three different periods through frontiers,
keyword frequency, centrality, and clustering of
subject words helps researchers in the field to quickly
locate the development and history of the evolution of
acupuncture research and to accurately and quickly
grasp the research trends in this field.
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