Acupuncture electroceuticals: The convergence of traditional acupuncture theory and modern bioelectronic medicine

Electroceuticals, a term formed by combining "electronic" and "pharmaceuticals," were initially conceptualized as therapeutic devices that modulate neural signal transmission through the application of electrical stimulation.^1,2 Over time, the scope of electroceuticals has expanded beyond the nervous system to include a broader range of excitable and non-excitable tissues.

In recent years, there has been a growing trend of technological advancements integrating electroceuticals with traditional East Asian medicine, particularly those that employ acupuncture treatment.³ In this context, low-frequency electrical stimulation devices targeting acupuncture points—commonly referred to as electroacupuncture and, in some countries, recognized as reimbursable medical treatments—have gained notable clinical relevance. The United States National Institute of Health (NIH) also focuses on promoting the integration of acupoint research and bioelectronic medicine research by launching the Topological Atlas and Repository for Acupoint research (TARA) project in 20,25,⁴ which is a repository construction program for acupuncture related knowledge, in conjunction with the "Stimulating Peripheral Activity to Relieve Conditions (SPARC) program.⁵ This is a representative example of efforts to integrate acupoint research with peripheral nerve stimulation-based disease and symptom management technology, which is the basis of electroceuticals technology.⁶

Electroceuticals derived from electro acupuncture techniques are increasingly referred to in academic and clinical discourse by abbreviations such as “acupuncture electroceuticals” or “acupoint electroceuticals”. This term reflects their dual conceptual foundation, combining traditional acupuncture theories with contemporary bioelectronic mechanisms. Thia maybe useful in distinguishing these devices from those developed solely on biological principles that primarily target the nervous system.

In 2005, FDA approved the first electroceuticals for overactive bladder symptoms targeting, derived from electroacupuncture for SP6 acupoint. Among the electroacupuncture device and practice, the SP6-electroacupuncture stimulation for urinary symptom treatment refined and established as an independent modality as a "low-frequency treatment device equipped with 20 Hz fixed electrical stimulation program” thereby being recognized as an electroceutical administered by healthcare professionals.⁷ Furthermore, it evolved into an implantable electroceuticals that stimulates the posterior tibial nerve, the biological target of this stimulation in 2022 .⁸

Although the acupuncture electroceuticals have been developed from electroacupuncture, their principal focus lies in utilizing the bioelectrical responses elicited by stimulating nerves at the acupuncture points. However, acupuncture points cannot be explained by a single anatomical structure; rather, they are more appropriately understood as epistemological entities defined through the interpretation of distinctive therapeutic responses induced by diverse stimulation techniques (manual, thermal, electrical, etc.).⁹ In this context, acupuncture electroceuticals may be understood as a specialized modality that selectively employs only the bioelectrical responses among the various phenomena elicited by acupoint stimulation in traditional medicine. A principal advantage of electroceuticals lies in their capacity to selectively modulate targeted neural pathways without inducing the systemic side effects commonly associated with pharmacological agents, which arise from metabolic processing and systemic diffusion.^10,11 In practice, however, electroceuticals rarely targets single axons; rather, it stimulates bundles of nerves or fascicles. As a result, unintended neural activation may occur, producing off-target biological responses.¹² For example, a review of adverse effects of spinal cord stimulation for pain management reported that the same stimulation could produce contradictory effects, such as increased or decreased blood pressure.¹³ Furthermore, because electrical stimulation of acupoints is both an electroacupuncture technique and a neuromodulation-based treatment strategy, these two aspects must be considered simultaneously.

In general, the indications for electro-acupuncture in TM are not fixed and can vary depending on the practitioner's goals and patient’s symptom, even if the target acupoints are the same. The existence of multiple indications in TM suggests that acupoint stimulation may act on multiple targets, suggesting that, for example, SP6 stimulation for overactive bladder may act on other undesired targets as well. This unintended biological response may be due to the fact that the nerves at the acupoint are bundles of multiple nerves, or it may be due to other, as-yet-unidentified, meridian effects also. from the perspective of TM experts, various indications for acupoint stimulation in TM text, even if not explicitly stated in the regulatory approval process, are considered valid indications or are understood to be potential adverse effects. However, from the perspective of modern biomedical experts, only the stated indications are considered relevant, and adverse effects not reported in the regulatory approval process are not recognized as important. This creates a conflict of academic and clinical perspective due to the overlap between TM and modern biomedicine. However, from a patient safety perspective, it is necessary to respect the long-standing record of traditional medicine, at least with regard to the risk of adverse effects.

Acupoint electroceuticals encompass a wide range of modalities, including fixed devices employed in clinical settings, portable units intended for patient self-administration under professional supervision, locally applied wearable systems providing continuous real-time stimulation, implantable devices targeting specific acupoint point. Fixed and implantable devices are predominantly administered by healthcare professionals, whereas portable and locally applied wearable systems may allow patients to manage treatment at home under medical prescription. ensuring more consistent therapeutic effects than wearable systems. Therefore, these wearable or implantable systems offer significant advantages in addressing two of the biggest challenges of acupuncture: limited accessibility and ease of use (requiring an in-person visit to a healthcare provider). However, despite their ease of use, wearable and implantable medical devices carry a significantly higher risk of adverse effects than short-term electroacupuncture treatments administered under professional supervision in clinical settings. Long-term use, in particular, requires comprehensive consideration of the various risks of adverse effects not observed in short-term treatments. If these shortcomings can be overcome, it could be a great leap forward in overcoming the spatial and temporal limitations of acupuncture treatment. The distinctive features of electroacupuncture, acupoint based electroceuticals, electroceuticals, are summarized (Supplement 1).

The convergence of traditional acupoint theory and modern bioelectronic medicine may led to the emergence of acupuncture electroceuticals. This integration may expand acupuncture treatment beyond hospital settings into the However, significant differences and gaps in scientific evidence still exist between the acupuncture points of traditional medicine and the neurostimulation of electromedicine. To fully realize this potential, ongoing interdisciplinary collaboration to optimize device design, stimulation protocols, and clinical validation is necessary. Standardized technical standards and regulatory frameworks must be established, and ongoing scientific research must ensure safety, efficacy, and quality control. It may develop new types of electroceuticals by integrating traditional knowledge into therapeutic options for diverse clinical conditions.

Author contributions

Sunmi Choi: Conceptualization, Methodology, Resources, Writing original draft, Writing review & editing. Sanghun Lee: Conceptualization, Methodology, Writing original draft, Writing review & editing.

Funding

This study was funded by the Korea Institute of Oriental Medicine (KSN2511013).

Ethics statement

There are no ethical issues with this article.

Data availability

There are no available data beyond that cited in the references.

Supplementary materials

Declaration of competing interest

The authors declare no other conflicts of interest.

Appendix. Supplementary materials

Supplement 1. Comparison of electroacupuncture treatment, acupuncture electroceuticals, electroceuticals.