Efficacy and Safety of Acupuncture in Managing COPD: An Overview of Systematic Reviews

Figures & data

Figure 1 Flow diagram of study selection. The inclusion and exclusion of systematic reviews studying acupuncture for chronic obstructive pulmonary disease.

Abbreviations: CDSR, Cochrane Database of Systematic Reviews; CNKI, Chinese National Knowledge Infrastructure; VIP, Chinese Science and Technology Periodical Database; CBM, Chinese Biological Medicine Database; Wanfang, The Wanfang Database.

Table 1 Characteristics of Included Systematic Reviews on Acupuncture for COPD

Study	Country	Trails(n)	Intervention	Control	Outcome (s)	Quality assessment tools	Safety	Main Conclusion
Lou 2021^Citation36	China	16 (1425)	Moxibustion + CT	CT	②④⑤⑦⑧	Cochrane	Yes	The efficacy of moxibustion as adjuvant therapy for COPD in stable phase is better than conventional therapy
Wang 2020^Citation37	China	9 (681)	Manual acupuncture/Electroacupuncture/Moxibustion + CT	Sham electroacupuncture + CT or CT	①②③④⑤⑥⑰	Jadad scale	Yes	The efficacy of acupuncture in treating COPD was confirmed, with high safety.
Xie 2019^Citation38	China	8 (498)	Manual acupuncture/Manual acupuncture + ear acupressure/	Sham manual acupuncture + Sham ear acupressure + CT/CT	②④⑦⑨	Cochrane	Yes	Acupuncture appears to improve the lung function and decrease the levels of CAT and mMRC in patients with AECOPD.
Cao 2017^Citation39	China	9 (326)	Manual acupuncture/Electroacupuncture + CT/TENS	Sham manual acupuncture/Sham electroacupuncture + CT or Sham TENS	①③⑤⑥	Cochrane	Unknown	Acupuncture therapy can increase pulmonary function, exercise tolerance, and quality of life in COPD patients.
Yuan 2022^Citation40	China	11 (1050)	Moxibustion + CT	CT	②④⑤⑦⑧	Cochrane	Yes	Governor moxibustion is a safe and effective treatment for COPD
Yu 2022^Citation41	China	10 (756)	Moxibustion + CT	CT	①②③⑤⑦⑧	Cochrane	Unknown	Moxibustion combined with Conventional treatment may improve lung function and exercise endurance of COPD patients.
Coyle 2014^Citation42	Australia	16 (1016)	Manual acupuncture/TENS/Acupoint application	Manual acupuncture + CT/Sham TENS/Sham acupoint application	①③⑤⑥⑦⑪⑫⑬⑭	Cochrane	Yes	Acupuncture therapies may result in clinically important improvements in Quality of life and dyspnea.
Carles 2019^Citation43	Spain	27 (951)	Electroacupuncture/Warm needling/Manual acupuncture/ Manual acupuncture + ear acupuncture + CT	Sham electroacupuncture/Sham manual acupuncture + sham ear acupuncture+CT or CT	①④⑤⑥⑦⑨⑩⑬	Cochrane	Yes	Acupuncture might be beneficial for COPD, but due to the low quality of the studies this should be confirmed by future well-designed trials
Hsieh 2019^Citation44	China	12 (798)	Manual acupuncture/Warm needling + CT	CT	②④⑤⑥⑨	Cochrane	Yes	Acupuncture is an effective adjunctive non-pharmacological treatment to improve quality of life in patients under medical treatment for COPD.
Gu 2023^Citation45	China	17 (1516)	Acupoint catgut embedding +CT	CT	①②④⑯⑰	Cochrane	Yes	The clinical efficacy of acupoint catgut embedding combined with conventional medicine for stable COPD is better than that of conventional medicine
He 2022^Citation46	China	15 (1604)	Acupoint catgut embedding + CT	CT	①②④⑤⑧⑨⑯	Cochrane	Yes	The efficacy of acupuncture combined with Conventional therapy in the treatment of COPD patients is better than conventional therapy alone.
Cheng 2019^Citation47	China	20 (1750)	Acupoint application + CT	CT	④⑥⑯	Cochrane	Unknown	The available evidence suggests that based on the conventional treatment of COPD, the addition of acupoint application therapy can make patients gain more benefits.
Wu 2019^Citation48	China	14 (1293)	Acupoint application + CT	CT	④⑥⑫⑯	Cochrane	Yes	Current effective evidence shows that acupoint application has certain advantages in the prevention and treatment of COPD.
Hu 2019^Citation49	China	14 (1184)	Acupoint application + CT	CT	②④⑥⑨⑯	Cochrane	Yes	Acupoint application plus basic treatment can effectively relieve the clinical symptoms in patients with stable COPD. Its effect is superior to that of basic treatment alone.
Yu 2018^Citation50	China	10 (992)	Acupoint application + CT	CT	①②④⑥⑧	Cochrane	Unknown	For patients with stable COPD, point application can effectively improve lung function, reduce the frequency of acute exacerbation, improve the quality of life
Wei 2022^Citation51	China	10 (472)	TENS + CT	CT	①②⑤⑨⑩⑭	Cochrane	Yes	TENS seems to be effective in improving pulmonary function and health status in patients with COPD, with little effect on exercise capacity and dyspnea.
Pang 2020^Citation52	China	28 (1615)	Acupoint application + CT	CT	①③④⑤⑥⑦⑯	Cochrane	Yes	Acupoint application with CT appears to be more effective than CT or CT plus placebo only on improving the quality of life, but the effect on lung function is not obvious.
Zhou 2014^Citation53	China	21 (2327)	Acupoint application + CT	CT	①⑤⑥⑰	Cochrane	Yes	Acupoint application therapy used as an adjunct to conventional treatment, appears to be more effective than conventional treatment alone in patients with stable COPD.
Huang 2021^Citation54	China	11 (792)	Acupoint autohemotherapy	CT	①③⑤⑥⑦⑧⑨⑮	Cochrane	Yes	The clinical effects of AT plus medicine of the west therapy are better than that of western medicine alone in treating COPD.
Carles 2020^Citation22	Spain	33 (2618)	TENS/Moxibustion/Acupressure/Ear acupuncture + CT	Sham TENS/Sham moxibustion/Sham acupressure/Sham ear acupuncture + CT	①③④⑤⑥⑦⑨⑩	Cochrane	Yes	Acupressure could be beneficial for dyspnoea, quality of life and anxiety
Wang 2023^Citation55	China	16 (1500)	Acupoint application + CT	CT	②④⑥⑧⑨⑫	Cochrane	Yes	Acupoint application combined with conventional treatment in the treatment of COPD has obvious advantages over conventional treatment alone
Yin 2023^Citation56	China	42 (4192)	Acupoint application + CT	CT	④⑥⑨⑫⑯	Cochrane	Yes	Acupoint application can significantly improve the clinical symptoms of COPD patients

Notes: Acupuncture includes one of manual acupuncture, electroacupuncture, acupoint catgut embedding, moxibustion, acupoint application, and transcutaneous electrical nerve stimulation. ① forced expiratory volume in one second (FEV1); ② the percentage of forced expiratory volume in the first second to the expected value (FEV1%); ③ forced vital capacity (FVC); ④ the ratio of forced expiratory volume to forced vital capacity in the first second (FEV1/FVC); ⑤ six-minute walking distance (6MWD); ⑥ St. George’s Respiratory Questionnaire (SGRQ); ⑦ modified Medical Research Council (mMRC) scale; ⑧ acute exacerbation; ⑨ COPD assessment test (CAT); ⑩ dyspnea visual analog scale (DVAS); ⑪ shuttle walk test (SWT); ⑫ Body mass index, Obstruction, Dyspnea, Exercise capacity (BODE); ⑬ Chronic Respiratory Questionnaire (CRQ); ⑭ Borg scale (Borg); ⑮ Body Mass Index (BMI); ⑯ Effective rate ⑰ clinical symptom.

Abbreviation: CT, conventional treatment.

Table 2 Quality of the Included Reviews as Rated on the AMSTAR 2 Scale

Include Studies	Q1	Q 2*	Q3	Q4*	Q5	Q6	Q7*	Q8	Q9*	Q10	Q11*	Q12	Q13*	Q14	Q15*	Q16	Overall Quality
Lou 2021^Citation36	Y	N	N	Y	Y	Y	N	PY	Y	N	Y	Y	Y	Y	Y	N	CL
Wang 2020^Citation37	Y	N	N	PY	N	N	N	PY	Y	N	N	Y	N	Y	Y	N	CL
Xie 2019^Citation38	Y	N	N	PY	Y	N	N	Y	Y	N	Y	N	Y	Y	Y	N	CL
Cao 2017^Citation39	Y	N	N	PY	N	Y	N	PY	Y	N	Y	Y	N	N	N	N	CL
Yuan 2022^Citation40	Y	N	N	PY	Y	Y	N	PY	Y	N	N	Y	Y	N	N	N	CL
Yu 2022^Citation41	Y	N	N	PY	Y	Y	N	PY	Y	N	Y	Y	N	N	N	N	CL
Coyle 2014^Citation42	Y	N	N	PY	Y	Y	N	Y	Y	N	N	Y	Y	Y	Y	Y	CL
Carles 2019^Citation43	Y	Y	N	Y	Y	Y	N	PY	Y	N	Y	Y	Y	Y	Y	Y	L
Hsieh 2019^Citation44	Y	N	N	PY	Y	Y	N	PY	Y	N	Y	Y	Y	N	N	N	CL
Gu 2023^Citation45	Y	N	N	PY	Y	Y	N	PY	Y	N	N	Y	Y	N	Y	N	CL
He 2022^Citation46	Y	N	N	PY	Y	N	N	PY	Y	N	Y	Y	Y	N	Y	N	CL
Cheng 2019^Citation47	Y	N	N	PY	Y	Y	N	PY	Y	N	Y	Y	Y	Y	N	N	CL
Wu 2019^Citation48	Y	N	N	Y	Y	Y	N	PY	Y	N	Y	N	Y	Y	N	N	CL
Hu 2019^Citation49	Y	N	N	Y	Y	Y	N	Y	Y	N	Y	Y	Y	Y	Y	N	CL
Yu 2018^Citation50	Y	N	N	PY	Y	Y	N	PY	Y	N	Y	N	N	N	N	N	CL
Wei 2022^Citation51	Y	N	N	Y	Y	Y	N	Y	Y	N	Y	N	N	Y	N	N	CL
Pang 2020^Citation52	Y	Y	N	Y	N	N	N	Y	Y	N	Y	Y	Y	Y	Y	N	L
Zhou 2014^Citation53	Y	Y	N	Y	Y	Y	N	Y	Y	N	Y	Y	Y	Y	N	N	CL
Huang 2021^Citation54	Y	Y	N	Y	Y	Y	N	Y	Y	N	Y	Y	Y	N	Y	Y	L
Carles 2020^Citation22	Y	Y	N	Y	Y	Y	N	PY	Y	N	Y	Y	Y	Y	N	Y	CL
Wang 2023^Citation55	Y	N	N	PY	Y	Y	N	PY	Y	N	Y	Y	Y	Y	Y	N	CL
Yin 2023^Citation56	Y	N	N	PY	Y	Y	N	PY	Y	N	Y	Y	Y	Y	Y	N	CL
Number (%)	22 (100)	5 (23)	0 (0)	9 (41)	19 (86)	18 (82)	0 (0)	7 (32)	22 (100)	0 (0)	18 (82)	17 (77)	17 (77)	14 (64)	12 (55)	4 (18)

Note: *Key items of the AMSTAR.

Abbreviations: L, low quality; CL, critical low quality; Y, yes; N, no; PY, partial yes. AMSTAR, A Measurement Tool to Assess Systematic Reviews.

Table 3 Risk of Bias of the Included Systematic Reviews Assessed by Risk of Bias in Systematic Reviews

Included Studies	Phase-2				Phase-3
	1.Study Eligibility Criteria	2. Identification and Selection of Studies	3. Data Collection and Study Appraisal	4. Synthesis and Findings	Risk of Bias in the Review
Lou 2021^Citation36	L	H	U	H	H
Wang 2020^Citation37	H	H	U	H	H
Xie 2019^Citation38	L	H	L	H	H
Cao 2017^Citation39	H	H	U	H	H
Yuan 2022^Citation40	L	H	L	H	H
Yu 2022^Citation41	L	H	L	H	H
Coyle 2014^Citation42	L	L	U	H	L
Carles 2019^Citation43	L	L	L	L	L
Hsieh 2019^Citation44	L	H	U	L	L
Gu 2020^Citation45	L	H	L	H	H
He 2022^Citation46	L	H	H	H	H
Cheng 2019^Citation47	H	H	U	U	H
Wu 2019^Citation48	L	H	L	U	H
Hu 2019^Citation49	H	H	U	H	H
Yu 2018^Citation50	L	H	L	H	H
Wei 2022^Citation51	L	L	L	L	L
Pang 2020^Citation52	L	U	U	L	L
Zhou 2014^Citation53	L	L	L	H	H
Huang 2021^Citation54	L	L	L	L	L
Carles 2020^Citation22	L	L	L	L	L
Wang 2023^Citation55	L	H	L	H	H
Yin 2023^Citation56	L	H	L	U	L

Abbreviations: L, low risk; H, high risk; U, unclear risk.

Figure 2 Graphical presentation of PRISMA-A.

Abbreviations: Y, yes; PY, partial yes; N, no; PRISMA-A, Preferred Reporting Items for Systematic Reviews and Meta-analyses for Acupuncture.

Table 4 Result of Lung Function

Intervention		Trails(n)	I2 (%)	Effect (95% CI)	p	Quality
Intervention Group	Control Group
FEV1
Acupoint application + CT	CT	5 (545)	33	MD 0.12 (0.04, 0.20)	P=0.002	High
Acupoint autohemotherapy + CT	CT	5 (348)	94	SMD 0.32 (0.26, 0.39)	P<0.00001	Low
TENS + CT	CT	5 (238)	51	MD 0.13 (0.11, 0.14)	P< 0.00001	Low
Acupoint catgut embedding + CT	CT	8 (724)	0	MD 0.04 (0.00, 0.09)	P=0.04	High
Moxibustion + CT	CT	1 (180)	/	MD 0.54 (0.45, 0.63)	P<0.05	Very Low
Manual acupuncture + CT	Sham acupuncture + CT	1 (62)	/	MD 0.00 (−0.15, 0.15)	P>0.05	Very Low
TENS	Sham TENS	3 (110)	0	MD 0.04 (−0.05, 0.13)	P>0.05	Very Low
Acupoint application	Sham acupoint application	1 (126)	/	MD 0.01 (−0.19, 0.21)	P>0.05	Very Low
Ear acupuncture	Sham ear acupuncture	4 (224)	0	MD 0.05 (−0.05, 0.14)	P=0.33	Low
FEV1%
Moxibustion + CT	CT	13 (1188)	50	MD 4.00 (2.63, 5.37)	P < 0.00001	Moderate
Manual acupuncture + CT	Sham manual acupuncture + CT	8 (494)	86	MD 3.20 (0.56, 5.83)	P=0.02	Low
Electroacupuncture + CT	Sham electroacupuncture + CT	3 (107)	0	MD 8.85 (2.11, 15,59)	P=0.01	Low
Manual acupuncture + ear acupuncture + CT	Sham manual acupuncture + sham ear acupuncture + CT	1 (43)	/	MD 5.40 (2.55, 8.25)	P<0.05	Very Low
Acupoint application + CT	CT	11 (974)	38	MD 3.04 (1.76, 4.33)	P<0.00001	Moderate
TENS	Sham TENS	2 (90)	78	MD 7.79 (−3.46, 19.04)	P=0.17	Very Low
Warm needling+ CT	CT	5 (371)	78	MD 3.40 (0.01, 6.79)	P=0.05	Low
FEV1/FVC
Moxibustion + CT	CT	10 (809)	75	MD 3.56 (1.69, 5.43)	P=0.0002	Low
Electroacupuncture + CT	Sham Electroacupuncture + CT	3 (107)	0	MD10.40 (4.79, 16.01)	p=0.0003	Very Low
Manual acupuncture + CT	CT	5 (373)	84	MD 4.28 (2.44, 6.12)	p<0.00001	Low
Manual acupuncture + ear acupuncture + CT	Sham manual acupuncture + sham ear acupuncture + CT	1 (43)	/	MD 4.97 (2.00, 7.94)	P<0.05	Very Low
Manual acupuncture	CT	1 (61)	/	MD 2.79 (0.23, 5.35)	P<0.05	Very Low
Warm needling+ CT	CT	6 (435)	83	MD 3.03 (−0.57, 6.63)	P=0.1	Low
Acupoint catgut embedding + CT	CT	7 (742)	96	MD 3.75 (−0.56, 8.06)	P=0.09	Low
FVC
Acupoint autohemotherapy + CT	CT	4 (326)	100	SMD 0.34 (0.11, 0.57)	P=0.004	Very Low
Manual Acupuncture +CT	Sham acupuncture +CT	1 (62)	/	MD 0.00 (−0.27, 0.27)	P>0.05	Very Low
TENS	Sham TENS	7 (288)	25	SMD 0.12 (−0.16, 0.39)	P=0.40	Low
Electroacupuncture + CT	Sham electroacupuncture + CT	3 (112)	0	MD 2.01 (−5.25, 9.26)	P=0.59	Low

Abbreviations: TENS, Transcutaneous electrical nerve stimulation; CT, conventional treatment; /, Not available.

Table 5 Result of Exercise Capacity

Intervention		Trails(n)	I2 (%)	Effect (95% CI)	p	Quality
Intervention Group	Control Group
6MWD
Moxibustion + CT	CT	3 (240)	33	MD 35.00 (18.02, 51.99)	P<0.0001	Very Low
Acupoint catgut embedding + CT	CT	4 (428)	0	MD 28.16 (17.31, 39.00)	P<0.00001	Very Low
Acupoint autohemotherapy + CT	CT	4 (249)	99	MD 29.82 (19.31, 40.33)	P<0.00001	Low
Acupoint application + CT	CT	5 (421)	69	MD 16.77 (7.15, 26.39)	p=0.0006	Low
TENS + CT	CT	6 (312)	62	MD 14.68 (6.92, 22.44)	P=0.0002	Very Low
Manual acupuncture + ear acupuncture + CT	Sham manual acupuncture + sham ear acupuncture + CT	1 (43)	/	MD 5.40 (2.55,8.25)	P<0.05	Very Low
Warm needling+ CT	CT	3 (226)	82	MD 51.44 (14.00, 88.88)	P=0.007	Low
Electroacupuncture + CT	Sham Electroacupuncture + CT	2 (71)	0	MD 68.82 (10.81, 126.83)	P=0.02	Very Low
Manual Acupuncture +CT	CT	2 (160)	92	MD 14.23 (−22.17, 50.63)	P=0.44	Very Low
TENS	Sham TENS	3 (128)	0	MD 6.59 (−2.00, 15.19)	P=0.13	Very Low

Abbreviations: TENS, Transcutaneous electrical nerve stimulation; CT, conventional treatment; /, Not available.

Table 6 Result of Quality of Life

Intervention		Trails(n)	I2 (%)	Effect (95% CI)	p	Quality
Intervention Group	Control Group
SGRQ
Manual acupuncture +CT	Sham manual acupuncture + CT	1 (68)	/	MD −10.09 (−18.43, −3.37)	P<0.05	Very Low
Acupoint application + CT	CT	9 (799)	90	MD −6.77 (−9.81, −3.72)	P<0.0001	Low
Electroacupuncture + CT	Sham electroacupuncture + CT	1 (30)	/	MD 6.93 (−14.80, 0.94)	P>0.05	Very Low
TENS	Sham TENS	1 (20)	/	MD 17.80 (−96.22, 60.62)	P>0.05	Very Low
Manual Acupuncture +CT	CT	1 (40)	/	MD 0.30 (−6.83, 7.43)	P=0.93	Very Low
CAT
Moxibustion + CT	CT	5 (453)	88	MD −3.40 (−5.82, −0.98)	P=0.006	Very Low
Acupoint catgut embedding + CT	CT	9 (707)	90	MD −2.39 (−3.65, −1.13)	P=0.0002	Low
Acupoint application + CT	CT	7 (529)	12	MD −3.33 (−3.87, −2.79)	P<0.00001	Moderate
Acupoint autohemotherapy + CT	CT	4 (303)	55	SMD 3.22 (2.72, 3.73)	P<0.00001	Low
Warm needling+ CT	CT	2 (120)	0	MD −4.77 (−6.53, −3.01)	P<0.00001	Moderate
Manual acupuncture + ear acupressure +CT	Sham manual acupuncture + sham ear acupressure + CT	1 (29)	/	MD −4.30 (−6.32, −2.28)	p<0.05	Very Low
Manual acupuncture + acupoint application + CT	Sham manual acupuncture + sham acupoint application + CT	1 (29)	/	MD −4.20 (−6.28, −2.21)	p<0.05	Very Low
TENS + CT	CT	2 (99)	55	MD −4.25 (−5.24, −3.27)	P<0.00001	Low

Abbreviations: TENS, Transcutaneous electrical nerve stimulation; CT, conventional treatment; /, Not available.

Table 7 Result of Dyspnea

Intervention		Trails(n)	I2 (%)	Effect (95% CI)	p	Quality
Intervention Group	Control Group
mMRC
Moxibustion + CT	CT	5 (320)	84	MD −0.52 (−0.88, −0.15)	P=0.006	Very Low
Acupoint application + CT	CT	3 (236)	43	SMD −1.14 (−1.53, - 0.75)	P<0.0001	Low
Acupoint catgut embedding + CT	CT	2 (147)	29	MD −0.15 (−0.29, −0.02)	P=0.03	Low
Manual acupuncture + acupoint application + CT	Sham manual acupuncture + sham acupoint application + CT	1 (29)	/	MD −0.60 (−0.99, −0.20)	P<0.05	Very Low
Manual acupuncture + ear acupressure + CT	Sham manual acupuncture + sham ear acupressure + CT	1 (43)	/	MD −0.90 (−1.24, −0.56)	P<0.05	Very Low
Manual acupuncture + CT	CT	2 (121)	67	MD 0.07 (−0.48, 0.62)	P=0.81	Very Low
Manual acupuncture + CT	Sham acupuncture + CT	1 (62)	/	MD −0.50 (−1.07, 0.07)	P>0.05	Very Low
Borg scale
TENS + CT	CT	2 (90)	77	MD −0.46 (−0.86, −0.06)	P=0.03	Low
Acupoint application + CT	CT	1 (126)	/	MD −0.34 (−0.38, −0.30)	P<0.05	Low
Manual acupuncture + CT	Sham manual acupuncture + CT	1 (62)	/	MD −0.50 (−1.07, 0.07)	p>0.05	Low
Manual acupuncture +CT	CT	2 (121)	0	MD −0.38 (−0.80, 0.04)	p=0.08	Low

Abbreviations: TENS, Transcutaneous electrical nerve stimulation; CT, conventional treatment; /, Not available.

Table 8 Result of Acute Exacerbation

Intervention		Trails(n)	I2 (%)	Effect (95% CI)	p	Quality
Intervention Group	Control Group
Acute Exacerbation
Moxibustion + CT	CT	2 (128)	0	MD −0.31 (−0.49, −0.14)	P=0.0005	Moderate
Acupoint catgut embedding + CT	CT	5 (481)	96	MD −0.54 (−0.91, −0.17)	P=0.004	Low
Acupoint application + CT	CT	6 (626)	45	MD −0.66 (−0.76, −0.57)	P<0.00001	Moderate
Acupoint application + CT	Sham acupoint application + CT	2 (211)	4	MD 0.19 (−0.03, 0.40)	p=0.08	Very Low

Abbreviation: CT, conventional treatment.

Table 9 Types of Acupoints Used for COPD

Acupuncture Therapy	No. of Primary Studies (Total/Reported Studies)	Acupuncture Points (No. of Primary Study)
Acupuncture	42/40	BL13 (21), CV17 (21), ST36 (21), BL23 (18), EX-B1 (13), BL43 (11), BL20 (10), ST40 (9), LU5 (8), KI3 (7), BL12 (7), CV6 (6)
Moxibustion	31/31	Du-meridian (17), BL13 (10), DU14 (6), ST36 (5), BL20 (5), BL12 (4), EX-B1 (3), BL23 (3), ST40 (3)
TENS	11/11	EX-B1 (9), BL13 (4), BL23 (2), ST36 (2), LU7 (1), LU1 (1)
Acupoint catgut embedding	22/22	BL13 (22), BL23 (21), ST36 (18), EX-B1 (18), ST40 (16)
Acupoint application	57/56	BL13 (56), BL23 (28), DU14 (26), EX-B1 (22), BL20 (21), CV22 (19), CV17 (17)
Acupoint autohemotherapy	11/11	BL13 (11), BL23 (10), BL20 (9), ST40 (9)
Acupressure	8/8	GV14 (5), BL13 (4), BL23 (3), LU10 (3), ST36 (2), GV22 (2), CV12 (2), LI4 (2)
Ear acupuncture	6/6	CO14 (6), CO10 (5), CO16 (4), CO13 (3)
Total	188/185	BL13 (128), BL23 (85), EX-B1 (65), ST36 (48), BL20 (45), CV17 (38), ST40 (37), DU14 (32), CV22 (21)

Note: The most frequently used (more than 30% of the included studies in each intervention) acupuncture points.

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