Effects and mechanisms of acupuncture on women related health

doi:10.1007/s11684-023-1051-5

Front. Med.

2024, Vol. 18

Issue (1) : 46-67 https://doi.org/10.1007/s11684-023-1051-5

Effects and mechanisms of acupuncture on women related health

Huichao Qin^1,², Jiaxing Feng², Xiaoke Wu²(

)

¹. Department of Reproductive Medicine, Heilongjiang Provincial Hospital, Harbin Institute of Technology, Harbin 150036, China
². Department of Obstetrics and Gynecology, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin 150040, China

Download: PDF(560 KB) HTML
Export: BibTeX | EndNote | Reference Manager | ProCite | RefWorks

Abstract

Globally, public health interventions have resulted in a 30-year increase in women’s life expectancy. However, women’s health has not increased when socioeconomic status is ignored. Women’s health has become a major public health concern, for those women from developing countries are still struggling with infectious and labor-related diseases, and their counterparts in developed countries are suffering from physical and psychological disorders. In recent years, complementary and alternative medicine has attracted wide attentions with regards to maintaining women’s health. Acupuncture, a crucial component of traditional Chinese medicine, has been used to treat many obstetric and gynecological diseases for thousands of years due to its analgesic and anti-inflammatory effects and its effects on stimulating the sympathetic/parasympathetic nervous system. To fully understand the mechanism through which acupuncture exerts its effects in these diseases would significantly extend the list of available interventions and would allow for more reasonable advice to be given to general practitioners. Therefore, by searching PubMed and CNKI regarding the use of acupuncture in treating obstetric and gynecological diseases, we aimed to summarize the proven evidence of using acupuncture in maintaining women’s health by considering both its effectiveness and the underlying mechanisms behind its effects.

Keywords acupuncture women health clinical efficacy mechanism

Corresponding Author(s): Xiaoke Wu

About author:

Li Liu and Yanqing Liu contributed equally to this work.

Just Accepted Date: 04 December 2023 Online First Date: 22 December 2023 Issue Date: 22 April 2024

Cite this article:

Huichao Qin,Jiaxing Feng,Xiaoke Wu. Effects and mechanisms of acupuncture on women related health[J]. Front. Med., 2024, 18(1): 46-67.

URL:

https://academic.hep.com.cn/fmd/EN/10.1007/s11684-023-1051-5
https://academic.hep.com.cn/fmd/EN/Y2024/V18/I1/46

Ref. ID	Disease entities	Design	Sample size	Number of treatments	Interventions	Conclusion	Limitation
25	PD	RCT	74	12 treatments over the course of three menstrual cycles	Group A: LF-MA Group B: HF-MA Group C: LF-EA Group D: HF-EA	Acupuncture can reduce the intensity and duration of pain, with no difference between the four groups, and the effect can be sustained for one year after entering the trial	Small sample size; the acupoint protocol was not provided
26	PD	RCT	600	Three menstrual cycles	Group A: before menstruation at Shiqizhui (EX-B8) Group B: when pain occurred, treated at EX-B8 Group C: before menstruation at Sanyinjiao (SP6), Diji (SP8), Ciliao (BL32), and EX-B8 Group D: when pain occurred, treated at SP6, SP8, BL32, and EX-B8 Group E: no treatment	Treating before menstruation is better than immediately treating when pain occurs; a single point is better than multiple points when treating as soon as pain occurs; and EX-B8 is a convenient point	Adverse events were not mentioned
27	PD	RCT	80	One session	Group A: saline injection at SP6 and the right buttock Group B: vitamin K deep muscle injection in the right buttock and saline injection at a non-acupoint near but not including SP6 Group C: vitamin K injection at SP6 and saline injection in the right buttock	Acupoint injection of vitamin K3 quickly relieves menstrual pain	Small sample size; no mention of adverse events
28	Endome-triosis	RCT	106	A 30-min session once per day, 3 times a week, for 12 weeks giving a total of 39 sessions	Acupuncture: Guanyuan (CV4), bilateral SP6, Taichong (LR3), Zhaohai (KI6), and Qichong (ST30) Sham acupuncture: performed at non-acupoints	Acupuncture can relieve dysmenorrhea, shorten the pain time, and improve well-being and quality of life in women with endometriosis, although its efficacy recedes after the termination of therapy	No mention of adverse events; acupuncturists not blinded to treatment
29	Endome-triosis	RCT	31	Twice a week with intervals of at least 48 h for 16 sessions over 8 weeks	Acupuncture + usual care group: SP6, SP8, Xuehai (SP10), Guilai (ST29), Zusanli (ST36), Zhongji (CV3), CV4, and LR3 Usual care group	Acupuncture is an acceptable and well tolerated therapy that may relieve pelvic discomfort and enhance quality of life	Small sample size
30	Cesarean delivery	RCT	174	Four sessions at 6, 12, 24, and 48 h after surgery	PCIA + sham EA group: PCIA combined with sham acupoints (20 mm away from ST36 and SP6) PCIA + 2 Hz EA group: PCIA combined with acupuncture at ST36 and SP6 at a frequency of 2-Hz continuous wave PCIA + 20/100 Hz EA group: PCIA combined with acupuncture at ST36 and SP6 at the frequency of 20/100 Hz continuous wave	EA can be a safe and effective routine complementary therapy for patient-controlled intravenous analgesia for pain management after cesarean delivery	Limited patient demographic variability; the presence of confounding factors such as mood and sleep
31	Cesarean delivery	RCT	180	One session within 20 min of the cesarean delivery	Acupuncture group: auricular acupoints — namely MA-SC (kidney), MA-TF1, MA-IC1 (lung), MA-AT1 (subcortex) — and body acupoints, including LI4, ST36, SP6, BL25, BL26, and BL27 Placebo acupuncture group: the skin areas around acupoints were treated with a SVESA neural pen Standard care group: received the standard postoperative analgesia	Acupuncture is effective and safe in relieving pain and accelerating the mobilization of patients after cesarean delivery and can be a supplemental or routine therapy for pain control in patients after cesarean delivery	The inability to blind the practitioners; non-randomized groups; a single-center design
32	Vaginal delivery	RCT	360	One session	CSEA + AI group: acupoint injection at ST36 and SP6 combined with CSEA CSEA-only group AI group: acupoint injection at ST36 and SP6 Control group: no intervention	The CSEA + AI group had significantly lower VAS scores, adverse events, and dose of ropivacaine/sufentanil and had shorter labor duration	Not completely double blinded

Tab.1 The RCTs of acupuncture for pain-related conditions affecting women’s health.

Ref. ID	Design	Sample size	Number of treatments	Interventions	Conclusion	Limitation
53	RCT	84	Twice weekly for 2 weeks, once weekly for 6 weeks, and once every other week for 8 weeks, for a total of 14 sessions over 16 weeks	LF-EA: CV3, CV6, ST29, SP6, SP9 stimulated electrically with LF-EA of 2 Hz and LI4, Neiguan (PC6) stimulated manually Physical exercises: brisk walking, cycling, or any other aerobic exercise at least 30 min for no less than 3 days per week No active intervention: received oral information about the benefits of regular physical exercise	LF-EA and physical exercise improved hyperandrogenism and menstrual frequency more effectively than no intervention in PCOS patients. LF-EA was superior to physical exercise in treating hyperandrogenism and oligo/amenorrhea	The variability of sham methods, the location and depth of needling, and the number and duration of treatments
54	RCT	54	Twice a week, with each session separated by an interval of 2–4 days for a total of 32 sessions over 16 weeks	Acupuncture group: Set 1: CV3, CV6, SP6, ST29, Yinlingquan (SP9), LI4, and Baihui (GV20). Set 2: Tianshu (ST25), ST29, CV3, SP9, LI4, GV20, LR3, and PC6 Control group: shallow acupoints through EA without electricity at 4 non-meridian points in the shoulders and upper arms	The treatment of PCOS by acupuncture may be beneficial in improving glucose and lipid metabolism. Sham acupuncture may also improve several aspects of glucose and lipid metabolism through the placebo effect	Some heterogeneities in the results such as body weight; small sample size
55	RCT	1000	Twice a week, with a maximum of 32 acupuncture treatments	Active acupuncture protocol includes Set 1 and Set 2 which was alternated every other treatment. Set 1: GV20, CV6, CV3, ST29, SP9, SP6; Set 2: GV20, ST27, ST29, CV6, CV3, PC6, SP6, LR3 with low- frequency (2 Hz) Sham acupuncture protocol is using the thin needles inserted superficially, < 5 mm, in non- acupuncture points at acromion and lateral on humerus. Needles were not stimulated by manual rotation when inserted. Electrical stimulator was attached to the needles but no stimulation was delivered Clomiphene or placebo: patients started with an initial oral dose of 1 pill of clomiphene (50 mg) from days 3 to 7 of the menstrual cycle. The dosage of oral medication was increased by 1 pill in the absence of ovulation or maintained in the presence of ovulation. The maximum dosage of clomiphene didn’t exceed 150 mg per day or 750 mg per cycle. The treatment could be repeated for up to 4 cycles Group A: active acupuncture plus clomiphene Group B: control acupuncture plus clomiphene Group C: active acupuncture plus placebo Group D: control acupuncture plus placebo	Among Chinese women with PCOS, the use of acupuncture with or without clomiphene, compared with control acupuncture and placebo, did not increase live births	–
57	RCT	32	Twice a week for 10–13 weeks, with two sets of 11 and 13 acupoints alternating every other treatment	Acupuncture group: Set 1: CV3, CV6, ST29, SP6, SP9, LI4, GV20. Set 2: CV3, CV6, ST25, ST29, SP6, LR3, PC6, GV20 Control group: visited the same physical therapists, twice weekly for 10–13 weeks	The treatment with acupuncture can reduce the levels of ovarian and adrenal sex steroid, thereby improving the ovulation rate of lean/overweight PCOS patients	Small sample size; no reporting of adverse events; no use of placebo or sham needles
58	RCT	54	30 min per session for a total of 16 weeks	The treatment protocol was consistent with that of Ref. 54	EA can improve anxiety/depression and quality of life and may influence levels of NE and 5-HT in PCOS patients	Small sample size; no reporting of adverse events
59	RCT	72	Twice weekly for 2 weeks, once weekly for 6 weeks, and once every other week for 8 weeks (14 treatments over 16 weeks)	Acupuncture:CV3, CV6, ST29, SP6, SP9 stimulated electrically with LF-EA of 2 Hz, and LI4, PC6 stimulated manually Exercises: brisk walking, cycling, or any other aerobic exercise at least 30 min, no less than 3 days per week No active intervention: received oral information about the benefits of regular physical exercise No intervention: –	There was a modest improvement in depression and anxiety scores in women treated with acupuncture, and improved HRQoL scores were noted in both intervention groups	The variability of sham methods, location and depth of needling, and the number and duration of treatments

Tab.2 The RCTs of acupuncture for PCOS

Ref. ID	Design	Sample size	Number of treatments	Interventions	Conclusion	Limitation
79	RCT	150	One session at least 30 min before oocyte aspiration	EA group: LI4, Waiguan (TE5), ST29, GV20, and ST36 Control group: 0.25–0.5 mg alfentanil and 0.25 mg atropine	EA has similar anesthetic properties as alfentanil during oocyte aspiration and thus can be an alternative option during oocyte aspiration	Non-blinded; no reporting of adverse events; small sample size
82	RCT	848	Three times, with the first session given after 6–8 days of follicle stimulation, and two sessions given prior to and after ET	Acupuncture group: first treatment: ST29, CV4, Qihai (CV6), SP6 and SP10; 1 h prior to ET: ST29, SP8, SP10, LR3, CV4, one point from Shenmen (HT7), PC6, or GV29, and auricular point Zhigong; following ET: GV20, KI3, ST36, SP6, PC6, and auricular point Shenmen (MA-TF1) Sham acupuncture group: non-insertive acupuncture	Acupuncture at the time of ovarian stimulation and ET resulted in no significant difference in live birth rates	Did not achieve the planned sample size; single blinding; non-identical eligibility criteria
83	RCT	739	Two sessions, with 2 Hz applied for 30 min at 24 h before ET and 30 min after ET	TEAS: 24 h before ET: SP8, ST29, EX-CA1, and SP10 30 min after ET: ST36, Zhongwan (CV12), BL23, CV4, and KI3 Control: IVF treatment	TEAS can increase the pregnancy rate in women undergoing IVF-ET, especially in older women; TEAS can improve endometrial receptivity	Not blinded; no reporting of adverse events
86	RCT	150	Two sessions, 25 min before and after ET	Acupuncture group: body acupoints before ET: PC6, SP8, LR3, GV20, and ST29; after ET: ST36, SP6, SP10, and LI4; and auricular acupuncture: MA-TF1, Zhigong, Neifenmi, and Naodian Control group: lying quietly	Acupuncture during IVF does not increase pregnancy rates, but can make patients more relaxed and optimistic	Single-blinded; small sample size; no reporting of adverse events
87	RCT	848	The same as Ref. 82	The treatment protocol was consistent with that of Ref. 82	Acupuncture can reduce anxiety during ET. Women have reduced emotional well-being 3 months following the IVF cycle, highlighting ongoing unmet psychosocial needs	The same as Ref. 82.
88	RCT	228	Three sessions, including injection on day 9 and immediately before and after ET	Acupuncture group: the acupuncture protocol was consistent with that of Ref. 86 Sham acupuncture group: using sham acupoints that were located close to but not on real acupoints	Acupuncture has a small effect on pregnancy and live birth rates that is not statistically significant, and it is safe for women undergoing ET	Single-blindness; no reporting of adverse events

Tab.3 The RCTs of acupuncture for infertility undergoing IVF-ET

Ref. ID	Design	Sample size	Number of treatments	Interventions	Conclusion	Limitation
109	RCT	33	3 times a day, 30 min each time, for 7 consecutive days	Group A: deep acupuncture at PC6 on days 1, 2, 5, and 6 and acupuncture at PC6 on days 3 and 4 Group B: superficial acupuncture at PC6 on days 1, 2, 5, and 6 and deep acupuncture at PC6 on days 3 and 4	In comparison with placebo, acupuncture at PC6 may help HG patients recover better and faster	Small sample size; single-blindness; no reporting of adverse events
110	RCT	593	The first week was treated twice, then once a week for a total of 4 weeks	Traditional acupuncture: the liver qi stagnation pattern for CV12, PC6, Yanglingquan (GB34), Shangwan (CV13), Youmen (KI21), Liangqiu (ST34), ST36; the stomach or spleen qi deficiency pattern for ST36, PC6, CV12; the stomach heat pattern for Neiting (ST44), Jianli (CV11), ST34, Liangmen (ST21), PC6 and Quze (PC3); the phlegm pattern for ST40,SP9, Burong (ST19), Pishu (BL20), KI21; the heart qi deficiency pattern for Tongli (HE5), PC6, ST36, Juque (CV14); the heart fire pattern for PC6, CV14, Xinshu (BL15) P6 acupuncture: PC6 Sham acupuncture: acupuncture needles inserted into an area close to, but not on, acupuncture points Control group: no acupuncture	Acupuncture is an effective treatment for women who experience nausea and dry retching in early pregnancy. A time-related placebo effect was found for some women	Single-blindness; no reporting of adverse events
111	RCT	90	4 times a day, 10 min each time for 5 consecutive days	The acupressure group: PC6 pressure The sham acupressure group: pressure at TE5 The medication group: vitamin B6 (tab 40 mg, oral) 1/2 tab every 8 h and metoclopramide (tab 5 mg, oral) 5 mg every 8 h	It seems that PC6 acupoint pressure can reduce the severity of nausea, vomiting, and retching in pregnant women	Small sample size; single-blindness; no reporting of adverse events
112	RCT	66	7 days	The acupressure group: SeaBands on PC6 point and identical looking tablets were used as placebo in the same regimen as vitamin B6 The vitamin B6 group: SeaBands on the dummy point and 50 mg tablets of vitamin B6 were prescribed every 12 h for 5 days	Acupressure therapy is not more effective than vitamin B6 in reducing nausea and vomiting in symptomatic women in the first trimester of pregnancy	Single-blindness; not reported adverse events
113	RCT	128	Three times a day, for 30 s for 4 days	Auriculotherapy group: point zero, stomach, sympathetic autonomic, Shen Men cardia The sham control group: the points where these magnetic seeds were placed (e.g., the vision, knee, shoulder, and eyes) had no effects on the nausea and vomiting	Pregnant women who experience nausea may achieve relief with the proper application of effective points on the ears to manage nausea and vomiting as a supplementary and alternative therapy	Not reported adverse events
116	RCT	352	Acupuncture treatment for 30 min per day, up to 14 sessions over 2 weeks	Placebo plus acupuncture group: the core points were PC6 and ST36, and adjuvant points included the liver heat pattern for LR3, the stomach deficiency pattern for CV12, and the phlegm-dampness pattern for Fenglong (ST40) Doxylamine–pyridoxine plus sham acupuncture group: sham acupuncture was a pragmatic placebo needle on sham acupoints with the same acupuncture protocol Acupuncture plus doxylamine–pyridoxine group Placebo plus sham acupuncture group	Both acupuncture and doxylamine–pyridoxine alone was efficacious for moderate to severe NVP. Their combination may yield a potentially greater benefit than each alone	–

Tab.4 The RCTs of acupuncture for NVP

Tab.5 The RCTs of acupuncture for perinatal complications

Ref. ID	Design	Sample size	Number of treatments	Interventions	Conclusion	Limitation
138	RCT	209	20 sessions decided by the acupuncturist and patient within the first 6 months (acupuncture group) or within the second 6 months (waitlist control group)	Acupuncture needling based on anatomical location	Acupuncture treatments was associated with significant reduction in VMS and several quality-of-life measures compared with no acupuncture, and the clinical benefit persisted for at least 6 months after treatment	No reporting of specific acupoints; potential unreliability and risk of bias associated with self-reporting of VMS
139	RCT	40	Acupuncture for 12 weekly treatments and three capsules of Chinese medicine orally with water twice per day	TCM acupoints: CV4, GV20, PC6, ST36, SP6, LI4, KI3, and Fengchi (GB20) and 7–10 supplementary acupoints based on individual’s TCM syndrome type as determined by TCM practitioners, i.e., kidney yang with spleen yang deficiency: Pishu (BL20), BL23, SP9, CV6; kidney yin with liver yin deficiency: Ganshu (BL18), BL23, Yinxi (HT6), KI6, LR3 Sham acupoint: needles were inserted superficially into seven bilateral sites that did not correspond to established TCM acupoints	TCM acupoints were superior to sham acupoint and verum CHM in reducing menopausal symptoms, whereas verum CHM showed no significant improvements when compared with placebo CHM	Small sample size; did not take into account TCM treatment principles
140	RCT	70	One treatment per week for five consecutive weeks	The intervention group: CV3, CV4, Ququan (LR8), SP6, and SP9 for the first 5 weeks The control group: the same protocol as the intervention group after 6 weeks	The standardized and brief acupuncture treatment produced a fast and clinically relevant reduction in moderate-to-severe menopausal symptoms during the six-week intervention	Small sample size; lack of placebo; no correct acupuncture technique training; not double-blinded
141	RCT	76	3 times per week for 10 times sessions	Acupuncture group: BL23 and BL18 with unilateral Qimen (LR14) and Jingmen (GB25) Placebo-acupuncture group: Streitberger needles at the same acupoints	Acupuncture can contribute to improvement in the short term treatment of PMI, both subjectively and objectively	Small sample size
143	RCT	360	24 sessions, 30 min each session, over 8 weeks (3 times per week)	EA group: CV4 and ST25, EX-CA1, SP6 Sham EA group: nonacupoints laterally and horizontally 1–2 cun (approximately 1–2 inches) away from the corresponding acupoints	Although it seemed to improve the quality of life, 8 weeks of EA might not relieve menopausal symptoms among women during menopause transition	Small sample size
144	RCT	68	One tablet once daily and 3 sessions per week of LA for 12 weeks	Drug group: oral calcium and vitamin D3 supplement containing fluoride Drug/LA group: oral calcium and vitamin D3 supplement containing fluoride plus LA including CV4, Mingmen (GV4) and bilaterally Dazhu (BL11), BL18, BL20, BL23, ST36, SP6, GB25, Yanglingquan (GB34), and Xuanzhong (GB39)	LA in combination with calcium and vitamin D supplementation containing fluoride is an effective modality for improving forearm BMD and reducing pain in osteoporotic post-menopausal women	Small sample size; lack of follow-up to assess the lasting effect of LA on BMD and pain; non-blinded

Tab.6 The RCTs of acupuncture for menopausal transition

1	SJ Blumenthal. Critical women’s health issues in the 21st century. JAMA 2000; 283(5): 667 https://doi.org/10.1001/jama.283.5.667-JMS0202-3-1
2	CA Stuenkel, JE Manson. Women’s health—traversing medicine and public policy. N Engl J Med 2021; 384(22): 2073–2076 https://doi.org/10.1056/NEJMp2105292
3	MS Fejzo, J Trovik, IJ Grooten, K Sridharan, TJ Roseboom, Å Vikanes, RC Painter, PM Mullin. Nausea and vomiting of pregnancy and hyperemesis gravidarum. Nat Rev Dis Primers 2019; 5(1): 62 https://doi.org/10.1038/s41572-019-0110-3
4	J O’Heney, S McAllister, M Maresh, M Blott. Fetal monitoring in labour: summary and update of NICE guidance. BMJ 2022; 379: o2854 https://doi.org/10.1136/bmj.o2854
5	ER Duralde, TH Sobel, JE Manson. Management of perimenopausal and menopausal symptoms. BMJ 2023; 382: e072612 https://doi.org/10.1136/bmj-2022-072612
6	J Qiu. China plans to modernize traditional medicine. Nature 2007; 446(7136): 590–591 https://doi.org/10.1038/446590a
7	H Williams, L Sweet, K Graham. Acupuncture during pregnancy and the perinatal period: women’s attitudes, beliefs and practices. Women Birth 2020; 33(3): e286–e294 https://doi.org/10.1016/j.wombi.2019.04.010
8	TJ Kaptchuk. Acupuncture: theory, efficacy, and practice. Ann Intern Med 2002; 136(5): 374–383 https://doi.org/10.7326/0003-4819-136-5-200203050-00010
9	S Chang. The meridian system and mechanism of acupuncture—a comparative review. Part 1: the meridian system. Taiwan J Obstet Gynecol 2012; 51(4): 506–514 https://doi.org/10.1016/j.tjog.2012.09.004
10	SM Reverby. Acupuncture’s radical roots and political branches. Am J Public Health 2021; 111(5): 760–761 https://doi.org/10.2105/AJPH.2021.306199
11	WHO. WHO global report on traditional and complementary medicine 2019. 2019. Available at the website of WHO (accessed September 11, 2023)
12	T Chen, WW Zhang, YX Chu, YQ Wang. Acupuncture for pain management: molecular mechanisms of action. Am J Chin Med 2020; 48(4): 793–811 https://doi.org/10.1142/S0192415X20500408
13	J Feng, J Wang, Y Zhang, Y Zhang, L Jia, D Zhang, J Zhang, Y Han, S Luo. The efficacy of complementary and alternative medicine in the treatment of female infertility. Evid Based Complement Alternat Med 2021; 2021: 6634309 https://doi.org/10.1155/2021/6634309
14	L Lu, Y Zhang, X Tang, S Ge, H Wen, J Zeng, L Wang, Z Zeng, G Rada, C Ávila, C Vergara, Y Tang, P Zhang, R Chen, Y Dong, X Wei, W Luo, L Wang, G Guyatt, C Tang, N Xu. Evidence on acupuncture therapies is underused in clinical practice and health policy. BMJ 2022; 376: e067475 https://doi.org/10.1136/bmj-2021-067475
15	S Zuarez-Easton, O Erez, N Zafran, J Carmeli, G Garmi, R Salim. Pharmacologic and nonpharmacologic options for pain relief during labor: an expert review. Am J Obstet Gynecol 2023; 228(5 5S): S1246–S1259 https://doi.org/10.1016/j.ajog.2023.03.003
16	SG Fletcher, PE Zimmern. Differential diagnosis of chronic pelvic pain in women: the urologist’s approach. Nat Rev Urol 2009; 6(10): 557–562 https://doi.org/10.1038/nrurol.2009.178
17	S Iacovides, I Avidon, FC Baker. What we know about primary dysmenorrhea today: a critical review. Hum Reprod Update 2015; 21(6): 762–778 https://doi.org/10.1093/humupd/dmv039
18	N Sinaii, SD Cleary, N Younes, ML Ballweg, P Stratton. Treatment utilization for endometriosis symptoms: a cross-sectional survey study of lifetime experience. Fertil Steril 2007; 87(6): 1277–1286 https://doi.org/10.1016/j.fertnstert.2006.11.051
19	S Teal, A Edelman. Contraception selection, effectiveness, and adverse effects: a review. JAMA 2021; 326(24): 2507–2518 https://doi.org/10.1001/jama.2021.21392
20	HS Taylor, AM Kotlyar, VA Flores. Endometriosis is a chronic systemic disease: clinical challenges and novel innovations. Lancet 2021; 397(10276): 839–852 https://doi.org/10.1016/S0140-6736(21)00389-5
21	PL Shipman. Why is human childbirth so painful?. American Scientist 2013; 101(6): 426 https://doi.org/10.1511/2013.105.426
22	CA Smith, CT Collins, KM Levett, M Armour, HG Dahlen, AL Tan, B Mesgarpour. Acupuncture or acupressure for pain management during labour. Cochrane Database Syst Rev 2020; 2(2): CD009232 https://doi.org/10.1002/14651858.CD009232.pub2
23	on Practice Bulletins—Obstetrics Committee. Practice Bulletin No. 177: obstetric analgesia and anesthesia. Obstet Gynecol 2017; 129(4): e73–e89 https://doi.org/10.1097/AOG.0000000000002018
24	C Bucstain, G Garmi, N Zafran, S Zuarez-Easton, J Carmeli, R Salim. Risk factors and peripartum outcomes of failed epidural: a prospective cohort study. Arch Gynecol Obstet 2017; 295(5): 1119–1125 https://doi.org/10.1007/s00404-017-4337-5
25	M Armour, HG Dahlen, X Zhu, C Farquhar, CA Smith. The role of treatment timing and mode of stimulation in the treatment of primary dysmenorrhea with acupuncture: an exploratory randomised controlled trial. PLoS One 2017; 12(7): e0180177 https://doi.org/10.1371/journal.pone.0180177
26	YX Ma, XN Ye, CZ Liu, PY Cai, ZF Li, DQ Du, G Guo, SZ Chen, JP Zhao, JJ Liu, HQ Yi, SZ Gao. A clinical trial of acupuncture about time-varying treatment and points selection in primary dysmenorrhea. J Ethnopharmacol 2013; 148(2): 498–504 https://doi.org/10.1016/j.jep.2013.04.045
27	C Wade, L Wang, WJ Zhao, F Cardini, F Kronenberg, SQ Gui, Z Ying, NQ Zhao, MT Chao, J Yu. Acupuncture point injection treatment of primary dysmenorrhoea: a randomised, double blind, controlled study. BMJ Open 2016; 6(1): e008166 https://doi.org/10.1136/bmjopen-2015-008166
28	PS Li, XM Peng, XX Niu, L Xu, E Hung Yu Ng, CC Wang, JF Dai, J Lu, RN Liang. Efficacy of acupuncture for endometriosis-associated pain: a multicenter randomized single-blind placebo-controlled trial. Fertil Steril 2023; 119(5): 815–823 https://doi.org/10.1016/j.fertnstert.2023.01.034
29	M Armour, AE Cave, SM Schabrun, GZ Steiner, X Zhu, J Song, J Abbott, CA Smith. Manual acupuncture plus usual care versus usual care alone in the treatment of endometriosis-related chronic pelvic pain: a randomized controlled feasibility study. J Altern Complement Med 2021; 27(10): 841–849 https://doi.org/10.1089/acm.2021.0004
30	Y Jin, X Yu, S Hu, L Liu, B Wang, Y Feng, Y Li, B Xiong, L Wang. Efficacy of electroacupuncture combined with intravenous patient-controlled analgesia after cesarean delivery: a randomized clinical trial. Am J Obstet Gynecol MFM 2023; 5(2): 100826 https://doi.org/10.1016/j.ajogmf.2022.100826
31	TI Usichenko, BJ Henkel, C Klausenitz, T Hesse, G Pierdant, M Cummings, K Hahnenkamp. Effectiveness of acupuncture for pain control after cesarean delivery: a randomized clinical trial. JAMA Netw Open 2022; 5(2): e220517 https://doi.org/10.1001/jamanetworkopen.2022.0517
32	L Wu, H Zhao, Z Zhang, M Huang, S Wu, C Fang, R Wang, S Li, W Yi, A Zhou. Combined spinal-epidural anesthesia with acupoint injection for labor anesthesia reduces IL-1β/IL-10 ratio in maternal peripheral blood, umbilical cord blood and improves the labor outcomes: a prospective randomized controlled trial. Clin Immunol 2022; 236: 108935 https://doi.org/10.1016/j.clim.2022.108935
33	KC Bishop, AC Ford, JA Kuller, S Dotters-Katz. Acupuncture in obstetrics and gynecology. Obstet Gynecol Surv 2019; 74(4): 241–251 https://doi.org/10.1097/OGX.0000000000000663
34	KA Kho, JK Shields. Diagnosis and management of primary dysmenorrhea. JAMA 2020; 323(3): 268–269 https://doi.org/10.1001/jama.2019.16921
35	AW Horne, SA Missmer. Pathophysiology, diagnosis, and management of endometriosis. BMJ 2022; 379: e070750 https://doi.org/10.1136/bmj-2022-070750
36	JH Lee, KJ Jang, YT Lee, YH Choi, BT Choi. Electroacupuncture inhibits inflammatory edema and hyperalgesia through regulation of cyclooxygenase synthesis in both peripheral and central nociceptive sites. Am J Chin Med 2006; 34(6): 981–988 https://doi.org/10.1142/S0192415X06004454
37	S Liu, Z Wang, Y Su, L Qi, W Yang, M Fu, X Jing, Y Wang, Q Ma. A neuroanatomical basis for electroacupuncture to drive the vagal-adrenal axis. Nature 2021; 598(7882): 641–645 https://doi.org/10.1038/s41586-021-04001-4
38	L Mingfu, D Xiaotong, S Xiaojing, J Jin, Z Jinling, H Ying. Study on the dynamic compound structure composed of mast cells, blood vessels, and nerves in rat acupoint. Evid Based Complement Alternat Med 2013; 2013: 160651 https://doi.org/10.1155/2013/160651
39	Y Li, Y Yu, Y Liu, W Yao. Mast cells and acupuncture analgesia. Cells 2022; 11(5): 860 https://doi.org/10.3390/cells11050860
40	P Boadas-Vaello, S Castany, J Homs, B Álvarez-Pérez, M Deulofeu, E Verdú. Neuroplasticity of ascending and descending pathways after somatosensory system injury: reviewing knowledge to identify neuropathic pain therapeutic targets. Spinal Cord 2016; 54(5): 330–340 https://doi.org/10.1038/sc.2015.225
41	ML Hu, FY Zhou, JJ Liu, Y Ding, JM Zhong, MX Ding. Electroacupuncture inhibits the activation of p38MAPK in the central descending facilitatory pathway in rats with inflammatory pain. Evid Based Complement Alternat Med 2017; 2017: 7531060 https://doi.org/10.1155/2017/7531060
42	Z Lyu, Y Guo, Y Gong, W Fan, B Dou, N Li, S Wang, Y Xu, Y Liu, B Chen, Y Guo, Z Xu, X Lin. The role of neuroglial crosstalk and synaptic plasticity-mediated central sensitization in acupuncture analgesia. Neural Plast 2021; 2021: 8881557 https://doi.org/10.1155/2021/8881557
43	T Huang, L Yang, S Jia, X Mu, M Wu, H Ye, W Liu, X Cheng. Capillary blood flow in patients with dysmenorrhea treated with acupuncture. J Tradit Chin Med 2013; 33(6): 757–760 https://doi.org/10.1016/S0254-6272(14)60008-X
44	YX Ma, LX Ma, XL Liu, YX Ma, K Lv, D Wang, JP Liu, JM Xing, HJ Cao, SZ Gao, J Zhu. A comparative study on the immediate effects of electroacupuncture at Sanyinjiao (SP6), Xuanzhong (GB39) and a non-meridian point, on menstrual pain and uterine arterial blood flow, in primary dysmenorrhea patients. Pain Med 2010; 11(10): 1564–1575 https://doi.org/10.1111/j.1526-4637.2010.00949.x
45	M Anim-Somuah, RM Smyth, AM Cyna, A Cuthbert. Epidural versus non-epidural or no analgesia for pain management in labour. Cochrane Database Syst Rev 2018; 5: CD000331 https://doi.org/10.1002/14651858.CD000331.pub4
46	JJ Wang, FG Yang, CC Tsai, AS Chao. The neural basis of pain during labor. Am J Obstet Gynecol 2023; 228(5 5S): S1241–S1245 https://doi.org/10.1016/j.ajog.2023.02.012
47	W Wang, N Sung, A Gilman-Sachs, J Kwak-Kim. T helper (Th) cell profiles in pregnancy and recurrent pregnancy losses: Th1/Th2/Th9/Th17/Th22/Tfh Cells. Front Immunol 2020; 11: 2025 https://doi.org/10.3389/fimmu.2020.02025
48	WY Yu, LX Ma, Y Tian, JD Mu, Z Zhang, TY Sun, X Qian, JX Wang. Acupuncture alleviates menstrual pain in rat model via suppressing eotaxin/CCR3 axis to weak EOS-MC activation. Evid Based Complement Alternat Med 2022; 2022: 4571981 https://doi.org/10.1155/2022/4571981
49	HF Escobar-Morreale. Polycystic ovary syndrome: definition, aetiology, diagnosis and treatment. Nat Rev Endocrinol 2018; 14(5): 270–284 https://doi.org/10.1038/nrendo.2018.24
50	S Palomba. Is fertility reduced in ovulatory women with polycystic ovary syndrome? An opinion paper. Hum Reprod 2021; 36(9): 2421–2428 https://doi.org/10.1093/humrep/deab181
51	R Azziz, E Carmina, Z Chen, A Dunaif, JSE Laven, RS Legro, D Lizneva, B Natterson-Horowtiz, HJ Teede, BO Yildiz. Polycystic ovary syndrome. Nat Rev Dis Primers 2016; 2(1): 16057 https://doi.org/10.1038/nrdp.2016.57
52	V Calcaterra, E Verduci, H Cena, VC Magenes, CF Todisco, E Tenuta, C Gregorio, R De Giuseppe, A Bosetti, E Di Profio, G Zuccotti. Polycystic ovary syndrome in insulin-resistant adolescents with obesity: the role of nutrition therapy and food supplements as a strategy to protect fertility. Nutrients 2021; 13(6): 1848 https://doi.org/10.3390/nu13061848
53	E Jedel, F Labrie, A Odén, G Holm, L Nilsson, PO Janson, AK Lind, C Ohlsson, E Stener-Victorin. Impact of electro-acupuncture and physical exercise on hyperandrogenism and oligo/amenorrhea in women with polycystic ovary syndrome: a randomized controlled trial. Am J Physiol Endocrinol Metab 2011; 300(1): E37–E45 https://doi.org/10.1152/ajpendo.00495.2010
54	J Johansson, L Redman, PP Veldhuis, A Sazonova, F Labrie, G Holm, G Johannsson, E Stener-Victorin. Acupuncture for ovulation induction in polycystic ovary syndrome: a randomized controlled trial. Am J Physiol Endocrinol Metab 2013; 304(9): E934–E943 https://doi.org/10.1152/ajpendo.00039.2013
55	XK Wu, E Stener-Victorin, HY Kuang, HL Ma, JS Gao, LZ Xie, LH Hou, ZX Hu, XG Shao, J Ge, JF Zhang, HY Xue, XF Xu, RN Liang, HX Ma, HW Yang, WL Li, DM Huang, Y Sun, CF Hao, SM Du, ZW Yang, X Wang, Y Yan, XH Chen, P Fu, CF Ding, YQ Gao, ZM Zhou, CC Wang, TX Wu, JP Liu, EHY Ng, RS Legro, H; PCOSAct Study Group Zhang. Effect of acupuncture and clomiphene in Chinese women with polycystic ovary syndrome: a randomized clinical trial. JAMA 2017; 317(24): 2502–2514 https://doi.org/10.1001/jama.2017.7217
56	RS Legro, RG Brzyski, MP Diamond, C Coutifaris, WD Schlaff, P Casson, GM Christman, H Huang, Q Yan, R Alvero, DJ Haisenleder, KT Barnhart, GW Bates, R Usadi, S Lucidi, V Baker, JC Trussell, SA Krawetz, P Snyder, D Ohl, N Santoro, E Eisenberg, H; NICHD Reproductive Medicine Network Zhang. Letrozole versus clomiphene for infertility in the polycystic ovary syndrome. N Engl J Med 2014; 371(2): 119–129 https://doi.org/10.1056/NEJMoa1313517
57	RS Legro, HX Barnhart, WD Schlaff, BR Carr, MP Diamond, SA Carson, MP Steinkampf, C Coutifaris, PG McGovern, NA Cataldo, GG Gosman, JE Nestler, LC Giudice, PC Leppert, ER; Cooperative Multicenter Reproductive Medicine Network Myers. Clomiphene, metformin, or both for infertility in the polycystic ovary syndrome. N Engl J Med 2007; 356(6): 551–566 https://doi.org/10.1056/NEJMoa063971
58	X Chen, Y Lan, L Yang, Y Liu, H Li, X Zhu, Y Zhao, C Long, M Wang, Q Xie, Z Li, J Wu. Acupuncture combined with metformin versus metformin alone to improve pregnancy rate in polycystic ovary syndrome: a systematic review and meta-analysis. Front Endocrinol (Lausanne) 2022; 13: 978280 https://doi.org/10.3389/fendo.2022.978280
59	HX Dong, Q Wang, Z Wang, XK Wu, L Cheng, ZM Zhou, L Yang, P Yi, DM Huang. Impact of low frequency electro-acupuncture on glucose and lipid metabolism in unmarried PCOS women: a randomized controlled trial. Chin J Integr Med 2021; 27(10): 737–743 https://doi.org/10.1007/s11655-021-3482-z
60	Z Wang, H Dong, Q Wang, L Zhang, X Wu, Z Zhou, L Yang, D Huang. Effects of electroacupuncture on anxiety and depression in unmarried patients with polycystic ovarian syndrome: secondary analysis of a pilot randomised controlled trial. Acupunct Med 2019; 37(1): 40–46 https://doi.org/10.1136/acupmed-2017-011615
61	E Stener-Victorin, G Holm, PO Janson, D Gustafson, M Waern. Acupuncture and physical exercise for affective symptoms and health-related quality of life in polycystic ovary syndrome: secondary analysis from a randomized controlled trial. BMC Complement Altern Med 2013; 13(1): 131 https://doi.org/10.1186/1472-6882-13-131
62	R Azziz, E Carmina, D Dewailly, E Diamanti-Kandarakis, HF Escobar-Morreale, W Futterweit, OE Janssen, RS Legro, RJ Norman, AE Taylor, SF; Task Force on the Phenotype of the Polycystic Ovary Syndrome of The Androgen Excess Witchel, Society PCOS. The Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome: the complete task force report. Fertil Steril 2009; 91(2): 456–488 https://doi.org/10.1016/j.fertnstert.2008.06.035
63	E Stener-Victorin, Q Deng. Epigenetic inheritance of polycystic ovary syndrome—challenges and opportunities for treatment. Nat Rev Endocrinol 2021; 17(9): 521–533 https://doi.org/10.1038/s41574-021-00517-x
64	E Stener-Victorin, M Maliqueo, M Soligo, V Protto, L Manni, E Jerlhag, M Kokosar, A Sazonova, CJ Behre, M Lind, C Ohlsson, K Højlund, A Benrick. Changes in HbA1c and circulating and adipose tissue androgen levels in overweight-obese women with polycystic ovary syndrome in response to electroacupuncture. Obes Sci Pract 2016; 2(4): 426–435 https://doi.org/10.1002/osp4.78
65	G Xu, A Zhang, J Liu, X Wang, J Feng, Y Chen. Effects of electroacupuncture on ovarian expression of the androgen receptor and connexin 43 in rats with letrozole-induced polycystic ovaries. Evid Based Complement Alternat Med 2020; 2020: 3608062 https://doi.org/10.1155/2020/3608062
66	J Sun, C Jin, H Wu, J Zhao, Y Cui, H Liu, L Wu, Y Shi, B Zhu. Effects of electro-acupuncture on ovarian P450arom, P450c17α and mRNA expression induced by letrozole in PCOS rats. PLoS One 2013; 8(11): e79382 https://doi.org/10.1371/journal.pone.0079382
67	Y Feng, J Johansson, R Shao, L Mannerås-Holm, H Billig, E Stener-Victorin. Electrical and manual acupuncture stimulation affect oestrous cyclicity and neuroendocrine function in an 5α-dihydrotestosterone-induced rat polycystic ovary syndrome model. Exp Physiol 2012; 97(5): 651–662 https://doi.org/10.1113/expphysiol.2011.063131
68	E Diamanti-Kandarakis, A Dunaif. Insulin resistance and the polycystic ovary syndrome revisited: an update on mechanisms and implications. Endocr Rev 2012; 33(6): 981–1030 https://doi.org/10.1210/er.2011-1034
69	A Dunaif, KR Segal, DR Shelley, G Green, A Dobrjansky, T Licholai. Evidence for distinctive and intrinsic defects in insulin action in polycystic ovary syndrome. Diabetes 1992; 41(10): 1257–1266 https://doi.org/10.2337/diab.41.10.1257
70	M Kokosar, A Benrick, A Perfilyev, E Nilsson, T Källman, C Ohlsson, C Ling, E Stener-Victorin. A single bout of electroacupuncture remodels epigenetic and transcriptional changes in adipose tissue in polycystic ovary syndrome. Sci Rep 2018; 8(1): 1878 https://doi.org/10.1038/s41598-017-17919-5
71	A Benrick, M Kokosar, M Hu, M Larsson, M Maliqueo, RR Marcondes, M Soligo, V Protto, E Jerlhag, A Sazonova, CJ Behre, K Højlund, P Thorén, E Stener-Victorin. Autonomic nervous system activation mediates the increase in whole-body glucose uptake in response to electroacupuncture. FASEB J 2017; 31(8): 3288–3297 https://doi.org/10.1096/fj.201601381R
72	A Benrick, NJ Pillon, E Nilsson, E Lindgren, A Krook, C Ling, E Stener-Victorin. Electroacupuncture mimics exercise-induced changes in skeletal muscle gene expression in women with polycystic ovary syndrome. J Clin Endocrinol Metab 2020; 105(6): 2027–2041 https://doi.org/10.1210/clinem/dgaa165
73	J Wu, X Chen. Acupuncture therapy protects PCOS patients with diabetes by regulating miR-32-3p/PLA2G4A pathway. Am J Transl Res 2021; 13(8): 8819–8832
74	F Zhang, T Ma, X Tong, Y Liu, P Cui, X Xu, J Shi, W Hu, W Lu, Z Pei, M Xu, X Li, C Xu, Y Feng. Electroacupuncture improves metabolic and ovarian function in a rat model of polycystic ovary syndrome by decreasing white adipose tissue, increasing brown adipose tissue, and modulating the gut microbiota. Acupunct Med 2022; 40(4): 347–359 https://doi.org/10.1177/09645284211056663
75	HL Zhang, ZJ Huo, HN Wang, W Wang, CQ Chang, L Shi, D Li, R Li, J Qiao. Acupuncture ameliorates negative emotion in PCOS patients: a randomized controlled trial. Chin Acupunct Moxibustion (Zhongguo Zhen Jiu) 2020; 40(4): 385–390 https://doi.org/10.13703/j.0255-2930.20191231-k0005
76	N Chaudhari, M Dawalbhakta, L Nampoothiri. GnRH dysregulation in polycystic ovarian syndrome (PCOS) is a manifestation of an altered neurotransmitter profile. Reprod Biol Endocrinol 2018; 16(1): 37 https://doi.org/10.1186/s12958-018-0354-x
77	A Busnelli, M Reschini, L Cardellicchio, W Vegetti, E Somigliana, P Vercellini. How common is real repeated implantation failure? An indirect estimate of the prevalence.. Reprod Biomed Online 2020; 40(1): 91–97 https://doi.org/10.1016/j.rbmo.2019.10.014
78	YL Hong, Y Tan, YY Yin, YJ Zou, YH Guo, XW Nie. Effect of electro-acupuncture on clinical outcomes and ovarian hyperstimulation syndrome in in vitro fertilization and embryo transplantation. Chin J Integr Tradit West Med (Zhongguo Zhong Xi Yi Jie He Za Zhi) 2014; 34(11): 1292–1296
79	RR Wang, MH Su, LY Liu, YY Lai, XL Guo, D Gan, XY Zheng, H Yang, SY Yu, FR Liang, W Wei, Y Zhong, J Yang. Systematic review of acupuncture to improve ovarian function in women with poor ovarian response. Front Endocrinol (Lausanne) 2023; 14: 1028853 https://doi.org/10.3389/fendo.2023.1028853
80	X Liu, W Shi, Z Liu, S Shi, C Ke, P Zhang, Z Tan, W Zhang. Effects of acupuncture on luteinized unruptured follicle syndrome: a meta-analysis of randomized controlled trials. Complement Ther Med 2020; 49: 102319 https://doi.org/10.1016/j.ctim.2020.102319
81	E Stener-Victorin, U Waldenström, L Nilsson, M Wikland, PO Janson. A prospective randomized study of electro-acupuncture versus alfentanil as anaesthesia during oocyte aspiration in in-vitro fertilization. Hum Reprod 1999; 14(10): 2480–2484 https://doi.org/10.1093/humrep/14.10.2480
82	E Stener-Victorin. The pain-relieving effect of electro-acupuncture and conventional medical analgesic methods during oocyte retrieval: a systematic review of randomized controlled trials. Hum Reprod 2005; 20(2): 339–349 https://doi.org/10.1093/humrep/deh595
83	P Humaidan, K Brock, L Bungum, E Stener-Victorin. Pain relief during oocyte retrieval—exploring the role of different frequencies of electro-acupuncture. Reprod Biomed Online 2006; 13(1): 120–125 https://doi.org/10.1016/S1472-6483(10)62025-1
84	CA Smith, S de Lacey, M Chapman, J Ratcliffe, RJ Norman, NP Johnson, C Boothroyd, P Fahey. Effect of acupuncture vs sham acupuncture on live births among women undergoing in vitro fertilization: a randomized clinical trial. JAMA 2018; 319(19): 1990–1998 https://doi.org/10.1001/jama.2018.5336
85	X Feng, N Zhu, S Yang, L Wang, W Sun, R Li, F Gong, S Han, R Zhang, J Han. Transcutaneous electrical acupoint stimulation improves endometrial receptivity resulting in improved IVF-ET pregnancy outcomes in older women: a multicenter, randomized, controlled clinical trial. Reprod Biol Endocrinol 2022; 20(1): 127 https://doi.org/10.1186/s12958-022-00997-0
86	C Zhu, W Xia, J Huang, X Zhang, F Li, X Yu, J Ma, Q Zeng. Effects of acupuncture on the pregnancy outcomes of frozen-thawed embryo transfer: a systematic review and meta-analysis. Front Public Health 2022; 10: 987276 https://doi.org/10.3389/fpubh.2022.987276
87	F Ramezanzadeh, MM Aghssa, N Abedinia, F Zayeri, N Khanafshar, M Shariat, M Jafarabadi. A survey of relationship between anxiety, depression and duration of infertility. BMC Womens Health 2004; 4(1): 9 https://doi.org/10.1186/1472-6874-4-9
88	AD Domar, I Meshay, J Kelliher, M Alper, RD Powers. The impact of acupuncture on in vitro fertilization outcome. Fertil Steril 2009; 91(3): 723–726 https://doi.org/10.1016/j.fertnstert.2008.01.018
89	CA Smith, S de Lacey, M Chapman, J Ratcliffe, RJ Norman, NP Johnson, P Fahey. The effects of acupuncture on the secondary outcomes of anxiety and quality of life for women undergoing IVF: a randomized controlled trial. Acta Obstet Gynecol Scand 2019; 98(4): 460–469 https://doi.org/10.1111/aogs.13528
90	C Smith, M Coyle, RJ Norman. Influence of acupuncture stimulation on pregnancy rates for women undergoing embryo transfer. Fertil Steril 2006; 85(5): 1352–1358 https://doi.org/10.1016/j.fertnstert.2005.12.015
91	F Zhu, B Zhao, J Wu, S Yin, T Ma, Z Li, X Zhu, T Wang, B Yang, D Che. Effect of transcutaneous electrical acupoint stimulation on pregnancy outcomes in women with in vitro fertilization-embryo transfer: a systematic review and meta-analysis. Front Cell Dev Biol 2022; 10: 1068894 https://doi.org/10.3389/fcell.2022.1068894
92	H Yang, WH Hu, GX Xu, ZH Yin, SY Yu, JJ Liu, ZY Xiao, XY Zheng, J Yang, FR Liang. Transcutaneous electrical acupoint stimulation for pregnancy outcomes in women undergoing in vitro fertilization-embryo transfer: a systematic review and meta-analysis. Front Public Health 2022; 10: 892973 https://doi.org/10.3389/fpubh.2022.892973
93	F You, X Du, T Zhang, Y Wang, Y Lv, L Zeng. High-frequency electroacupuncture improves endometrial receptivity via regulating cell adhesion molecules and leukemia inhibitory factor/signal transducer and activator of transcription signaling pathway. Bioengineered 2021; 12(2): 10470–10479 https://doi.org/10.1080/21655979.2021.1997367
94	H Dong, Z Zhong, W Chen, X Wu, Q Zhang, G Huang, W Yang. Effect of acupuncture on endometrial angiogenesis and uterus dendritic cells in COH rats during peri-implantation period. Evid Based Complement Alternat Med 2017; 2017: 3647080 https://doi.org/10.1155/2017/3647080
95	W Chen, J Chen, M Xu, Z Zhong, Q Zhang, W Yang, G Huang. Electroacupuncture facilitates implantation by enhancing endometrial angiogenesis in a rat model of ovarian hyperstimulation. Biol Reprod 2019; 100(1): 268–280 https://doi.org/10.1093/biolre/ioy176
96	JS Han. Acupuncture: neuropeptide release produced by electrical stimulation of different frequencies. Trends Neurosci 2003; 26(1): 17–22 https://doi.org/10.1016/S0166-2236(02)00006-1
97	S Andersson, T Lundeberg. Acupuncture—from empiricism to science: functional background to acupuncture effects in pain and disease. Med Hypotheses 1995; 45: https://doi.org/10.1016/0306-9877(95)90117-5
98	YL Jiang, XH Yin, YF Shen, XF He, JQ Fang. Low frequency electroacupuncture alleviated spinal nerve ligation induced mechanical allodynia by inhibiting TRPV1 upregulation in ipsilateral undamaged dorsal root ganglia in rats. Evid Based Complement Alternat Med 2013; 2013: 170910 https://doi.org/10.1155/2013/170910
99	GY Xu, G Li, N Liu, LYM Huang. Mechanisms underlying purinergic P2X3 receptor-mediated mechanical allodynia induced in diabetic rats. Mol Pain 2011; 7: 60 https://doi.org/10.1186/1744-8069-7-60
100	NM Tang, HW Dong, XM Wang, ZC Tsui, JS Han. Cholecystokinin antisense RNA increases the analgesic effect induced by electroacupuncture or low dose morphine: conversion of low responder rats into high responders. Pain 1997; 71(1): 71–80 https://doi.org/10.1016/S0304-3959(97)03341-1
101	PF White, WF Craig, AS Vakharia, E Ghoname, HE Ahmed, MA Hamza. Percutaneous neuromodulation therapy: does the location of electrical stimulation effect the acute analgesic response?. Anesth Analg 2000; 91(4): 949–954 https://doi.org/10.1097/00000539-200010000-00034
102	ES Ghoname, WF Craig, PF White, HE Ahmed, MA Hamza, NM Gajraj, AS Vakharia, CE Noe. The effect of stimulus frequency on the analgesic response to percutaneous electrical nerve stimulation in patients with chronic low back pain. Anesth Analg 1999; 88(4): 841–846 https://doi.org/10.1097/00000539-199904000-00030
103	M Ho, LC Huang, YY Chang, HY Chen, WC Chang, TC Yang, HD Tsai. Electroacupuncture reduces uterine artery blood flow impedance in infertile women. Taiwan J Obstet Gynecol 2009; 48(2): 148–151 https://doi.org/10.1016/S1028-4559(09)60276-X
104	R Chang, PH Chung, Z Rosenwaks. Role of acupuncture in the treatment of female infertility. Fertil Steril 2002; 78(6): 1149–1153 https://doi.org/10.1016/S0015-0282(02)04348-0
105	E Stener-Victorin, U Waldenström, SA Andersson, M Wikland. Reduction of blood flow impedance in the uterine arteries of infertile women with electro-acupuncture. Hum Reprod 1996; 11(6): 1314–1317 https://doi.org/10.1093/oxfordjournals.humrep.a019378
106	J Kim, KH Shin, CS Na. Effect of acupuncture treatment on uterine motility and cyclooxygenase-2 expression in pregnant rats. Gynecol Obstet Invest 2000; 50(4): 225–230 https://doi.org/10.1159/000010321
107	JS Han, XH Chen, SL Sun, XJ Xu, Y Yuan, SC Yan, JX Hao, L Terenius. Effect of low- and high-frequency TENS on Met-enkephalin-Arg-Phe and dynorphin A immunoreactivity in human lumbar CSF. Pain 1991; 47(3): 295–298 https://doi.org/10.1016/0304-3959(91)90218-M
108	JS Han, L Terenius. Neurochemical basis of acupuncture analgesia. Annu Rev Pharmacol Toxicol 1982; 22(1): 193–220 https://doi.org/10.1146/annurev.pa.22.040182.001205
109	JR Niebyl. Clinical practice. Nausea and vomiting in pregnancy. N Engl J Med 2010; 363(16): 1544–1550 https://doi.org/10.1056/NEJMcp1003896
110	S Jarvis, C Nelson-Piercy. Management of nausea and vomiting in pregnancy. BMJ 2011; 342(jun17 1): d3606 https://doi.org/10.1136/bmj.d3606
111	CP Carlsson, P Axemo, A Bodin, H Carstensen, B Ehrenroth, I Madegård-Lind, C Navander. Manual acupuncture reduces hyperemesis gravidarum: a placebo-controlled, randomized, single-blind, crossover study. J Pain Symptom Manage 2000; 20(4): 273–279 https://doi.org/10.1016/S0885-3924(00)00185-8
112	C Smith, C Crowther, J Beilby. Acupuncture to treat nausea and vomiting in early pregnancy: a randomized controlled trial. Birth 2002; 29(1): 1–9 https://doi.org/10.1046/j.1523-536X.2002.00149.x
113	F Tara, H Bahrami-Taghanaki, M Amini Ghalandarabad, Z Zand-Kargar, H Azizi, H Esmaily, H Azizi. The effect of acupressure on the severity of nausea, vomiting, and retching in pregnant women: a randomized controlled trial. Complement Med Res 2020; 27(4): 252–259 https://doi.org/10.1159/000505637
114	M Jamigorn, V Phupong. Acupressure and vitamin B6 to relieve nausea and vomiting in pregnancy: a randomized study. Arch Gynecol Obstet 2007; 276(3): 245–249 https://doi.org/10.1007/s00404-007-0336-2
115	R Negarandeh, M Eghbali, L Janani, F Dastaran, K Saatchi. Auriculotherapy as a means of managing nausea and vomiting in pregnancy: a double-blind randomized controlled clinical trial. Complement Ther Clin Pract 2020; 40: 101177 https://doi.org/10.1016/j.ctcp.2020.101177
116	C McParlin, A O’Donnell, SC Robson, F Beyer, E Moloney, A Bryant, J Bradley, CR Muirhead, C Nelson-Piercy, D Newbury-Birch, J Norman, C Shaw, E Simpson, B Swallow, L Yates, L Vale. Treatments for hyperemesis gravidarum and nausea and vomiting in pregnancy: a systematic review. JAMA 2016; 316(13): 1392–1401 https://doi.org/10.1001/jama.2016.14337
117	JA Roscoe, SE Matteson. Acupressure and acustimulation bands for control of nausea: a brief review. Am J Obstet Gynecol 2002; 186(5 Suppl 2): S244–S247 https://doi.org/10.1067/mob.2002.122606
118	XK Wu, JS Gao, HL Ma, Y Wang, B Zhang, ZL Liu, J Li, J Cong, HC Qin, XM Yang, Q Wu, XY Chen, ZL Lu, YH Feng, X Qi, YX Wang, L Yu, YM Cui, CM An, LL Zhou, YH Hu, L Li, YJ Cao, Y Yan, L Liu, YX Liu, ZS Liu, RC Painter, EHY Ng, JP Liu, BWJ Mol, CC Wang. Acupuncture and doxylamine-pyridoxine for nausea and vomiting in pregnancy : a randomized, controlled, 2 × 2 factorial trial. Ann Intern Med 2023; 176(7): 922–933 https://doi.org/10.7326/M22-2974
119	MY Tan, SH Shu, RL Liu, Q Zhao. The efficacy and safety of complementary and alternative medicine in the treatment of nausea and vomiting during pregnancy: a systematic review and meta-analysis. Front Public Health 2023; 11: 1108756 https://doi.org/10.3389/fpubh.2023.1108756
120	A Sato, Y Sato, A Suzuki, S Uchida. Neural mechanisms of the reflex inhibition and excitation of gastric motility elicited by acupuncture-like stimulation in anesthetized rats. Neurosci Res 1993; 18(1): 53–62 https://doi.org/10.1016/0168-0102(93)90105-Y
121	Y Li, G Tougas, SG Chiverton, RH Hunt. The effect of acupuncture on gastrointestinal function and disorders. Am J Gastroenterol 1992; 87(10): 1372–1381
122	H Lu, C Zheng, Y Zhong, L Cheng, Y Zhou. Effectiveness of acupuncture in the treatment of hyperemesis gravidarum: a systematic review and meta-analysis. Evid Based Complement Alternat Med 2021; 2021: 2731446 https://doi.org/10.1155/2021/2731446
123	MJ Lu, Z Yu, Y He, Y Yin, B Xu. Electroacupuncture at ST36 modulates gastric motility via vagovagal and sympathetic reflexes in rats. World J Gastroenterol 2019; 25(19): 2315–2326 https://doi.org/10.3748/wjg.v25.i19.2315
124	YS Su, W He, C Wang, H Shi, YF Zhao, JJ Xin, XY Wang, HY Shang, L Hu, XH Jing, B Zhu. “Intensity-response” effects of electroacupuncture on gastric motility and its underlying peripheral neural mechanism. Evid Based Complement Alternat Med 2013; 2013: 535742 https://doi.org/10.1155/2013/535742
125	C Takeshige, T Sato, T Mera, T Hisamitsu, J Fang. Descending pain inhibitory system involved in acupuncture analgesia. Brain Res Bull 1992; 29(5): 617–634 https://doi.org/10.1016/0361-9230(92)90131-G
126	D Zou, WH Chen, K Iwakiri, R Rigda, M Tippett, RH Holloway. Inhibition of transient lower esophageal sphincter relaxations by electrical acupoint stimulation. Am J Physiol Gastrointest Liver Physiol 2005; 289(2): G197–G201 https://doi.org/10.1152/ajpgi.00023.2005
127	AC Nutaitis, NA Meckes, AM Madsen, CT Toal, K Menhaji, CM Carter-Brooks, KA Propst, LC Hickman. Postpartum urinary retention: an expert review. Am J Obstet Gynecol 2023; 228(1): 14–21 https://doi.org/10.1016/j.ajog.2022.07.060
128	R Lauterbach, C Ferrer Sokolovski, J Rozenberg, A Weissman. Acupuncture for the treatment of post-partum urinary retention. Eur J Obstet Gynecol Reprod Biol 2018; 223: 35–38 https://doi.org/10.1016/j.ejogrb.2018.01.029
129	Y Zhu, F Wang, J Zhou, S Gu, L Gong, Y Lin, X Hu, W Wang, A Zhang, D Ma, C Hu, Y Wu, L Guo, L Chen, L Cen, Y He, Y Cai, E Wang, H Chen, J Jin, J Huang, M Jin, X Sun, X Ye, L Jiang, Y Zhang, J Zhang, J Lin, C Zhang, G Shen, W Jiang, L Zhong, Y Zhou, R Wu, S Lu, L Feng, H Guo, S Lin, Q Chen, J Kong, X Yang, M Tang, C Liu, F Wang, XM Hu, HW Lee, X Xu, R Zhang, N Robinson, MS Lee, J Han, F Qu. Effect of acupoint hot compress on postpartum urinary retention after vaginal delivery: a randomized clinical trial. JAMA Netw Open 2022; 5(5): e2213261 https://doi.org/10.1001/jamanetworkopen.2022.13261
130	D Li, X Wu, S Xiao. Study on the regularity of acupoint selection for acupuncture treatment of postpartum urinary retention. Guiding J Tradit Chin Med Pharm (Zhong Yi Yao Dao Bao) 2021; 27: 151–154, 159
131	Biurrun G Perú, E Gonzalez-Díaz, Fernández C Fernández, Corona A Fernández. Post partum urinary retention and related risk factors. Urology 2020; 143: 97–102 https://doi.org/10.1016/j.urology.2020.03.061
132	PD Chen, ZX Yang, C Zhou, QX Wu, F Liu, Y Ning. Clinical research thinking of acupuncture and moxibustion intervention on postpartum urinary retention. West J Tradit Chin Med (Xi Bu Zhong Yi Yao) 2019; 32(9): 38–40
133	YJ Zhang. Clinical research progress of acupuncture in treating postpartum urinary retention. Shanghai J Acupunct Moxibustion (Shanghai Zhen Jiu Za Zhi) 2011; 30: 504–507
134	JP Zhang, YQ Wang, MQ Yan, ZA Li, XP Du, XQ Wu. Menopausal symptoms and sleep quality during menopausal transition and postmenopause. Chin Med J (Engl) 2016; 129(7): 771–777 https://doi.org/10.4103/0366-6999.178961
135	CJ Crandall, JM Mehta, JE Manson. Management of menopausal symptoms: a review. JAMA 2023; 329(5): 405–420 https://doi.org/10.1001/jama.2022.24140
136	SS Tang, XJ Yin, W Yu, L Cui, ZX Li, LJ Cui, LH Wang, W Xia. Prevalence of osteoporosis and related factors in postmenopausal women aged 40 and above in China. Chin J Epidemiol (Zhonghua Liu Xing Bing Xue Za Zhi) 2022; 43(4): 509–516 https://doi.org/10.3760/cma.j.cn112338-20210826-00680
137	C Farquhar, J Marjoribanks, A Lethaby, JA Suckling, Q Lamberts. Long term hormone therapy for perimenopausal and postmenopausal women. Cochrane Database Syst Rev 2009; (2): CD004143 https://doi.org/10.1002/14651858.CD004143.pub3
138	VA Flores, L Pal, JE Manson. Hormone therapy in menopause: concepts, controversies, and approach to treatment. Endocr Rev 2021; 42(6): 720–752 https://doi.org/10.1210/endrev/bnab011
139	M Pan, X Pan, J Zhou, J Wang, Q Qi, L Wang. Update on hormone therapy for the management of postmenopausal women. Biosci Trends 2022; 16(1): 46–57 https://doi.org/10.5582/bst.2021.01418
140	NE Avis, RR Coeytaux, S Isom, K Prevette, T Morgan. Acupuncture in Menopause (AIM) study: a pragmatic, randomized controlled trial. Menopause 2016; 23(6): 626–637 https://doi.org/10.1097/GME.0000000000000597
141	M Nedeljkovic, L Tian, P Ji, A Déglon-Fischer, P Stute, E Ocon, M Birkhäuser, B Ausfeld-Hafter. Effects of acupuncture and Chinese herbal medicine (Zhi Mu 14) on hot flushes and quality of life in postmenopausal women: results of a four-arm randomized controlled pilot trial. Menopause 2014; 21(1): 15–24 https://doi.org/10.1097/GME.0b013e31829374e8
142	KS Lund, V Siersma, J Brodersen, FB Waldorff. Efficacy of a standardised acupuncture approach for women with bothersome menopausal symptoms: a pragmatic randomised study in primary care (the ACOM study). BMJ Open 2019; 9(1): e023637 https://doi.org/10.1136/bmjopen-2018-023637
143	C Fu, N Zhao, Z Liu, LH Yuan, C Xie, WJ Yang, XT Yu, H Yu, YF Chen. Acupuncture improves peri-menopausal insomnia: a randomized controlled trial. Sleep 2017; 40(11): https://doi.org/10.1093/sleep/zsx153
144	YM Di, L Yang, JL Shergis, AL Zhang, Y Li, X Guo, CC Xue, C Lu. Clinical evidence of Chinese medicine therapies for depression in women during perimenopause and menopause. Complement Ther Med 2019; 47: 102071 https://doi.org/10.1016/j.ctim.2019.03.019
145	Z Liu, Y Ai, W Wang, K Zhou, L He, G Dong, J Fang, W Fu, T Su, J Wang, R Wang, J Yang, Z Yue, Z Zang, W Zhang, Z Zhou, H Xu, Y Wang, Y Liu, J Zhou, L Yang, S Yan, J Wu, J Liu, B Liu. Acupuncture for symptoms in menopause transition: a randomized controlled trial. Am J Obstet Gynecol 2018; 219(4): 373.e1–373.e10 https://doi.org/10.1016/j.ajog.2018.08.019
146	ES Hassan, AM Maged, A Kotb, M Fouad, N El-Nassery, WM Kamal. Effect of laser acupuncture on pain and density of bone in osteoporotic postmenopausal women: a randomized controlled trial. Menopause 2023; 30(5): 545–550 https://doi.org/10.1097/GME.0000000000002166
147	WY Huang, IL Hsin, DR Chen, CC Chang, CT Kor, TY Chen, HM Wu. Circulating interleukin-8 and tumor necrosis factor-α are associated with hot flashes in healthy postmenopausal women. PLoS One 2017; 12(8): e0184011 https://doi.org/10.1371/journal.pone.0184011
148	Y Xu, S Hong, X Zhao, S Wang, Z Xu, S Ding, K Zhang, Y Zhang, L Xu, N Yu, T Zhao, Y Yan, F Yang, Y Liu, K Yu, B Liu, Y Guo, G Pang. Acupuncture alleviates rheumatoid arthritis by immune-network modulation. Am J Chin Med 2018; 46(5): 997–1019 https://doi.org/10.1142/S0192415X18500520
149	X Li, K Wu, Q Dong, H Chen, C Li, Z Ren, F Liu, X Yue, C Xia, Y Wang, Y Luo, L Li, R Zhao, Z Wang, D Qin. Overall adjustment acupuncture improves osteoporosis and exerts an endocrine-modulating effect in ovariectomized rats. Front Endocrinol (Lausanne) 2022; 13: 1074516 https://doi.org/10.3389/fendo.2022.1074516
150	X Zheng, G Wu, Y Nie, Y Lin. Electroacupuncture at the governor vessel and bladder meridian acupoints improves postmenopausal osteoporosis through osteoprotegerin/RANKL/RANK and Wnt/β-catenin signaling pathways. Exp Ther Med 2015; 10(2): 541–548 https://doi.org/10.3892/etm.2015.2553
151	H Fan, F Ji, Y Lin, M Zhang, W Qin, Q Zhou, Q Wu. Electroacupuncture stimulation at CV4 prevents ovariectomy-induced osteoporosis in rats via Wnt-β-catenin signaling. Mol Med Rep 2016; 13(3): 2485–2491 https://doi.org/10.3892/mmr.2016.4849
152	X Zheng, Y Nie, C Sun, G Wu, Q Cai, S Huang, Y Lin. Long-term electroacupuncture stimulation prevents osteoporosis in ovariectomised osteopaenic rats through multiple signalling pathways. Acupunct Med 2018; 36(3): 176–182 https://doi.org/10.1136/acupmed-2016-011268
153	T Priebe, SH Stumpf, R Zalunardo. Can a science-based definition of acupuncture improve clinical outcomes?. J Integr Med 2017; 15(3): 165–171 https://doi.org/10.1016/S2095-4964(17)60338-8
154	authors listed No. Acupuncture. NIH Consens Statement 1997; 15(5): 1–34

[1]	Linhua Zhao, Chuanxi Tian, Yingying Yang, Huifang Guan, Yu Wei, Yuxin Zhang, Xiaomin Kang, Ling Zhou, Qingwei Li, Jing Ma, Li Wan, Yujiao Zheng, Xiaolin Tong. Practice and principle of traditional Chinese medicine for the prevention and treatment of COVID-19[J]. Front. Med., 2023, 17(6): 1014-1029.
[2]	Chong Li, Xinyi Li, Ke He, Yang Wu, Xiaoming Xie, Jiju Yang, Fan Zhang, Yang Yue, Huifeng Hao, Shaokun Zhao, Xin Li, Guihua Tian. Discovery of the mechanisms of acupuncture in the treatment of migraine based on functional magnetic resonance imaging and omics[J]. Front. Med., 2023, 17(5): 993-1005.
[3]	Wencheng Zhang, Yangyang Cui, Yuan Du, Yong Yang, Ting Fang, Fengfeng Lu, Weixia Kong, Canjun Xiao, Jun Shi, Lola M. Reid, Zhiying He. Liver cell therapies: cellular sources and grafting strategies[J]. Front. Med., 2023, 17(3): 432-457.
[4]	Jia Zhong, Hua Bai, Zhijie Wang, Jianchun Duan, Wei Zhuang, Di Wang, Rui Wan, Jiachen Xu, Kailun Fei, Zixiao Ma, Xue Zhang, Jie Wang. Treatment of advanced non-small cell lung cancer with driver mutations: current applications and future directions[J]. Front. Med., 2023, 17(1): 18-42.
[5]	Julia Prinz, Nicola Maffulli, Matthias Fuest, Peter Walter, Frank Hildebrand, Filippo Migliorini. Acupuncture for the management of dry eye disease[J]. Front. Med., 2022, 16(6): 975-983.
[6]	Yang Liao, Qu Xing, Qianqian Li, Jing Zhang, Ruiyuan Pan, Zengqiang Yuan. Astrocytes in depression and Alzheimer’s disease[J]. Front. Med., 2021, 15(6): 829-841.
[7]	Xuqiang Wei, Baoyan Liu. Acupuncture is ineffective for chronic low back pain? A critical analysis and rethinking[J]. Front. Med., 2021, 15(5): 767-775.
[8]	Awanish Kumar, Anil Kumar. *Antibiotic resistome of Salmonella typhi: molecular determinants for the emergence of drug resistance*[J]. Front. Med., 2021, 15(5): 693-703.
[9]	Zhaoshi Bao, Yongzhi Wang, Qiangwei Wang, Shengyu Fang, Xia Shan, Jiguang Wang, Tao Jiang. Intratumor heterogeneity, microenvironment, and mechanisms of drug resistance in glioma recurrence and evolution[J]. Front. Med., 2021, 15(4): 551-561.
[10]	Danyang Song, Jianyu Hao, Daiming Fan. Biological properties and clinical applications of berberine[J]. Front. Med., 2020, 14(5): 564-582.
[11]	Hudan Pan, Yanfang Zheng, Zhongqiu Liu, Zhongwen Yuan, Rutong Ren, Hua Zhou, Ying Xie, Liang Liu. Deciphering the pharmacological mechanism of Guan-Jie-Kang in treating rat adjuvant-induced arthritis using omics analysis[J]. Front. Med., 2019, 13(5): 564-574.
[12]	Xiaoyi Li, Hong Kang, Wensheng Liu, Sarita Singhal, Na Jiao, Yong Wang, Lixin Zhu, Ruixin Zhu. In silico design of novel proton-pump inhibitors with reduced adverse effects[J]. Front. Med., 2019, 13(2): 277-284.
[13]	Won-Mo Jung, In-Soo Park, Ye-Seul Lee, Chang-Eop Kim, Hyangsook Lee, Dae-Hyun Hahm, Hi-Joon Park, Bo-Hyoung Jang, Younbyoung Chae. Characterization of hidden rules linking symptoms and selection of acupoint using an artificial neural network model[J]. Front. Med., 2019, 13(1): 112-120.
[14]	Hujie Song, Xiao Chen, Yalan Yu, Ling Zhang. Xingnao Kaiqiao acupuncture combined with Angong Niuhuang Wan for a patient under persistent vegetative state: a case report[J]. Front. Med., 2018, 12(3): 334-339.
[15]	Dahai Zhao, Zhiruo Zhang. Qualitative analysis of direction of public hospital reforms in China[J]. Front. Med., 2018, 12(2): 218-223.

Viewed

Full text

Abstract

Cited

Shared

Discussed