An overview of the evidence to guide decision-making in acupuncture therapies for early recovery after acute ischemic stroke

 

You have got to be kidding:

Impossible to have effects except as a placebo. Energy meridians have never been proven to exist.
No mechanism of action is possible. 

But you're also using appeal to antiquity  which is not scientific.

But if you believe, have at it, recognizing these possible side effects;

acupuncture side effects

An overview of the evidence to guide decision-making in acupuncture therapies for early recovery after acute ischemic stroke

Liuding Wang^†, Xiansu Chi^†, Jian Lyu, Zhenmin Xu, Guojing Fu, Yue Liu, Shaojiao Liu, Wenran Qiu, Hongxi Liu, Xiao Liang^* and Yunling Zhang^*

• Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China

Background: Acupuncture is a proven technique of traditional Chinese medicine (TCM) for ischemic stroke. The purpose of this overview was to summarize and evaluate the evidence from current systematic reviews (SRs) of acupuncture for early recovery after acute ischemic stroke (AIS).

Methods: We performed a comprehensive search for SRs of acupuncture for AIS in seven electronic databases up to May 23, 2022. Two reviewers independently selected SRs, extracted data, evaluated the methodological quality using the Assessment of Multiple Systematic Reviews 2 (AMSTAR 2), and rated evidence certainty using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE).

Results: Seven SRs were included. The overall methodological quality of SRs was critically low. As for GRADE, 3 outcomes had moderate-quality evidence, 14 had low-quality evidence, and 12 had very low-quality evidence. Moderate-quality evidence demonstrated that initiating acupuncture therapies within 30 days of AIS onset significantly improves neurological function and the total effective rate of patients. Low-quality evidence showed that for patients within 2 weeks of AIS onset Xingnao Kaiqiao acupuncture (XNKQ Ac) could reduce disability rate and might reduce mortality. Regarding the safety of acupuncture therapies, low-quality evidence showed that there was no difference in the incidence of adverse reactions between the 2 groups, and very-low quality evidence showed that acupuncture did not promote hemorrhagic conversion.

Conclusions: In the acute and early recovery phases after AIS onset, acupuncture is a promising therapeutic strategy to improve the curative effect of current treatments, especially in the recovery of neurological function. Patients in the acute phase might receive XNKQ Ac, and patients in the early recovery phase might receive EA¹, CA, or SA. However, considering the current certainty of evidence, a solid recommendation warrants further exploration.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022335426.

Introduction

At present, acute ischemic stroke (AIS) remains a prominent cause of death and disability worldwide (1), despite breakthroughs in emergency therapy over the past years. Intravenous thrombolysis (IVT) and endovascular therapies (EVTs) have been the preferred treatments for patients with AIS (2). However, the majority of AIS patients did not receive IVT or EVTs due to late arrival to emergency departments. As for patients fortunately treated with recanalization therapies, they may suffer from ischemia/reperfusion (I/R) injury caused by highly harmful oxidative stress (OS) (3). In other words, even with currently evidence-based, effective therapies, there is a lack of an optimum therapeutic strategy to timely protect the brain from damage in the acute or early recovery stages.

As one of the various modalities of traditional Chinese medicine (TCM), acupuncture has gained international recognition, particularly in recent years (4). In the treatment of ischemic stroke, previous studies have indicated that acupuncture might prevent secondary brain injury by reducing oxidation (5). This potential mechanism of acupuncture removing superoxide has also been demonstrated in other nervous system diseases, such as vascular dementia and spinal cord injury (6–8). In animal models of ischemic stroke, acupuncture therapies may not only suppress the excessive production of reactive oxygen species (ROS), but also activate the inherent antioxidant enzymes (9). Fundamentally, acupuncture therapies may ameliorate mitochondrial dysfunction, which is manifested in raising the activities of mitochondrial respiratory enzymes (10). Regarding clinical benefits, there were numerous systematic reviews (SRs) evaluating the efficacy of acupuncture therapies for ischemic stroke from acute to convalescent and sequela stages (11–14). Since oxidative damage is the most severe within 24 h after onset (15), it is of great significance to investigate the efficacy and safety of acupuncture for ischemic stroke during the acute stage. A network meta-analysis also showed that the optimal time-point of acupuncture for stroke was within 48 h post-stroke, and the vital validity period lasted until 15 days after the attack (16). However, the paucity of systematic evaluation of evidence certainty is the reason why acupuncture therapies cannot be brought to the bedside of patients with AIS. The overview of SRs has been generally recognized to facilitate clinical decision-making. A study published in the British Medical Journal strongly calls for more effective evidence dissemination of acupuncture to solve the dilemma that evidence on acupuncture is underused in clinical practice (4). Therefore, we conducted this overview to summarize the existing evidence and critically evaluate the overall evidence quality of acupuncture therapies for early recovery after AIS.

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