Acupuncture improves stroke recovery and reshapes brain networks

HOW?

Ask your competent? doctor to explain the mechanism of action since energy meridians have never been proven to exist.

 No mechanism of action is possible except as a placebo or do you believe in hand waving.

Acupuncture improves stroke recovery and reshapes brain networks

A new study published in CNS Neuroscience and Therapeutics highlights the potential benefits of acupuncture in alleviating neurological impairment and improving motor recovery in patients with stroke.

Researchers investigate acupuncture's effects on neuroplasticity

Ischemic stroke is a leading cause of physical disability in adults, often resulting in unilateral motor impairment or hemiplegia, a condition of complete or severe muscle paralysis on one side of the body. Post-stroke hemiplegia significantly affects the overall quality of life of affected individuals and puts heavy economic pressure on the healthcare system and families.

Several clinical studies have revealed abnormal functional connectivity in brain regions involved in vital motor functions in stroke patients, including the sensorimotor, default mode, and cognitive control networks. Studies have also highlighted brain structural alterations in stroke patients, including cortical thinning.

The recovery of motor function in stroke patients is associated with complex structural and functional reorganization of the brain. Recent evidence highlights the potency of acupuncture in improving neurological functions. However, it remains largely unknown whether acupuncture helps restore the brain's structural and functional frameworks in stroke patients.

Given that acupuncture is considered to be a safe, effective, and low-cost complementary treatment for stroke, this randomized controlled trial aimed to explore neural mechanisms by which acupuncture adjusts motor dysfunction in patients with post-stroke hemiplegia.

Researchers track brain changes after treatment

A total of 56 stroke patients were enrolled in the trial. They were randomly allocated in a 2:1 ratio to receive either real acupuncture or sham acupuncture (control group) over a period of two weeks.

Industry Focus eBook - Cell & Gene Therapy (1st Edition) eBook Industry Focus: Cell & Gene TherapyDownload the latest edition

After completion of the intervention period, all patients were assessed for motor impairment and recovery, neurological deficits, and limb motor control. Post-intervention structural and functional changes in the brain were also assessed using Magnetic Resonance Imaging (MRI).

After exclusions related to treatment completion and MRI data quality, 46 patients were included in the final MRI analysis.

Acupuncture improves motor recovery beyond sham

Post-treatment assessments showed that motor function improved in both groups, but patients who received real acupuncture experienced greater gains in limb motor control and overall motor recovery than those in the sham acupuncture group. These clinical improvements were accompanied by measurable changes in brain function and structure.

MRI analyses revealed reduced disjointedness and a trend toward lower flexibility within the default mode network, changes that were associated with better motor outcomes.

Acupuncture was also linked to increased gray matter volume in regions involved in sensorimotor processing and cognitive-motor integration. Importantly, participants who showed larger reductions in default mode network disruption and greater increases in gray matter volume also tended to experience greater improvements in motor impairment and recovery. 

Findings support further rehabilitation research using acupuncture

The findings suggest that acupuncture may support motor recovery after stroke by promoting changes in both brain function and structure. Patients who received real acupuncture showed better motor control and recovery, accompanied by signs of a more stable and less fragmented default mode network, a brain system involved in attention, self-awareness, and other cognitive processes that help guide movement.

The treatment was also associated with increased gray matter volume in regions linked to sensorimotor processing, cognition, and coordination, suggesting broader recovery-related adaptations across the brain. Together, these functional and structural changes may help support the planning and execution of movement following stroke.

The authors caution, however, that MRI-derived changes in gray matter volume are imaging markers of structural adaptation rather than direct evidence of cellular-level neuroplasticity. They also note that some clinical improvement was observed in the sham acupuncture group, potentially reflecting placebo-related effects and the standard pharmacotherapy received by both groups.

In addition, the trial did not demonstrate a statistically significant group-by-time interaction, and the lack of long-term follow-up means it remains unclear whether the observed brain changes translate into lasting functional benefits. Larger studies with extended follow-up will therefore be needed to confirm the findings and clarify the role of acupuncture as a complementary rehabilitation strategy.

Download your PDF copy by clicking here.

Effects of acupuncture on brain tissue metabolism and neurological function in patients with ischemic stroke: a systematic review and meta-analysis

 

Ask your competent? doctor to explain the mechanism of action since energy meridians have never been proven to exist.

 No mechanism of action is possible except as a placebo.

Effects of acupuncture on brain tissue metabolism and neurological function in patients with ischemic stroke: a systematic review and meta-analysis

• 

  Song Li 1,2†

• 

  Mengqi Yue 3†

• X

  Xu Chen 3

• X

  Xiahui Zhang 2

• L

  Lijun Huang 2

• Z

  Ziyi Wang 2

• Y

  Yanling Jin 2

• Q

  Qian Ma 2

• L

  Lei Ma 2*

• J

  Jing Shi 2*

• 1. Heilongjiang University of Chinese Medicine, Harbin, China

• 2. Yunnan Provincial Hospital of Traditional Chinese Medicine, The First Affiliated Hospital of Yunnan University of Chinese Medicine, Kunming, China

Abstract

Objective: 

This study aims to explore the effects of acupuncture on brain tissue metabolism and neurological function in regions centers of patients with ischemic stroke (IS).

Methods: 

From the establishment of the database until May 20, 2025, a comprehensive search was conducted across several databases, including CNKI, WanFang, VIP Database, CBM, PubMed, Cochrane Library, Embase, and Web of Science. This search specifically targeted clinical randomized controlled trials (RCTs) that investigated the effects of acupuncture on cerebral tissue metabolism within the center of IS lesions and its subsequent impact on neurological function. The literature was meticulously screened, and information was extracted in accordance with the PRISMA guidelines. The quality of the literature was assessed using the risk of bias scale recommended in the Cochrane Handbook for Systematic Reviews of Interventions, version 5.1.0. Additionally, the quality of the included literature and the meta-analysis were evaluated using RevMan 5.4.

Results: 

This study included 9 randomized controlled trials involving 602 patients. The meta-analysis results indicate that acupuncture treatment significantly improves the NAA/Cr ratio [MD = 0.19, 95% CI (0.14–0.24), p < 0.00001, 8 studies, 526 subjects] and reduces the Cho/Cr ratio [MD = −0.25, 95% CI (−0.36, −0.15), p < 0.00001]. However, no significant difference was observed in reducing the Lac/Cr ratio [MD = 0.04, 95% CI (−0.24, 0.32), p = 0.79]. Additionally, acupuncture treatment led to significant improvements in the NIHSS score [MD = −2.84, 95% CI (−3.76, −1.92), p < 0.00001], the FMA score [MD = 12.94, 95% CI (7.07, 18.81), p < 0.0001], and the MoCA score [MD = 3.20, 95% CI (2.30–4.10), p < 0.00001, 2 studies, 120 subjects] compared to non-acupuncture treatment. Overall, acupuncture demonstrated superior efficacy in improving the NAA/Cr, and Cho/Cr ratios, as well as the FMA, MoCA, and NIHSS scores, among IS patients.

Conclusion: 

Adding acupuncture therapy to conventional treatment improves brain tissue metabolism and neurological function in patients with IS. It shows better efficacy compared to conventional treatment alone. However, evidence for specific outcome measures is limited. High-quality, large-scale RCTs are needed to strengthen the evidence base.

Systematic review registration: 

https://www.crd.york.ac.uk/, CRD42024579263.

Therapeutic efficacy of acupuncture on motor dysfunction in ischemic stroke patients with hemiplegia and its EEG characteristics: protocol for a randomized, sham-acupuncture controlled, assessor-and-statistician-blinded trial

Ask your competent? doctor to explain the mechanism of action since energy meridians have never been proven to exist.

 No mechanism of action is possible except as a placebo.

Therapeutic efficacy of acupuncture on motor dysfunction in ischemic stroke patients with hemiplegia and its EEG characteristics: protocol for a randomized, sham-acupuncture controlled, assessor-and-statistician-blinded trial

Yue-Hua  GuYue-Hua GuJun-Xian  ChenJun-Xian ChenCui-Na  YanCui-Na YanLi-Wei  WangLi-Wei WangYi-Ling  MiuYi-Ling MiuJian-Xiang  LiJian-Xiang LiYi- Yun  GuYi- Yun GuJie  XuJie XuMing  XiaMing XiaXiao-Jing  ZhangXiao-Jing ZhangLu  YuLu Yu*

Background: 

Stroke is the second leading cause of death in the world, with high disability rate in survivors, among which ischemic stroke accounts for over 80% of the total. Limb dysfunction is a common neurological deficit symptom left by ischemic stroke. Timely rehabilitation therapy in the early recovery stage of stroke is important for neurological function improvement. Acupuncture therapy for "simultaneous treatment of phlegm and blood stasis", selecting acupoints based on pathogenic characteristics of ischemic stroke, has been applied to treat stroke patients with hemiplegia in our center, and it has exhibited significant effects. However, high-quality clinical evidence of this acupuncture strategy is still lacking. Therefore, the present study aims to evaluate the efficacy and safety of acupuncture therapy in improving limb function of patients with recovery-stage ischemic stroke. 

Methods: 

This study will be a single-center, randomized, assessor-and-statistician-blinded, sham acupuncture-controlled clinical trial. After informed consent signing, 70 eligible patients with limb dysfunction in post-stroke recovery stage will be randomized into the treatment group or sham acupuncture group in a 1:1 ratio. The treatment course will last for 2 weeks, and the scale evaluation and EEG examination will be conducted before and after treatment. The primary outcome is the changes of limb function pre and post treatment using the modified Fugl-Meyer scale. Secondary outcomes include score changes in Berg Balance Scale, Fugl-Meyer Assessment Sensory Function Scale, Modified Ashworth Score, Barthel Index and TCM syndrome score pre and post treatment. Additionally, we will employ EEG to evaluate regulation effects of acupuncture on cortical neuronal excitability and functional connectivity across brain regions in stroke patients, and screen EEG-based biomarkers with predictive value. 

Discussion: 

This study aims to evaluate the efficacy and safety of acupuncture therapy in stroke patients with hemiplegia, and to explore electrophysiological mechanisms of the therapeutic effects. The study will provide high-quality clinical evidence for the application of acupuncture therapy with acupoint combination based on the TCM theory in neurological rehabilitation for ischemic stroke. Trial registration: This study protocol has been registered at itmctr.ccebtcm.org.cn (Registration No. ITMCTR2025001171)

Efficacy of elongated needles for motor and balance function after a stroke: a systematic review and meta-analysis

Finally figured out this is acupuncture. Ask your competent? doctor to explain the mechanism of action since energy meridians have never been proven to exist.

No mechanism of action is possible except as a placebo.

 Efficacy of elongated needles for motor and balance function after a stroke: a systematic review and meta-analysis

Shuyan Zhang

¹Haichun Zhou^2*

• ¹Heilongjiang University of Chinese Medicine, Harbin, China
²The Fourth Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China

Introduction: This systematic review aimed to evaluate the efficacy and safety of elongated needle therapy in improving motor and balance functions after stroke, to inform its clinical adoption in rehabilitation.

Methods and Analysis: We searched PubMed, Web of Science, EMBASE, Medicine, CNKI, CBM, Wanfang, and VIP from inception to May 1, 2024, for randomized controlled trials (RCTs) assessing elongated needles for post-stroke limb movement and balance dysfunction. Primary outcomes were balance and motor ability; secondary outcomes included Activities of Daily Living (ADL) and adverse events. Meta-analysis used RevMan 5.4 and Stata 16.0. Heterogeneity was explored via subgroup/meta-regression/sensitivity analyses (if significant). Two reviewers independently assessed bias risk using Cochrane tools. Outcome quality was evaluated with GRADE.

Results: This meta-analysis included 18 randomized controlled trials (RCTs), encompassing a total of 1,230 subjects. The results indicated that elongated needles, utilized either as a solo intervention or in conjunction with other modalities, markedly enhanced balance capabilities in stroke patients when compared to conventional acupuncture, rehabilitation training, oral Chinese medicine, and alternative therapies including electroacupuncture and acupoint sticking (MD = 6.34, P < 0.001, I² = 85%, 95% CI = 4.80–7.89). Furthermore, elongated needles, whether applied alone or in combination with other therapies, significantly improved the motor function of limbs in patients (SMD = 1.21, I² = 92%, 95% CI = 0.63–1.79). Additionally, elongated needles, when used alone or in conjunction with other treatments, demonstrated greater efficacy in enhancing patients' activities of daily living compared to conventional acupuncture alone, rehabilitation training, or their combined regimen (SMD = 1.13, I² = 83%, 95% CI = 0.70–1.55). However, further clinical research is warranted to substantiate the advantages of elongated needles over other therapies, including electroacupuncture and acupoint sticking. In terms of safety, the overwhelming majority of the studies included in the analysis reported the absence of adverse reactions.

Conclusion: Evidence from current studies indicates that elongated needle may improve post-stroke patients' balance and motor function, and enhance their daily living skills. However, the number of rigorous scientific studies is limited, and there is considerable variability across studies, limiting the confidence in these findings. Therefore, the clinical effectiveness of this treatment still requires additional validation. It is imperative to conduct more high-quality, large-scale, multi-center RCTs that conform to international guidelines to establish the efficacy of this therapy's clinical applications.

Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42024542151.

Acupuncture alleviates hemorrhagic transformation after delayed rt-PA treatment for acute ischemic stroke by regulating the mitophagy-NLRP3 inflammasome pathway

 Ask your competent? doctor to explain the mechanism of action since energy meridians have never been proven to exist.

No mechanism of action is possible.

Acupuncture alleviates hemorrhagic transformation after delayed rt-PA treatment for acute ischemic stroke by regulating the mitophagy-NLRP3 inflammasome pathway

Tao Jiang^1,2Qianqian Liu^1,2Huanhuan Liu^1,2Zheng Huang^1,2Mengning Yang^1,2Peiyan Huang^1,2Yiting Shen^1,3Yangyang Song^1,2Wentao Xu^1,2Xinchang Zhang^1,2*Guangxia Ni^1,2*

• ¹College of Acupuncture-Moxibustion and Tuina, Nanjing University of Chinese Medicine, Nanjing, China
• ²Key Laboratory of Acupuncture and Medicine Research of Ministry of Education, Nanjing University of Chinese Medicine, Nanjing, China
• ³College of Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, China

Background: The clinical application of recombinant tissue plasminogen activator (rt-PA) is significantly constrained by hemorrhagic transformation (HT), a common and severe complication following thrombolysis for ischemic stroke. Notably, the mitochondrial injury-mediated NLRP3 inflammasome plays a crucial role in HT after delayed rt-PA thrombolysis in acute ischemic stroke. Although acupuncture has demonstrated antioxidant and anti-inflammatory effects in acute cerebral infarction, its impact on delayed rt-PA thrombolysis, especially concerning mitophagy and the NLRP3 inflammasome, remains unclear. This study investigates how acupuncture protects against HT resulting from mitochondrial damage and NLRP3 inflammasome activation after delayed rt-PA thrombolysis in acute cerebral stroke.

Methods: We selected an embolic stroke model in rats and assessed brain injury after delayed rt-PA in acute ischemic stroke using neurological deficit score, volume of brain infarct, the permeability assay of the blood–brain barrier (BBB), and HT. Then, the levels of proteins and mRNA involved in mitophagy and the NLRP3 inflammasome pathway were measured by western blot and real-time PCR. The levels of interleukin-18 (IL-18) and interleukin-1β (IL-1β) were assessed using enzyme-linked immunosorbent assay (ELISA). Morphological changes in the BBB and mitochondria of neurons were observed via transmission electron microscopy.

Results: Acupuncture significantly improved neurological deficit scores, volume of cerebral infarction, BBB destruction, and HT in an embolic stroke model rat. Furthermore, acupuncture induced mitophagy and substantially downregulated the activity of the NLRP3 inflammasome. Additionally, the use of mitochondrial inhibitors significantly reversed the suppressive impact of acupuncture on the NLRP3 inflammasome.

Conclusion: Acupuncture can promote mitophagy and suppress NLRP3 inflammasome activation to decrease HT after delayed rt-PA therapy for acute ischemic stroke.

1 Introduction

Stroke is a leading cause of disability and death in China, with ischemic stroke being the most common type, representing approximately 86.8% of all cases (1). Currently, the best treatment for ischemic stroke is intravenous recombinant tissue fibrinogen activator (rt-PA). Nevertheless, this approach is constrained by a short time window (within 4.5 h) (2). Delayed rt-PA thrombolysis may lead to several severe complications, including hemorrhagic transformation (HT), cerebral edema, and reperfusion injury, with HT being the most frequently observed complication (3, 4).

The inflammasome is strongly implicated in the development of ischemic stroke (5). The Nod-like receptor protein 3 (NLRP3) inflammasome is a complex multiprotein structure that includes the NLRP3 receptor, apoptosis-associated speck-like protein containing the caspase-recruiting domain (ASC), and the precursor form of Caspase-1 (Pro-caspase-1) (6). The activated NLRP3 complex eventually triggers the release of interleukin-18 (IL-18) and interleukin-1β (IL-1β). These cytokines trigger downstream signaling pathways and initiate inflammatory responses. This process disrupts tight junction (TJ) proteins, thereby enhancing the permeability of the blood–brain barrier (BBB) and increasing the incidence of HT (7, 8).

Mitophagy can selectively eliminate defective or impaired mitochondria and is a critical mechanism for maintaining the quality of mitochondria (9). Extensive research has demonstrated that the Pink1 (PTEN-inducible putative kinase 1)/Parkin (E3 ubiquitin ligase) pathway constitutes the canonical mitophagy mechanism (10, 11). Upon mitochondrial injury, Pink1 is activated and subsequently recruits Parkin to the outer membrane (12). Activated Parkin is identified by P62 (an autophagy junction protein) and facilitates the transport of mitochondria to autophagic vesicles through its interaction with the protein LC3, which induces the generation of mitochondrial autophagic vesicles that ultimately merge with lysosomes to eliminate damaged mitochondria (9). Meanwhile, some reports have suggested that mitophagy mediated by Pink1/Parkin is an essential mechanism for suppressing the activity of the NLRP3 inflammasome (13, 14). Moreover, mitophagy may mitigate brain damage in ischemic stroke rats via its inhibitory effect on NLRP3 inflammasome activation (15).

Accumulating evidence indicates that acupuncture may substantially decrease neurological impairment score and cerebral infarction volume in ischemic stroke rats while also inhibiting NLRP3 and Caspase-1 expression, thereby providing a neuroprotective effect (16). Meanwhile, acupuncture can protect neurons from damage through enhancing mitophagy through the Pink1/Parkin-dependent pathway (17).

Although acupuncture has been demonstrated to exert neuroprotective effects in cerebral ischemia, its effects on mitophagy and interactions with NLRP3 inflammasomes remain unknown. This study examined the potential of acupuncture to mitigate HT following delayed rt-PA thrombolysis in acute ischemic stroke rats by modulating the mitophagy-NLRP3 inflammasome pathway.

More at link.

Acupuncture versus rehabilitation for post-stroke shoulder-hand syndrome: a systematic review and meta-analysis of randomized controlled trials

 

Impossible for acupuncture to have effects except as a placebo. Energy meridians have never been proven to exist.

Acupuncture versus rehabilitation for post-stroke shoulder-hand syndrome: a systematic review and meta-analysis of randomized controlled trials

Jinyuan Shi^1,2†Fuyan Chen^1,2*†‡Yang Liu^1,2†Mingtong Bian^1,2Xiaowei Sun^1,2Ru Rong^1,2Shuo Liu^1,2

• ¹Department of Acupuncture, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
• ²National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China

Background: Shoulder-hand syndrome (SHS) is one of the common sequelae after stroke, which not only hinders the recovery of patients, but also increases the economic burden of the family. In the absence of effective treatment measures, acupuncture treatment has been widely used in China to treat post-stroke shoulder-hand syndrome, but the details are unclear. Therefore, this review aims to evaluate the true efficacy of acupuncture in patients with SHS.

Methods: We searched eight databases [PubMed, Embase, Web of Science, Cochrane library, China Biomedical Literature Database (CBM), China Science and Technology Journal (VIP) database, the China National Knowledge Infrastructure (CNKI) database, and Wan fang database] from its inception to March 2025, randomized controlled trials (RCTs) of SHS acupuncture treatment combined with rehabilitation (Rehab). Two investigators independently used pre-designed forms to extract valid data from eligible randomized controlled trials. Meta-analysis was implemented through the Rev. Man software (version 5.4). The strength of the evidence obtained was implemented using the GRADE profiler software. Adverse events (AEs) were collected by reading the full text and used to evaluate the safety of acupuncture treatment.

Results: Forty-seven studies, involving 4,129 participants, met the eligibility criteria, and were included in the review. Overall meta-analysis showed that combined acupuncture rehabilitation significantly improved motor function (upper-limb Fugl-Meyer Assessment (FMA): 41 studies, mean difference (MD) 9.50, 95% confidence interval (CI) [8.47, 10.53]) and pain reduction (visual analog score (VAS): 37 studies, MD: −1.49, 95% CI [−1.66, −1.33]). It also improved activities of daily living (ADL) compared to rehabilitation alone (ADL: 17 studies, MD: 11.94, 95% CI [8.26, 13.63]). There was no significant difference in the occurrence of adverse events (AEs) between acupuncture treatment combined with Rehab and Rehab alone (p > 0.05). The certainty of the evidence was rated low level because of flaws in the study design and considerable heterogeneity among the included studies.

Conclusion: This review found that acupuncture treatment combined with Rehab treatment may have a positive promoting effect on improving motor function, reducing pain, and improving daily living ability in SHS patients. However, due to the existing methodological quality issues, our findings should be treated with caution. Future high-quality studies are urgently needed to validate our findings.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024536169.

1 Introduction

Stroke is the second largest cause of death worldwide and the first leading cause of acquired long-term disability, leading to an annual global economic burden (1). Post-stroke shoulder hand syndrome (PS-SHS), also known as post-stroke complex regional pain syndrome, is experienced by more than 50% of stroke patients (2), it usually occurs between 2 and 3 months of an acute event and usually presents with pain, hyperalgesia, joint swelling, and limited range of motion (3). Post-stroke shoulder hand syndrome is difficult to treat, and its symptoms may persist for a long time, resulting in limited upper limb function or even irreversible permanent apraxia (4, 5). In addition, SHS may hinder the overall recovery, prolong hospitalization, limit the patients’ activities of daily living (ADL), reduce the quality of life, and bring heavy economic burden on the patients and their families (6). Currently, commonly used treatments for post-stroke SHS include drug therapy, soaking in cold water, physical therapy (PT), occupational therapy (OT), psychotherapy, and sympathetic block (7, 8). Although these conventional treatments were initially found to be effective, their adverse effects cannot be ignored. Low-dose oral steroids are effective in improving the SHS after stroke (9), for example, to avoid adverse effects associated with long-term drug use, steroids are only indicated for short-term treatment and are considered a difficult factor for long-term post-stroke SHS (5), early referral to PT, OT, and psychotherapy may prevent the progression of symptoms (10). However, the disadvantages of these approaches, such as high healthcare costs, increased workforce investment, and increased demands for patient collaboration, have also received attention. In addition, the expertise of rehabilitation therapists varies from different regions, which will affect the treatment effect. The incidence of SHS after stroke remains high and is a challenging problem to be addressed. To date, consistently effective and good patient compliance methods are still lacking (11).

As a basic therapy for the prevention and treatment of traditional Chinese medicine (TCM), acupuncture has been used in clinical practice in China for thousands of years (12). According to the site of application, acupuncture can be divided into abdominal acupuncture (AA) and scalp acupuncture (SA). In addition, according to the surgical method, acupuncture can be divided into manual needle (MA), electro-acupuncture (EA), and warm acupuncture (WA) has been proved to have the advantages of low price, good effect and simple operation (13). Moreover, as a non-pharmacological intervention, acupuncture has better efficacy on chronic diseases difficult to treat with traditional treatment methods, such as low back pain and renal disease (14, 15). As a result of these advantages, acupuncture has received continued interest from the general public and health professionals (16). Furthermore, more medical institutions are using acupuncture clinically and show that acupuncture can be used as a prospective therapeutic measure to improve motor function in patients with SHS (6, 17).

In the last few years, three reviews have been published on acupuncture for SHS. The meta-analysis published in 2018 (18) only evaluated the effect of manual acupuncture on the treatment efficacy in patients with SHS, and manual acupuncture represented only one acupuncture form, and the findings were necessarily limited. The meta-analysis published in 2019 (19) included only 13 studies totaling 1,040 patients, an insufficient sample size, and only evaluated the effect of electroacupuncture effects in SHS patients, and the findings were limited. The meta-analysis, published in 2019 (20), selected FMA, VAS and ADL as outcome measures. The results showed that acupuncture treatment had excellent efficacy in relieving the symptoms of SHS. However, the intervention did not involve warm acupuncture. Therefore, we conducted a systematic review of the latest evidence on acupuncture (including warm acupuncture) as an add-on treatment for the clinical treatment of post-stroke SHS. Furthermore, with the widespread use of acupuncture treatment, more research is published in recent years (17, 21). Therefore, the aim of this review was to explore the effect of acupuncture treatment on the relief of clinical symptoms in patients with SHS and to update previous published reviews.