A systematic review and meta-analysis provides compelling and statistically significant evidence that acupuncture is a clinically effective treatment modality for patients suffering from chronic rhinosinusitis (CRS). The study, conducted by Zhao and colleagues, synthesized data from ten randomized controlled trials (RCTs), offering high-level evidence that acupuncture significantly improves both subjective symptom scores and objective clinical findings in CRS patients [1].
Chronic rhinosinusitis is characterized by persistent inflammation of the nasal and paranasal mucosa lasting more than 12 weeks. Typical symptoms include nasal obstruction, purulent discharge, hyposmia (reduced ability to smell), and facial pain or pressure. Despite advances in pharmacological and surgical approaches, recurrence and incomplete symptom resolution remain problematic in conventional medical settings. In this context, Zhao et al.’s review presents acupuncture as a viable intervention that not only improves clinical symptoms but also demonstrates measurable anatomical and immunologic changes in the nasal passages [1].
Among the most prominent findings in this meta-analysis was a significant improvement in the Total Effective Rate (TER), a composite index of clinical improvement based on symptom resolution and objective findings. Patients treated with acupuncture had a TER that was 17% higher than those in the control groups receiving Western medicine alone (RR = 1.17; 95% CI: 1.05–1.30; p = 0.005) [1]. Reductions in the Visual Analogue Scale (VAS) for nasal symptoms were also marked, with a mean decrease of 2.04 points (95% CI: −2.10 to −1.98; p < 0.00001). Quality of life scores measured by the Sino-Nasal Outcome Test (SNOT-20) improved significantly in acupuncture groups by a mean of 3.48 points (95% CI: −4.30 to −2.65; p < 0.00001) [1].
Acupuncture also yielded quantifiable improvements in physical examination findings. Endoscopic evaluations using the Lund-Kennedy scoring system demonstrated a statistically significant mean reduction of 1.25 points (95% CI: −1.82 to −0.68; p < 0.0001), while CT scan results analyzed via the Lund-Mackay system revealed an average improvement of 1.23 points (95% CI: −1.80 to −0.66; p < 0.0001) [1].
The acupuncture protocols used in the analyzed trials were rigorous and standardized. Treatments were administered once or twice daily for periods ranging from one to fourteen days. Sessions lasted between 20 and 30 minutes, with needle retention maintained throughout. The manual technique involved stimulating the needles every ten minutes to maintain the deqi sensation, a crucial therapeutic parameter in Chinese medicine. Two of the studies incorporated electroacupuncture. In these cases, low-frequency stimulation was applied using alternating waveforms at 2 Hz and 100 Hz, with intensity levels ranging between 8 and 12 mA. This form of stimulation was typically employed at bilateral facial points such as LI20 (Yingxiang) and Bitong to enhance sinus drainage and local circulation [1].
Needles used across studies were single-use, sterile, filiform types. Common gauges included 0.25 mm × 25–40 mm and 0.30 mm × 75 mm. Insertion depth ranged from 0.3 to 1.3 cun, depending on point location. Facial acupoints were generally treated with shallow insertions, while deeper points such as ST36 (Zusanli) required longer needles and greater depth of insertion. Manual techniques included lifting-thrusting and twirling, applied in either reinforcing or reducing methods according to the patient’s Chinese medical pattern diagnosis [1].
The most frequently used acupuncture points were LI4 (Hegu), LI20 (Yingxiang), EX-HN3 (Yintang), GV20 (Baihui), GV24 (Shenting), BL2 (Zanzhu), EX-HN5 (Taiyang), and ST36 (Zusanli). These points were universally applied, regardless of TCM differentiation, reflecting their broad utility in cases of nasal obstruction and immune system dysregulation. LI4 and LI20 were favored for their role in regulating the Yangming channel and facilitating sinus drainage. Yintang and GV20 were selected to clear the orifices and regulate upper jiao qi. ST36 was employed as a general immune modulator and qi tonic [1].
Beyond these foundational points, the review documented a comprehensive list of additional acupoints employed in various trials: ST7 (Xiaguan), SI18 (Quanliao), EX-HN8 (Bitong), PC6 (Neiguan), GB34 (Yanglingquan), LV2 (Xingjian), LV3 (Taichong), LI11 (Quchi), ST40 (Fenglong), ST44 (Neiting), SJ17 (Yifeng), SI3 (Houxi), CV22 (Tiantu), BL13 (Feishu), BL20 (Pishu), and BL23 (Shenshu) [1].
These points were not used arbitrarily but rather tailored to specific diagnostic patterns. For example, ST40 and SP6 were used in cases of phlegm-damp accumulation, while GB34, LV2, and LV3 were indicated for liver fire or shaoyang pathology. Points such as PC6 and CV22 were chosen for their ability to regulate qi in the chest and throat, supporting the relief of postnasal drip and throat discomfort. In addition to acupuncture, two studies incorporated moxibustion, specifically applying ginger-separated moxa to EX-HN3 (Yintang) and LI20 during needle retention. This combination was intended to warm the meridians and enhance circulation, in accordance with classical Chinese medicine theory [1].
The safety profile of acupuncture in this context was favorable. Among the ten included RCTs, six reported on minor adverse events, and none documented serious complications. Minor side effects such as transient bruising or local soreness were infrequent and occurred at similar rates in both treatment and control groups. These findings reaffirm acupuncture’s safety when performed by qualified practitioners using appropriate sterilization and anatomical techniques [1].
From a biomedical standpoint, the therapeutic benefits observed in the studies may be attributable to acupuncture’s influence on inflammatory pathways and mucociliary clearance (the process by which the respiratory tract removes mucus and trapped particles through coordinated ciliary movement). While direct cytokine measurements were not reported across all studies, related research suggests that acupuncture can modulate interleukin-6 and tumor necrosis factor-alpha levels, reduce local mucosal edema, and improve vascular perfusion to sinus tissues. These mechanisms may account for the improvements observed in imaging and endoscopic assessments [1].
In summary, this review provides strong evidence that acupuncture is an effective and safe treatment option for chronic rhinosinusitis. These evidence-based protocols show that both symptom reduction and objective improvements in mucosal health are achievable through acupuncture administered with skill and attention to technique by licensed acupuncturists.
Source:
1. Lee B, Kwon CY, Park MY. Acupuncture for the Treatment of Chronic Rhinosinusitis: A PRISMA-Compliant Systematic Review and Meta-Analysis. Evid Based Complement Alternat Med. 2022 Aug 31;2022:6429836.
