Acupuncture for Parkinson’s Disease: Efficacy Evaluation and Mechanisms in the Dopaminergic Neural Circuit

Table 1

The clinical efficacy of acupuncture in the patients with Parkinson’s disease.

Study	Clinical trial design	Clinical condition	Intervention	Comparison	Acupoints	Acupuncture parameters	Outcomes
Lei et al. (2016) [19]	RCT	PD patients	EA ()	Sham EA ()	GV20, GV14; bilateral foot motor, sensory area, balance area, LI4, ST36, GB34, BL40, SP6, KI3, LR3	Asymmetric biphasic square wave pulse, 100 μS pulse width, “deqi”, 100 Hz or 4 Hz, three times a week, 3 weeks	Primary outcome: STHW↑, STFW↑, DTFW↑, and DTHW↑; Secondary outcome: UPRDS scores↓
Kong et al. (2017) [20]	RCT	PD patients with moderately severe fatigue	Acupuncture ()	Sham acupuncture ()	CV6; bilateral PC6, ST36, LI4, SP6, KI3	5-30 inches, no flicking or rotation of needles after insertion, 20 minutes, twice a week, at least 3 days apart, 5 weeks, 10 sessions	Primary outcome: MFI-GF↓; Secondary outcome: MFI-total score↓, UPDRS-motor↓
Kluger et al. (2016) [21]	RCT	PD patients with moderate or severe fatigue	EA ()	Sham acupuncture ()	GV20, GV24; bilateral LI10, HT7, ST36, SP6	0.5-1 cm, twisted three times to the right, 30 minutes, every two weeks, 6weeks	Primary outcome: MFIS (total, physical, cognitive, psychosocial)↓; Secondary outcomes: PDQ-39↓, HADS (depression)↓, ESS↓, AES↓
Yu et al. (2019) [22]	Comparison trials	PD patients with pain	Acupuncture+medication ()	Medication ()	GV20; bilateral 77.18, GB34	5-10 mm, “deqi” for 20 s, 30 minutes, 1-3 sessions per week, separated by at least 1 day, 8 weeks	Primary outcome: KPPS↓, UPDRS (total)↓, enhanced connectivity at the four areas, a significant correlation between functional connectivity changes and KPPS
Shulman et al. (2002) [23]	Controlled trial	Idiopathic PD patients (stages I-III)	EA ()	Self-control	Bilateral LI4, GB34, ST36, K3, KI7, SP6, SI3, TB5	Intensity knob: 0; electric exciter switch: 1; wave form: intermittent; twice a week, 10/16 treatments	Sleep and rest category: SIP (sleep and rest)↓
Cristian et al. (2005) [24]	RCT	PD patients (stages II-III)	EA ()	Sham acupuncture group ()	GV20; bilateral K3, K10, BL60, L3, ST41, ST36, GB34, bafeng points, MH6, LI4	4 Hz, 20 minutes, 5 sessions, 2 weeks	NS
Aroxa et al. (2016) [25]	RCT	Idiopathic PD patients (stages I-III)	Acupuncture+medication ()	Medication ()	Bilateral LR3, SP6, LI4, TE5, HT7, PC6, LI11, GB20	30 minutes, once a week, 8 weeks	Sleep disorders evaluation: PDSS↑
Fukuda et al. (2016) [26]	Controlled trial	PD patients (stages I-III)	Acupuncture ()	Self-control	Bilateral ST36, SP6, LR3, LI4, LI11, GB20, BL18, BL23	Inserted perpendicularly, 10-20 mm, 10-15 minutes, only once	Tongue function: mean tongue pressure↑, mean swallowing reflex latency↓, saliva swallow↓
Chen et al. (2015) [2]	Comparison clinical trial	PD patients	Acupuncture+medication ()	Medication ()	DU20; bilateral GB20, LI11, LI10, LI4, GB31, ST32, GB34, GB38	MA, 5-30 mm, 15 minutes, twice a week, 18 (short-term)/36 (long-term) weeks	Short-term: UPDRS (total scores and subscores I, II, III, and IV)↓, BDI-II score↓, WHO-QOL score↓; Long-term: UPDRS (total scores and subscores I, II, III, and IV)↓, BDI-II score↓
Wang et al. (2002) [27]	Controlled trial	PD patients (stages I-III)	Acupuncture ()	Blank control ()	Group 1: DU20; bilateral GB20, LI4, SP6, LR3; group 2: Extra6; bilateral LI11, SJ5, GB34, ST36, ST40, Extra21	MA at Extra6, GB13, and GB20, then electric stimulator with continuous wave for 15 minutes; the rest acupoints: uniform reinforcing-reducing method, 40 minutes; once every other day, 3 months	The Webster’s cumulative scores↓, correlation analysis of ABP indices and the cumulative scores in Webster’s scale↓, the latent period of V wave and the intermittent periods of III-V peak and I-V peak↓
Yeo et al. (2018) [28]	Controlled trial	Idiopathic PD patients	EA+MA ()	Self-control	Right GB34, LR3 (EA); Bilateral LR3, LI11, ST36, GB20, SP6, LI4, GB34 (MA)	EA: 15 minutes, 120 Hz, twice a week, 8 weeks; MA: 3 to 15  mm, 15 minutes; twice a week, 8 weeks	UPDRS (total, 1, 2, 3, and4) score↓, BDI-II scores↓, neural responses (thalamus, cingulate gyrus, anterior cingulate, lingual gyrus, parahippocampal gyrus, lateral globus pallidus, mammillary body, middle temporal gyrus, cuneus, and fusiform gyrus)↑
Cho et al. (2017) [29]	RCT	Idiopathic PD patients (stages I-IV)	Acupuncture+BVA ()	Sham treatment ()/conventional treatment ()	Bilateral GB20, LI11, GB34, ST36, LR3	BVA: injected diluted bee venom 0.1 ml; EA: 1-1.5 cm, rotated at 2 Hz for 10 seconds to achieve “deqi”, 15 minutes; twice a week, 12 weeks	Primary outcome: UPDRS (part II+III) scores↓; Secondary outcomes: UPDRS (part II and III) scores↓, gait speed↓, gait number↑, PIGD↓
Eng et al. (2006) [30]	Controlled trial	Idiopathic PD patients	Acupuncture+Yin Tui Na ()	Self-control	Bilateral ST42, SP3, LI11, LI15, LI20, ST7, ST36	7-10 minutes, 8-14 Hz, once a week, 6 months, 24 sessions	UPDRS (I and II) scores↓, UPDRS (III) scores↑, PDQ-39 total score↓, BDI↓
Doo et al. (2015) [31]	Controlled trial	Idiopathic PD patients	Acupuncture and BVA+conventional treatment ()	Self-control	Bilateral GB20, LI4, GB34, ST36, LR3	BVA: injected diluted bee venom 0.1 ml; EA: 1-1.5 cm, rotated at 2 Hz for 10 seconds to achieve “deqi”, 15 minutes; twice per week, 12 weeks	Primary outcome: UPDRS (part II+III) scores↓; Secondary outcomes: UPDRS (part II and III) scores↓, gait speed ↓, PDQL score↑
Ren (2008) [32]	Controlled trial	PD patients	Acupuncture+Madopar ()	Madopar ()	From TE14 to TE2, from PC2 to PC7 (areas being tapped); Bilateral TE4, LI5, PC7, SI6, LI11, LU5, PC3, HT3, TE14, LI15, SI9, LR4, KI3, ST41, SP9, GB34, BL40, GB30, BL36 (MA)	Tap: with a plum-blossom needle, until skin turns red; MA: uniform reinforcing and reducing method, 30 minutes; once a day, 10 sessions a course, 3-5 days between courses, 2 courses	Total effective rate↑, the minimum dose of Madopar needed↓

RCT: randomized controlled trial; PD: Parkinson’s disease; EA: electroacupuncture; GV20: Baihui; GV14: Dazhui; LI4: Hegu; ST36: Zusanli; GB34: Yanglingquan; BL40: Weizhong; SP6: Sanyinjiao; KI3: Taixi; LR3: Taichong; STHW: single-task habitual walking; STFW: single-task fast walking; DTFW: dual-task fast walking; DTHW: dual-task habitual walking; UPDRS: Unified Parkinson’s Disease Rating Scale; PC6: Neiguan; CV6: Qihai; MFI-GF: General Fatigue score of the Multidimensional Fatigue Inventory; GV24: Shenting; LI10: Shousanli; HT7: Shenmen; MFIS: Modified Fatigue Impact Scale; PDQ-39: 39-item Parkinson’s Disease Questionnaire; HADS: Hospital Anxiety and Depression Scale; ESS: Epworth Sleepiness Scale; AES: Apathy Evaluation Scale; 77.18: Shenguan; KPPS: King’s Parkinson’s Disease Pain Scale; KI7: Fuliu; SI3: Houxi; TB5: Waiguan; SIP: Sickness Impact Profile; KI10: Yingu; BL60: Kunlun; NS: no significance; ST41: Jiexi; MH6: Yinwei; TE5: Waiguan; LI11: Quchi; GB20: Fengchi; PDSS: Parkinson’s Disease Sleep Scale; BL18: Ganshu; BL23: Shenshu; DU20: Baihui; GB31: Fengshi; ST32: Futu; GB38: Juegu; MA: manual acupuncture; BDI-II: Beck Depression Inventory-Version 2; WHO-QOL: WHO quality of life; Extra6: Sishencong; SJ5: Waiguan; ST40: Fenglong; Extra21: Huatuojiaji; GB13: Benshen; ABP: auditory evoked brain stem potential; TE14: Jianliao; TE2: Yemen; PC2: Tianquan; PC7: Daling; TE4: Yangchi; LI5: Yangxi; SI6: Yanglao; LU5: Chize; PC3: Quze; HT3: Shaohai; LI15: Jianyu; SI9: Jianzhen; LR4: Zhongfeng; SP9: Yinlingquan; GB30: Huantiao; BL36: Chengfu; BVA: bee venom acupuncture; PIGD: postural instability and gait disturbance; PDQL: Parkinson’s Disease Quality of Life Questionnaire; ST42: Chongyang; SP3: Taibai; LI20: Yingxiang; ST7: Xiaguan.