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 (n = 10)	Sham EA (n = 5)	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 (n = 20)	Sham acupuncture (n = 20)	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 (n = 47)	Sham acupuncture (n = 47)	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 (n = 9)	Medication (n = 7)	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 (n = 20)	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 (n = 7)	Sham acupuncture group (n = 7)	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 (n = 11)	Medication (n = 11)	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 (n = 13)	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 (n = 20)	Medication (n = 20)	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 (n = 29)	Blank control (n = 14)	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 (n = 10)	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 (n = 29)	Sham treatment (n = 29)/conventional treatment (n = 15)	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 (n = 25)	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 (n = 11)	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 (n = 50)	Madopar (n = 30)	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.