TABLE 2.

Treatment specifications and details of eligible studies.

Study	Country	Intervention	Number of acupuncture sessions	Duration of sessions (min)	Acupuncture points targeted	Interval between acupuncture treatments	Additional treatment details
Gao et al. (14)	China	Catgut embedment-Moxibustion-Bloodletting with plum blossom needling (Cohort 1) vs. Finasteride 1 mg/day qd for 3 months with 5-day rest between each course of treatment (Cohort 2)	Catgut embedment: 3, Moxibustion: 50 (10 courses, with each course consisting of 5 sessions), Bloodletting with plum blossom needling: 4	Moxibustion: 30	Acupoints used for catgut embedment: Dong’s acupuncture point (defined as 1.5 cun or 1.5 times the distance between DIP and PIP of the middle finger below SP 9), Minghuang (T 88.12) and Zusanli (ST 36). Acupoints used for moxibustion: Qihai (CV 6), Guanyuan (CV 4)	Catgut embedment: performed once a month, for a total of 3 sessions. Moxibustion: performed every other day for a total of 50 sessions. Bloodletting with plum blossom needling: performed. every other week	During catgut embedment, catguts were sterilized and embedded onto acupoints using disposable needles. Moxibustion was performed using moxa sticks (Yaowang Pharmacy Limited Co., Anguo, China) applied into three-hole and four-hole moxa boxes placed on acupoints of interest. For bloodletting, plum-blossom needling was used in areas of hair loss.
Jin et al. (18)	China	Combined electroacupuncture and acupoint injection of Mecobalamin (Cohort 1) vs. seven-star needle tapping once every day and a couple of times of rubbing the affected area using a fresh ginger piece daily for 30 days (control) (Cohort 2)	Approximately 26 (sessions performed 6 out of 7 days a week, observed over 30-day period)	30	None, scalp pierced in area of hair loss. Treatment for some patients was augmented by puncturing Baihui (GV 20), Fengchi (GB 20) and Taiyang (EX-HN 5). Other acupoints were targeted depending on patient specific chief-complaints (e.g., for anemia, use Zusanli (ST 36) and Xuehai (SP 10); for “qi stagnation” and “blood stasis,” use Taichong (LR 3), Xuehai (SP 10), Neiguan (PC 6) and Touwei (ST 8); for dizziness, use Shangxing (GV 23) and Zusanli (ST 36); for insomnia, use Shenmen (HT 7) and Sanyinjiao (SP 6); for lower back pain and tinnitus, use Shenshu (BL 23) and Taixi (KI 3)	Electroacupuncture cohort: Daily with 1-day interval after 6 consecutive days of treatment, seven-star needle tapping (control) cohort: daily self-administration	Acupuncture needles are first inserted into the muscular layer of the scalp, at the border of the affected hair loss area. Electroacupuncture is performed at a frequency of “200 times per minute.” Additionally, the needle is manipulated in a twirling manner for 1–2 min, for a minimum of 1 min, before withdrawing the needle to the superficial layer of the scalp where it is then retained for the remainder of the 30-min session. These steps are repeated on the opposite side of hair loss. Needles are kept apart to avoid short circuiting.
Kawashima et al. (20)	Japan	Japanese Kampo medicine (JKM) formulas in combination with acupuncture. After “relapse,” (163 days after discontinuing treatment) self-administration of pine-needle acupuncture was initiated in combination with the JKM formulas.	Not reported, 159 days with JKM + acupuncture, 238 days with JKM + self-administration of pine-needle	15 min for acupuncture, 2–3 min for pine-needle self-acupuncture	None, targeted area of hair loss (needles placed laterally from the edge of the lesion toward the center)	Performed weekly for acupuncture, once or twice weekly for pine-needle acupuncture self-administration	JKM consisted of pharmaceutical grade saikokaryukotsubor- eito extract (7.5 g/day; Kotaro Pharmaceutical Co., Ltd., Osaka, Japan) and rokumiga (7.5 g/day; Tsumura and Co., Tokyo, Japan). Disposable Seven-star Needles (Suzhou Acupuncture Goods Co., Ltd., Suzhou, China) were used for plum blossom acupuncture, which consistent of local stimulation with needles for 2–3 min once or twice each week.
Li et al. (22)	China	Plum blossom needling with “qi-invigorating superficies-consolidating” therapy (Cohort 1) vs. Oral cystine 50 mg TID, Vitamin B6 10 mg TID (Cohort 2)	10	10	None, scalp pierced in hair loss area until skin began to bleed lightly with needles coated with hair growth preparation consisting of cacumen biotae, Rhizoma drynariae, Salvia miltiorrhiza, white mulberry bark, and Zanthoxylum bungeanum	Performed every other day	“Qi-invigorating superficies-consolidating” therapy included the following: astragalus (30 g), saponin (10 g), forsythia (10 g), poria (10 g), aquilaria (10 g), stone acorus (5 g), acacia peel (30 g), Platycodon grandiflorum (10 g), Chuanxiong rhizome (10 g), Lignum millettiae (30 g), cork (5 g), Tribulus terrestris (15 g), Bauhinia peel (15 g), charred hawthorn (15 g), mulberry (15 g), Polygonum multiflorum (30 g), Radix sileris (15 g), and fried atractylodes (10 g). Patients took 1 dose per day for a total of 14 doses.
Su et al. (23)	China	5% 5-aminolevulinic acid-based photodynamic therapy (ALA-PDT) combined with oral isotretinoin (10 mg) TID. Fire needle intervention was used as a pretreatment for ALA-PDT.	4	NA	None, targeted follicular papules, nodules, cysts and alopecia areas	Performed every 2 weeks	Acupuncture needles were sanitized under fire and used to pierce targeted areas including follicular papules, nodules, cysts and areas of hair loss. Purulent secretions were cleaned with. cotton swabs. Areas were then prepped with 5% 5-AMA and then incubated under light for 2 h at a wavelength of 630 ± 5 nm and an energy density of 70 mw/cm for 20 min. This was performed every 2 weeks for a total of 4 sessions. Isotretinoin was administered three times a day for 4 months.
Wu et al. (15)	China	Acupuncture	36	30	Baihui (GV 20), Taiyang (EX-HN 5), Fengmen (BL 12), Xinshu (BL 15), Ganshu (BL 18), Shenshu (BL 23), Zusanli (ST 36), Sanyinjiao (SP 6), Xuanzhong (GB 39), Taix (K 13), Kunlun (BL 60), Taichong (LR 3), Neiguan (PC 6), Waiguan (TE 5), Shenmen (HT 7), Hegu (L1 4), Tianshu (ST 25), Zhongwan (CV 12), Qihai (CV 6), Guanyuan (CV 4), Danzhong (CV 17), Juliao (ST 3), Shuigou (GV 26) and Chengjiang (CV 24)	Performed 3 times a week
Zhang et al. (16)	China	Medicated thread moxibustion using the traditional Zhuang medicine method	14	NA, each acupoint was cauterized 2 times, once every 2 days for 4 weeks.	Kuihua (Points specific to Zhuang medicine method, location of the point dependent on the shape and size of local skin lesions on the body surface wherein a group of acupoints were selected along the periphery and midpoint of the body: Zusanli (ST 36), Xuehai (SP 10), Baihui (DU 20), and Taichong (LR 3)	Performed every other day	Held between the thumb and index finger, the exposed end of a medicated thread was lit under an alcohol lamp and applied to points of interest.
Zhu and Wu (17)	China	Acupuncture and pricking of plum-blossom needle therapy (Cohort 1) vs. Cystine tablets 0.1 g TID, Vitamin B1 20 mg TID and 2% Minoxidil Solution applied topically BID (Cohort 2)	40 (4 courses comprised of 10 sessions)	30	Major acupoints: Shenshu (BL 23), Ganshu (BL 18), Taixi (KI 3), Sanyinjiao (SP 6), Xuehai (SP 10), Geshu (BL 17), Zusanli (ST 36), Fengchi (GB 20), Baihui (GV 20), Shangxing (GV 23) and Shuaigu (GB 8). Adjunct acupoints: Neiting (ST 44) for alopecia above the forehead; Taichong (LR 3) for alopecia affected the vertex; Waiguan (TE 5) for alopecia affecting bilateral sides of the head; and Houxi (SI 3) for alopecia affecting the occiput.	Performed every other day	Needles were manipulated every 10 min using a twisting technique consisting of moving the needle back and forth between the thumb and the index finger. Plum-blossom needling in areas of hair loss was performed after acupuncture. The strength of the needling was dependent on the severity and the duration of hair loss.

ALA-PDT, 5-aminolevulinic acid-based photodynamic therapy; JKM, Japanese Kampo medicine; BID, twice a day; TID, three times a day; NA, not available.