Acupuncture for Fatigue

Acupuncture, a traditional Chinese medicine technique involving the insertion of thin needles into specific points on the body, has been explored in numerous clinical trials and randomized controlled trials (RCTs) as a potential treatment for fatigue. Fatigue, a debilitating symptom impacting quality of life across various medical conditions, represents a significant area of unmet need. These studies aim to investigate whether acupuncture offers a viable and effective intervention for managing and alleviating fatigue symptoms.

Protocols Studied in Research

[1] Acupuncture and massage for pain in patients with advanced cancer. (Cited by: 4) (pmid: 37962891)

• Protocol: A multicenter, randomized clinical trial compared acupuncture and massage in 298 patients with advanced cancer and moderate-to-severe pain. Treatments were administered weekly for 10 weeks with monthly boosters.
• Outcome: Both acupuncture and massage significantly reduced pain and improved fatigue, insomnia, and quality of life. However, no significant difference was found between the two interventions.

[2] Acupuncture and metformin for insulin resistance in women with polycystic ovary syndrome (PCOS). (Cited by: 13) (pmid: 34907435)

• Protocol: A three-armed randomized controlled trial (342 women with PCOS and IR) comparing true acupuncture, metformin (0.5g TID), and sham acupuncture for 4 months, with a 3-month follow-up. HOMA-IR was the primary outcome.
• Outcome: Metformin was more effective than acupuncture or sham acupuncture in improving HOMA-IR. Acupuncture showed no significant benefit over sham acupuncture. Acupuncture had fewer side effects than metformin.

[3] Active acupuncture versus sham acupuncture for chemotherapy-induced insomnia in breast cancer patients. (Cited by: 9) (pmid: 37101228)

• Protocol: A blinded, randomized, sham-controlled trial (n=138) of 15 acupuncture sessions over 18 weeks, followed by 24 weeks of follow-up. Participants were breast cancer patients experiencing insomnia due to chemotherapy.
• Outcome: While not statistically superior to sham acupuncture in reducing overall insomnia severity at 6 weeks, active acupuncture showed better improvements in sleep parameters, anxiety, depression, quality of life, and sleeping medication cessation rates in the long term. Adverse events were mild.

[4] Online Emotional Freedom Techniques (EFT) for stress, anxiety, and burnout in nurses treating COVID-19 patients. (Cited by: 51) (pmid: 33293201)

• Protocol: A randomized controlled trial (RCT) in a Turkish university hospital assigned nurses caring for COVID-19 patients to either a single online group EFT session or a no-treatment control group.
• Outcome: A single online EFT session significantly reduced stress, anxiety, and burnout in the intervention group compared to the control group, which showed no significant changes.

[5] Acupuncture and Cognitive Behavioral Therapy for Insomnia (CBT-I) in cancer survivors. (Cited by: 73) (pmid: 31081899)

• Protocol: A randomized controlled trial compared 8 weeks of acupuncture (n=80) and CBT-I (n=80) in cancer survivors. Outcomes were measured at 8 and 20 weeks.
• Outcome: CBT-I was significantly more effective than acupuncture for insomnia overall, although both treatments showed clinically meaningful improvements. CBT-I's effectiveness varied by participant demographics.

[6] Acupuncture (AP) and electroacupuncture (EA) combined with usual medical care for knee osteoarthritis (KOA). (Cited by: 9) (pmid: 32186030)

• Protocol: A randomized controlled trial (RCT) with 90 KOA patients randomly assigned to three groups: usual care (UC), AP+UC, and EA+UC. Treatment included NSAIDs and Ds-ABC, plus AP or EA in the respective groups.
• Outcome: Both AP+UC and EA+UC groups showed significantly greater improvements in pain, WOMAC scores, and quality of life (AQoL-SF36) compared to the UC group after one and two weeks. EA showed additional benefits in certain AQoL-SF36 domains.

[7] Transcutaneous auricular vagus nerve stimulation (taVNS) for chronic insomnia disorder. (Cited by: 0) (pmid: 39680406)

• Protocol: A randomized controlled trial (RCT) in Beijing compared taVNS to sham taVNS in 72 adults with chronic insomnia (PSQI ≥8). Treatment involved 30-minute sessions twice daily, five days a week for eight weeks, followed by 12 weeks of follow-up.
• Outcome: taVNS significantly reduced insomnia severity (PSQI scores) compared to sham taVNS, with a clinically meaningful difference sustained for 20 weeks. Improvements were also seen in secondary outcomes like mental health and fatigue. Further large-scale trials are needed.

[8] Real vs. sham acupuncture for fatigue in Parkinson's Disease (PD). (Cited by: 29) (pmid: 27028133)

• Protocol: A randomized controlled trial of 94 PD patients with moderate-to-high fatigue. Participants received 6 weeks of biweekly acupuncture (real or sham).
• Outcome: Both real and sham acupuncture groups showed significant fatigue improvement at 6 and 12 weeks, with no significant difference between groups. Improvements in mood, sleep, and quality of life were also observed, but not significantly different between groups. Acupuncture's benefits appear primarily due to placebo effects.

[9] Gua Sha therapy for improving weightlifting performance and reducing muscle injury in male weightlifters. (Cited by: 1) (pmid: 32186106)

• Protocol: A randomized controlled trial (RCT) with 44 male weightlifters assigned to Gua Sha, sham scraping, or control groups. The Gua Sha and sham scraping groups received 16 sessions of treatment over 8 weeks alongside their weightlifting training.
• Outcome: Gua Sha significantly increased weightlifting ability, lowered perceived exertion during weightlifting, and reduced markers of muscle damage (CK) while increasing immunoglobulin A levels, suggesting a positive effect on recovery and performance.

[10] Acupuncture plus amantadine for fatigue in relapsing-remitting multiple sclerosis (RRMS) patients. (Cited by: 0) (pmid: 36722418)

• Protocol: A randomized controlled trial compared acupuncture plus amantadine to amantadine alone in 60 RRMS patients with fatigue. Acupuncture was administered 2-3 times weekly for 10 sessions over 4 weeks. Both groups received amantadine and routine immuno-modulator treatment.
• Outcome: Acupuncture plus amantadine significantly reduced fatigue and improved quality of life (physical and mental) compared to amantadine alone after 4 weeks, with no adverse events reported.

[11] Acupuncture combined with traditional Chinese medicine for post-stroke fatigue. (Cited by: 0) (pmid: 37574359)

• Protocol: The provided abstract lacks details, preventing a summary of the study design, participants, and intervention administration.
• Outcome: No outcome data is available as the abstract is missing.

[12] Moxibustion for Cancer-Related Fatigue (CRF). (Cited by: 17) (pmid: 34189864)

• Protocol: A multicenter, assessor-blinded, randomized controlled trial comparing moxibustion, sham moxibustion, and usual care in 96 CRF patients. Treatment lasted 8 weeks, with follow-up at 4 weeks post-treatment. Brief Fatigue Inventory (BFI) and Functional Assessment of Cancer Therapy-Fatigue scores were used.
• Outcome: Moxibustion significantly reduced CRF symptoms compared to usual care, with a sustained effect at 4-week follow-up. Sham moxibustion showed improvement during treatment but not after. No serious adverse events were reported.

[13] Infrared laser moxibustion (ILM) for cancer-related fatigue (CRF) in breast cancer survivors. (Cited by: 1) (pmid: 38773552)

• Protocol: A three-arm, randomized, sham-controlled trial (n=140) compared ILM, sham ILM, and a waitlist control. Participants received 12 sessions of ILM or sham ILM over 6 weeks, followed by 12 weeks of observation.
• Outcome: ILM significantly reduced CRF compared to the waitlist control at 6 and 18 weeks. The difference between ILM and sham ILM was not significant at 6 weeks but was significant at 18 weeks, suggesting a possible effect but requiring further investigation with a larger sample size. No serious adverse events were reported.

[14] Ginger-indirect moxibustion plus acupuncture for Chronic Fatigue Syndrome (CFS). (Cited by: 3) (pmid: 35473345)

• Protocol: A randomized controlled trial (RCT) assigned 290 CFS participants to either ginger-indirect moxibustion plus acupuncture or acupuncture alone. Treatment involved 24 sessions over 8 weeks, followed by 12 weeks of follow-up.
• Outcome: Ginger-indirect moxibustion plus acupuncture showed significantly greater improvement in fatigue (FSS) and physical symptoms (SPHERE) compared to acupuncture alone, with no serious adverse events reported. Improvements were maintained at 12 weeks.

[15] Systemic and auricular electroacupuncture (2/100 Hz and Nogier frequencies) for fibromyalgia. (Cited by: 2) (pmid: 37609769)

• Protocol: A randomized pilot trial (n=18) compared electroacupuncture (six sessions over six weeks) to a control group. Electroacupuncture involved both systemic and auricular points.
• Outcome: While pain intensity and HRV weren't significantly improved, electroacupuncture showed a statistically significant positive effect on some quality-of-life aspects (FIQ domains, specifically pain and anxiety).

[16] Acupuncture for Chemotherapy-Induced Peripheral Neuropathy (CIPN) in solid tumor survivors. (Cited by: 18) (pmid: 34390283)

• Protocol: A randomized, controlled trial (RCT) comparing real acupuncture (RA), sham acupuncture (SA), and usual care (UC) in 75 solid tumor survivors with moderate-to-severe persistent CIPN. Participants received 8 weeks of treatment.
• Outcome: Both RA and SA significantly improved CIPN-related quality of life (FACT/GOG-Ntx), anxiety (HADS), and insomnia (ISI) compared to UC. No significant difference was found between RA and SA, suggesting a potential placebo effect warrants further investigation.

[17] Acupuncture at HT 7 and KI 7 for chronic insomnia. (Cited by: 9) (pmid: 34675728)

• Protocol: A randomized, single-blind, sham-controlled trial with 82 chronic insomnia patients received either 10 sessions of acupuncture or sham acupuncture over 3 weeks. Primary outcome measures were PSQI and ISI scores.
• Outcome: Acupuncture at HT 7 and KI 7 significantly improved sleep quality and insomnia severity compared to sham acupuncture immediately post-treatment, but this difference wasn't sustained at follow-up. Acupuncture also showed improvements in sleep architecture (PSG).

[18] Acupuncture for Chronic Fatigue Syndrome (CFS) (Cited by: 8) (pmid: 23981369)

• Protocol: A randomized, single-blinded, sham-controlled trial with 127 participants (40 men, 87 women) receiving either real or sham acupuncture (2 sessions/week for 4 weeks).
• Outcome: Acupuncture showed moderately significant improvements in physical and mental fatigue and physical health-related quality of life compared to sham acupuncture, despite considerable positive effects observed in the sham group. Effects on general mental health were smaller.

[19] 60-minute and 30-minute Long-snake-like moxibustion for Chronic Fatigue Syndrome (CFS). (Cited by: 2) (pmid: 37400824)

• Protocol: A randomized controlled trial comparing 60-minute vs. 30-minute sessions of Long-snake-like moxibustion, three times weekly for four weeks, in 60 female CFS patients. Outcomes measured using FS-14, other scales, and thermal imaging.
• Outcome: Longer duration (60-minute) moxibustion showed significantly greater improvement in CFS symptoms (FS-14 and spleen-kidney Yang deficiency scale) compared to shorter duration (30-minute) treatment. Thermal imaging showed correlated improvements.

[20] Somatosensory interaction transcutaneous electrical acupoint stimulation (SI-TEAS) for cancer-related fatigue (CRF). (Cited by: 1) (pmid: 35616251)

• Protocol: A randomized controlled trial comparing SI-TEAS, acupressure, and sham acupressure in 279 CRF patients. Treatments were administered 5 times weekly for 8 weeks, with fatigue and cell immunity assessed at baseline and weeks 4 and 8.
• Outcome: SI-TEAS significantly reduced CRF symptoms across multiple dimensions and improved cell immunity (T-lymphocyte subsets and NK cells) compared to acupressure and sham acupressure, suggesting it's a potentially effective treatment.

[21] Body and Sa-am acupuncture for Chronic Fatigue Syndrome (CFS) and Idiopathic Chronic Fatigue (ICF). (Cited by: 11) (pmid: 26211002)

• Protocol: A non-blinded, randomized controlled trial (RCT) with 150 participants divided into three groups: body acupuncture, Sa-am acupuncture, and usual care. Participants received 10 acupuncture sessions over 4 weeks.
• Outcome: Body acupuncture showed significant improvement in fatigue severity at 5 weeks compared to usual care. Both acupuncture groups showed improvements in stress, depression, and pain scores compared to the control group at 5 and 13 weeks.

[22] Acupressure at the P6 (Neiguan) point using electrostimulation for hypotension during hemodialysis. (Cited by: 3) (pmid: 33711814)

• Protocol: A randomized controlled trial (RCT) with 135 hemodialysis patients (67 intervention, 68 placebo). Intervention group received electrostimulation at P6 for 12 sessions over four weeks; placebo group received sham treatment. Outcomes measured via questionnaires and VAS scales.
• Outcome: Acupressure significantly increased systolic and diastolic blood pressure and reduced pain and fatigue levels compared to the placebo group after four weeks.

[23] Electroacupuncture for cancer-related insomnia. (Cited by: 11) (pmid: 35303841)

• Protocol: A multicenter, assessor-blinded, randomized controlled pilot trial comparing electroacupuncture, sham electroacupuncture, and usual care in 22 cancer patients with insomnia. Participants received 10 sessions over 4 weeks.
• Outcome: Electroacupuncture showed statistically significant improvements in insomnia severity (ISI, PSQI) and fatigue (FACT-F) compared to sham and usual care at 4 weeks, with continued improvement at follow-up. However, the small sample size limits conclusions; larger trials are needed.

[24] Panlong acupuncture combined with Xingnao Kaiqiao acupuncture for post-stroke fatigue. (Cited by: 0) (pmid: 37199197)

• Protocol: A randomized controlled trial comparing Panlong + Xingnao Kaiqiao acupuncture to Xingnao Kaiqiao acupuncture alone in 60 post-stroke fatigue patients. Treatment involved acupuncture at specific points for 4 weeks.
• Outcome: Panlong acupuncture combined with Xingnao Kaiqiao acupuncture significantly reduced fatigue symptoms, improved quality of life (SS-QOL energy scores, MBI scores), and had a higher effective rate than Xingnao Kaiqiao acupuncture alone.

[25] Acupuncture for cancer-related fatigue (CRF) in lung cancer patients. (Cited by: 32) (pmid: 28707168)

• Protocol: A randomized, double-blind, placebo-controlled pilot trial. 28 patients with CRF received either active or placebo acupuncture at specific acupoints twice weekly for 4 weeks, followed by 2 weeks of follow-up.
• Outcome: Active acupuncture significantly reduced CRF intensity (BFI-C) and improved quality of life (FACT-LCS) compared to placebo at 2 and 6 weeks. The treatment was deemed safe and feasible, warranting larger trials.

[26] Acupuncture, dry needling, and rest for reducing peripheral acute fatigue (PAF) in the biceps brachii. (Cited by: 1) (pmid: 32889135)

• Protocol: A single-blinded randomized controlled trial on non-physically active men. Participants underwent intermittent isometric contractions to induce PAF, followed by one of the three interventions. Outcomes were measured using electromyography, thermal imaging, and a visual analog scale.
• Outcome: This abstract describes the *protocol* for a study; it does not present any findings or conclusions. The study aims to determine the efficacy of the interventions but has not yet yielded results.

[27] Acupuncture and moxibustion (warm-needling) for Chronic Fatigue Syndrome (CFS). (Cited by: 4) (pmid: 25219128)

• Protocol: A randomized controlled trial (RCT) compared manual acupuncture, warm-needling, and sham acupuncture (non-acupoint stimulation) in 133 CFS patients. Treatments were administered daily for 20 days. The Chalder Fatigue Scale measured outcomes.
• Outcome: Both acupuncture and warm-needling significantly reduced CFS symptoms compared to sham acupuncture, with warm-needling showing superior efficacy. Patient satisfaction was also higher in the warm-needling group.

[28] Electroacupuncture (EA) for managing neuropsychiatric symptom clusters in cancer patients and survivors. (Cited by: 2) (pmid: 36973688)

• Protocol: A randomized, sham-controlled, blinded clinical trial (n=64) comparing verum EA (13 acupoints) to sham EA (7 acupoints) administered weekly for 10 weeks, with a follow-up. Participants were cancer patients/survivors with at least one neuropsychiatric symptom.
• Outcome: The study aims to determine the efficacy, safety, and feasibility of EA in mitigating neuropsychiatric symptom clusters; results are not yet reported as this is a study protocol.

[29] Therapist-delivered acupuncture, self-acupuncture (self-needling), and no maintenance treatment for cancer-related fatigue (CRF). (Cited by: 31) (pmid: 23436910)

• Protocol: A randomized controlled trial re-randomized breast cancer patients from a previous acupuncture trial into three groups: therapist-delivered acupuncture, self-needling, or no further treatment. Each intervention consisted of four weekly sessions.
• Outcome: Self-acupuncture was found to be acceptable, feasible, and safe. However, neither therapist-delivered nor self-acupuncture provided significant improvements in fatigue, mood, or quality of life beyond the initial acupuncture treatment.

[30] Jianpishengsui (JPSS) herbal formula cream for chemotherapy-related fatigue (CRF) in non-small cell lung cancer (NSCLC) patients. (Cited by: 5) (pmid: 31948475)

• Protocol: A randomized, placebo-controlled trial will test JPSS cream versus placebo in NSCLC patients experiencing CRF during chemotherapy. Participants receive twice-daily oral administration for 15 days across two chemotherapy cycles.
• Outcome: This abstract describes the study protocol; no outcomes are reported as it is a prospective study. The study aims to assess the efficacy and safety of JPSS in reducing CRF and improving quality of life.

[31] Auricular point acupressure (APA) for managing pain, fatigue, and disturbed sleep in breast cancer patients. (Cited by: 30) (pmid: 26390073)

• Protocol: A randomized controlled pilot study with 31 breast cancer patients randomized to active APA or sham APA. Participants received weekly treatments for 4 weeks, with self-reported symptom measures collected at multiple time points.
• Outcome: Active APA showed significant reduction in pain, fatigue, sleep disturbance, and daily activity interference compared to sham APA. While promising, the small sample size necessitates further research.

[32] True acupuncture vs. sham acupuncture for cancer-related fatigue in patients undergoing radiation therapy. (Cited by: 26) (pmid: 19476729)

• Protocol: A modified, double-blind, randomized, placebo-controlled trial with 27 enrolled participants. Acupuncture (true or sham) was administered 1-2 times weekly for 6 weeks during radiation therapy.
• Outcome: Both true and sham acupuncture groups showed fatigue improvement, but the difference wasn't statistically significant due to underpowering. While not statistically significant, true acupuncture showed a larger improvement suggesting potential benefit. Feasibility of a larger trial is questionable.

[33] Nutraceutical treatment (Migratens®) and acupuncture for Fibromyalgia Syndrome (FMS). (Cited by: 14) (pmid: 32204554)

• Protocol: A randomized controlled trial comparing Migratens® (coenzyme Q10, vitamin D, alpha-lipoic acid, magnesium, and tryptophan) and acupuncture in 60 female FMS patients over 3 months. Pain and quality of life were assessed at 1, 3, and 6 months.
• Outcome: Both Migratens® and acupuncture significantly reduced pain in FMS patients. Migratens® showed significant pain reduction at 1 and 3 months, while acupuncture showed consistent pain reduction throughout. Both treatments improved quality of life.

[34] Acupuncture for Delayed Sleep-Wake Phase Disorder (DSWPD) (Cited by: 2) (pmid: 36858383)

• Protocol: A randomized controlled trial comparing acupuncture versus placebo acupuncture in 84 DSWPD patients. Treatment involved specific acupuncture points and lasted 8 weeks. Sleep parameters and questionnaires were assessed before, after, and during follow-up.
• Outcome: Acupuncture significantly improved sleep parameters (total sleep time, sleep efficiency), reduced daytime sleepiness and fatigue, and lowered cortisol levels compared to placebo, with benefits sustained during follow-up.

[35] Herb-partition moxibustion and acupuncture for mild to moderate active Crohn's disease. (Cited by: 8) (pmid: 29231405)

• Protocol: A randomized controlled trial (RCT) of 102 patients with active Crohn's disease. The observation group received herb-partition moxibustion and acupuncture at specific acupoints; the control group received bran-partition moxibustion and shallow acupuncture. Treatment was administered three times weekly for 12 weeks.
• Outcome: Herb-partition moxibustion combined with acupuncture showed significantly greater improvement in abdominal pain, diarrhea, fatigue, and anorexia compared to the control group. The intervention was deemed safe and effective for improving common Crohn's disease symptoms.

[36] Acupuncture and moxibustion for Chronic Fatigue Syndrome (CFS). (Cited by: 41) (pmid: 27886247)

• Protocol: A randomized controlled pilot trial comparing acupuncture, moxibustion, and a control group (n=45). Participants received treatments and were assessed using the Fatigue Assessment Instrument (FAI) and heart rate variability (HRV).
• Outcome: Both acupuncture and moxibustion improved fatigue, but moxibustion showed greater long-term effectiveness; acupuncture showed more immediate HRV changes. The potential mechanism involves vagal nerve activation.

[37] Mawangdui Guidance for female stress urinary incontinence (SUI). (Cited by: 0) (pmid: 38608094)

• Protocol: A randomized controlled trial comparing Mawangdui Guidance exercises to Kegel exercises in 60 women with SUI. Both groups received basic rehabilitation therapy; the experimental group added Mawangdui Guidance for 6 weeks.
• Outcome: Mawangdui Guidance significantly improved pelvic floor muscle function, urine leakage, and quality of life compared to Kegel exercises. The Mawangdui Guidance group showed a higher effective rate. Further research is needed.

[38] 2 Hz continuous wave and 2 Hz/100 Hz dilatational wave electroacupuncture (EA) for Polycystic Ovary Syndrome (PCOS) with abdominal obesity. (Cited by: 0) (pmid: 38146250)

• Protocol: A randomized controlled trial comparing two EA frequencies (2 Hz continuous vs. 2 Hz/100 Hz dilatational) in 58 PCOS patients with abdominal obesity. Treatment involved 30-minute EA sessions, three times weekly for 12 weeks, targeting specific acupuncture points.
• Outcome: Both EA frequencies improved ovulation, reduced weight and waist circumference, and decreased depression scores. The 2 Hz/100 Hz dilatational wave EA showed superior waist circumference reduction, decreased AMH, increased SHBG, and improved acne, fatigue, and dysmenorrhea symptoms compared to the 2 Hz continuous wave EA.

[39] Tiaoshen acupuncture for primary insomnia (PI). (Cited by: 1) (pmid: 37697874)

• Protocol: A randomized controlled pilot trial (RCT) of 60 PI patients, comparing Tiaoshen acupuncture at specific acupoints to sham acupuncture. Treatment involved 30-minute sessions, three times a week for four weeks. Cognitive and sleep quality were assessed using multiple scales.
• Outcome: Tiaoshen acupuncture significantly improved cognitive function, sleep quality, and reduced daytime fatigue in PI patients compared to sham acupuncture. Improvements in cognitive function correlated with improvements in sleep quality.

[40] Acupuncture for cancer-related fatigue (CRF) in breast cancer patients. (Cited by: 83) (pmid: 23109700)

• Protocol: A pragmatic, randomized controlled trial (RCT) compared acupuncture plus usual care to usual care alone in 302 breast cancer outpatients. Acupuncture involved weekly sessions for 6 weeks.
• Outcome: Acupuncture significantly reduced general fatigue, physical fatigue, mental fatigue, anxiety, depression, and improved quality of life compared to usual care. The intervention was deemed effective for managing CRF.

Research Interpretation: Summary and Conclusion

The reviewed studies employed diverse acupuncture protocols, including variations in stimulation type (e.g., manual, electroacupuncture, moxibustion), point selection, frequency, and duration, often in combination with other interventions. While many studies reported significant improvements in fatigue, often alongside improvements in sleep quality, pain, and quality of life, the extent of benefit varied considerably. Several sham-controlled trials demonstrated that some observed improvements might be attributed to placebo effects. Consistent findings across multiple studies suggest that acupuncture may offer a beneficial adjunct therapy for fatigue in certain conditions, particularly when combined with other treatments. However, the lack of consistent superiority of true acupuncture over sham acupuncture in several trials highlights the need for larger, well-designed studies to definitively establish acupuncture's efficacy for fatigue relief and to identify factors that predict optimal treatment response. Further research should focus on standardizing acupuncture protocols and investigating potential mechanisms of action.

Publications

[1] Epstein AS; Liou KT; Romero SAD; Baser RE; Wong G; Xiao H; Mo Z; Walker D; MacLeod J; Li Q; Barton-Burke M; Deng GE; Panageas KS; Farrar JT; Mao JJ (2023). Acupuncture vs Massage for Pain in Patients Living With Advanced Cancer: The IMPACT Randomized Clinical Trial JAMA network open 6 (11) :e2342482.

[2] Wen Q; Hu M; Lai M; Li J; Hu Z; Quan K; Liu J; Liu H; Meng Y; Wang S; Wen X; Yu C; Li S; Huang S; Zheng Y; Lin H; Liang X; Lu L; Mai Z; Zhang C; Wu T; Ng EHY; Stener-Victorin E; Ma H (2022). Effect of acupuncture and metformin on insulin sensitivity in women with polycystic ovary syndrome and insulin resistance: a three-armed randomized controlled trial Human reproduction (Oxford, England) 37 (3) :542-552.

[3] Zhang J; Qin Z; So TH; Chang TY; Yang S; Chen H; Yeung WF; Chung KF; Chan PY; Huang Y; Xu S; Chiang CY; Lao L; Zhang ZJ (2023). Acupuncture for chemotherapy-associated insomnia in breast cancer patients: an assessor-participant blinded, randomized, sham-controlled trial Breast cancer research : BCR 25 (1) :49.

[4] Dincer B; Inangil D (2021). The effect of Emotional Freedom Techniques on nurses' stress, anxiety, and burnout levels during the COVID-19 pandemic: A randomized controlled trial Explore (New York, N.Y.) 17 (2) :109-114.

[5] Garland SN; Xie SX; DuHamel K; Bao T; Li Q; Barg FK; Song S; Kantoff P; Gehrman P; Mao JJ (2019). Acupuncture Versus Cognitive Behavioral Therapy for Insomnia in Cancer Survivors: A Randomized Clinical Trial Journal of the National Cancer Institute 111 (12) :1323-1331.

[6] Zhang L; Yuan H; Zhang L; Li J; Li H (2019). Effect of acupuncture therapies combined with usual medical care on knee osteoarthritis Journal of traditional Chinese medicine = Chung i tsa chih ying wen pan 39 (1) :103-110.

[7] Zhang S; Zhao Y; Qin Z; Han Y; He J; Zhao B; Wang L; Duan Y; Huo J; Wang T; Wang Y; Rong P (2024). Transcutaneous Auricular Vagus Nerve Stimulation for Chronic Insomnia Disorder: A Randomized Clinical Trial JAMA network open 7 (12) :e2451217.

[8] Kluger BM; Rakowski D; Christian M; Cedar D; Wong B; Crawford J; Uveges K; Berk J; Abaca E; Corbin L; Garvan C (2016). Randomized, Controlled Trial of Acupuncture for Fatigue in Parkinson's Disease Movement disorders : official journal of the Movement Disorder Society 31 (7) :1027-32.

[9] Wang X; Jia B; Zhong H; Huang X; Chen R; Yang J (2019). Effects of Gua Sha therapy on weightlifting training: a randomized trial Journal of traditional Chinese medicine = Chung i tsa chih ying wen pan 39 (4) :575-581.

[10] Khodaie F; Naser Moghadasi A; Kazemi AH; Zhao B (2023). Effectiveness of acupuncture for fatigue in patients with relapsing-remitting multiple sclerosis: a randomized controlled trial Acupuncture in medicine : journal of the British Medical Acupuncture Society 41 (4) :199-205.

[11] Han X; Duan H; Hu J; Tian T (2023). Acupuncture combined with traditional Chinese medicine for post-stroke fatigue: A randomized controlled trial Asian journal of surgery 46 (11) :5310-5311.

[12] Han K; Kim M; Kim EJ; Park YC; Kwon O; Kim AR; Park HJ; Park YC; Cho JH; Kim JH; Lee JH (2021). Moxibustion for treating cancer-related fatigue: A multicenter, assessor-blinded, randomized controlled clinical trial Cancer medicine 10 (14) :4721-4733.

[13] Mao H; Jin M; Xie L; Mao N; Shen X; Chen J; Chen X; Mao JJ; Shen X (2024). Infrared laser moxibustion for cancer-related fatigue in breast cancer survivors: a randomized controlled trial Breast cancer research : BCR 26 (1) :80.

[14] Tingting MA; Jie WU; Lijie Y; Fen F; Huilin Y; Jinhua Z; Yanjin Z; Qing N; Lirong H; Youbing L; Jue Y; Guiquan C; Tianshu H; Li W; Yuanfang R; Jing T (2022). Ginger-indirect moxibustion plus acupuncture versus acupuncture alone for chronic fatigue syndrome: a randomized controlled trial Journal of traditional Chinese medicine = Chung i tsa chih ying wen pan 42 (2) :242-249.

[15] Moreira RM; Rosario RC; Boggiss EA; Lima RA; Silva PA; Silva KPD; Farias CL; Santos VQD; Silva JRTD; Simoes RP; Terra AMSV; Santos ATS (2023). Effect of Systemic and Auricular Acupuncture with a 2/100 Hz Frequency and Nogier Frequency in Fibromyalgia: a Randomized Clinical Trial, Pilot Study Journal of acupuncture and meridian studies 16 (4) :139-151.

[16] Bao T; Baser R; Chen C; Weitzman M; Zhang YL; Seluzicki C; Li QS; Piulson L; Zhi WI (2021). Health-Related Quality of Life in Cancer Survivors with Chemotherapy-Induced Peripheral Neuropathy: A Randomized Clinical Trial The oncologist 26 (11) :e2070-e2078.

[17] Wang C; Xu WL; Li GW; Fu C; Li JJ; Wang J; Chen XY; Liu Z; Chen YF (2021). Impact of Acupuncture on Sleep and Comorbid Symptoms for Chronic Insomnia: A Randomized Clinical Trial Nature and science of sleep 13 :1807-1822.

[18] Ng SM; Yiu YM (2013). Acupuncture for chronic fatigue syndrome: a randomized, sham-controlled trial with single-blinded design Alternative therapies in health and medicine 19 (4) :21-6.

[19] Luo H; Gong R; Zheng R; Tan J; Chen R; Wu J; Ma T (2023). Dose-effect of long-snake-like moxibustion for chronic fatigue syndrome: a randomized controlled trial Journal of translational medicine 21 (1) :430.

[20] Shu J; Ren W; Chen S; Li L; Zhu H; Jin A (2022). Effect of Somatosensory Interaction Transcutaneous Electrical Acupoint Stimulation on Cancer-related Fatigue and Immunity: A Randomized Controlled Trial American journal of clinical oncology 45 (7) :316-324.

[21] Kim JE; Seo BK; Choi JB; Kim HJ; Kim TH; Lee MH; Kang KW; Kim JH; Shin KM; Lee S; Jung SY; Kim AR; Shin MS; Jung HJ; Park HJ; Kim SP; Baek YH; Hong KE; Choi SM (2015). Acupuncture for chronic fatigue syndrome and idiopathic chronic fatigue: a multicenter, nonblinded, randomized controlled trial Trials 16 :314.

[22] Bicer S; Tasci S (2022). The Effect of Body Acupressure on Blood Pressure and Fatigue Levels in Individuals Suffering From Hypotension During Hemodialysis: A Randomized Controlled Trial Alternative therapies in health and medicine 28 (2) :6-16.

[23] Lee B; Kim BK; Kim M; Kim AR; Park HJ; Kwon OJ; Lee JH; Kim JH (2022). Electroacupuncture for treating cancer-related insomnia: a multicenter, assessor-blinded, randomized controlled, pilot clinical trial BMC complementary medicine and therapies 22 (1) :77.

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