Acupuncture for stroke 2026

Stimulated by Zheng et al 2026.[1]

PSD – post-stroke dysphagia
PSA – post-stroke aphasia
RA – rheumatoid arthritis
PPI – proton pump inhibitor
IF – impact factor
PSM – propensity score matching
HR – hazard ratio (aHR – adjusted HR)
mRS – modified Rankin Scale
rTPA – recombinant tissue plasminogen activator
EVT – endovascular thrombectomy
CI – confidence interval
UTI – urinary tract infection
TCM – traditional Chinese medicine
GI – gastrointestinal

– key to acronyms

Stroke comes up quite frequently on this blog (see Stroke). Mostly we have discussed treatment of dysphagia (see PSD) and aphasia (see PSA) and the reduced risk of stroke (in insomnia, in migraine, and in RA) or the reduced risk of complications following a stroke (pneumonia risk in patients on PPIs, and injury risk). We have also looked at post-stroke depression.

The last time we discussed the actual treatment of stroke was in 2022 – see Acupuncture for stroke 2022. This paper, published in BMC Complementary Medicine and Therapies (IF 3.4), looks at inpatient acupuncture treatment of patients admitted with ischaemic strokes. It is a retrospective observational study from Taiwan, and the outcome measured was mortality risk. It is smaller than most similar such studies I have highlighted here (see Retrospective cohorts). This is likely to be because the data comes from a single centre (Kaohsiung Veterans General Hospital) where acupuncture is offered as an adjunct to inpatient stroke care.

Over a 4-year period from the start of 2017 to the end of 2020, 1455 patients were treated as inpatients for ischaemic stroke and met the eligibility criteria for this study. Of these, 348 (~24%) received acupuncture whilst in hospital. There was no PSM performed in this retrospective cohort, but HRs were adjusted for age, sex, and any baseline parameters where the difference between groups had a p value less than 0.2, which seems quite conservative.

The acupuncture cohort were more physically disabled at baseline (based on the mRS), but a higher proportion received rTPA, EVT, and rehabilitation whilst in hospital. Looking at the relative percentages in these different categories makes it impossible to judge which cohort had a better or worse prognosis.

Mortality risk at 12 months was lower in the acupuncture cohort (aHR 0.45, 95% CI 0.22 to 0.93). There was a trend towards lower mortality at 3 and 6 months, but the top of the 95% CI was just over 1 at both time points (aHR 0.46, 95% CI 0.20 to 1.06 and aHR 0.52, 95% CI 0.24 to 1.12 respectively).

In the background details of this paper, the authors comment that ischaemic stroke is the leading cause of disability in Taiwan.[2] They then list a series of previous retrospective cohort studies suggesting reduced risks of various conditions in patients with stroke associated with acupuncture. I casually scanned the list expecting to have seen and commented on all of them already, and to my surprise I had missed them all! More embarrassing still, the first of them listed was published in our journal.[3]

Here is a list of what I missed.

Acupuncture is associated with a decreased risk of:

• UTI in patients with stroke in Taiwan (aHR 0.76)[3]
• UTI in patients with stroke and 11+ sessions (aHR 0.57)[3]
• Pneumonia in patients with stroke in Taiwan (aHR 0.86)[4]
• Pneumonia in patients with stroke and 6+ sessions (aHR 0.77)[4]
• Mortality in patients with subacute or chronic stroke in Korea (aHR 0.32)[5]
• Heart attack in patients with stroke in Taiwan (aHR 0.86)[6]
• Heart attack in patients with stroke and 15+ sessions (aHR 0.61)[6]
• Dementia in patients with stroke in Taiwan (aHR 0.73)[7]
• Dementia in patients with stroke plus rehabilitation (aHR 0.64)[7]

One paper I can be forgiven for overlooking did not have acupuncture in the title, unlike all those above. It referred (in the title) to the use of adjuvant therapy with TCM in hospitalised stroke patients,[8] and was published in the Journal of Ethnopharmacology (IF 5.4), although the majority of patients actually received acupuncture alone, rather than acupuncture and herbal medicine or any other combination of TCM treatments.

This study reported a reduction in complications following stroke associated with TCM therapy (mostly acupuncture). The complications recorded were UTI, pneumonia, epilepsy, GI haemorrhage, fracture, decubitus ulcer, and mortality. The reduction in these combined risks associated with adjuvant acupuncture was about 40% (aHR 0.60).

Reduced medical costs associated with patients receiving adjuvant TCM therapy were also reported in this study, although it is not clear whether or not the extra costs of the adjuvant treatment was accounted for.

In summary, there seems to be a number of studies suggesting reduced risks of stroke-related complications associated with adjuvant acupuncture, and the relevant publications were distributed over the last decade.

References

1          Zheng L-C, Wang Y-F, Yin C-H, et al. Acupuncture for inpatients with ischemic stroke in Southern Taiwan: real-world data. BMC Complement Med Ther. Published Online First: 7 January 2026. doi: 10.1186/s12906-025-05239-5

2          Tsai C-F, Wang Y-H, Teng N-C, et al. Incidence, subtypes, sex differences and trends of stroke in Taiwan. PloS One. 2022;17:e0277296. doi: 10.1371/journal.pone.0277296

3          Yang J-L, Chen T-L, Yeh C-C, et al. Acupuncture treatment and the risk of urinary tract infection in stroke patients: a nationwide matched cohort study. Acupunct Med. 2019;37:175–83. doi: 10.1177/0964528419834017

4          Chang C-C, Chen T-L, Lin C-S, et al. Decreased risk of pneumonia in stroke patients receiving acupuncture: A nationwide matched-pair retrospective cohort study. PLOS ONE. 2018;13:e0196094. doi: 10.1371/journal.pone.0196094

5          Choi S-R, Kim E-S, Jang B-H, et al. A Time-Dependent Analysis of Association between Acupuncture Utilization and the Prognosis of Ischemic Stroke. Healthcare. 2022;10:756. doi: 10.3390/healthcare10050756

6          Chuang S-F, Shih C-C, Yeh C-C, et al. Decreased risk of acute myocardial infarction in stroke patients receiving acupuncture treatment: a nationwide matched retrospective cohort study. BMC Complement Altern Med. 2015;15:318. doi: 10.1186/s12906-015-0828-8

7          Shih C-C, Yeh C-C, Hu C-J, et al. Risk of dementia in patients with non-haemorrhagic stroke receiving acupuncture treatment: a nationwide matched cohort study from Taiwan’s National Health Insurance Research Database. BMJ Open. 2017;7:e013638. doi: 10.1136/bmjopen-2016-013638

8          Chang C-C, Chen T-L, Chiu HE, et al. Outcomes after stroke in patients receiving adjuvant therapy with traditional Chinese medicine: A nationwide matched interventional cohort study. J Ethnopharmacol. 2016;177:46–52. doi: 10.1016/j.jep.2015.11.028

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Declaration of interests MC