Hindawi Publishing Corporation

Evidence-Based Complementary and Alternative Medicine

Volume 2015, Article ID 401914, 20 pages
http://dx.doi.org/10.1155/2015/401914

Review Article
Acupoint Catgut Embedding for Obesity: Systematic Review and
Meta-Analysis

Taipin Guo,1 Yulan Ren,2 Jun Kou,2 Jing Shi,3 Sun Tianxiao,2 and Fanrong Liang2
1
School of Acupuncture-Moxibustion and Tuina and Rehabilitation, Yunnan University of Traditional Chinese Medicine,
Kunming 650500, China
2
School of Acupuncture-Moxibustion and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu 610075, China
3
Yunnan Province Hospital of Traditional Chinese Medicine, Kunming 650021, China

Correspondence should be addressed to Fanrong Liang; acuresearch@126.com

Received 8 May 2015; Accepted 16 July 2015

Academic Editor: Mariangela Rondanelli

Copyright © 2015 Taipin Guo et al. This is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Acupoint catgut embedding (ACE) was applied widely to antiweight in China. The aim of this review is to estimate the effectiveness
and safety of ACE on obesity. A literature search was conducted in PubMed, Cochrane Library, EBASE, CNKI, and so forth, using
combination subject terms of obesity (or overweight, weight loss, etc.) and acupoint catgut embedding (or catgut implantation,
catgut embedding). Improvement rate, reduction of body weight and body mass index (BMI), and so forth were analyzed. 43
studies were included for systematic review and meta-analysis. Although with poor methodological quality, ACE was superior to
manual acupuncture (MA), sham, and cupping in improvement rate and presented a better tendency (OR > 1) compared with
drugs and electroacupuncture (EA). Mean values of weight loss by ACE were 1.14 kg, 1.26 kg, 1.79 kg, and 3.01 kg comparing with
MA, drugs, EA, and sham, respectively. Mean of BMI reduced to 0.56 kg/m2 , 0.83 kg/m2 , 0.79 kg/m2 , and 1.63 kg/m2 comparing
with MA, drugs, EA, and sham. Less adverse effects were reported. Pooled outcomes presented a tendency of equal or superior
effects to other interventions and fewer side effects. Future high quality trials with rigorous design and positive FDA approved drug
as control are urgent to assess the effect of ACE for obesity. PROSPERO registration number is as follows: CRD42015016006.

1. Introduction
Obesity, a common kind of metabolic disease, is character-
ized by redundant accumulation and abnormal distribution
of fat. With transformation of modern lifestyle and diet
structure, such as more intake of refined food and less
physical activity, the prevalence of overweight and obesity
is increasing amazingly in either developed countries or
developing ones. Particularly in the last decade, the growth
rate of obesity has ascended exponentially. For example [1, 2],
the morbidity was 10% ∼40% in most European countries,
and it was up to 35.5% in 2009∼2010 in America in contrast to
30.5% in 1999∼2002 and 22.9% in 1988∼1994. With the world’s
most populous country being China, the obesity morbidity
was just 1.5% in 1992, 7.1% in 2002, and up to 18% in 2011
[3, 4], and in some region it reached 37.71% [5]. According
to the prediction [6] of World Health Organization (WHO),
2.3 billion people may suffer overweight and 0.7 billion get
obesity.
According to WHO report in 2005 [6], obesity was
deemed one of the top ten risk factors for many diseases like
hypertension, diabetes, cardiovascular disease, stroke, and
many cancers, and nearly 2.6 million people died directly
due to obesity or overweight every year. Studies [7, 8] by
working group on obesity in China (WGOC) revealed the
morbidity rate of hypertension was 2.5 times higher when
the body mass index (BMI) ≥ 24 kg/m2 than when BMI <
24 kg/m2 and 3.3 times higher with BMI ≥ 28 kg/m2 than
with BMI < 24 kg/m2 . Specifically, central obesity seemed
more dangerous than systematic obesity, and even with mild
obesity the morbidity and mortality of coronary heart disease
increased when the waist circumference got bigger [9–11]. So,
health problem is superior to aesthetics in obesity, and it urges
finding a nice treatment.
2 Evidence-Based Complementary and Alternative Medicine
Although the etiology and pathogenesis are still unclear,
many clinical practice guidelines have been developed world-
wide by relative medical and health organizations based
on the existing evidences. For instance, with the American
Clinical Guidelines of Overweight and Obesity released
by National Heart, Lung and Blood Institute (NHLBI) of
National Institutes of Health (NIH) since 2000 and with
the reassessment of new evidences by American College of
cardiology (ACC), American Heart Association (AHA), and
NHLBI, a new version of guideline for the management of
overweight and obesity in adults bas been made in 2013
[12]. Besides, Canada, China, and Europe have also published
their prevention guides, which promoted the concern and
management of obesity [4, 13, 14].
Obviously, the therapies of obesity are much similar in
all the guidelines, consisting of the lifestyle modification
of diet and exercise, drug, surgery, and complication ther-
apy. Restriction of high calorie diet intake and increase of
physical activity are recognized as the primary and most
valid type of antiobesity, particularly for children because
of the prohibition of drug and surgery in children’s weight
loss by American Food and Drug Administration (FDA).
Studies [15, 16] also showed reduction of higher energy food
intake such as high glucose and high fat and/or increase of
physical activity could improve bodily functions and reduce
fat. However, Cochrane system review [17] indicated that,
due to insufficient longer-term evidences, the short-term
adjustment of food consumption and movement was difficult
to achieve sustained weight reduction. The change of diet and
activity habit shaped for many years was difficult to adhere to
for a long time, and this led to the failure of weight loss for
weight regain [18].
So far, American FDA approved only 4 short-time use
drugs as phentermine, diethylpropion, phendimetrazine, and
benzphetamine and 3 medium- and long-time use ones as
orlistat, lorcaserin, and phentermine plus topiramate-ER.
Although these antiweight drugs were tested to be effective
by comparison with placebo, there are 5% of them that
were invalid [19]. Besides, there were so many obvious
side effects like headache, dizziness, nausea and vomiting,
insomnia, dry mouth, taste alteration, diarrhea, constipation,
hypoglycemia, and change of cognition that the harm brought
about by them was more than obesity itself, and these drugs
frequently failed in decrease of cardiovascular morbidity and
mortality and medical costs in the long run [19]. The efficacy
and safety were still under suspicion, and it may be related
to the ambiguity of obesity pathogenesis that the drug action
was hard to selectively cut down the adipose tissue and there
was no harm of health at molecular level [20]. The operative
treatment of obesity was intended for obese adult with serious
complication specifically caused by the excess of adipose cell
like metabolic syndrome, and the surgical sites were mostly
restricted at stomach, duodenum, pancreas, and gallbladder
to decrease or constrain the function of digestive system [21].
Considering the side reaction and that there is no benefit
to cardiovascular risks in antiobesity drugs and the high
risk and narrow use of surgery, more clinicians have applied
complementary and alternative therapy including TCM to
lose weight [22].
A study showed there were 1088 articles of weight loss
using TCM in CNKI database by 2012, and most of the meth-
ods were herbs and acupuncture [23]. Chinese herb was used
to strengthen spleen and 𝑞𝑖 and have bowel movement, and
radix astragali, bighead Atractylodes rhizome, and rhubarb
were the most used ones [24]. However, the side effects like
lack of strength and anorexia were difficult to avoid [25].
RCTs [26–30] manifested acupuncture was useful to
reduce BMI, waist, and abdomen circumference and improve
the quality of life, featuring less side effects, multifarious
intervention means like ACE, auricular needle, EA, hand
acupuncture, auricular plaster therapy, and so on. A review
[31] of RCTs indicated acupuncture seemed more effective
comparing to western antiobesity drugs; the mean of weight
reduction was 0.65 kg by acupuncture and 0.08 kg by TCM
drugs, and the mean of BMI reduction was 0.83 kg/m2 by
acupuncture and 0.18 kg/m2 by TCM drugs.
However, owing to the long-term adherence of anti-
weight drugs, the conflict of time between treatment and
daily work, and high expense of treating, more patients
abandoned therapy. Hence, the method of ACE, developed
from TCM acupuncture with a certain section of absorbable
catgut suture implanted in acupoint, characterized by easy
operation, durable and strong stimulation, and long interval
between each treatment, has broadly been used to lose
weight in China. Despite lack of effectiveness evaluated and
normative management plan, most Chinese TCM hospitals
and weight loss institutions have conducted ACE to treat
obesity based on their own experience. To estimate the safety
and effect appeared to be especially important, and it was also
necessary to provide a treatment suggestion based on current
evidences. The primary aims of this systematic review are to
estimate the effectiveness and safety of ACE on obesity and
formulate a treatment suggestion.
2. Methods
2.1. Study Selection (Inclusive and Exclusive Criteria)
2.1.1. Types of Study. To evaluate the curative effects of ACE
on obesity and weight loss, this review was confined to RCTs
comparing ACE with a control group, which contained drug,
no treatment, placebo, diet and exercise therapy, and other
types of acupuncture like MA, EA, ear auricular pressure
treatment, acupoint pressure, and so forth. It is deemed
a randomized study if the trial stated the “randomization”
phrase, and the blinding was not restricted. Besides, Chinese
and English were the limitation of language. The animal
mechanism studies, case reports, self-pre- and postcontrol, or
non-RCTs were excluded.
2.1.2. Types of Participants. It included the participants with
no limitation of age, gender, and type of overweight or obe-
sity, including children obesity and abdominal obesity. The
definitions of obesity or overweight using BMI, body weight,
or percentage of weight excess compared with ideal weight
were included. Patients with severe medical conditions, who
are pregnant, and with drug-induced obesity were excluded.
Evidence-Based Complementary and Alternative Medicine
2.1.3. Types of Intervention. Clinical trials estimating the
treatment of ACE used alone were included. Studies with
cointerventions of drugs and other types of acupuncture
such as MA, EA, massage, pressure, and laser acupuncture
were included if the same intervention as control and other
cointerventions were excluded. The control interventions
with other types of acupuncture, drugs, no treatment (wait-
listed or treatment as usual), placebo (no catgut implanted),
and diet or physical activity therapy were included. Studies to
compare the effect of difference of catgut length, operation,
or acupoint prescription were excluded.
2.1.4. Types of Outcome Measures. The primary outcomes
consisted of improvement rate, reduction of body weight,
BMI, hip circumference (HC), and waist circumference
(WC). Secondary outcomes included the side effects, such
as bleeding, serious discomfort, subcutaneous nodules, and
infection. Treatment suggestions including frequency of acu-
point prescription, frequency of treatment time, and course
were also shown according all the included RCTs.
2.2. Data Sources and Search Methods. A literature search
was conducted up to November 2014 in the databases
of PubMed, Cochrane Library, EBSCO, Web of Science,
EBASE, Springer, WHO International Clinical Trials Registry
Platform (ICTRP), CNKI, Wanfang, CBM, and VIP, using
the combination subject terms of obesity (or overweight,
weight loss, weight control, weight reduction, and slim)
and acupoint catgut embedding (or catgut implantation,
catgut embedding). The item of RCT was also chosen in
corresponding databases and the languages of Chinese and
English were restricted.
2.2.1. Data Extraction and Quality Assessment. Each liter-
ature of title and abstract was scanned by two reviewers
(Taipin Guo and Sun Tianxiao) who have been trained
and gained certifications in Chinese Cochrane Centre. All
relevant articles of full text were investigated. The extracted
information included descriptions of studies, characteristics
of participants, interventions of both observation group and
control group, adverse effect, and quality. Risk of bias was
used to evaluate the quality of study. The decision of risk was
made by two reviewers. If inconsistent results appeared, the
final decisions were made by all the authors. For missing or
ambiguous data, we tried to contact the author as possible,
and for duplicate publication we only selected the original.
2.2.2. Measures of Publication Bias and Treatment Effect.
Review Manager (version 5.1, the Nordic Cochrane Centre,
Copenhagen, Denmark) was applied to assess curative effect
and publication bias. Forest plot was used to illustrate the
relative strength of curative effect. Meanwhile, according to
Cochrane handbook suggestion, the funnel plot was pictured
to describe publication bias visually as the number of trials
was more than 10. There was no publication bias as a symmet-
ric inverted funnel while the publication bias or a systematic
difference of small or big sample size effects existed as an
asymmetric funnel. The heterogeneity result was indicated
3
using 𝐼2 values, and random effect model was chosen when
𝐼2 > 50% or fixed effect model when 𝐼2 < 50%. An odds
ratio (OR) > 1 suggested greater reduction of body weight
(≥2 kg) or BMI (≥0.5 kg m−2 ) in the ACE group than control
group in calculation of discrete data. The calculation of mean
differences of changes in body weight and BMI between
ACE and control groups was also conducted. Because of
most literatures showing only pre- and posttreatment values,
mean change was obtained by subtracting pretreatment from
posttreatment values and standard deviation (SD) change was
calculated by the given pre- and posttreatment SD according
to Cho’s formula [75].
3. Results
3.1. Study Description and Participants. Our initial search
identified 958 probable articles from the databases, of which
386 were reserved with 572 excluded for duplication. 47
articles were selected at the scan of titles and abstracts based
on the inclusive and exclusive criteria. Finally, 43 studies with
3520 participants met the inclusion criteria and were included
to this systematic review with 2 nonrandomizations and 2
redundant publications eliminated by full text view. In these
43 trials, there were 30 articles [32–61] reporting the weight
loss effect of ACE (1241 patients) with MA (1096 patients), 4
ACE (153 patients) versus drugs (165 patients) [62–65], 5 ACE
(155 patients) versus EA (155 patients) [58, 66–69], 2 ACE
(88 patients) versus sham (88 patients) (that with the same
operation as ACE but the catgut was not implanted [70, 71]),
1 ACE (40 patients) versus cupping (40 patients) [72], 2 ACE
plus EA (66 patients) versus EA (57 patients) [73, 74], and 2
ACE plus MA (91 patients) versus MA (85 patients) [42, 43],
and all the included trials were from China. The articles were
filtrated as shown in Figure 1.
3.2. Risk of Bias in Included Studies. As shown in Figure 2,
the methodological quality of all the 43 articles was poor and
probably in high risk with almost no reports of both alloca-
tion concealment and blinding of participants, acupunctur-
ists, or statisticians except 1 reported, respectively [38, 70].
Only 18 of 43 reported the random sequence generation with
13 [33–35, 41, 46, 48, 50, 53, 60, 61, 68, 70, 72] in low risk
and 5 [44, 51, 57, 63, 74] in high risk. The simple size varied
from 20 to 150 participants (20 to 150 participants in ACE
groups and 20 to 90 in control groups). Two articles [63, 70]
reported a small proportion of dropout whose data was also
excluded from analysis, but the reasons were not given or
clearly described. None of them stated the calculation of
sample size. More details were reported in Table 1 based on
EBM PICOs (patient, intervention, control, and outcomes)
principle. Because all of the studies did not publish the trial
protocols or registration, the selective reporting of outcomes
cannot be judged.
3.3. Comparison 1: ACE versus MA
3.3.1. Frequency of Improvement. There were 30 trials with
2392 patients [32–61] in the comparison of ACE versus MA
 4

Table 1: Characteristics of RCTs of ACE for obesity.

First Intervention Outcome (ACE versus Ct.) Side effects
author, No. in Frequency of Frequency of Ct.
Acupoints of ACE Types of Ct. With benefits No effect ACE Ct.
year ACE/Ct. ACE (total times) (total times)
Cao 2006 LI11, RN12, ST25, RN6, SP9, SP6, 1 per 1-2 day(s)
150/90 MA 1 per 20 days (3) IR, BW, BMI / NR NR
[32] AShi (45)
Chen 1 per 1-2 day(s)
40/40 ST34, RN12, ST25, RN9, ST40 MA 1 per 1 week (4) / / NR NR
2007 [33] (19)
Chen
40/40 SI4, BL22, BL17 MA 1 per 1 week (2) 5 per 1 week (10) IR, BW, FP / NR NR
2014 [34]
Ding
23/22 Not Given MA 1 per 10 days (3) 1 per 2 days (15) IR / NR NR
2006 [35]
Ding
65/64 RN12, ST25, ST40, LI 11 MA 1 per 10 days (3) 1 per 2 days (15) IR / NR NR
2006 [36]
Jin 2009 RN12, RN10, RN6, RN5, RN4,
45/44 MA 1 per 1 week (4) 1 per 1 day (30) IR / NR NR
[37] SP15, ST25, ST26, ST24
Li 2009 SP13, SP14, SP15, ST29, ST25,
53/53 MA 1 per 15 days (3) 1 per 2 days (23) IR / NR NR
[38] ST24, ST21, RN24
Li 2007 WC, THC, HC, FP,
36/36 Individualization treatment MA 1 per 2 week (9) 1 per 2 days (63) / NR NR
[39] BM
Li 2006
30/21 ST21, ST25, RN6, ST40 MA 1 per 1 week (4) 6 per 1 week (48) HDL / NR NR
[40]
Li 2014
41/41 GB26, ST25, SP15, RN12, RN6 MA 1 per 1 week (8) 1 per 2 days (28) / / NR NR
[41]
Li 2009
72/68 Individualization treatment MA 1 per 10 days (6) 3 per 1 week (24) / / NR NR
[42]
Liu 2008 1 per 1-2 day(s)
27/28 RN13, RN12, ST36, ST25 MA 1 per 35 days (2) / / NR NR
[43] (38)
Liu 2008 RN12, RN10, RN4, RN6, ST25, 1 per 8 days (3); 1 1 per 1-2 day(s)
40/40 MA IR / NR NR
[44] SP15, ST24, ST28 per 15 days (3) (20)
Liu 2007 ST25, RN4, RN9, ST36, ST40,
32/32 MA 1 per 2 weeks (2) 1 per 2 day (14) / / NR NR
[45] SP6
Meng ST37, ST40, SP6, SP4, ST34,
48/48 MA 1 per 1 weeks (4) 1 per 1 day (30) IR / NR NR
2005 [46] ST25, BL20, BL21, BL25
Ruan BL25, ST25, BL21, RN12, BL27, 1 per 1-2 day(s)
35/35 MA 1 per 2 weeks (4) IR, WHR / NR NR
2009 [47] RN4, ST37, ST40, SP9 (25)
Tian 2014 RN12, LR13, ST25, RN4, SP15,
22/22 MA 1 per 15 days (4) 1 per 1 day (52) IR / NR NR
[48] ST37, ST40
Wang
60/30 RN9, RN7, ST25, ST40 MA 1 per 1 month (3) 1 per 1 day (63) / IR NR NR
2001 [49]
Evidence-Based Complementary and Alternative Medicine
 Table 1: Continued.
First Intervention Outcome (ACE versus Ct.) Side effects
author, No. in Frequency of Frequency of Ct.
Acupoints of ACE Types of Ct. With benefits No effect ACE Ct.
year ACE/Ct. ACE (total times) (total times)
Wang ST37, ST40, SP6, SP4, ST34,
30/30 MA 1 per 1 weeks (4) 1 per 1 day (30) IR / NR NR
2006 [50] ST25, BL20, BL21, BL25
Xia 2014
36/36 ST25, ST36, RN13, RN12 MA 1 per 15 days (6) 1 per 3 days (30) / IR NR NR
[51]
Xiong
25/23 AShi, RN12, ST25, GB26 MA 1 per 1 weeks (8) 1 per 1 day (56) / / NR NR
2006 [52]
BL18, BL20, BL23, ST40, SP6,
Xu 2014 OD, BMI, WHR,
30/30 ST36, RN12, RN10, ST25, ST29, MA 1 per 2 weeks (6) 1 per 2 days (42) / NR NR
[53] IR
RN4, EX-CA1, SP9
Yan 2007 ST25, ST40, ST36, SP6, BL21, 1 per 15 days
35/33 MA 1 per 1 day (>90) BMI, IR / NR NR
[54] BL20, BL25, ST28 (6–10)
RN12, ST34, RN9, RN4, ST25,
Yang 2011
30/30 SP15, LI 11, SJ6, ST44, ST40, MA 1 per 15 days (4) 6 per 1 week (30) IR / NR NR
[55]
Evidence-Based Complementary and Alternative Medicine

ST37, SP6, SP9

Yao 2014 RN12, ST25, RN6, SP15, ST28, 1 per 10–14 days BMI, WC, HC,
25/25 MA 5 per 1 week (60) / NR NR
[56] SP14, ST24, ST40, SP6 (6–8) OD, FP, IR
Yin 2007 RN12, RN9, RN6, RN4, ST25,
27/26 MA 1 per 1 week (4) 1 per 1 day (30) / / NR NR
[57] SP15, ST36, SP9
Zhang ST25, RN12, LI 11, SP9, ST40,
30/30 MA 1 per 1 week (8) not clear WC, BW, BMI, IR NR NR
2014 [58] LR3, ST29, RN10, RN3, SJ6
Zhang
78/47 LI 11, RN12, ST25, RN6 MA 1 per 15 days (3) 1 per 1 day (30) IR / NR NR
2007 [59]
Zhang
30/30 RN12, ST25, RN6, ST37 MA 1 per 15 days (6) 1 per 2 days (36) / / NR NR
2006 [60]
Zhang
30/30 RN12, ST25, RN6, ST37 MA 1 per 10 days (3) 1 per 2 days (45) appetite / NR NR
2008 [61]
headache, dry mouth,
10 mg per 1 time, anorexia, insomnia,
Nie 2007 drug
56/70 RN12, RN4, ST25, AShi 1 per 20 days (6) 1 time per 1 day, / / NR constipation, rapid
[62] (sibutramine)
total 56 days heartbeat, mild high
blood pressure
subcutaneous
0.7 g per 1 time,
Cong RN12, RN9, ST25, BL25, ST34, drug indurations gastrointestinal
32/31 1 per 1 week (8) 3 times per 1 day, BW, BMI, WHR /
2007 [63] SP4 (ZhiBiTuo) (𝑛 = 5), red and discomfort (𝑛 = 6)
total 8 weeks
swollen (𝑛 = 1)
5
 6

Table 1: Continued.
First Intervention Outcome (ACE versus Ct.) Side effects
author, No. in Frequency of Frequency of Ct.
Acupoints of ACE Types of Ct. With benefits No effect ACE Ct.
year ACE/Ct. ACE (total times) (total times)
RN12, ST25, SP15, RN6, RN4, 10 mg per 1 time,
Zhang drug
35/34 RN3, LA14, RN9, ST40, SP6, 1 per 15 days (6) 1 time per 1 day, / / / 𝑛=5
2010 [64] (sibutramine)
GB30, BL37, LI 11 total 56 days
Li 2014 GB26, GB27, GB28, RN4, KI13, drug
30/30 1 per 1 week (4) not clear IR, leptin, insulin / NR NR
[65] ST28, BL52 (metformin)
Zhang
40/40 RN10, RN5, ST25, ST23, ST27 EA 3 per 1 week (24) 3 per 1 week (24) WHR, BW, TC, TG / NR NR
2008 [66]
RN13, RN12, RN10, RN7, RN9,
RN4, RN6, ST25, ST24, ST26,
Zhu 2014
25/25 SP15, SP14, GB26, GB27, LI14, EA 1 per 2 weeks (4) 3 per 1 week (24) / / NR NR
[67]
SJ13, LI4, LI 11, GB31, GB32,
ST34, ST36, ST37, ST40, SP6, SP9
Huang RN12, ST25, SP15, RN9, RN6, BW, IR, BMI,
30/30 EA 1 per 1 week (4) 3 per 1 week (24) medical cost NR NR
2011 [68] RN4, ST36, Ashi WC, HC, WHR
Ruan ST21, ST25, ST28, Ashi, RN12, IR, BW, BMI, WC,
30/30 EA 1 per 1 week (8) 3 per 1 week (24) / NR NR
2010 [69] RN9, ST27, GB26, Ashi HC, WHR
Guo RN12, RN10, RN6, RN4, ST40,
68/65 Sham 1 per 1 week (8) 1 pre 1 week (8) IR / NR NR
2009 [70] SP15, ST24, ST36
IR, BW, BMI, HC,
Jia 2014 ST24, ST28, GB26, SP14, ST21,
20/20 Sham 1 per 15 days (6) 1 per 15 days (6) CC, WC, HC, / NR NR
[71] ST25, ST40
THC, SC
Hou 2014 RN12, ST25, RN4, RN6, ST36, 1 per 15–20 days 2-3 per 1 week
40/40 Cupping IR, WC / NR NR
[72] ST40 (4) (8–12)
ST25, RN12, RN4, BL25, BL20,
Pan 2009 ST24, SP15, RN9, RN7, BL21,
40/40 EA 1 per 1 day (60) 3 per 1 week (20) WHR, BMI, / NR NR
[73] BL26, ST26, GB26, RN11, RN6,
BL23, BL28
IR, BW, BMI, WC,
Tang RN12, ST25, RN6, RN4, ST34, 1 per 1-2 day(s)
33/32 EA 1 per 15 days (3) WHR, HAMD, / NR NR
2009 [74] ST36, SP4, BL15, BL20 (15)
HAMA, PSQI
ACE: acupoint catgut embedding, MA: manual acupuncture, EA: electroacupuncture, Ct.: control, IR: improvement rate, BW: body weight, BMI: body mass index, CC: chest circumference, FP: fat percentage,
THC: thigh circumference, BM: basic metabolism, HC: hip circumference, WHR: waist hip rate, BM: basal metabolism, OD: obesity degree, TC: total cholesterol, TG: triacylglycerol, SC: shank circumference, HDL:
high-density lipoprotein, HAMD: Hamilton depression scale, HAMA: Hamilton anxiety scale, and PSQI: Pittsburgh sleep quality index.
Evidence-Based Complementary and Alternative Medicine
Evidence-Based Complementary and Alternative Medicine 7

291 CNKI was presented optically by the asymmetry of funnel plot

135 CBM (Figure 6).
248 Wanfang For the reduction of body weight, as shown in Figure 7,
237 VIP the merged results of 12 studies [33, 34, 39–41, 45, 51, 56–58,
5 PubMed 60, 61] demonstrated no variance in the two groups using a
10 EBSCO fixed effects model (MD = 1.14, 95% CI = −0.12∼2.40, 𝑝 =
7 Springer 0.08). No heterogeneity (𝐼2 = 6%, Chi2 test 𝑝 = 0.39) and
8 Cochrane Library their publication bias were found in Figure 8.
13 Embase
3 Web of Science
1 ICTRP 3.3.3. Reduction of WC and HC. The combined reduction
of WC from 9 trials [39–41, 47, 53, 56, 58, 60, 61] was
572 duplications of significant difference between the two groups (MD =
2.20, 95% CI = 0.62∼3.79, 𝑝 = 0.007), and no significant
97 reviews heterogeneity was found (𝐼2 = 0%, Chi2 test 𝑝 = 0.89),
70 case reports as shown in Figure 9. However, the therapy of ACE was not
386 articles 46 combining therapy superior to MA according to the pooled outcome of HC
70 TCM theory discussion (MD = 0.47, 95% CI = 0.99∼1.94, 𝑝 = 0.53); no significant
23 animal mechanism heterogeneity (𝐼2 = 0%, Chi2 test 𝑝 = 0.72) was shown in
26 other diseases Figure 10.
3 different styles of catgut embedding
4 conference summary and others
1 in ICTRP without results 3.4. Comparison 2: ACE versus Drug

47 articles 2 not randomized 3.4.1. Frequency of Improvement. Two trials [62, 64] reported
2 redundant publications the frequency of improvement and there was no difference
between ACE group and drug group (OR = 1.14, 95% CI =
43 articles 0.33∼3.90, 𝑝 = 0.84). No significant heterogeneity was tested
among the results (𝐼2 = 0%, Chi2 test 𝑝 = 0.65) (Figure 11).

(1) Reduction of BMI and Body Weight. Four trials [62–65]

30 catgut embedding versus acupuncture
4 catgut embedding versus drugs
5 catgut embedding versus electroacupuncture (1 reutilization)
2 catgut embedding versus sham catgut embedding
1 catgut embedding versus cupping
4 catgut embedding + control versus control (2 reutilizations)
Figure 1: Flow diagram or the number of studies included and
excluded.
and all of them evaluated the frequency of improvement.
The heterogeneity within each trial was low (𝐼2 = 42%,
Chi2 test 𝑝 = 0.01), and fixed effect model was applied to
calculate the incorporated data. The pooled outcomes showed
more improvement of obesity participants in ACE groups
than in MA groups (OR = 2.01, 95% CI = 1.58∼2.56, 𝑝 <
0.01) (Figure 3). The symmetry was shown in funnel plot and
indicated low publication bias (Figure 4).
3.3.2. Reduction of BMI and Body Weight. 12 studies reported
the decline of BMI [33, 39–42, 51, 53, 54, 57, 58, 60, 61], and
no difference was found between the two groups of catgut
embedding versus MA (MD = 0.56, 95% CI = −0.36∼1.49,
𝑝 = 0.23) tested by random effect model for their statistic
heterogeneity (𝐼2 = 69%, Chi2 test 𝑝 = 0.0002) which may
be caused by the differences of frequency of intervention,
manipulations, and participants (Figure 5). Publication bias
reported the reduction of BMI, and the combined results
indicated no significant difference between the two interven-
tions (OR = 0.83, 95% CI = −0.25∼1.91, 𝑝 = 0.84). It was
considerably heterogeneous among the 4 studies (𝐼2 = 77%,
Chi2 test 𝑝 = 0.004) and might be caused by the difference in
drugs or frequency of ACE (Figure 12).
The pooled results of 3 studies [62–64] showed that there
was no significant difference about body weight loss between
the intervention of ACE and drugs (MD = 1.26, 95% CI =
−0.77∼3.30, 𝑝 = 0.22). There was no significant heterogeneity
between the studies (𝐼2 = 15%, Chi2 test 𝑝 = 0.31)
(Figure 13).
(2) Reduction of WC and HC. For the outcome of WC
reduction, there were 2 trials [62, 64] reported and no
significant difference by their combination (MD = 1.20, 95%
CI = −0.54∼2.94, 𝑝 = 0.18). There was no heterogeneity
between the results (𝐼2 = 0%, Chi2 test 𝑝 = 0.58) (Figure 14).
One trial [62] reported the decrease of HC, and no difference
between the two groups was shown (MD = 0.26, 95% CI =
−2.65∼3.17, 𝑝 = 0.86) (Figure 15).
3.5. Comparison 3: ACE versus EA
3.5.1. Frequency of Improvement. There was no statistical
difference in frequency of improvement according to the
combined results of 4 studies [58, 67–69] comparing the
ACE with EA (OR = 1.73, 95% CI = 0.77∼3.92, 𝑝 = 0.19).
8 Evidence-Based Complementary and Alternative Medicine

Blinding of participants and personnel (performance bias)

Blinding of outcome assessment (detection bias)
Random sequence generation (selection bias)

Incomplete outcome data (attrition bias)

Allocation concealment (selection bias)

Selective reporting (reporting bias)

Other biases

Cao 2006 +
Chen et al. 2007 + +
Chen et al. 2014 + +
Cong et al. 2007 − +
Ding and Ma 2006 + +
Ding et al. 2006a +
Guo et al. 2009 + + +
Hou et al. 2014 + +
Huang and Pan 2011 + + +
Jia et al. 2014 +
Jin 2009 +
Li and Ge 2006 +
Li and Tian 2007 +
Li and Wu 2009 − +
Li and Lu 2009a +
Li et al. 2014 + +
Li et al. 2014a +
Liu and Xun 2007 +
Liu and Li 2008 +
Liu and Su 2008a − +
Meng and Chen 2005 + +
Nie 2007 +
Pan et al. 2009 +
Ruan and Lu 2009 +
Ruan et al. 2010 +
Tang et al. 2009 − +
Tian and He 2014 + +
Wang et al. 2001 +
Wang 2006 + + Random sequence generation (selection bias)
Xia 2014 − + Allocation concealment (selection bias)
Xiong and Zuo 2006 + Blinding of participants and personnel (performance bias)
Xu 2014 + + Blinding of outcome assessment (detection bias)
Yan 2007 + Incomplete outcome data (attrition bias)
Yang et al. 2011 + Selective reporting (reporting bias)
Yao 2014 +
Yin and Huo 2007 − + Other biases
Zhang and Fu 2006 + +
Zhang 2007 + 0 25 50 75 100
Zhang et al. 2008 + + (%)
Zhang et al. 2008a +
Zhang et al. 2010 + Low risk of bias
Zhang et al. 2014 + Unclear risk of bias
Zhu and Xu 2014 + High risk of bias

Figure 2: Risk of bias summary and graph.

Significant heterogeneity was not tested among the results heterogeneity between the results was shown (𝐼2 = 79%, Chi2
(𝐼2 = 28%, Chi2 test 𝑝 = 0.25) (Figure 16). test 𝑝 = 0.002) and maybe explained the difference of patients
or acupoint prescriptions (Figure 17).
3.5.2. Reduction of BMI and Body Weight. The pooled results Significant difference of body weight loss (MD = 1.79, 95%
of 4 trials [58, 67–69] released the idea that ACE treatment CI = 0.777∼2.81, 𝑝 = 0.0006) was tested by the pooled results
was not better than EA statistically in reduction of BMI of 4 trials [58, 66, 68, 69]. There was no obvious heterogeneity
(MD = 0.79, 95% CI = −0.42∼2.00, 𝑝 = 0.20). Substantial among the results (𝐼2 = 0%, Chi2 test 𝑝 = 0.98) (Figure 18).
Evidence-Based Complementary and Alternative Medicine 9

Acupoint catgut embedding Manual acupuncture Odds ratio Odds ratio

Study or subgroup Weight
Events Total Events Total M-H, fixed, 95% CI M-H, fixed, 95% CI
Cao 2006 141 150 72 90 5.7% 3.92 [1.68, 9.15]
Chen et al. 2007 36 40 35 40 3.7% 1.29 [0.32, 5.19]
Chen et al. 2014 38 40 28 40 1.5% 8.14 [1.69, 39.32]
Ding and Ma 2006 20 23 15 22 2.1% 3.11 [0.69, 14.07]
Ding et al. 2006a 59 65 54 64 5.3% 1.82 [0.62, 5.35]
Jin 2009 44 45 39 44 0.9% 5.64 [0.63, 50.40]
Li and Ge 2006 28 30 20 21 1.7% 0.70 [0.06, 8.26]
Li and Tian 2007 33 36 34 36 3.0% 0.65 [0.10, 4.12]
Li and Wu 2009 50 53 42 53 2.5% 4.37 [1.14, 16.69]
Li and Lu 2009a 63 72 62 68 8.4% 0.68 [0.23, 2.02]
Li et al. 2014 30 41 29 41 8.2% 1.13 [0.43, 2.96]
Liu and Xun 2007 29 32 28 32 2.8% 1.38 [0.28, 6.73]
Liu and Li 2008 40 40 40 40 Not estimable
Liu and Su 2008a 18 27 23 28 8.0% 0.43 [0.12, 1.53]
Meng and Chen 2005 47 48 42 48 0.9% 6.71 [0.78, 58.08]
Ruan and Lu 2009 33 35 30 35 1.8% 2.75 [0.50, 15.25]
Tian and He 2014 19 22 14 22 2.0% 3.62 [0.81, 16.15]
Wang et al. 2001 59 60 27 30 0.6% 6.56 [0.65, 65.95]
Wang 2006 28 30 22 30 1.6% 5.09 [0.98, 26.43]
Xia 2014 20 36 24 36 11.3% 0.63 [0.24, 1.62]
Xiong and Zuo 2006 23 25 22 23 1.9% 0.52 [0.04, 6.18]
Xu 2014 23 30 27 30 6.7% 0.37 [0.08, 1.58]
Yan 2007 32 35 27 33 2.5% 2.37 [0.54, 10.39]
Yang et al. 2011 29 30 21 30 0.7% 12.43 [1.46, 105.74]
Yao 2014 22 25 19 25 2.4% 2.32 [0.51, 10.54]
Yin and Huo 2007 21 27 19 26 4.6% 1.29 [0.37, 4.52]
Zhang and Fu 2006 29 31 26 30 1.8% 2.23 [0.38, 13.20]
Zhang 2007 74 78 37 47 2.5% 5.00 [1.47, 17.02]
Zhang et al. 2008 29 32 26 30 2.7% 1.49 [0.30, 7.28]
Zhang et al. 2014 25 30 12 30 2.1% 7.50 [2.24, 25.06]
Total (95% CI) 1268 1124 100.0% 2.01 [1.58, 2.56]
Total events 1142 916
Heterogeneity: 𝜒2 = 48.03, df = 28 (p = 0.01); I2 = 42%
Test for overall effect: Z = 5.66 (p < 0.00001) 0.002 0.1 1 10 500
Manual acupuncture Acupoint catgut embedding

Figure 3: Forest figure of the frequency of improvement in the comparison of ACE versus MA.

0.5
SE (log[OR])

1.5

2
0.002 0.1 1 10 500
OR

Figure 4: Funnel plots of the frequency of improvement in the comparison of ACE versus MA.

3.5.3. Reduction of WC and HC. Three studies [58, 68,
69] reported no difference in WC loss between the two
interventions (MD = 1.89, 95% CI = −0.79∼4.57, 𝑝 = 0.17),
and no heterogeneity was observed (𝐼2 = 0%, Chi2 test 𝑝 =
0.49) (Figure 19). Two studies [68, 69] indicated there was no
difference in HC loss between the two interventions (MD =
4.38, 95% CI = −0.95∼4.72, 𝑝 = 0.011), and heterogeneity was
shown, maybe caused by differences of patients or acupoint
prescriptions (Figure 20).
3.6. Comparison 4: ACE versus Sham
3.6.1. Frequency of Improvement. The pooled results of 2 trials
[70, 71] showed there were significant differences (OR = 9.13,
10 Evidence-Based Complementary and Alternative Medicine

Acupoint catgut embedding Manual acupuncture Mean difference Mean difference

Study or subgroup Weight
Mean SD Total Mean SD Total IV, random, 95% CI IV, random, 95% CI
Chen et al. 2007 6.2 4.1698 40 7.3 4.41928 40 8.3% −1.10 [−2.98, 0.78]
Li and Ge 2006 3.81 3.89189 30 3.99 3.41425 21 7.9% −0.18 [−2.20, 1.84]
Li and Tian 2007 6.98 4.19175 36 6.04 4.88307 36 7.6% 0.94 [−1.16, 3.04]
Li and Wu 2009 2.27 3.30079 72 1.97 3.34072 68 10.7% 0.30 [−0.80, 1.40]
Li et al. 2014 1.22 4.03546 41 1.33 3.4689 41 9.0% −0.11 [−1.74, 1.52]
Xia 2014 2.9 4.50081 36 4.36 5.18819 36 7.2% −1.46 [−3.70, 0.78]
Xu 2014 7.11 3.25374 30 2.5 3.28114 30 9.0% 4.61 [2.96, 6.26]
Yan 2007 4.09 4.25226 35 2.45 4.23395 33 7.9% 1.64 [−0.38, 3.66]
Yin and Huo 2007 0.7 3.45987 27 0.92 3.32892 26 8.4% −0.22 [−2.05, 1.61]
Zhang and Fu 2006 3.3 7.54785 31 2.4 4.272 30 5.3% 0.90 [−2.17, 3.97]
Zhang et al. 2008 2.6 3.97366 32 3.1 2.93087 30 8.7% −0.50 [−2.23, 1.23]
Zhang et al. 2014 3.88 2.43039 30 2.37 2.70355 30 10.1% 1.51 [0.21, 2.81]
Total (95% CI) 440 421 100.0% 0.56 [−0.36, 1.49]
Heterogeneity: 𝜏2 = 1.77; 𝜒2 = 35.89, df = 11 (p = 0.0002); I2 = 69%
Test for overall effect: Z = 1.19 (p = 0.23) −4 −2 0 2 4
Manual acupuncture Acupoint catgut embedding

Figure 5: Forest figure of BMI loss in the comparison of ACE versus MA.

0.5
SE (MD)

1.5

2
−4 −2 0 2 4
MD

Figure 6: Funnel plots of BMI loss in the comparison of ACE versus MA.

Acupoint catgut embedding Manual acupuncture Mean difference Mean difference

Study or subgroup Weight
Mean SD Total Mean SD Total IV, fixed, 95% CI IV, fixed, 95% CI
Chen et al. 2007 5.21 5.56015 40 4.91 6.08224 40 24.4% 0.30 [−2.25, 2.85]
Chen et al. 2014 7.41 8.04679 40 4.74 8.04159 40 12.8% 2.67 [−0.86, 6.20]
Li and Ge 2006 7.54 7.37871 30 6.78 7.07104 21 9.9% 0.76 [−3.25, 4.77]
Li and Tian 2007 8.5 7.99567 36 8.7 7.90187 36 11.8% −0.20 [−3.87, 3.47]
Li et al. 2014 3.36 15.9564 41 3.49 12.8534 41 4.1% −0.13 [−6.40, 6.14]
Liu and Xun 2007 4.8 12.1224 32 4.1 11.6396 32 4.7% 0.70 [−5.12, 6.52]
Xia 2014 3.67 10.1656 36 7.34 9.98714 36 7.4% −3.67 [−8.33, 0.99]
Yao 2014 12.71 10.7402 25 7.5 9.7651 25 4.9% 5.21 [−0.48, 10.90]
Yin and Huo 2007 2.01 12.404 27 2.38 12.5356 26 3.5% −0.37 [−7.09, 6.35]
Zhang and Fu 2006 7.6 12.4012 31 3.6 9.85951 30 5.1% 4.00 [−1.61, 9.61]
Zhang et al. 2008 6.5 14.8091 32 3.4 12.7644 30 3.4% 3.10 [−3.77, 9.97]
Zhang et al. 2014 10.04 8.87957 30 5.49 8.77646 30 8.0% 4.55 [0.08, 9.02]
Total (95% CI) 400 387 100.0% 1.14 [−0.12, 2.40]
Heterogeneity: 𝜒2 = 11.67, df = 11 (p = 0.39); I2 = 6%
Test for overall effect: Z = 1.77 (p = 0.08) −10 −5 0 5 10
Manual acupuncture Acupoint catgut embedding

Figure 7: Forest figure of body weight loss in the comparison of ACE versus MA.

95% CI = 4.30∼11.36, 𝑝 < 0.00001) in the improvement rate
comparing ACE with sham in which the needling instrument
was just penetrated but the catgut was not implanted. There
was no heterogeneity among the results (𝐼2 = 32%, Chi2 test
𝑝 = 0.22) (Figure 21).
3.6.2. Reduction of BMI and Body Weight. One study [71]
reported the BMI loss, and no significant effect was observed
(MD = 1.63, 95% CI = −0.19∼3.45, 𝑝 < 0.08) (Figure 22).
The result of body weight loss was of significant difference
(MD = 3.10, 95% CI = 0.20∼6.00, 𝑝 < 0.04) between the two
Evidence-Based Complementary and Alternative Medicine 11

SE (MD)
3

5
−10 −5 0 5 10
MD

Figure 8: Funnel plots of body weight loss in the comparison of ACE versus MA.

Acupoint catgut embedding Manual acupuncture Mean difference Mean difference

Study or subgroup Weight
Mean SD Total Mean SD Total IV, fixed, 95% CI IV, fixed, 95% CI
Li and Ge 2006 14.86 13.1737 30 14.75 11.7364 21 5.3% 0.11 [−6.78, 7.00]
Li and Tian 2007 13.55 9.21132 36 10.6 9.76703 36 13.1% 2.95 [−1.44, 7.34]
Li et al. 2014 7.69 12.251 41 4.78 10.5008 41 10.3% 2.91 [−2.03, 7.85]
Ruan and Lu 2009 11.33 9.60738 35 9.58 9.6751 35 12.4% 1.75 [−2.77, 6.27]
Xu 2014 5.8 8.18511 30 6.09 9.0555 30 13.2% −0.29 [−4.66, 4.08]
Yao 2014 12.06 10.9901 25 7.42 8.70007 25 8.4% 4.64 [−0.85, 10.13]
Zhang and Fu 2006 8.6 9.62705 31 4.8 10.2781 30 10.1% 3.80 [−1.20, 8.80]
Zhang et al. 2008 9.3 8.25045 32 8.5 9.45357 30 12.9% 0.80 [−3.63, 5.23]
Zhang et al. 2014 10.26 8.50743 30 7.06 8.03859 30 14.4% 3.20 [−0.99, 7.39]
Total (95% CI) 290 278 100.0% 2.20 [0.62, 3.79]
Heterogeneity: 𝜒2 = 3.59, df = 8 (p = 0.89); I2 = 0%
Test for overall effect: Z = 2.72 (p = 0.007) −10 −5 0 5 10
Manual acupuncture Acupoint catgut embedding

Figure 9: Forest figure of WC loss in the comparison of ACE versus MA.

Acupoint catgut embedding Manual acupuncture Mean difference Mean difference

Study or subgroup Weight
Mean SD Total Mean SD Total IV, fixed, 95% CI IV, fixed, 95% CI
Li and Ge 2006 13.42 11.316 30 8.3 12.4299 21 4.8% 5.12 [−1.56, 11.80]
Li and Tian 2007 5.46 11.7367 36 4.1 11.4692 36 7.5% 1.36 [−4.00, 6.72]
Li et al. 2014 4.6 8.31179 41 4.8 6.49485 41 20.6% −0.20 [−3.43, 3.03]
Ruan and Lu 2009 6.57 11.4781 35 5.53 10.5597 35 8.1% 1.04 [−4.13, 6.21]
Xu 2014 3.2 6.24818 30 3.41 6.28 30 21.4% −0.21 [−3.38, 2.96]
Yao 2014 12.06 10.9931 25 7.42 8.70007 25 7.1% 4.64 [−0.86, 10.14]
Yin and Huo 2007 2 7.63035 27 3.04 6.86278 26 14.1% −1.04 [−4.94, 2.86]
Zhang and Fu 2006 4.1 34.5336 31 3.2 34.5484 30 0.7% 0.90 [−16.44, 18.24]
Zhang et al. 2008 3.5 7.30205 32 3.9 7.55447 30 15.7% −0.40 [−4.10, 3.30]
Total (95% CI) 287 274 100.0% 0.47 [−0.99, 1.94]
Heterogeneity: 𝜒2 = 5.36, df = 8 (p = 0.72); I2 = 0%
Test for overall effect: Z = 0.63 (p = 0.53) −20 −10 0 10 20
Manual acupuncture Acupoint catgut embedding

Figure 10: Forest figure of HC loss in the comparison of ACE versus MA.

interventions tested by merging the 2 studies [70, 71], and no CI = −2.75∼6.39, 𝑝 = 0.43) (Figure 25) in the comparison of
heterogeneity among the results (𝐼2 = 0%, Chi2 test 𝑝 = 0.53) the two interventions.
(Figure 23) was tested.

3.6.3. Reduction of WC and HC. Just 1 study [71] reported the 3.7. Comparison 5: ACE versus Cupping Therapy. Only 1 study
loss of WC and HC, and the loss of WC was of significant reported the comparison of ACE with cupping therapy. ACE
difference (MD = 7.51, 95% CI = 2.95∼12.07, 𝑝 = 0.001) was superior to cupping therapy in improvement rate (OR =
(Figure 24), while the loss of HC was not (MD = 1.92, 95% 3.77, 95% CI = 1.21∼11.79, 𝑝 = 0.02) (Figure 26) and WC loss
12 Evidence-Based Complementary and Alternative Medicine

Acupoint catgut embedding Drug Odds ratio Odds ratio

Study or subgroup Weight
Events Total Events Total M-H, fixed, 95% CI M-H, fixed, 95% CI
Nie 2007 54 56 68 70 45.3% 0.79 [0.11, 5.82]
Zhang et al. 2010 32 35 30 34 54.7% 1.42 [0.29, 6.89]
Total (95% CI) 91 104 100.0% 1.14 [0.33, 3.90]

Total events 86 98
Heterogeneity: 𝜒2 = 0.20, df = 1 (p = 0.65); I2 = 0%
Test for overall effect: Z = 0.21 (p = 0.84) 0.002 0.1 1 10 500
Drug Acupoint catgut embedding

Figure 11: Forest figure of frequency of improvement in the comparison of ACE versus drug.

Acupoint catgut embedding Drug Mean difference Mean difference

Study or subgroup Weight
Mean SD Total Mean SD Total IV, random, 95% CI IV, random, 95% CI
Cong et al. 2007 2.14 1.51433 32 2.8 3.25009 31 22.6% −0.66 [−1.92, 0.60]
Li and Lu 2009a 1.22 2.46846 30 0.35 1.64557 30 24.8% 0.87 [−0.19, 1.93]
Nie 2007 3.52 3.09 56 2.8 1.82705 70 26.4% 0.72 [−0.20, 1.64]
Zhang et al. 2010 2.79 1.66141 35 0.61 2.2283 34 26.2% 2.18 [1.25, 3.11]
Total (95% CI) 153 165 100.0% 0.83 [−0.25, 1.91]
Heterogeneity: 𝜏2 = 0.94; 𝜒2 = 13.27, df = 3 (p = 0.004); I2 = 77%
Test for overall effect: Z = 1.50 (p = 0.13) −4 −2 0 2 4
Drug Acupoint catgut embedding

Figure 12: Forest figure of BMI loss in the comparison of ACE versus drug.

Acupoint catgut embedding Drug Mean difference Mean difference

Study or subgroup Weight
Mean SD Total Mean SD Total IV, fixed, 95% CI IV, fixed, 95% CI
Cong et al. 2007 6.51 12.4671 32 1.09 12.254 31 11.1% 5.42 [−0.68, 11.52]
Nie 2007 8.86 11.4555 56 7.1 11.4082 70 25.7% 1.76 [−2.26, 5.78]
Zhang et al. 2010 7.25 5.13019 35 6.92 5.70866 34 63.2% 0.33 [−2.23, 2.89]
Total (95% CI) 123 135 100.0% 1.26 [−0.77, 3.30]

Heterogeneity: 𝜒2 = 2.35, df = 2 (p = 0.31); I2 = 15%

Test for overall effect: Z = 1.22 (p = 0.22) −20 −10 0 10 20
Drug Acupoint catgut embedding

Figure 13: Forest figure of body weight loss in the comparison of ACE versus drug.

Acupoint catgut embedding Drug Mean difference Mean difference

Study or subgroup Weight
Mean SD Total Mean SD Total IV, fixed, 95% CI IV, fixed, 95% CI
Nie 2007 7.52 9.53944 56 7.12 9.19889 70 27.9% 0.40 [−2.90, 3.70]
Zhang et al. 2010 5.51 4.87 35 4 3.77016 34 72.1% 1.51 [−0.54, 3.56]
Total (95% CI) 91 104 100.0% 1.20 [−0.54, 2.94]

Heterogeneity: 𝜒2 = 0.31, df = 1 (p = 0.58); I2 = 0%

Test for overall effect: Z = 1.35 (p = 0.18) −10 −5 0 5 10
Drug Acupoint catgut embedding

Figure 14: Forest figure of WC loss in the comparison of ACE versus drug.

Acupoint catgut embedding Drug Mean difference Mean difference

Study or subgroup Weight
Mean SD Total Mean SD Total IV, random, 95% CI IV, random, 95% CI
Nie 2007 4.92 8.12663 56 4.66 8.44164 70 100.0% 0.26 [−2.65, 3.17]
Total (95% CI) 56 70 100.0% 0.26 [−2.65, 3.17]

Heterogeneity: not applicable

Test for overall effect: Z = 0.18 (p = 0.86) −20 −10 0 10 20
Acupoint catgut embedding Drug

Figure 15: Forest figure of HC loss in the comparison of ACE versus drug.
Evidence-Based Complementary and Alternative Medicine 13

Control electro-
Acupoint catgut embedding acupuncture Odds ratio Odds ratio
Study or subgroup Weight
Events Total Events Total M-H, random, 95% CI M-H, random, 95% CI
Huang and Pan 2011 27 30 26 30 20.4% 1.38 [0.28, 6.80]
Ruan et al. 2010 28 30 24 30 18.5% 3.50 [0.65, 18.98]
Zhang et al. 2014 25 30 18 30 30.4% 3.33 [1.00, 11.14]
Zhu and Xu 2014 16 25 18 25 30.7% 0.69 [0.21, 2.28]
Total (95% CI) 115 115 100.0% 1.73 [0.77, 3.92]
Total events 96 86
Heterogeneity: 𝜏2 = 0.19; 𝜒2 = 4.14, df = 3 (p = 0.25); I2 = 28%
Test for overall effect: Z = 1.32 (p = 0.19) 0.002 0.1 1 10 500
Electroacupuncture Acupoint catgut embedding

Figure 16: Forest figure of frequency of improvement in the comparison of ACE versus EA.

Acupoint catgut embedding Electroacupuncture Mean difference Mean difference

Study or subgroup Weight
Mean SD Total Mean SD Total IV, random, 95% CI IV, random, 95% CI
Huang and Pan 2011 1.9 3.53501 30 1.37 2.3416 30 21.9% 0.53 [−0.99, 2.05]
Ruan et al. 2010 4.46 3.15544 30 2.23 3.15685 30 21.1% 2.23 [0.63, 3.83]
Zhang et al. 2014 3.88 2.43039 30 2.64 2.58374 30 24.4% 1.24 [−0.03, 2.51]
Zhu and Xu 2014a 1.16 0.59 25 1.47 0.66 25 32.5% −0.31 [−0.66, 0.04]
Total (95% CI) 115 115 100.0% 0.79 [−0.42, 2.00]
Heterogeneity: 𝜏2 = 1.15; 𝜒2 = 14.50, df = 3 (p = 0.002); I2 = 79%
Test for overall effect: Z = 1.28 (p = 0.20) −4 −2 0 2 4
Electroacupuncture Acupoint catgut embedding

Figure 17: Forest figure of BMI loss in the comparison of ACE versus EA.

(MD = 2.07, 95% CI = 1.30∼2.84, 𝑝 < 0.00001) (Figure 27),
and other outcomes were not reported.
3.7.1. Comparison 6: ACE Plus Control versus Control. We
selected 4 combining therapy trials [42, 43, 73, 74] which
could identify the ACE effect, and the improved rate of patient
and the reduction of BMI and body weight were reported.
3.7.2. Frequency of Improvement. The effect rate was not
different in both comparisons of ACE plus EA versus EA (OR
= 2.50, 95% CI = 0.95∼6.60, 𝑝 = 0.06) from 2 trials [73, 74]
with no heterogeneity (𝐼2 = 0%, Chi2 test 𝑝 = 0.85) and ACE
plus MA versus MA (OR = 1.67, 95% CI = 0.62∼4.49, 𝑝 =
0.31) from 2 trials [42, 43] with no heterogeneity (𝐼2 = 46%,
Chi2 test 𝑝 = 0.17). The significant improvement was shown
when the two comparisons with 4 trials [42, 43, 73, 74] were
combined (OR = 2.06, 95% CI = 1.03∼4.10, 𝑝 = 0.04), with
no heterogeneity among results (𝐼2 = 0%, Chi2 test 𝑝 = 0.50)
(Figure 28).
3.7.3. Reduction of BMI and Body Weight. Two studies [73,
74] of comparisons between ACE plus EA and EA have both
reported the changes of BMI and body weight. There were
significant decreases of both BMI (MD = 1.29, 95% CI = 0.64∼
1.95, 𝑝 = 0.0001) (Figure 29) with no heterogeneity (𝐼2 = 0%,
Chi2 test 𝑝 = 0.95) and body weight (MD = 3.79, 95% CI =
0.58∼7.01, 𝑝 = 0.02) with no heterogeneity (𝐼2 = 0%, Chi2
test 𝑝 = 0.65) (Figure 30) in ACE plus EA group as opposed
to EA group in line with the pooled results of the 2 trials.
3.8. Adverse Events. Among these studies, only 3 trials [62–
64] reported the side effects in the comparison between ACE
and drugs. Nie [62] reported headache, dry mouth, anorexia,
insomnia, constipation, rapid heartbeat, and mild high blood
pressure in sibutramine drug group. Cong et al. [63] reported
subcutaneous indurations (𝑛 = 5), red and swollen (𝑛 =
1) in ACE group, and gastrointestinal discomfort (𝑛 = 6)
in Chinese patent medicine ZhiBiTuo group. Zhang et al.
[64] just reported 5 cases in sibutramine drug group that
experienced side effects and no more details were reported.
3.9. Treatment Suggestion. A total of 63 acupoints have been
extracted from all the included RCTs except for 2 trials
[39, 42] of individual treatment for flexibility and 1 trial
[35] not given, and the frequency of usage of them was
listed as Figure 31. Obviously, the acupoints of ST25, RN12,
ST40, RN4, RN6, SP15, RN9, SP6, and ST36 were the most
used to lose weight. According to all the included RCTs, the
frequency of treatment time ranged from 1 time per 35 days
to 3 times per 1 week (alternate use to acupoints), and most
of the frequencies were 1∼2 time(s) per 7∼15 days. The total
times of treatment were varied from 2 to 24, and 4∼8 times
were most used. So, the treatment suggestion may be suitable
as acupoints of ST25, RN12, ST40, RN4, RN6, SP15, RN9, SP6,
and ST36, 1 time per week, lasting 4∼8 times for 1∼2 month(s).
4. Discussions
There were a total of 43 trials with 3520 patients included
in this review, all of them from China. The therapy of ACE
has been evaluated by comparing with sham, drugs, and
other different intervention forms of acupuncture such as
MA, EA, and cupping jar. Previous systematic reviews [31,
75] have excluded the trials of the contrasts of different
14 Evidence-Based Complementary and Alternative Medicine

Acupoint catgut embedding Electroacupuncture Mean difference Mean difference

Study or subgroup Weight
Mean SD Total Mean SD Total IV, fixed, 95% CI IV, fixed, 95% CI
Huang and Pan 2011 5.77 9.3736 30 4.08 7.48649 30 5.6% 1.69 [−2.60, 5.98]
Ruan et al. 2010 7.43 8.04125 30 4.74 8.04288 30 6.3% 2.69 [−1.38, 6.76]
Zhang et al. 2008a 6.61 2.48 40 4.87 2.63 40 82.7% 1.74 [0.62, 2.86]
Zhang et al. 2014 10.04 8.87957 30 8.37 8.35883 30 5.4% 1.67 [−2.69, 6.03]
Total (95% CI) 130 130 100.0% 1.79 [0.77, 2.81]
Heterogeneity: 𝜒2 = 0.20, df = 3 (p = 0.98); I2 = 0%
Test for overall effect: Z = 3.45 (p = 0.0006) −10 −5 0 5 10
Electroacupuncture Acupoint catgut embedding

Figure 18: Forest figure of body weight loss in the comparison of ACE versus EA.

Acupoint catgut embedding Electroacupuncture Mean difference Mean difference

Study or subgroup Weight
Mean SD Total Mean SD Total IV, fixed, 95% CI IV, fixed, 95% CI
Huang and Pan 2011 5.15 9.86056 30 4.59 8.55378 30 33.0% 0.56 [−4.11, 5.23]
Ruan et al. 2010 11.87 10.5733 30 7.15 10.7961 30 24.6% 4.72 [−0.69, 10.13]
Zhang et al. 2014 10.26 8.50743 30 8.98 7.78696 30 42.3% 1.28 [−2.85, 5.41]
Total (95% CI) 90 90 100.0% 1.89 [−0.79, 4.57]
Heterogeneity: 𝜒2 = 1.45, df = 2 (p = 0.48); I2 = 0%
Test for overall effect: Z = 1.38 (p = 0.17) −20 −10 0 10 20
Electroacupuncture Acupoint catgut embedding

Figure 19: Forest figure of WC loss in the comparison of ACE versus EA.

Acupoint catgut embedding Electroacupuncture Mean difference Mean difference

Study or subgroup Weight
Mean SD Total Mean SD Total IV, random, 95% CI IV, random, 95% CI
Huang and Pan 2011 4.36 7.74188 30 2.58 4.8647 30 52.3% 1.78 [−1.49, 5.05]
Ruan et al. 2010 15.57 7.00205 28 8.34 7.57904 24 47.7% 7.23 [3.24, 11.22]
Total (95% CI) 58 54 100.0% 4.38 [−0.95, 9.72]
2 2 2
Heterogeneity: 𝜏 = 11.39; 𝜒 = 4.29, df = 1 (p = 0.04); I = 77%
Test for overall effect: Z = 1.61 (p = 0.11) −20 −10 0 10 20
Acupoint catgut embedding Electroacupuncture

Figure 20: Forest figure of HC loss in the comparison of ACE versus EA.

Acupoint catgut embedding Sham Odds ratio Odds ratio

Study or subgroup Weight
Events Total Events Total M-H, fixed, 95% CI M-H, fixed, 95% CI
Guo et al. 2009 59 68 31 65 87.5% 7.19 [3.06, 16.88]
Jia et al. 2014 17 20 4 20 12.5% 22.67 [4.37, 117.47]
Total (95% CI) 88 85 100.0% 9.13 [4.30, 19.36]
Total events 76 35
Heterogeneity: 𝜒2 = 1.47, df = 1 (p = 0.22); I2 = 32%
Test for overall effect: Z = 5.76 (p = 0.00001) 0.002 0.1 1 10 500
Sham Acupoint catgut embedding

Figure 21: Forest figure of frequency of improvement in the comparison of ACE versus sham.

Acupoint catgut embedding Sham Mean difference Mean difference

Study or subgroup Weight
Mean SD Total Mean SD Total IV, fixed, 95% CI IV, fixed, 95% CI
Jia et al. 2014 1.77 2.84528 20 0.14 3.03649 20 100.0% 1.63 [−0.19, 3.45]
Total (95% CI) 20 20 100.0% 1.63 [−0.19, 3.45]
Heterogeneity: not applicable
Test for overall effect: Z = 1.75 (p = 0.08) −4 −2 0 2 4
Acupoint catgut embedding Sham

Figure 22: Forest figure of BMI loss in the comparison of ACE versus sham.
Evidence-Based Complementary and Alternative Medicine 15

Acupoint catgut embedding Sham Mean difference Mean difference

Study or subgroup Weight
Mean SD Total Mean SD Total IV, fixed, 95% CI IV, fixed, 95% CI
Guo et al. 2009 5.11 10.8655 68 2.63 9.58365 65 69.3% 2.48 [−1.00, 5.96]
Jia et al. 2014 4.87 9.4794 20 0.37 7.24913 20 30.7% 4.50 [−0.73, 9.73]
Total (95% CI) 88 85 100.0% 3.10 [0.20, 6.00]
Heterogeneity: 𝜒2 = 0.40, df = 1 (p = 0.53); I2 = 0%
Test for overall effect: Z = 2.10 (p = 0.04) −10 −5 0 5 10
Sham Acupoint catgut embedding

Figure 23: Forest figure of body weight loss in the comparison of ACE versus sham.

Acupoint catgut embedding Sham Mean difference Mean difference

Study or subgroup Weight
Mean SD Total Mean SD Total IV, fixed, 95% CI IV, fixed, 95% CI
Jia et al. 2014 7.68 7.72495 20 0.17 6.98621 20 100.0% 7.51 [2.95, 12.07]
Total (95% CI) 20 20 100.0% 7.51 [2.95, 12.07]
Heterogeneity: not applicable
Test for overall effect: Z = 3.22 (p = 0.001) −20 −10 0 10 20
Sham Acupoint catgut embedding

Figure 24: Forest figure of WC loss in the comparison of ACE versus sham.

Acupoint catgut embedding Sham Mean difference Mean difference

Study or subgroup Weight
Mean SD Total Mean SD Total IV, fixed, 95% CI IV, fixed, 95% CI
Jia et al. 2014 1.85 7.51864 20 0.03 7.22211 20 100.0% 1.82 [−2.75, 6.39]
Total (95% CI) 20 20 100.0% 1.82 [−2.75, 6.39]
Heterogeneity: not applicable
Test for overall effect: Z = 0.78 (p = 0.43) −4 −2 0 2 4
Sham Acupoint catgut embedding

Figure 25: Forest figure of HC loss in the comparison of ACE versus sham.

Acupoint catgut embedding Cupping therapy Odds ratio Odds ratio

Study or subgroup Weight
Events Total Events Total M-H, fixed, 95% CI M-H, fixed, 95% CI
Hou et al. 2014 35 40 26 40 100.0% 3.77 [1.21, 11.79]
Total (95% CI) 40 40 100.0% 3.77 [1.21, 11.79]
Total events 35 26
Heterogeneity: not applicable
Test for overall effect: Z = 2.28 (p = 0.02) 0.005 0.1 1 10 200
Cupping therapy Acupoint catgut embedding

Figure 26: Forest figure of improvement rate in the comparison of ACE versus cupping therapy.

types of acupuncture. In our opinion, it was also valuable to
assess the effect of ACE comparing with other acupuncture
interventions and a better choice may be provided for both
doctors and obesity patients.
The overall quality of these identified trials was poor and
in high risk of bias. Although all the trials have claimed
randomization, most of them did not illustrate the generation
of random sequence. It was hard to apply blinding of partici-
pants and acupuncturist. These trials seldom reported alloca-
tion concealment and blinding of participants, acupuncturist,
and outcome assessment. The sample was also very small in
most comparisons in this review.
Despite methodological quality and sample size limi-
tations, all the pooled outcomes (improvement rate, loss
of weight, BMI, WC, and HC) have presented a tendency
of consistent superior effects of ACE or combined therapy
comparing with other interventions (MA, EA, drugs, sham,
and cupping), and less adverse effect was reported. There
were different versions of evaluation standard to estimate the
improvement rate, but all of them basically claimed the loss of
body weight was more than 2 kg or BMI more than 0.5 kg/m2 .
Hence, the results could be combined. The pooled data of
improvement rate displayed that ACE was more effective
than MA, sham, and cupping (𝑝 < 0.05). The combined
therapy of ACE with MA or EA was also better than MA
or EA alone (𝑝 < 0.05) in improvement rate. Although in
contrast with drugs or EA, the improvement rate was 3.79 kg
16 Evidence-Based Complementary and Alternative Medicine

Acupoint catgut embedding Cupping therapy Mean difference Mean difference

Study or subgroup Weight
Mean SD Total Mean SD Total IV, fixed, 95% CI IV, fixed, 95% CI
Hou et al. 2014 5.17 1.89 40 3.1 1.62 40 100.0% 2.07 [1.30, 2.84]
Total (95% CI) 40 40 100.0% 2.07 [1.30, 2.84]
Heterogeneity: not applicable
Test for overall effect: Z = 5.26 (p < 0.00001) −4 −2 0 2 4
Cupping therapy Acupoint catgut embedding

Figure 27: Forest figure of WC loss in the comparison of ACE versus cupping therapy.

ACE + EA/MA EA/MA Odds ratio Odds ratio

Study or subgroup Weight
Events Total Events Total M-H, fixed, 95% CI M-H, fixed, 95% CI

23.1.1 acupoint catgut embedding plus + electroacupuncture

Tang et al. 2009 31 33 27 32 14.3% 2.87 [0.51, 16.01]
Pan et al. 2009 35 40 30 40 32.3% 2.33 [0.72, 7.59]
Subtotal (95% CI) 73 72 46.6% 2.50 [0.95, 6.60]
Total events 66 57
Heterogeneity: 𝜒2 = 0.04, df = 1 (p = 0.85); I2 = 0%
Test for overall effect: Z = 1.85 (p = 0.06)
23.1.2 acupoint catgut embedding + manual acupuncture
Liu and Su 2008a 27 28 23 28 7.1% 5.87 [0.64, 53.93]
Li and Wu 2009 64 70 62 68 46.4% 1.03 [0.32, 3.37]
Subtotal (95% CI) 98 96 53.4% 1.67 [0.62, 4.49]
Total events 91 85
Heterogeneity: 𝜒2 = 1.87, df = 1 (p = 0.17); I2 = 46%
Test for overall effect: Z = 1.02 (p = 0.31)
Total (95% CI) 171 168 100.0% 2.06 [1.03, 4.10]
Total events 157 142
Heterogeneity: 𝜒2 = 2.35, df = 3 (p = 0.50); I2 = 0%
0.01 0.1 1 10 100
Test for overall effect: Z = 2.05 (p = 0.04)
EA/MA ACE + EA/MA
Test for subgroup differences: 𝜒2 = 0.32, df = 1 (p = 0.57); I2 = 0%

Figure 28: Forest figure of improvement rate in the comparison of ACE plus control versus control.

ACE + EA EA Mean difference Mean difference

Study or subgroup Weight
Mean SD Total Mean SD Total IV, fixed, 95% CI IV, fixed, 95% CI
Pan et al. 2009 3.84 2.28685 40 2.57 2.47958 40 39.5% 1.27 [0.22, 2.32]
Tang et al. 2009 2.8 1.68083 33 1.49 1.78681 32 60.5% 1.31 [0.47, 2.15]
Total (95% CI) 73 72 100.0% 1.29 [0.64, 1.95]
Heterogeneity: 𝜒2 = 0.00, df = 1 (p = 0.95); I2 = 0%
Test for overall effect: Z = 3.86 (p = 0.0001) −10 −5 0 5 10
EA ACE + EA

Figure 29: Forest figure of BMI loss in the comparison of ACE plus EA versus EA.

ACE + EA EA Mean difference Mean difference

Study or subgroup Weight
Mean SD Total Mean SD Total IV, fixed, 95% CI IV, fixed, 95% CI
Pan et al. 2009 11.36 11.2206 40 6.7 11.2514 40 42.6% 4.66 [−0.26, 9.58]
Tang et al. 2009 6.52 8.26303 33 3.37 9.15556 32 57.4% 3.15 [−1.09, 7.39]
Total (95% CI) 73 72 100.0% 3.79 [0.58, 7.01]
Heterogeneity: 𝜒2 = 0.21, df = 1 (p = 0.65); I2 = 0%
Test for overall effect: Z = 2.31 (p = 0.02) −20 −10 0 10 20
EA ACE + EA

Figure 30: Forest figure of body weight loss in the comparison of ACE plus EA versus EA.
Evidence-Based Complementary and Alternative Medicine
Frequency of acupoints
ST44
SJ13
RN11
LI4
KI13
GB30
BL52
BL27
BL18
ST27
RN3
ST29
RN13
SP14
ST28
ST34
LI11
ST24
RN9
RN4
ST25
0 10 20 30 40
Frequency
Figure 31: Frequency of acupoints in ACE.
compared with EA alone; forest figures visually described a
better tendency in ACE group (OR > 1).
The mean reductions of body weight by ACE also might
be more effective which were 1.14 kg, 1.26 kg, 1.79 kg, and
3.01 kg, respectively, contrasted to MA, drugs, EA (𝑝 < 0.05),
and sham (𝑝 < 0.05). The mean reduction of body weight
by ACE combined with EA was 3.79 kg than by EA alone
(𝑝 < 0.05). Comparing with MA, drugs, EA, and sham, the
mean BMI accordingly reduced to 0.56 kg/m2 , 0.83 kg/m2 ,
0.79 kg/m2 , and 1.63 kg/m2 in obesity treated by ACE. The
BMI loss was 1.29 kg/m2 in ACE combined with EA group
than EA alone (𝑝 < 0.05).
WC and HC were removed more by ACE comparing
with control. WC reduction was generally supposed to be
meaningfulness in prevention and treatment of diabetes
and cardiovascular diseases [76]. HC was also regarded as
important as WC in prediction of diabetes and cardiovascular
diseases [77]. In this review, the mean decreases of WC were
2.20 cm, 1.20 cm, 1.89 cm, 7.51 cm, and 2.07, comparing with
MA (𝑝 < 0.05), drugs, EA, sham (𝑝 < 0.05), and cupping
(𝑝 < 0.05) correspondingly. Meanwhile, the changes of HC
were 0.47 cm, 0.26 cm, 4.38 cm, and 1.82 cm comparing with
MA, drugs, EA, and sham accordingly.
However, in the identified 4 trials [62–65] of comparison
between ACE and drug, only 2 trials [62, 64] applied sibu-
tramine as control which has been withdrawn from market
by the American Food and Drug Administration (FDA) in
2010 for its potential cardiovascular risk [78], and the other 2
studies [63, 65] used metformin and Chinese patent medicine
ZhiBiTuo for controls which did not belong to antiobesity
drugs and had benefits of weight loss.
There was another review [79] that included 9 literatures
from PubMed database which has reported the therapy of
ACE using descriptive comments with a quantitative analysis
17
and revealed the same result regarding its effect of equality
or superiority comparing to control treatments. Furthermore,
another 2 systematic reviews [31, 75] have reported results
that acupuncture including the types of MA, EA, catgut
embedding, and cotreatment was superior or similar to
pharmacotherapy and diet control based on the pooled
data, and the different effects among the different types of
acupuncture are not included. Our results indicated that the
effects of ACE were also greater than or equal to other kinds
of acupuncture and other kinds of drug and nondrug therapy.
In some sense, ACE might be more effective for obesity.
Lowering expense and time should be another advantage
of ACE in the fast-paced society time. The treatment fre-
quency of ACE is 1 time per week normally, while it is 3 times
per week in MA or EA. Mostly, the patients will stay in clinical
room more than 30 minutes every treatment time, but the
therapy time should be less by ACE. According to Chinese
cost of treating, it should be more economical by ACE than
MA or EA, which has been proved by Huang and Pan [68].
In ancient TCM theory, obesity has been recorded since
two thousand years in Huangdi Neijing, and the increasing
intake of sweet and greasy foods is the main cause. The water
and soil type of TCM constitutions are the susceptible popu-
lation. The dysfunction of spleen and stomach is the essential
reason. Obesity patient often suffers from the syndrome of 𝑞𝑖
deficiency and phlegm retardation [80, 81]. The therapeutic
principles were tonifying 𝑞𝑖 and dissolving sputum, and the
needle should penetrated deeply the acupoint and retained
for a long time [81].
In this review, we have also sequenced the usage fre-
quency of acupoint, and the acupoints of ST25, RN12, ST40,
RN4, RN6, SP15, RN9, SP6, and ST36 were the most used.
Distribution in abdomen and thigh hypertrophic muscles
of spleen, stomach, and ren meridians is the characteristic
of antiobesity acupoint prescription, which has the ability
of strengthening spleen and eliminating dampness in TCM
theory.
The limitations of this review were inferior quality of
included trials and small sample size. Besides, most trials
focused on the comparison of different types of acupuncture
and reported less the positive drug as control. This limited the
universality of the findings and acceptability. However, this
review was the first of quantitative analysis of ACE, and the
treatment advice was given.
5. Conclusions
Our review found the evidences that the effects of obesity
treated by ACE were superior or equal to other interventions
(MA, EA, drugs, sham, and cupping) based on the assessment
of the pooled outcomes (improvement rate, loss of weight,
BMI, WC, and HC). Further high quality studies with the
rigorous designed and positive FDA approved drug as control
are urgent to evaluate the effect of ACE for treating obesity.
Disclosure
Taipin Guo and Yulan Ren are the co-first authors of this
paper.
18
Conflict of Interests
The authors declare no conflict of interests.
Acknowledgments
This survey was funded by a Grant from State Key Develop-
ment Program for Basic Research of China (973 Program, no.
2012CB518501) and Transformation Platform Construction
Program for Science and Technology Achievement of the
Sichuan Province (no. 2012FZ0082).
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