Acupuncture for benign prostatic hyperplasia in the elderly: A systematic review of acupoints
Guo et al. · Medicine · 2025
Evidence Level
MODERATEOBJECTIVE
Analyze patterns of acupoint selection in acupuncture for benign prostatic hyperplasia in elderly men
WHO
Elderly men with benign prostatic hyperplasia
DURATION
Analysis of studies published through September 2024
POINTS
Guanyuan (CV-4), Zhongji (CV-3), Sanyinjiao (SP-6), Qihai (CV-6), Shenshu (BL-23)
🔬 Study Design
Studies analyzed
n=85
Review of articles on acupuncture for BPH
📊 Results in numbers
Total acupoints identified
Frequency of Guanyuan (CV-4)
Frequency of Zhongji (CV-3)
Most used meridian (Conception Vessel)
Percentage highlights
📊 Outcome Comparison
Frequency of use of main acupoints
This study identified the most effective acupuncture points for treating prostate problems in elderly men. The research shows that specific points such as Guanyuan and Zhongji are the most widely used by acupuncturists, providing a scientific basis for treatment.
Article summary
Plain-language narrative summary
Benign prostatic hyperplasia (BPH) is a condition that affects more than 50% of men aged 50 years and older, causing significant lower urinary tract symptoms that impair quality of life. This study represents a comprehensive analysis of acupoint selection patterns used in acupuncture treatment of BPH, employing advanced data mining techniques to identify the most effective combinations. The researchers conducted a systematic review of 270 initially screened articles, of which 85 met rigorous inclusion criteria. Using the Traditional Chinese Medicine Inheritance Support System (TCMISS) platform, frequency patterns, association rules, and cluster analyses were performed to identify the most clinically relevant acupoints.
The results revealed that 61 unique acupoints were identified, with the most frequently selected points being Guanyuan (CV-4), Zhongji (CV-3), Sanyinjiao (SP-6), Qihai (CV-6), and Shenshu (BL-23). The Conception Vessel (CV) meridian was the most used, with 173 occurrences, followed by the Bladder (BL) meridian with 120 occurrences and the Spleen (SP) meridian with 55 occurrences. Topological analysis showed that the most effective acupoints are located primarily on the chest and abdomen (47.8%) and on the back and waist (27.3%), reflecting the Traditional Chinese Medicine principle of selecting proximal points for lower urinary tract disorders. The most frequent acupoint combinations included Zhongji (CV-3) with Sanyinjiao (SP-6), Guanyuan (CV-4) with Qihai (CV-6), and Guanyuan (CV-4) with Sanyinjiao (SP-6).
Association-rule analysis revealed that when Sanyinjiao (SP-6) and Shuidao (ST-28) are selected, Zhongji (CV-3) must be paired with 100% confidence, demonstrating specific therapeutic synergies. Cluster analysis identified five main treatment groupings, each reflecting different therapeutic approaches based on TCM theory. The first cluster focused on clearing damp-heat and activating blood circulation, while the second emphasized tonifying the kidney and spleen for deficiency patterns. From a mechanistic standpoint, acupoints CV-3 and CV-4 correlate neuroanatomically with spinal segments T12-L1, which innervate the bladder detrusor muscle, explaining their efficacy in treating BPH-related urinary retention.
Stimulation of these points increases parasympathetic activity, promoting detrusor contraction and sphincter relaxation. The study also identified significant limitations in the current literature, including heterogeneity in electroacupuncture parameters, variations in needling depth, and inconsistencies in diagnostic criteria. These findings provide a robust scientific basis for standardized acupoint selection in BPH treatment, offering evidence-based guidance for clinical acupuncturists. The results suggest that treatment protocols should focus on the identified core acupoints, particularly those of the Conception Vessel meridian, to optimize therapeutic outcomes in elderly patients with BPH.
Strengths
- 1Comprehensive analysis of 85 studies with rigorous methodology
- 2Use of an advanced data-mining platform (TCMISS)
- 3Clear identification of evidence-based acupoint patterns
- 4Cluster analysis revealing synergistic combinations
Limitations
- 1Significant heterogeneity in intervention parameters
- 2Language limitation — most studies in Chinese
- 3Variations in diagnostic criteria across studies
- 4Lack of randomized clinical trials in international databases
Expert Commentary
Dr. Marcus Yu Bin Pai
MD, PhD · Pain Medicine · Physical Medicine and Rehabilitation · Medical Acupuncture
▸ Clinical Relevance
Benign prostatic hyperplasia affects more than half of men over 50, and management of lower urinary tract symptoms remains a concrete clinical challenge, especially in elderly patients with multiple comorbidities that limit the use of alpha-blockers or anticholinergics. This systematic review of 85 studies offers clinicians a rational roadmap of acupoint selection based on frequency of use and association analysis, something that was lacking in non-Chinese-language literature. The neuroanatomical correspondence between CV-3 and CV-4 and the T12-L1 spinal segments, which innervate the detrusor, justifies the choice of these points from a neurophysiological rationale understandable to any physiatrist. This makes acupuncture a plausible integrative option for patients awaiting urological evaluation, who decline surgery, or who do not tolerate conventional pharmacotherapy.
▸ Notable Findings
What stands out in this analysis is not only the isolated frequency of the points — Guanyuan (CV-4) at 13.1% and Zhongji (CV-3) at 11.6% — but the discovery of the association rule with 100% confidence: when SP-6 and ST-28 are selected, CV-3 must necessarily be part of the protocol. This type of finding, generated by data mining via the TCMISS platform, translates into probabilistic language a clinical logic that was previously transmitted only empirically. The predominance of the Conception Vessel with 173 occurrences, and the topographic distribution with 47.8% of points on the abdomen and chest and 27.3% in the lumbar region, suggests somatotopic coherence aligned with what we know about sacral neuromodulation and parasympathetic influence on micturition. The five clusters identified in the cluster analysis reveal differentiated therapeutic strategies according to the patient's clinical pattern.
▸ From My Experience
In my practice in the pain and rehabilitation outpatient clinic, I have increasingly received elderly men referred by urologists for complementary management of urinary symptoms, especially those in whom alpha-blocker titration is limited by orthostatic hypotension. What this article confirms is quite close to what we use empirically: CV-3, CV-4, and SP-6 make up the core of the protocols we apply in these patients. I usually observe subjective improvement in flow and urinary urgency after four to six sessions, with stabilization around ten to twelve sessions. We frequently combine low-frequency electroacupuncture at these abdominal points with guidance on pelvic floor exercises. The profile that responds best, in my experience, is the patient with predominant irritative symptoms and no severe outflow obstruction — cases with elevated post-void residual go directly to the urologist.
Full original article
Read the full scientific study
Medicine · 2025
DOI: 10.1097/MD.0000000000043802
Access original articleScientific Review
Marcus Yu Bin Pai, MD, PhD
CRM-SP: 158074 | RQE: 65523 · 65524 · 655241
PhD in Health Sciences, University of São Paulo. Board-certified in Pain Medicine, Physical Medicine and Rehabilitation, and Medical Acupuncture. Scientific review and curation of every entry in this library.
Learn more about the author →Medical disclaimer: This content is for educational purposes only and does not replace consultation, diagnosis, or treatment by a qualified professional. Some information may be assisted by artificial intelligence and is subject to inaccuracies. Always consult a physician.
Content reviewed by the medical team at CEIMEC — Integrated Centre for Chinese Medicine Studies, a reference in Medical Acupuncture for over 30 years.
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