Treatment of Knee Osteoarthritis with Acupuncture Combined with Chinese Herbal Medicine: A Systematic Review and Meta-Analysis

Knee osteoarthritis is a condition that affects millions of people worldwide and represents one of the leading causes of pain and functional limitation in the knees. This condition is characterized by progressive deterioration of articular cartilage, causing pain, stiffness, and movement difficulties that can significantly impact patients' quality of life. With population aging and increased life expectancy, the number of people affected by knee osteoarthritis has been growing steadily. Currently available treatment options include anti-inflammatory drugs, intra-articular injections, physical therapy, and, in more severe cases, surgery.

However, many conventional treatments have important limitations, such as drug side effects or high costs of surgical procedures.

In this context, traditional Chinese medicine (中醫) has been attracting growing interest as a therapeutic alternative, especially the combination of acupuncture and Chinese herbal medicine. Although individual studies had shown promising benefits from this integrated approach, there was still a lack of robust scientific evidence to guide professionals and patients regarding its actual efficacy. To fill this gap, researchers at the Hubei University of Traditional Chinese Medicine conducted a comprehensive systematic review and meta-analysis to scientifically assess the benefits of combined acupuncture and Chinese herbal medicine treatment for knee osteoarthritis.

The primary objective of this study was to rigorously analyze all available scientific evidence on the joint use of acupuncture and Chinese herbal medicines in the treatment of knee osteoarthritis. To this end, the investigators performed a systematic search in Chinese and international scientific databases, including CNKI, Wanfang, VIP, PubMed, EMBASE, and Cochrane Library, covering studies published from database inception through May 2021. Only randomized controlled studies, which represent the gold standard in clinical research, were selected, ensuring greater reliability of the results. Three independent researchers conducted the entire search, selection, and analysis process, following rigorous inclusion and exclusion criteria.

The inclusion criteria required that studies compare the combined treatment of acupuncture and Chinese herbal medicine with other treatments, such as acupuncture alone, herbal medicine alone, or conventional drugs. The investigators analyzed four main indicators to assess the efficacy of the treatments: the overall response rate, which measures how many patients showed significant improvement; the visual analog scale for pain, which quantifies pain intensity reported by patients; the WOMAC index, which evaluates pain, stiffness, and physical function; and the Lysholm score, which specifically measures knee function. To ensure the quality of the analysis, the studies were evaluated for risk of bias using internationally standardized tools.

The final analysis included 33 randomized controlled studies involving 3,954 patients with knee osteoarthritis. The results were extremely promising and showed significant benefits of the combined treatment across all assessed measures. Regarding the overall response rate, patients who received acupuncture combined with Chinese herbal medicine were 5.41 times more likely to show significant clinical improvement compared with the control groups. As for pain, measured by the visual analog scale, the combined treatment produced an average reduction of 1.86 points in pain intensity, representing clinically relevant relief.

The WOMAC index, which comprehensively assesses the symptoms and functional limitations of osteoarthritis, showed an average improvement of 13.05 points in the group receiving the combined treatment. This difference is considered clinically significant and indicates that patients experienced less pain, less joint stiffness, and better capacity to perform daily activities. The Lysholm score, focused specifically on knee function, showed an average improvement of 10.47 points, demonstrating that the combined treatment was effective in restoring joint function and improving knee stability and mobility.

It is important to note that the studies analyzed reported few adverse effects related to the combined treatment. The adverse events mentioned were mild and included transient gastrointestinal discomfort in some patients who used herbal medicine, and mild lower-extremity edema in isolated cases. These effects were temporary and resolved with discontinuation or adjustment of the treatment, demonstrating that the combined approach has a favorable safety profile.

The clinical implications of these findings are substantial for both patients and health professionals. For patients, the results indicate that combined treatment with acupuncture and Chinese herbal medicine may offer an effective and safe alternative to conventional treatments, with the potential to significantly reduce pain, improve joint function, and increase quality of life. This approach may be particularly valuable for patients who have experienced side effects with anti-inflammatory drugs or who seek less invasive treatments before considering surgical procedures.

For health professionals, this study provides solid scientific evidence to support the integrated use of acupuncture and Chinese herbal medicine in the management of knee osteoarthritis. The data suggest that this therapeutic combination can be implemented as part of a comprehensive treatment plan, potentially reducing reliance on conventional drugs and their associated side effects. Integrative medicine, which combines conventional and traditional evidence-based approaches, represents a growing trend in modern clinical practice.

Nonetheless, the investigators acknowledge important limitations of their analysis that should be considered when interpreting the results. The first significant limitation is that all included studies were conducted in China and published in Chinese, which may limit the generalizability of the findings to populations of other ethnicities or different cultural contexts. In addition, most of the studies analyzed had limited methodologic quality, with deficiencies in the randomization process, lack of adequate blinding, and relatively small sample sizes.

Another important limitation was the significant heterogeneity between studies regarding the acupuncture protocols used, including different acupuncture points, frequency, and duration of sessions. Similarly, herbal formulations varied considerably between studies, making it difficult to identify which specific components of the treatment were most effective. This variability also extended to the outcome assessment criteria and follow-up periods, which may have influenced the final statistical analysis.

The authors emphasize that, despite the promising results, higher methodologic quality studies are needed to definitively confirm these findings. Future studies should include multicenter clinical trials with larger samples, standardized treatment protocols, longer follow-up periods, and more detailed assessment of possible adverse effects. It would also be valuable to include studies conducted in different countries and cultures to verify whether the observed benefits are universally applicable.

In conclusion, this