The efficacy of acupuncture combined with Chinese herbal medicine in the treatment of gastric ulcer: A systematic review and meta-analysis

This systematic meta-analysis investigated the efficacy of acupuncture combined with traditional Chinese medicine (TCM) in the treatment of gastric ulcers, analyzing data from 17 randomized clinical trials involving 1,632 patients. The study represents an important contribution to the scientific understanding of integrative therapies in the management of gastroenterological diseases. Gastric ulcer is a common clinical condition that affects 5-10% of the general population, characterized by upper abdominal pain and, in more severe cases, may progress to gastric cancer in approximately 1.9% of patients within 3 years. Conventional treatment is based primarily on proton pump inhibitors, H2 antagonists, and antibiotics, but still presents limitations such as high recurrence rates and significant adverse effects.

The study methodology followed rigorous guidelines, with a comprehensive search of Chinese and international databases through January 2025. The researchers used the Cochrane tool for risk of bias assessment and RevMan 5.3 software for statistical analyses. The inclusion criteria focused on trials that compared acupuncture combined with Chinese herbal medicine versus treatments without acupuncture. The results demonstrated significant superiority of the combined treatment in multiple parameters.

The clinical efficacy rate was 94.2% in the treatment group versus 77.9% in the control group (OR = 4.83, 95% CI = 3.36-6.93). Eradication of Helicobacter pylori, a bacterium frequently associated with ulcers, was achieved in 76.8% of patients treated with acupuncture and herbal medicine versus 59.9% of controls (OR = 3.94, 95% CI = 2.35-6.6). Notably, the recurrence rate was drastically lower in the combined treatment group (OR = 0.19, 95% CI = 0.1-0.35). Subgroup analyses revealed that different acupuncture modalities — including manual acupuncture, moxibustion, and catgut embedding — all demonstrated superior efficacy when combined with herbal medicine.

The most commonly used acupuncture points included Zhongwan (CV-12), Neiguan (PC-6), Zusanli (ST-36), Pishu (BL-20), and Weishu (BL-21), following traditional principles of harmonizing the stomach and strengthening the spleen. From a TCM perspective, gastric ulcer is understood as the result of imbalances between aggressive and defensive factors of the gastric mucosa, frequently involving spleen and stomach deficiency or qi stagnation. Treatment aims to restore balance by regulating qi, strengthening digestive function, and eliminating pathogenic factors. The proposed mechanisms include modulation of the autonomic nervous system, improvement of gastric microcirculation, regulation of brain-gut peptides such as gastrin, and anti-inflammatory effects that reduce harmful cytokines.

The therapeutic combination demonstrated the ability to significantly reduce gastrin levels (MD = -18.39, 95% CI = -20.68 to -16.11), suggesting effective modulation of gastric function. The safety profile was favorable, with few adverse events reported in the analyzed studies. The clinical implications are substantial, suggesting that integrative therapy may offer advantages over conventional treatments alone. The holistic approach of TCM, considering treatment individualization based on syndrome differentiation, may explain the superior results observed.

The ability to reduce recurrences is particularly clinically relevant, as it represents a significant challenge in the conventional management of gastric ulcers. In the context of growing antibiotic resistance to H. pylori, the demonstration of greater efficacy in bacterial eradication through integrative methods offers promising perspectives for the future of treatment.