Acupuncture at Shen shu, in healthy volunteers, whilst standing, decreased sympathetic nervous activity associated with plasma renin concentration which was not seen in sham or control (3).

EA (1mA, 2Hz) at Bai hui (DU20) and Shen shu, for 15 min, daily, 10 day as a course for a total of 4 courses, with an interval of 1 day, was shown to shorten the average maze escape latency, the number of platform crossing times was significantly increased, the average fluorescence intensity of NeuN and the number of NeuN-positive cells in hippocampus dentate gyrus region increased, the expression levels of Iba-1, TNF-α, IL-6 and IL-1β in hippocampus were decreased in Alzheimer’s disease rats and serious changes in morphology were somewhat reversed (4)

EA of Bai hui, Feng fu (DU16) and Shen shu can effectively improve the learning-memory ability in AD mice, which may be related to its function in inhibiting neuronal apoptosis in the hippocampus and down-regulating the expression levels of Aβ, Caspase 3 and Bax proteins in both hippocampus and cerebral cortex (5). 

Similarly researchers using Bai hui and Shen shu found that, with electroacupuncture, the, ‘can reduce inflammatory reaction and Aβ level, suppress activation of astrocytes and microglia, and up-regulate expression of AQP4 in the hippocampus tissue in APP/PS1 transgenic mice, which may contribute to its effect in improving recognition memory ability, suggesting a role of EA intervention in delaying the development of AD via promoting the drainage of Aβ by the glymphatic system in the brain.’ (6)

EA of both DU20+BL23 and DU20+BL23+BL13 (Fei shu) acupoint can improve learning-memory ability of AD rats, which is associated with their effects in down-regulating the expression of IL-1β and TNF-α in the PFC and hippocampus to reduce inflammatory reaction. There were no significant differences between the two acupoint groups in the therapeutic effects (7)

EA of BL23 can improve the learning-memory ability in SAMP8 mice, which is associated with its effect in down-regulating the expression of hippocampal CDK5, p25 and Tau-5 proteins (8)

Researchers noted a similar effect with daily electroacupuncture at Bai hui and Shen shu (9).

These points, plus Da zhui (DU14) also inhibit complement C1q-dependent microglial phagocytosis in the hippocampus, which was associated with improvements in memory and learning in age accelerated mice (10). 

Additionally, researchers found Shen shu and Bai hui was able to regulate hippocampal autophagy and removal of neurofibrillary tangles by suppressing PI3K/AKT/mTOR signaling pathway and thus improving memory and learning in Alzheimer’s disease rats (11). 

Bai hui and Shen shu, and for a stronger effect alongside metformin, ‘can improve cognitive ability and relieve senile plaques formation in cerebral cortex and hippocampus in Alzheimer’s disease (AD) mice, which may be associated with their functions in down-regulating the expression of βACE1 and up-regulating the expression of insulin-degrading enzyme.’ (12). 

EA at Bai hui, Feng fu and Shen shu can improve the learning-memory ability in AD mice, promote the proliferation and differentiation of endogenous neural stem cells towards neurons and inhibit the proliferation and differentiation of endogenous neural stem cells towards astrocytes in the hippocampus, which may be achieved by regulating Jagged1/Notch1 pathway (13).

EA, at Bai hui, Da zhui and Shen shu, can also improve myelination in Alzheimer’s disease rats which leads to improvements in the anxiety-like behavior and learning and memory ability of SAMP8 mice (14). 

Acupuncture at 13 points of the Governor Vessel, Shen shu (BL23), Tai xi (KI3), Yang ling quan (GB34), Zu san li (ST36) and San yin jiao (SP6), Shen ting (DU24) Qian ding (DU21), Bai hui (DU20), and Si shen cong (Ex-HN 1) combined with rehabilitation therapy was better than that alone for children with cerebral palsy. The children in the acupuncture and rehabilitation group also showed more progress in cerebral development and lower levels of nerve damage (15)

EA of Bai hui (DU20), Feng fu (DU14) and BL23 can improve the recognition memory ability of mice with radiation-induced brain injury, which may be related to its effect in promoting the proliferation and differentiation of stem cells in the hippocampus (16). 

EA (6 times a week for a month) at Bai hui (DU20), Shen ting (DU24), Pi shu (BL20), Shen shu (BL23), Zu san li (ST36), San yin jiao (SP6), Fei shu (BL13), He gu (LI4) and Tai chong (LR3)  can improve the cognitive impairment of mice, as well as regulate body weight, blood glucose, and improve the cell morphology in the hippocampus, which may be related to its function in regulating the IRE1α-JNK pathway and related proteins (17)

‘EA at Bai hui, Da zhui and Shen shu can improve the learning and memory abilities of vascular dementia rats, alleviate the ultrastructural damage of neurons in hippocampal CA1 area, and repair the damaged neurons. The mechanism may be related to the reduction of reactive oxygen species level, LC3-Ⅱ/LC3-Ⅰ ratio, NLRP3 and Beclin1 protein expression, the decrease of neuronal autophagy, inhibition of activation of NLRP3 inflammasome and alleviation of central inflammatory response.’ (18)

By adding Zu san li to the above points, researchers found that EA, ‘can improve the cognitive dysfunction of vascular dementia model rats, which may be related to its function in regulating the imbalance of intestinal microbiota, thereby inhibiting the peripheral inflammatory factor.’ (19)

EA (2 Hz/15 Hz, 1.5 mA) at Guan yuan (REN4) Shen shu (BL23), Feng long (ST40） and Tian shu (ST25) for 20 min, 5 days a week for 6 weeks, can improve lipid metabolism and promote white adipose tissue browning in middle-aged and aged obese rats, which is possibly associated with its functions in activating AMPK/Sirt1 signaling pathway and up-regulating the level of Nrg4. After EA intervention, the increased levels of body mass, food intake, Lee’s index, epididymal fat and perirenal fat mass, serum TG, TC and LDL-C contents, and the expression of IL-6 protein, and the decreased levels of brown adipose mass, serum HDL-C and NE contents, expression levels of UCP1, PGC-1α, PRDM16, PPARγ and Nrg4 mRNAs, and those of AMPKα, Sirt1 and Nrg4 proteins in both white and brown adipose tissues were apparently reversed (20).

A review into acupuncture for obesity noted that Shen shu was one of the most commonly used points, after  Zu san li, Zhong wan, Nei guan, and San yin jiao. They are known to have, ‘roles in regulating gastrointestinal function, energy metabolism, and neuroimmune pathways.’ Treatments were 2-5 times a week for 2-8 weeks, 15-30 minute sessions. The study looked at obesity through the lens of the microbiota–gut–brain axis (MGBA) and discusses acupuncture multimodal ‘capacity to simultaneously enhance microbial diversity and SCFA production, modulate gut hormone profiles, activate vagal signaling, and rewire hypothalamic and limbic neural circuits involved in appetite regulation and emotional resilience.’ (21). 

Tai xi is an important point for premature ovarian failure, being the 6th most used, in order; Guan yuan (REN4), Shen shu (BL23), San yin jiao (SP6), Zhong ji (REN3), Pi shu (BL20), Tai xi (KI3), local points are also very commonly used. The researchers suggested the mechanisms could be related to, ‘regulating the hypothalamus-pituitary gland-ovarian axle (HPOA) function, the improvement of the histological morphology of the uterine, the improvement of body immunity through affecting the nerve-endocrine-immune regulation system as well as the regulation of the genetic and protein expressions of the signal pathway relevant with [premature ovarian failure]’ (22)

The abnormal functional connectivity between the hypothalamus and whole brain regions may be one of the central pathological factors of premature ovarian insufficiency (POI). Acupuncture, at Bai hui (DU20), Zhong wan (REN12), Shen ting (DU24), Shen shu (BL23), Ci liao (BL32), can improve the ovarian function and clinical symptoms of patients with POI, which may be related to its effect in regulating the FC between the hypothalamus and multiple brain regions (23).

Acupuncture, alternating between the protocol of Bai hui (DU20), Shen ting (DU24), Guan yuan (REN4), Ben shen (GB13), Huang shu (KI16), Da he (KI12), Luan chao (Extra), Zu san li (ST36), San yin jiao (SP6), Tai xi (KI3), Tai chong (LR3) and the protocol of Shen shu (BL23) and Ci liao (BL32) benefitted patients with diminished ovarian reserve leading to evels of FSH, FSH/LH decreased, and the levels of estradiol (E2) and antral follicle count (AFC) increased and a 15% pregnancy rate (24). 

Similarly acupuncture before ovulation at Guan yuan (REN4), Gui lai (ST29), Tai chong (LR3), Tai xi (KI3), Xue hai (SP10), San yin jiao (SP6), Zi gong (EX-CA 1), Yin ling quan (SP9), Zu san li (ST36), Shui dao (ST28), Da he (KI12) and Tian shu (ST25). Followed by acupuncture after ovulation at Ci liao (BL32), Shi qi zhui (EX-B 8), Gan shu (BL18), Shen shu (BL23), Ge shu (BL17) and Pi shu (BL20) benefitted patients with premature ovarian failure. Promoting regular menstruation, effectively regulating serum LH, FSH and E2 and improves the pituitary gland and the ovary endocrine in patients with premature ovarian failure. Such effect may be related to the improvements in the expressions of interferon-γ and tumor necrosis factor-α, the inhibition of the apoptosis of ovarian granulosa cells, the recovery of ovarian function and the enhancement of reserve capacity (25).

Acupuncture at Tai xi (KI3), Tai chong (LR3), Tai bai (SP3), San yin jiao (SP6), Shen shu (BL23), Gan shu (BL18), Pi shu (BL20), Guan yuan (REN4) is more effective than Bai hui (DU20), Guan yuan (REN4), Shen shu (BL23), Tai xi (KI3), San yin jiao (SP6) for perimenopausal symptoms across clinical scores as well as showing a stronger effect on regulating the hormones; estradiol, follicle stimulating hormone and luteinizing hormone (26)

Acupuncture, at BL23 or Guan yuan (REN4) and Zhong wan (REN12), can improve the menstrual disorder in rats with ovarian hypofunction, which is closely related to its effects in improving antioxidant stress ability and regulating the expressions of apoptosis-related protein and mRNA of ovarian gra-nulosa cells. This was shown in the results, ‘[with] more mature follicles, fewer atresia follicles, lower abnormal granulosa cell morphology and lower estrous cycle disorder ratio in both hormone therapy and acupuncture groups. After the interventions, the decreased ovarian wet weight and index, serum E2 and SOD contents, expressions of Bcl-2 protein and mRNA were significantly increased, and the increased levels of FSH and LH, malondialdehyde, expressions of Bax protein and mRNA were significantly decreased in both hormone therapy and acupuncture group. The effect of acupuncture was significantly superior to that of hormone in up-regulating SOD, Bax and Bcl-2 protein expressions (27). 

EA (1.0 mA, 100 Hz),alternatively at Shen shu (BL23) and Zhong wan (REN12) + Guan yuan (REN4) for 10 min, for 14 consecutive days, can improve ovarian function, and reduce oxidative stress damage in diminished ovarian reserve rats, which may be associated with its functions in up-regulating the expression of γ-GCS and GR protein and gene in the ovarian tissue. Downstream of this the researchers noted the disorder rate of estrous cycle, serum FSH, 8-OHDG and NTY contents and the decrease of serum AMH and E2, liver GSH and GSSG contents and GSH/GSSG ratio, ovarian optical density and degenerative morphological changes reversed vs diminished ovarian reserve rats (28)

Acupuncture, primarily, at Shen shu (BL23), Guan yuan (REN4), Tai xi (KI3), San yin jiao (SP6), was able to reduce alanine aminotransferase (ALT), aspartate aminotransferase (AST), galactosylhydroxylysyl glucosyltransferase (GGT), triglyceride (TG) and total cholesterol (TC) significantly, leading to significant improvements to liver injury in nonalcoholic steatohepatitis. This improvement was stronger than polyene phosphatidylcholine capsules (29).

EA ((2 Hz, 1 mA) at Shen shu and Tai chong (LR3) may enhance physical strength and promote cellular autophagy in the liver of aging mice by regulating AMPK/mTOR/ULK1 signaling, thereby inhibiting excessive oxidative stress, and delaying aging process to some extent (30).

Acupuncture and moxibustion at Da zhui (DU14), Gan shu (BL18), Shen shu (BL23), and Zu san li (ST36), 6 mins daily for a week, can reduce liver injury due to cisplatin chemotherapy by modulating IRE-1 signaling pathway, inhibiting the excessive activation of endoplasmic reticulum stress, and reducing liver cell apoptosis (31).

Acupuncture and moxibustion at Da zhui (DU14), Gan shu (BL18), Shen shu (BL23), and Zu san li (ST36), can reduce liver injury due to DDP chemotherapy by modulating the expression of apoptotic factors Caspase-3, Caspase-8 and Caspase-9 in liver tissues of DDP model mice and improving liver function, which may be one of the mechanisms of the effect of acupuncture and moxibustion to ameliorate liver injury after DDP chemotherapy (32).

Acupuncture and moxibustion at Ying xiang (LI20), He gu (LI4), Yin tang (EX-HN3) and Shen shu, daily for 30 days, is significantly effective and safe in treatment of allergic rhinitis. Its effect mechanism may be related to the balance modulation of Th1/Th2 and Th17/Treg cells mediated by naive CD4+T cells. Showing reduced serum IgE, RORγt and IL-33 and increased serum Foxp3 and IL-27 (33). 

Transcutaneous electroacupoint simulation at Zu san li (ST36) and Shen shu (BL23) (2 Hz/15 Hz, 1-2 mA), 20 min 6 times a week for 4 weeks, was shown to benefit rats with chronic fatigue syndrome. Improving the learning and memory ability of CFS rats, the mechanisms may be related to improving the neural structure of hippocampal CA1 region and up-regulating the expression levels of ERK/CREB/BDNF (34).

EA (2 Hz/100 Hz, 1 mA) at Bai hui (DU20), Shen ting (DU24) and Shen shu (BL23) for 20 min, daily for 21 days, can improve the motor activity in PTSD rats, which may be associated with its effect in increasing the binding ability of CREB to the synaptic key protein PSD95 to regulate the interaction between the synaptic plasticity and BDNF-TrkB signaling pathway of the amygdala and hippocampus. In simpler terms, EA at those points helps “rewire” the traumatized brain — it restores healthy communication between neurons in key emotional centers (amygdala, hippocampus) by boosting BDNF signaling and synaptic plasticity via CREB–PSD95 interactions. (35)

Acupuncture, at Baihui (GU20), Shenshu (BL23), Ganshu (BL18), and Sanyinjiao, daily for 4 weeks, alleviates perimenopausal depression through dual regulation of sex hormone homeostasis (elevating serum estradiol while suppressing follicle stimulating hormone, luteinizing hormone, and gonadotropin-releasing hormone) and activation of the PI3K/AKT/mTOR pathway, suggesting a potential mechanism for its antidepressant effects in perimenopause (36).

Acupuncture at Shen shu (BL23), Da chang shu (BL25), Huan tiao (GB30), and Wei zhong (BL40) was effective at treating 75% of a sample of 300 disc herniation patients, when used daily for 20 days. The researchers also used CT imagery to see what layer the herniation was. Acupuncture was more effective on the cases positioned in C layer. Regarding the horizontal plane, the effect was better on the cases with zone 1 and zone 1-2 involved. In terms of the grade of frontal plane, acupuncture was more effective on the cases graded Ⅰ and Ⅱ (37). 

Acupuncture at Yao yang guan (DU3), Shen shu (BL23), Wei zhong (BL40), Tai xi (KI3), and 1-3 ashipoints on the lower back and legs can reduce lower back pain, increasing the periaqueductal gray (VTA)/ventral tegmental area (PAG) resting state functional connectivity (rsFC) with the amygdala, and the increased rsFC was associated with decreased pain scores. Interestingly, baseline PAG-amygdala rsFC could predict four-week treatment response. In other words, their results suggest that acupuncture may simultaneously modulate the rsFC of key regions in the descending pain modulation (PAG) and reward systems (VTA), and the amygdala may be a key node linking the two systems to produce antinociceptive effects (38).

Alternative abdominal and lumbar points with each subsequent treatment appeared to give stornger effects, with the researchers noting, ‘acupuncture with yin-yang regulation method effectively alleviates pain, improves functional disability, increases multifidus muscle thickness, and reduces Young’s modulus values in elderly patients with chronic lower back pain due to lumbar disc herniation, which has superior therapeutic effect compared to local acupuncture.’ (39)

Acupuncture at, Ji zhong (DU6), Yao yang guan (DU3), ashipoints, Shen shu (BL23), Da chang shu (BL25), and Wei zhong (BL40), combined with thunder-fire moxibustion could effectively alleviate pain and improve lumbar function in patients of low back pain with cold-damp, possibly by regulating β-EP, 5-HT, and SP levels (40).

In a review, shen shu was found to be the most commonly used point for osteoporosis, followed by zu san li and pi shu (BL20). The underlying mechanisms may be linked with the regulation of the hypothalamic-pituitary-gonadal (adrenal) axis and activation of the Wnt/β-catenin and OPG/RANKL/RANK signaling pathways – which leads to increased bone formation and mineralization and reduced breakdown (41). 

Similarly EA, broadly every other day for 3 months, at Ming men (DU4), Ji zhong (DU6), Pi shu (BL20) and Shen shu (BL23) significantly increased the serum levels of estradiol and osteocalcin, decreased the serum levels of TRACP 5b and increased the bone mineral density of the lumbar vertebrae. This may have been achieved through the observed regulation of the OPG/RANKL and Wnt/β‑catenin signaling pathways (42).

Specific research into EA at Shen shu and Pi shu was shown to increase bone density, increase bone mass and trabecular bone, and promote trabecular bone rod-like changes in plate shape in osteoporosis rats, which is related to its effect in up-regulating the expression of Ac-histone H3 protein, and up-regulating the expression of bone formation-related proteins (43)

Acupuncture, at Xuan zhong (GB39), Shen shu (BL23) and Zu san li (ST36), can improve inflammation in the synovium of rats with early adjuvant arthritis by inhibiting the function of synovial mast cells, reducing total number and degranulation ratio, which may play an important underlying role in the immunoregulation of acupuncture on adjuvant arthritis (44). 

Additionally, acupuncture at Zhong liao (BL33), Xia liao (BL34), Gan shu (BL18), Shen shu (BL23), and Da chang shu (BL25), as well as biofeedback can reduce pain in patients with functional anorectal pain. Biofeedback provided more relief in patients with pelvic floor dyssynergia, and acupuncture provided greater improvements in mental health status (45).

Daily acupuncture, 6 times a week for 10 weeks, at Quchi (LI11), Zu san li (ST36), Tai chong (LR3), He gu (LI4), Shen shu (BL23), Ge shu( BL17) and Da zhui (DU14)  can inhibit the expression of NF-κB signaling pathway in RA patients, regulate the levels of related inflammatory factors, and thus improve the symptoms of RA patients. (46)

‘Acupoints such as Shen shu (BL23), Xue hai (SP10), Chen shan (BL57), Zu san li (ST36), San yin jiao (SP6), and Tai xi (KI3) are commonly involved in the treatment of restless leg syndrome. As far as the mechanism of action is concerned, it is suggested that acupuncture may target the autonomic nervous system to manifest its effects… Moreover, acupuncture is reported to reduce oxidative stress in brain parts and promotes neuroprotection by increasing levels of BDNF, GDNF, and cyclophilin. Besides reducing oxidative stress, acupuncture treatment is also found to exhibit antiapoptotic and anti-inflammatory effects.’ (47)

Acupuncture, primarily, at Ge shu (BL17), Wei wan xia shu (EX-B 3), Gan shu (BL18), Pi shu (BL20), Shen shu (BL23), Zu san li (ST36), Tai xi (KI3), Ashi points can benefit patients with diabetic distal symmetric multiple peripheral neuropathy, having a stronger effect than medication on clinical signs of sensory disorder, reflection disturbance and muscle weakness, nerve conduction and clinical curative effect (48). 

A proteomic study of acupuncture at Shen shu and Zu san li showed they can also help with diabetic neuropathy which lead to analgesic, antioxidant stress and hypoglycemic effect. Over 400 proteins were differently expressed, significantly, ‘proteins involved in oxidative stress injury regulation were dramatically altered.’ (49)

Shen shu is one of the most commonly used points for asthma, above other Lung and Kidney meridian points. However, the key points for a protocol were Fei shu (BL13), Feng men (BL12), Ding chuan (EX-B1), and Da zhui (DU14). (50)

Furthermore, ‘acupuncture versus sham/placebo control appeared to improve quality of life, FEV1%, symptoms, and asthma control, and reduced exacerbation frequency per year.’ (51)

Shen shu is one of the most commonly used points across various lung conditions, including Fei shu (BL13), Zu san li (ST36), and Da zhui (DU14). The therapeutic mechanisms involve anti-inflammatory effects and inhibition of airway remodeling, with targets mainly associated with the NF-κB signaling pathway (52).

Fei shu and Shen shu are also commonly used for chronic obstructive pulmonary disorders improving clinical scores with a ‘comprehensive regulatory effect’ (53). 

Alongside extracorporeal diaphragmatic pacing and conventional acupuncture, acupuncture at Fei shu (BL13), Pi shu (BL20), Shen shu (BL23) can improve the pulmonary function, respiratory muscle strength, trunk control and balance abilities in patients with post-stroke tracheotomy, and increase the extubation success rate (54).

Acupuncture, every other day for two weeks, at Fei shu (BL13), Pi shu (BL20), Shen shu (BL23), Ding chuan (EX-B1), and Tan zhong (REN17) can benefit rats with asthma. The mechanisms is, at least in part, related to inhibition of the P38MAPK signaling pathway, down-regulating ICAM-1 expression, and up-regulating IFN-γ expression to promote apoptosis of eosinophilic granulocytes and reduce eosinophilic granulocyte aggregation, thus alleviating the inflammatory response of airway in asthma (55). 

Acupuncture at Fei shu, Ding chuan and Shen shu protects pulmonary function and reduces the COPD-induced inflammatory response by decreasing cell inflammation and the production of TNF-α and IL-8. Acupuncture also enhanced HDAC2 mRNA and protein expression, suggesting a possible direct effect on protein structure through post-translational modifications (56).

EA of BL23 and Ge shu (BL17) can reduce the blood pressure in SHR, which may be related to its function in down-regulating expression of TIMP-1, PAI-1 and α-SMA proteins.This also led to reductions in the observed disordered arrangement of the renal cells, congestion and dilation of capillaries with thickened vascular wall, renal tubule atrophy and lumen stenosis with some necrosis of renal tubules, protein tubule and cell tubules, increase of some glomerular mesangial matrix and hyperplasia of fibrous tissue (57)

‘Acupuncture improve[s] clinical symptoms, renal function indices such as urinary albumin, urinary microalbumin, urine β2-microglobulin, and serum creatinine, as well as blood glucose and blood lipid in patients with diabetic kidney disease, and has a favorable safety profile. Zhong wan (REN12), Di ji (SP8), Xue hai (SP10), Zu san li (ST36), San yin jiao (SP6), Pi shu (BL20), Shen shu (BL23), and Yin ling quan (SP9) are the core acupoints for acupuncture in diabetic kidney disease’ (58)

Daily acupuncture and moxibustion, at San yin jiao (SP6), Shen shu (BL23) and  Pi shu (BL20), for a week, can effectively reduce kidney damage caused by contrast medium. The underlying mechanism may be that acupuncture and moxibustion accelerates the recovery of renal function and renal pathology by reducing local renal oxidative stress (increased superoxide dismutase, nitric oxide and reduced malondialdehyde) and inhibiting Notch signal pathways (59). 

EA (2 Hz/15 Hz, 1.0 mA), at Ge shu and Shen shu, 15 min each time, every other day for 12 weeks, could effectively alleviate hypertension and renal interstitial fibrosis in spontaneously hypertensive rats. The mechanism may be related to its function in reducing the expression of TGF-β1 and inhibiting epithelial mesenchymal transition in renal tissue (60).

EA (2 Hz/15 Hz, 0.3-0.5 mA) at Zu san li (ST36) and Shen shu (BL23) for 30 min, once daily for 7 days pretreatment, can lower blood glucose level and reduce renal apoptosis in hyperglycemia mice, which may be related to its effects in down-regulating the expression of TRPC6 and Caspase-3 and up-regulating the ratio of Bcl-2/Bax (61).

Daily acupuncture, alternating Xin shu (BL15), Gan shu (BL18), Pi shu (BL20), Shen shu (BL23) one day and then Guan yuan (REN4), Zhong ji (REN3), San yin jiao (SP6), Tai xi (KI3), Tai chong (LR3) the next, was more effective than daily Sailete tablets, 20 mg, for primary simple premature ejaculation (62)

A review of acupuncture for premature ejaculation found that acupuncture with other treatments was the most beneficial approach to treatment. Acupuncture on its own did have some quality of life benefits, improving the feeling of control over ejaculation and distress.  With Zu san li, Shen shu, Tai chong, and San yin jiao being the most commonly used points. Vs sham, acupuncture does improve intravaginal ejaculation latency time and Premature Ejaculation Diagnostic Tool scores, albeit with relatively low quality of research. (63)

Tai xi is among the most common points used for erectile dysfunction as well, in order; Guan yuan (REN4), Shen shu (BL23), San yin jiao (SP6), Ming men (DU4), Zu san li (ST36), Zhong ji (REN3), Ci liao (BL32), Qi hai (REN6), Tai xi (KI3) and Tai chong (LR3) (64).

‘EA, [at Zu san li (ST36), Shen shu (BL23), and San yin jiao (SP6)], significantly alleviates obesity-induced reproductive dysfunction by modulating leptin and kisspeptin signaling, reducing hypothalamic inflammation, and improving neurotransmitter and serum metabolic profiles, suggesting its potential as a therapeutic strategy for reproductive issues related to obesity’ (65) 

‘The warm needle moxibustion, mild moxibustion and EA therapies [at Guan yuan (REN4) and Shen shu, 5 times a week for 8 weeks], have an anti-aging effect by increasing serum testosterone and serum gonadal hormone levels in aged rats, which is possibly related to their effects in up-regulating the expression of hypothalamic KISS-1, GPR54, RFRP-3 and GPR147 mRNAs and testicle GnRH-R and GPR54 mRNAs, as well as down-regulating testicle GPR147 mRNA expression. The therapeutic effect of WNM, mild moxibustion and EA is evidently superior to that of medication.’ (66).

Acupuncture is safe and effective in the treatment of psoriasis, and acupuncture combined with moxibustion and fire acupuncture needle combined with western medicines are recommended as the main intervention method, with Ashi-point, Fei shu (BL13), Ge shu (BL17), Gan shu (BL18) and BL23 as the main acupoints (67).

Acupuncture, 3 times a week for 10 session, at Bai hui (DU20) Shen shu (BL23), Tai xi (KI3), An mian (Extra) improves sleep in patients with perimenopausal insomnia; improving sleep quality, sleep latency, sleep duration, sleep efficiency, hypnotic, daytime dysfunction (68), this was corroborated in another study (69).  

EA at Fei shu (BL13), Xin shu (BL15), Gan shu (BL18), Pi shu (BL20) and Shen shu (BL23), 10 min a day for 6 days can significantly improve the sleep in insomnia rats, which is closely associated with its effects in reducing the expression of peripheral benzodiazepine receptor in hippocampus and up-regulating the levels of hypothalamic 5-hydroxytryptamine (5-HT), 5-hydroxyindoleacetic acid (5-HIAA), TNF-α and IL-1β in hypothalamus (70).

Acupuncture at Shu, Mu or Yuan source points decreased serum uric acid and xanthine oxidase levels and significantly improved the  renal index in rats with gout and hyperuricemia. Mu points were the most effective for serum uric acid and xanthine oxidase, followed by Yuan source points. This could show improvements in renal damage (71) 

Acupuncture of BL23 and KI3 can effectively down-regulate serum uric acid level in hyperuricemia  rats, which may be related to its effects in down-regulating the expression of urate-anion transporter 1 (URAT1) and up-regulating the expression of organic anion transporter 1 (OAT1) in the kidney tissue (72).

Acupuncture at Hui yin (REN1); Zhong ji (REN3); Pang guang shu (BL28); Qu gu (REN2); or Shen shu (BL23)  or, in other words, at homotopic acupoints may produce dual effects on bladder motility: inhibiting bladder motility when in an active state and enhancing bladder motility when in a static state (73). 

In stress urinary incontinence (SUI) rats, it is found that the collagen is lost, the collagen degradation is increased, and the collagen synthesis is decreased in the anterior vaginal wall. Electroacupuncture for three days, 20 mins a time at Shen shu (BL23) and Hui yang (BL35) can inhibit the abnormal degradation of collagen, promote collagen synthesis, increase the total content of collagen in the anterior vaginal wall of SUI rats, and then achieve the purpose of treating SUI, and the curative effect of electroacupuncture at acupoints is better than that of electroacupuncture at non-acupoints. This was seen in increases in the expression of Col-I, Col-Ⅲ mRNAs and proteins, TIMP-1 mRNA and TGF-β mRNA and decreases in the expressions of MMP-1, MMP-2 mRNAs and proteins, MMP-9 mRNA, DCN mRNA and protein (74).

Benign prostatic hyperplasia (BPH) affects >50% of males aged ≥50 years, causing lower urinary tract symptoms that significantly impair quality of life. Acupuncture for BPH primarily targets Guan yuan (REN4), Zhong ji (REN3), San yin jiao (SP6), Qi hai (REN6), Shen shu (BL23), Shui dao (ST28), Pang guang shu (BL28), Yin ling quan (SP9), Qu gu (REN2), and Ci liao (BL32). This review pointed towards clinical and quality of life improvements in BPH patients (75). 

EA at Xin shu BL15, but not BL23 or sham, effectively prevented atrial fibrillation-induced macro- and micro-circulation dysfunction. Furthermore, EA at BL15 restored atrial fibrillation-induced vasomotricity impairment. Additionally, EA treatment prevented abnormal activation of the autonomic nerve system induced by atrial fibrillation, although it did not address vascular endothelial dysfunction. Importantly, excessive activation of paraventricular nucleus neurons negated the protective effects of EA treatment on atrial fibrillation-induced circulation dysfunction in rats (76).

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