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Thank you Verde Valley for a great year! Happy 4th of July!!!

Thank you Verde Valley!, Verde Valley Acupuncture in Cottonwood, AZ

Verde Valley Best of 2018 and the winners are...

Congrats to Verde Valley Acupuncture being voted best Health and Beauty clinicVerde Valley Best of 2018 and the winners are..., Verde Valley Acupuncture in Cottonwood, AZ

PLEASE Support Jeanette’s Humanitarian Mission to Nepal 2020

PLEASE HELP US HELP OTHERS, we can only help with your support for Nepal 2020

Please help Jeanette get to Nepal thru your donations to Verde Valley Acupuncture or thru Jeanette Campbell Indiegogo fund site after March 15th 2019 (currently under construction )   I have a $6000 goal

You may also donate directly to H.E.R.O. at to help us with costs and coordinating efforts for making this Nepal effort and other efforts a reality for some of the most disenfranchised peoples on the globe. I have a $2000 goal

PLEASE Support Jeanette’s Humanitarian Mission to Nepal 2020, Verde Valley Acupuncture in Cottonwood, AZ

HERO (Humanitarian Efforts Reaching Out) is dedicated to assisting people in poverty-stricken areas of the world build healthy, sustainable communities that thrive and grow. HERO has been asked by Tulku Tsori Rinpoche, to provide humanitarian relief to the people and animals of this ancient and sacred place.

Nepal is a small country nestled between India and China. Our HERO team will be traveling to an area north of Katmandu to a Tibetan Children's School Monastery devastated by the massive earthquake several years ago. 

This HERO team will be made up of approximately 15 volunteers. We will be carrying medical, veterinarian, solar and other sustainability supplies. Once there, the team will establish a way to deliver medical and veterinary care to the refugees, including children’s immunizations and pre-natal care. Rabies vaccine will be provided for dogs and the volunteers will tend to any medical needs the livestock may have. We expect to coordinate efforts with a Flagstaff Solar group for access to clean ( non-fire /smoke ) heat and energy sources to the school and monastery. We will assist the rebuilding efforts of the school and monastary buildings.

Im fortunate to be asked to join the HERO team to Nepal. As soon as I heard about the project, I knew Acupuncture and Chinese Medicine would be a powerful tool for healing a variety of both individual and community conditions of society's poorest and least fortunate.Being the only Acupuncturist on the team, I will bring healing assistance to the children students and Monks living with conditions such as: musculoskeletal pain, digestive pain, hypertension, diabetes, asthma, and recovery from environmental conditions. These Nepalese Tibetan Buddhist peoples strength and compassion in the face of their poverty and social disfranchisement are inspirational

I am a Diplomate of Traditional Chinese Medicine (Acupuncture, Chinese Herbs, Massage Therapy, and lifestyle guidance) with an emphasis on combination Acupuncture and Massage treatments. I have practiced therapeutic massage and teach for massage schools since 1995. With my ability to perform various styles of Acupuncture, Massage/Bodywork, Chinese herbal medicine, flower water essences, essential oil aromatherapy, and energy meditation, every treatment is individually tailored to specific needs. My unique approach blends eastern and western medical principals, striving for new and proven methods to improve our level of healing and health

Please consider contributing to my participation in the Humanitarian Mission to Nepal. Your support will help procure medical supplies, equipment, travel, and more.

Thank you in advance for your consideration!


“Wu Xing” - five phases or five processes used to describe changing states of being
The five element (or five phase theory) is used by many Shiatsu practitioners as a diagnostic tool to understand their clients physically, psychologically and spiritually. According to the Five Element theory, Chi (energy) can be subdivided into five different but interconnected phases: Fire, Earth, Metal, Water and Wood. As symbols of Nature, they relate to the energetic qualities of such things as the seasons, colors, flavors and emotions. Each element is associated with two meridians that are yin/yang partners. The elements follow the natural cycles of nature and each element is associated with a different time of day.
Early on, this theory was a way of describing natural processes hidden from ordinary view. It became a school of thought during the Han Dynasty (202 BCE) to describe not only nature, but aesthetic principles, historic events, political structures, social norms, cosmology, mortality, and medicine. As described in the Internet Encyclopedia of Philosophy, these Five elements, phases, processes embody an dynamic inter dependant aspects of the Universe’s ongoing existence and development.
“Mu” The Wood Element: The liver and gall bladder meridians are governed by the Wood element and is associated with initiating action and the energy of the morning. It gives the ability to plan, control and assert oneself. The emotion associated with it is anger.
“Huo” The Fire Element: The fire element governs two meridian pairs : the heart and small intestine meridian, and the heart protector and the triple heater. This element is associated with the middle of the day when energy is at its peak. It represents our self-identity and celebration. The emotions associated with it are Joy and Love.
“Tu” The Earth Element: The spleen and stomach meridians are governed by the Earth
element, which is associated with the late afternoon and a waning in activity. It relates to our ability to concentrate and analyse. The emotion associated with it is pensiveness.
“Jin” The Metal Element: The lung and large intestine meridians are governed by the Metal element, which is associated with evening and a balance between activity and rest. It enables us to know our boundaries and when it is appropriate to take in and let go. The emotion associated with it is grief.
“Shui” The Water Element: The kidney and bladder meridians are governed by the Water element, which is associated with night-time and rest. It provides us with the instinct for survival and procreation. The emotion associated with it is fear but this element is also the source of courage and endurance.

The Dan Tien and San Jiao
Both The Dan Tien and San Jiao have no association with western anatomy. The Dan Tien and San Jiao are linked by more than their location. If the Qi in one of the three Jiao’s becomes disturbed so will the function of the Dan Tien located in that area. If one of the Dan Tien is disturbed so will the associated Jiao.
Dan Tien / Tanden
The Dan Tien is literally translated as cinnabar field, or red field. According to the ancient Chinese theories, there are three Dan Tiens although the term is more often used to describe the lowest or most inferior of the three.
Also known as the elixir field, the Dan Tien is important with balance and strength. It is
located in the abdominal cavity three finger widths below and two finger widths behind the navel and corresponds with the physical centre of gravity.
San Jiao
The Triple Heater manifests as the bodies waterways. The triple heater is primarily energetic and does not have a physical component, unlike all the other organs.
San Jiao has been translated as “triple heater, and runs parallel with the Dan Tien. The San Jiao is also said to be a metabolism mechanism similar to an old-fashioned water wheel that is turned by incoming water and creates energy for accomplishing a task, such as grinding grain in the case of the water wheel, or for metabolizing and digesting food in the case of the San Jiao. The San Jiao is closely associated with the spleen functions of transformation and transportation, particularly the metabolism of incoming food. The San Jiao is also closely associated with the kidney’s function in TCM.
The San Jiao is the Hand Shao Yang meridian and the Yang Ministerial Fire Organ. The San Jiao presides in the torso divided into upper, middle, and lower regions.

The three Dan Tien:FIVE ELEMENT THEORY, Verde Valley Acupuncture in Cottonwood, AZ
Lower Dan Tien - located 1.3 inches below the navel and one inch in. It is also known as the golden stove, or the cauldron. It is associated with the endocrinal system. In Japan, this point is known as the Hara.
Middle Dan Tien – located in the centre of the chest, level with the heart. It corresponds to the physiological functions of respiration and the circulation of blood and Qii. It also functions as the emotional centre of the body.
Upper Dan Tien – located within the brain just behind a point directly between the eyebrows and corresponds to the Third Eye. It corresponds with the Shen and consciousness, as well as the physiological functioning of the brain and sensory organs.
The three San Jiao:
Lower San Jiao is below the naval, associated with the lower digestive organs of elimination and the reproductive organs.  Middle San Jiao is located below the diaphragm and above the navel, associated with early and middle stage digestion.
Upper San Jiao is located within the torso above the diaphragm, associated with the heart function and respiration.


Makko-Ho stretches are a series of meridian opening movements, which is part of the shiatsu system of health. They are useful not just because they stretch each pair of meridians, but because they can monitor the state of the meridian’s health by the ease and flexibility with which you can get into each position. They may appear to be similar to some yoga postures, but they differ in the intent and the way we work into them. With Makko Ho we try to remain in an state of relaxation, as we breath in, as we slowly move into the stretch on the exhale. While remaining in the stretch, try to remain relaxed through 3 deep breaths.
The Makko Ho exercises are used as a self healing technique by allowing the practitioner to both sedate and tonify the meridians through specific stretches to improve the flow of Qi. There is a stretch for each pair of meridians and are based on the theories of Traditional Chinese Medicine. Often it is said that they should be done in the sequence shown (i.e. Metal, Earth, Primary Fire, Water, Secondary Fire, and Wood). Begin the Makko Ho exercises by grounding yourself through relaxed, regulated breathing, while you focus on centering your energy. It is important that you settle into the stretches on the exhalation and that nothing is forced.
The emphasis is not so much on the physical stretch but on opening up and moving any stagnant energy in the body. Remember to focus on your breathing and try to note any changes going on within you during each stretch – this includes physical, emotional, and consciousness (Body, Mind, Spirit).

METAL Lung/Large IntestineMAKKO HO STRETCHES, Verde Valley Acupuncture in Cottonwood, AZ
To stretch these meridians, stand with your feet shoulder width apart, with your knees relaxed and unlocked. Link your thumbs together behind your back. As you exhale, raise your arms up behind you and, keeping your legs straight, allow your trunk to flex forward. Hold this position on inhalation, and then settle further into the stretch on exhalation (for three respirations). Hold this position before slowly rising to the original position.

EARTH Stomach/SpleenJeanette Campbell, L.Ac Dip. Oriental Medicine offers Acupuncture, Massage, Herbs in Cottonwood, AZ
To stretch these meridians, sit kneeling between your heels and, if you can do the stretch without straining your knees or the lower back, lie back flat on the floor with your arms outstretched on the floor above your head. Do not attempt this stretch if you have problems with your knees or lower back. You can go partly into the stretch by supporting your upper body with your arms and leaning gently back and, when in this position, thrust your pelvis forward.

PRIMARY FIRE Primary Fire – Heart/Small Intestine.Verde Valley Acupuncture in Cottonwood, AZ
To stretch these meridians, sit with the soles of the feet are against each other and with your feet pulled close. Relax your legs to allow your knees to lower. Clasp your feet with both hands and, with your back held straight, bend forward from the pelvis as you exhale. Hold this position on inhalation, and then settle further into the stretch on exhalation (for three respirations). Hold this position before slowly returning to the original sitting position.

WATER Kidney/Bladder.MAKKO HO STRETCHES, Verde Valley Acupuncture in Cottonwood, AZ
To stretch these meridians, sit on the floor with your back held straight and your legs straightened out in front of you. Raise your arms above your head, and as you exhale, bend forward from the hips, with your knees straight. Hold this position on inhalation, and then settle further into the stretch on exhalation (for three respirations). Hold this position before slowly returning to the original sitting position.

SECONDARY FIRE Secondary Fire – Heart Governor/Triple Heater.Jeanette Campbell, L.Ac Dip. Oriental Medicine offers Acupuncture, Massage, Herbs in Cottonwood, AZ
To stretch these meridians, sit with your legs crossed (if possible, in the lotus position or the half-lotus). Cross your arms so that they are opposite of your legs, (i.e. If your right leg is on top, the left hand is on top) and hold on to your knees. Bend forward as you exhale. Hold this position on inhalation, and then settle further into the stretch on exhalation (for three respirations). Hold this position before slowly returning to the original sitting position.

WOOD Liver/Gall Bladder.Verde Valley Acupuncture in Cottonwood, AZ
To stretch these meridians, sit up straight with one leg outstretched, flat on the floor, and with the foot upright. The other leg is tucked into the body. Bring your hands above the head with the palms facing each other and, on exhalation, lean sideways over the outstretched leg (keeping both buttocks on the floor). Hold this position on inhalation, and then settle further into the stretch on exhalation (for three respirations). Hold this position before slowly returning to the original sitting position. Repeat on the other side.

Why it’s so hard to figure out if acupuncture actually works? Should you stick a needle in it?

Source: Popular Science
By Kendra Pierre-Louis May 5, 2017
Does medicine have a bias against acupuncture?

That's the verdict of a paper (and an accompanying commentary) published earlier this week in The Journal of Alternative and Complementary Medicine. While there’s still no medical consensus on acupuncture, and most reputable medical organizations do not support its use for arthritic knee pain, the authors' critique lends interesting insight into the process by which medical procedures are accepted—and which are excluded.

How does alternative medicine get to be plain-old medicine?

Led by Stephen Birch of Kristiania University College in Norway, the researchers behind the new study allege that the United Kingdom’s National Institute for Health and Care Excellence (NICE), which details recommended treatments for given ailments, holds acupuncture to a higher standard than it does traditional medical modalities.

If all of the treatments that NICE recommend for knee arthritis—including weight loss and nonsteroidal anti-inflammatory (NSAID) drugs like ibuprofen—had to meet the minimum required standards that NICE sets for acupuncture, “opiates would become the first line of drug prescription,” wrote Birch et al.

Does acupuncture do anything?
To understand the article’s criticism, it helps to recognize that—despite the practice's mystical reputation—acupuncture might actually work sometimes. Earlier this year, the American College of Physicians listed acupuncture as a minimal invasive treatment of low back pain. It should be noted, however, that most low back pain tends to go away on its own.

A more intriguing example is a March study that appeared in the journal Brain, which found that acupuncture improved the outcomes for carpal tunnel syndrome by literally remapping the brain. Researchers came to that conclusion after exposing subjects diagnosed with carpal tunnel syndrome—broken into three groups—to acupuncture treatments.

Patients in the first group received an acupuncture treatment as prescribed by traditional Chinese Medicine—that is, needles were inserted at the site of the pain. The researchers exposed the second group to something known as distal needle acupuncture, in which acupuncture needles aren’t inserted where it hurts, but rather at other sites that practitioners say are connected to the painful regions by “channels of energy.” Yes, we know this sounds like snake oil—and the study authors aren’t alleging that the so-called channels exist. But if you want to know if something—a drug, a workout regimen, or in this case an acupuncture technique—has any effect, you have to test it.

Finally, a third group received what’s known as sham acupuncture, which is essentially the sugar pill of acupuncture. In this case, sham acupuncture involved non-penetrating placebo needles designed to convince participants that they had undergone a real acupuncture treatment. Each participant received 16 treatments of their designated form of acupuncture over the course of eight weeks.

At the end of the stud, all groups equally reported that their symptoms had improved. That's proof that acupuncture is a sham, right? Not exactly.

The researchers had specifically chosen carpal tunnel because, according to study author Vitaly Napadow, “carpal tunnel syndrome, as opposed to most chronic disorders like low back pain and fibromyalgia, is one of the few chronic pain disorders that has objective outcomes.” Napadow, who is the director of the Center for Integrative Pain Neuroimaging at the Martinos Center for Biomedical Imaging at Massachusetts General Hospital (MGH), says that when you’re talking about improvements in pain, the success of a treatment is basically measured by whether a patient says it's made them hurt less.

But carpal tunnel syndrome is different. Because it occurs when the median nerve gets entrapped, researchers can actually measure the transmission rate of an impulse sent across the wrist and determine whether a given treatment improves that rate.

Napadow found that while participants in all three categories stated that they felt an improvement in pain, only participants who had received acupuncture—either at the site of the pain, or, somewhat surprisingly, via those mysterious "energy channels"—actually experienced nerve transmission improvements. And to further make the case, participants who had needles inserted right at the wrist did indeed improve even more than those who received distal needle acupuncture.

Earlier studies had shown that carpal tunnel doesn’t just causes changes in the wrist—it also causes changes in regions of the brain’s gray matter. The nerve damage in the wrist creates a sort of blurring in the brain in terms of its ability to process signals from the hand. When Napadow stuck study participants in an fMRI, he found that those pathways in the brain had improved, though he's quick to note that even these impressive outcomes don't equate to 'curing' carpal tunnel. "We improved the disorder and certainly kept it from getting worse, but we did not magically heal the patient," he says.

But how does relate to Birch et al's critique of the U.K.’s exclusion of acupuncture from its recommendation for knee arthritis pain?

When is a placebo not a placebo?
Recall that if you were to throw out the objective measure’s—the fMRI and nerve conductivity tests—Napadow’s study looks like a dud, because patients expressed equal levels of pain reduction whether they experienced real acupuncture or sham acupuncture.

The whole point of a placebo is that it's inert. It doesn't actually have an effect on the body, making it an excellent control. But physical interventions aren't quite the same as sugar pills: even in sham acupuncture, there is some pressure or sensation being inflicted on the patient's body. In fact, some cases of "sham" acupuncture even involve the insertion a needle, though Napadow's study did not.

“There's a controversy as to what sham acupuncture is,” said Napadow, “you still have a tactile sensation and a somatosensory input as a result of sham acupuncture.”

This issue isn’t limited to acupuncture. For years, studies showed that patients who had certain kinds of knee surgeries for osteoarthritis—either having their knees cleaned out with an arthroscopic procedure known as a debridement, or having the joint washed out with a saline solution known as an arthroscopic lavage—reported less pain than patients who did nothing, despite the fact that the physiological basis of the procedures were unclear—and the fact that the treatments didn’t stop the progress of the arthritis.

But still, despite the fact that there wasn't any evidence that they actually worked, the surgical procedures were routinely done because patients reported feeling better. Ironically, that is the exact opposite of the stance that we take with acupuncture—even though it's less invasive.

But a 2002 study in the New England Journal of Surgery studied three groups of knee osteoarthritis patients: one group underwent the arthroscopic lavage procedure, another did the saline, and a third underwent a sham surgery—doctors essentially made an incision and then stitched the person back up. As in Napadow’s study, all three groups reported an equal reduction in pain. Notes the 2002 research team, “This study provides strong evidence that arthroscopic lavage with or without débridement is not better than and appears to be equivalent to a placebo procedure in improving knee pain and self-reported function. Indeed, at some points during follow-up, objective function was significantly worse in the débridement group than in the placebo group.”

In other words, it wasn’t the procedures that helped, but the perception that someone did anything at all to help. The problem, however, as Napadow’s study illustrates, is that when we’re talking about pain—where the metric for efficacy is “do you feelbetter”—the perceived efficacy of a placebo intervention can equal the actual benefits of a real intervention.

And yet, NICE lists both of the procedures examined in the 2002 study as recommended therapies for knee osteoarthritis. This is in part why the new study’s authors argue that acupuncture is being held to a higher standard than other accepted interventions. Specifically, they point to how NICE uses Effect Size (ES) as problematic. In many scientific studies, something known as a P value tells us that a relationship is statistically significant—that is, that aspirin might fight heart disease, or cheese makes us happy. The Effect Size is the magnitude of the difference between the two groups—how happy does cheese make you?

NICE recommends against acupuncture because they say that the effects are too small when compared to sham acupuncture to be considered beneficial, while in the same breath acknowledging, write Birch et al, that ‘‘few if any other commonly used treatments for osteoarthritis meet these thresholds for minimal clinically important differences.’’

The researchers ask a simple question: if most of the recommended treatments fail to meet this threshold, why is acupuncture excluded while arguably more invasive procedures are included? But as patients, we should perhaps be asking a different question. Why are we being recommended procedures that don’t work?

Cupping therapy versus acupuncture for pain-related conditions: a systematic review of randomized controlled trials and trial sequential analysis

Source: Chinese Medicine BioMed Central

© The Author(s) 2017
Received: 26 April 2017

Both cupping therapy and acupuncture have been used in China for a long time, and their target indications are pain-related conditions. There is no systematic review comparing the effectiveness of these two therapies.

Cupping therapy versus acupuncture for pain-related conditions: a systematic review of randomized controlled trials and trial sequential analysis, Verde Valley Acupuncture in Cottonwood, AZ

To compare the beneficial effectiveness and safety between cupping therapy and acupuncture for pain-related conditions to provide evidence for clinical practice.

Protocol of this review was registered in PROSPERO (CRD42016050986). We conducted literature search from six electronic databases until 31st March 2017. We included randomized trials comparing cupping therapy with acupuncture on pain-related conditions. Methodological quality of the included studies was evaluated by risk of bias tool. Mean difference, risk ratio, risk difference and their 95% confidence interval were used to report the estimate effect of the pooled results through meta-analysis or the results from each individual study. Trial sequential analysis (TSA) was applied to adjust random errors and calculate the sample size.

Twenty-three randomized trials with 2845 participants were included covering 12 pain-related conditions. All included studies were of poor methodological quality. Three meta-analyses were conducted, which showed similar clinical beneficial effects of cupping therapy and acupuncture for the rate of symptom improvement in cervical spondylosis (RR 1.13, 95% CI 1.01 to 1.26; n = 646), lateral femoral cutaneous neuritis (RR 1.10, 95% CI 1.00 to 1.22; n = 102) and scapulohumeral periarthritis (RR 1.31, 95% CI 1.15 to 1.51; n = 208). Results from other outcomes (such as visual analogue and numerical rating scale) in each study also showed no statistical significant difference between these two therapies for all included pain-related conditions. The results of TSA for cervical spondylosis demonstrated that the current available data have not reached a powerful conclusion. No serious adverse events related to cupping therapy or acupuncture was found in included studies.

Cupping therapy and acupuncture are potentially safe, and they have similar effectiveness in relieving pain. However, further rigorous studies investigating relevant pain-related conditions are warranted to establish comparative effectiveness analysis between these two therapies. Cost-effectiveness studies should be considered in the future studies to establish evidence for decision-making in clinical practice.
AcupunctureCupping therapyRandomized controlled trialSystematic reviewTrial sequential analysis

Traditional Chinese non-pharmaceutical therapies, such as acupuncture, are applied under the guidance of the Traditional Chinese Medicine (TCM) theory of syndrome differentiation. As an important part of TCM, these therapies mainly use manual or technique stimulations at specific body parts (especially acupoints) to dredge the meridian system. Generally, non-pharmaceutical therapies, including acupuncture, cupping therapy, moxibustion, massage (tuina), and guasha, are more likely to be accepted by patients since they have been used in treating numerous diseases or conditions and may have fewer side effects than drugs [1]. Acupuncture, as one of the most popular non-pharmaceutical therapy, has been widely used to treat diseases by regulating the functions of qi (vital energy) and blood of the organs through puncturing certain acupoints of meridians in the body with needles, to strengthen the resistance of the body against diseases [2]. A current clinical guideline issued by the American College of Physicians (ACP) recommends non-pharmacologic treatments (such as acupuncture, massage and superficial heat) as the priority treatments to patients with acute, subacute or chronic low back pain [3]. In addition, systematic reviews have reported that acupuncture was indicated for the treatment of chronic pain, mainly headaches, migraines, cervical pain, back pain, and pain from osteoarthritis [4, 5, 6, 7, 8, 9].

Cupping therapy also belongs to TCM non-pharmaceutical therapy, which has been used for long time [10]. Cupping practitioners utilize the flaming heating power to achieve suction (minus pressure) inside the glass cups to make them apply on the desired part of the body, and this suction on selected acupoints produces hyperemia or hemostasis, which may result in a therapeutic effect [11]. There are different types of cupping including retained cupping, flash cupping, moving cupping, wet cupping, medicinal cupping, and needling cupping [12]. Since a report about the Olympic swimmer Michael Phelps using cupping therapy to relieve his muscular discomfort, this treatment has become more and more popular outside China. However, although beneficial effects of cupping therapy have been reported in treating various diseases/conditions, there is lack of high-quality evidence to confirm its efficacy [13]. Our previous systematic reviews on cupping for pain-related conditions also identified no high-quality evidence to prove its effectiveness [14, 15].

Both acupuncture and cupping therapy are commonly used in treating similar conditions, especially pain-related conditions. Though the mechanism of acupuncture and cupping therapy may be different, both, therapies employ the meridian and acupoints to activate blood stasis and regulate the flow of qi to relieve pain. Cupping therapy has more advantages than acupuncture, such as a non-invasive therapy with relatively shorter treatment duration and potential less treatment cost. It is worthy to critically review the evidence of the comparison of these two therapies to inform clinical practice. Herein, to the objective of this review is to comprehensively review the evidence from randomized controlled trials (RCTs) comparing cupping therapy with acupuncture for pain-related conditions.
The protocol of this review was registered in PROSPERO (CRD42016050986) on 15th November 2016 (Achieved at Since pain-related conditions were most commonly treated by cupping therapy and acupuncture, we limited the target conditions (such as musculoskeletal pain, tissue pain and neuralgia pain) in this review to reduce the clinical heterogeneity among included studies.

Inclusion criteria
RCTs comparing cupping therapy with acupuncture were included. Pain-related conditions were classified by the type of tissue according to international statistical classification of disease and health related problems by World Health Organization [16], including musculoskeletal system pain (such as spondylopathies, lumbar spondylosis, knee osteoarthritis, acute tissue pain), and neurologic pain (such as lateral femoral cutaneous nerve and herpes zoster pain). Acupuncture is defined as the insertion of fine needles, sometimes in conjunction with electrical stimulus, to influence physiological functioning of the body. In this review, we included both manual acupuncture (including auricular therapy, scalp needle, and abdominal acupuncture) and electro-acupuncture. Cupping is defined that practitioners utilize the flaming heating power to achieve suction (minus pressure) inside the glass cups to make them apply on the desired part of the body. In this review, all types of cupping (i.e. wet cupping, herbal cupping, moving cupping, flash cupping or retained cupping) were included. Primary outcome measures included severity of pain, functional capacity, quality of life (QoL). Secondary outcomes included depression, rate of symptom improvement and adverse effects. There was no limitation on language and publication type.

Identification and selection of studies
We searched China Network Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP), Wan Fang Database, PubMed, EMBASE, and the Cochrane Library, all the searches ended at March 2017. The search terms included acupuncture-related terms (i.e. “acupuncture”, “acupoint”, “needle”, “electroacupuncture”, “manual acupuncture”, “auricular needling”, “scalp needle”, or “abdominal acupuncture”), combined with cupping-related terms (i.e. “cupping therapy”, “bleeding cupping”, “wet cupping”, “dry cupping”, “flash cupping”, “herbal cupping”, “moving cupping” or “retained cupping”) and pain-related terms (i.e. “ache”, “pain”, “painful”, or “analgesic”). Two authors (XY Yang and BY Lai) selected studies for eligibility and checked against the inclusion criteria independently.
Data extraction and risk of bias assessment
Two authors (YJ Zhang and XL Li) extracted the data from the included studies independently. The methodological quality of RCTs was assessed according to the criteria from the Cochrane Handbook for Systematic Reviews of Interventions [17]. The quality of studies was categorized into low, unclear, or high risk of bias according to the risk for each important outcome within included studies, including adequacy of generation of the allocation sequence, allocation concealment, blinding, whether there were incomplete outcome data and selected reporting the results. Studies which met all criteria were categorized to low risk of bias, studies which meet none of the criteria were categorized to high risk of bias, and those were categorized to unclear risk of bias if insufficient information acquired to make the judgment.
Data analysis
Data were extracted and calculated for frequency using Microsoft Excel 2007 (American: The Microsoft Corporation, 2007). Binary outcomes were summarized using risk ratio (RR) with 95% confidence intervals (CI) for relative effect and risk difference (RD) with 95% CI for absolute effect. The continuous outcomes were summarized using mean difference (MD) with 95% CI. Revman 5.3 (Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2016) was used for data analyses. Meta-analysis was used if the studies had similar clinical characteristics (such as study design, participants, interventions, control, and outcome measures) and acceptable statistical heterogeneity. Random-effect model was used for meta-analysis. Statistical heterogeneity was detected by I 2 test, an I 2 > 50% indicates the possibility of statistical heterogeneity among the studies. If I 2 was larger than 75%, which means there was obviously statistical heterogeneity among studies, only results from each single study were present respectively rather than pooling analysis. Funnel plot analysis was planned to be generated to detect publication bias.

Trial sequential analysis (TSA)
TSA can be performed if there are more than 5 included studies in the meta-analysis. We applied TSA version (Copenhagen: The Copenhagen Trial Unit, Center for Clinical Intervention Research, 2016) to calculate the required sample size in a meta-analysis and to detect the robustness of the result. We used the diversity-adjusted required information size estimated from a control event proportion of the included studies and a priori intervention effect of 5%, and the diversity which was estimated in the included studies.

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