Aphasia is an acquired impairment of language after brain damage, affecting some or all of speaking, understanding speech, reading and writing; about one in three people who have a stroke experience it, according to the 2016 Cochrane review of speech and language therapy by Brady and colleagues. Acupuncture for aphasia is studied almost entirely as an addition to that therapy: needles in the scalp, the tongue or the body, sometimes with electrical stimulation, given alongside language training and compared with the training alone. The meta-analyses below pool trials run in China, most without a sham arm. One multicentre sham-controlled trial of 252 people, published in 2024, reported higher aphasia scores with real acupuncture at 6 weeks and 6 months after stroke onset.
Is there a Cochrane review?
No. A search of PubMed and Europe PMC in November 2026 found no Cochrane review of acupuncture for aphasia. The nearest is the Cochrane review of speech and language therapy itself, updated in 2016 and searched to September 2015, which covers the therapy every acupuncture trial below adds to. It included 57 trials with 3,002 people. Against no speech and language therapy (27 comparisons, 1,620 people), therapy improved functional communication (standardised mean difference 0.28, 95% CI 0.06 to 0.49), reading, writing and expressive language, though on smaller numbers the benefit was not evident at follow-up. Therapy given at higher intensity, at a higher dose or over a longer period did better than less, at the cost of more people dropping out.
Systematic reviews and meta-analyses
None of these reviews is a Cochrane review. In the three that describe their trials in full, Sang, Liang and Feng, acupuncture was added to speech and language training and compared with the training alone or with another form of acupuncture; none of their trials had a sham arm, so the people treated knew whether they were being needled.
| Review | Trials and people | Comparison | Finding | Quality of trials |
|---|---|---|---|---|
| Zhang L 2025, network meta-analysis searched to December 2024 | 66 trials; participants not given in the abstract | Speech and language therapy plus electroacupuncture, acupuncture or non-invasive brain stimulation, against therapy alone and each other | Every combination did better than therapy alone; electroacupuncture plus therapy ranked first for speaking and repetition, transcranial direct current stimulation plus therapy for listening comprehension | Not stated in the abstract |
| Li J 2024, searched to December 2023 | 10 trials, 848 people | Acupuncture with or without language rehabilitation, against rehabilitation | Higher response rate and better comprehension, repetition, reading and spontaneous speech | Overall quality low |
| Liang 2022, network meta-analysis searched to April 2022 | 69 trials, 5,097 people, all in China | Body, scalp and tongue acupuncture, alone or combined, and speech and language training | Tongue acupuncture ranked first for overall response and spoken expression; body plus scalp acupuncture for repetition and naming | Almost all trials at high or unclear risk of bias for blinding of participants and assessors; no trial reported adverse effects |
| Feng 2022, network meta-analysis of motor aphasia, searched to March 2022 | 29 trials, 2,082 people | Five forms of acupuncture, each added to speech training, against speech training | All five better on response rate; scalp plus tongue acupuncture had the largest odds ratio (8.30) | Overall quality and number of studies limited, in the authors’ words |
| Yang 2022, tongue acupuncture, searched to June 2022 | 20 trials, 1,355 people | Tongue acupuncture, alone or added to conventional treatment, against conventional treatment | Better scores on the Chinese Functional Communication Profile; on the Aphasia Battery of Chinese only when added to conventional treatment | Not graded in the abstract |
| Fu 2022, scalp acupuncture, searched to November 2021 | 32 trials, 1,968 people | Scalp acupuncture plus Schuell’s language rehabilitation; trials against sham or no acupuncture, acupuncture alone or other therapy were eligible | Higher recovery and response rates across stroke and aphasia types (for example recovery, risk ratio 2.08, against rehabilitation alone) | Publication bias in some comparisons |
| Sang 2022, ischaemic stroke, searched to April 2021 | 13 trials, 848 people | Acupuncture plus speech and language therapy against therapy alone, in all 13 | Better Western Aphasia Battery scores for comprehension, spontaneous speech, repetition and naming (3 trials), in the subacute phase but not the acute | Assessors blinded in 1 trial; no trial reported adverse reactions |
| Zhang Y 2021, searched to July 2019 | 14 trials, 936 people | Acupuncture, alone or added to therapy, against therapy | Better scores on the Boston Diagnostic Aphasia Examination and the Aphasia Battery of Chinese | All trials at high risk of bias in assessment; poor reporting |
| Zhang B 2019 | 28 trials, 1,747 people | Trials of acupuncture against no treatment or placebo acupuncture were eligible | Better functional communication (standardised mean difference 1.01) and severity, speech, comprehension, repetition, naming, reading and writing | Not graded in the abstract |
The 2022 review by Sang and colleagues, at the First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, set out to compare acupuncture with sham acupuncture as well as with therapy alone, and found no sham-controlled trial to include; the course of acupuncture in its trials ran from 20 days to 16 weeks, three to seven times a week. Liang and colleagues wrote that their results are limited to the Chinese population, since every eligible study came from China. The rankings in the three network meta-analyses come from indirect comparisons across trials that differ in points, schedules and outcome scales, and they do not agree on a single method. Scalp acupuncture describes the scalp lines and the schools that use them.
The sham-controlled trial
The trial by Li and colleagues from the same Tianjin hospital, published in JAMA Network Open on 2 January 2024, ran in 3 hospitals in China from 2019 to 2021. It randomised 252 adults with motor aphasia, difficulty producing speech, after a stroke to manual or sham acupuncture, 30 sessions over 6 weeks; both groups also had 60-minute language training sessions on the same schedule, and conventional treatment. Real acupuncture used 8 fixed points, among them PC06 (Neiguan), GV26 (Shuigou), SP06 (Sanyinjiao) and CV23 (Lianquan). The sham placed needles shallowly at 8 non-acupoints about 25 mm to the side, without the needling sensation called de qi.
Of the 231 people analysed, the acupuncture group scored higher on the aphasia quotient of the Western Aphasia Battery, which Sang and colleagues describe as a measure of how severe the spoken-language deficit is, by 7.99 points at 6 weeks (95% CI 3.42 to 12.55) and by 10.34 points at 6 months after stroke onset; it also scored higher on the Chinese Functional Communication Profile at both times. Each group had 3 transient adverse reactions and no serious adverse event. The authors list two limits: they did not test whether participants could tell which needling they had, and some Western Aphasia Battery items were designed in English for a trial whose patients all spoke Chinese.
A 2025 meta-analysis by Wang and colleagues gathered 24 sham-controlled acupuncture trials across every complication of stroke, run in China and Korea; 2 of them studied aphasia, and its pooled outcomes did not include a language score. Sham acupuncture explains what a shallow-needling sham can and cannot rule out.
What guidelines say
- The Chinese Stroke Association’s 2019 update on stroke rehabilitation, by Zhang and colleagues, published in English in June 2020, recommends aphasia rehabilitation (Class I, Level A) and states that acupuncture is reasonable for aphasia treatment (Class IIa recommendation, Level B evidence). Its section on dysarthria, speech made unclear by weakness of the muscles that form it, does not mention acupuncture.
- A 2026 review of 12 stroke rehabilitation guidelines by Liu and colleagues lists the Chinese Stroke Association’s 2023 guideline and the 2022 Canadian Stroke Best Practice Recommendations as stating that acupuncture may be beneficial as an adjunct for spasticity, dysphagia, aphasia and cognitive impairment, and names acupuncture among the topics on which guidelines disagree.
- The 2023 NICE guideline on stroke rehabilitation in adults (NG236, published 18 October 2023 and current) asks speech and language therapists to give individualised therapy for aphasia and dysarthria and makes no recommendation on acupuncture. Its research recommendations ask for trials of acupuncture for swallowing and for spasticity, not for aphasia.
Stroke recovery sets these results beside the Cochrane reviews of acupuncture for the rest of stroke care, and Difficulty swallowing covers the trials of swallowing after stroke.
What the reviews could not settle
Whether real acupuncture differs from sham for aphasia rests on one trial of 252 people, which did not check whether its blinding held. The reviews that describe their trials compare acupuncture plus therapy with therapy alone, in people who knew they were being needled, and assessors were blinded in 1 of Sang’s 13 trials and judged at low risk on that item in 1 of Liang’s 69. The trials come almost entirely from China and score language with Chinese scales or response rates, and the reviews disagree on which form of acupuncture does best. No trial in the Sang or Liang reviews reported adverse events, so the safety record rests mainly on the one sham trial. No review reports an effect on long-term communication or daily life beyond the 6-month follow-up of the sham trial, and no Cochrane group has reviewed the question.
AcuiQ’s post-stroke aphasia, aphasia and dysarthria pages list the protocols individual studies prescribed, each with its citation.