Common cold

The common cold is an infection of the nose and throat that clears on its own, with a runny or blocked nose, sneezing, headache, cough and sometimes a fever, usually below 37.8°C, as a 2018 review protocol describes it. NICE’s guideline on acute sore throat records that a sore throat, including pharyngitis and tonsillitis, is often set off by a viral infection of the same airways, and that most people recover within about a week without antibiotics. The trials of acupuncture and related methods ask two questions: whether a course given over several weeks makes a cold less likely or milder, and whether a single session eases the pain of a sore throat. Moxibustion, which several of them test, is heat from burning moxa held over or set on a point (Moxibustion describes the forms).

Is there a Cochrane review of acupuncture for colds?

No. Cochrane has published no review or protocol on acupuncture, acupressure or moxibustion for the common cold. Its nearest, a 2007 review of Chinese medicinal herbs for colds by Wu and colleagues, included 14 trials with 2,440 patients, rated the methods of every one poor, and found that the lack of high-quality trials left it unable to recommend any herbal preparation.

For acupuncture itself, Cheng and colleagues at Yunnan University of Traditional Chinese Medicine published a protocol in March 2018 for a review of randomised trials, planning to search databases to 1 January 2019 and to measure how far symptoms fell after the first treatment, how many colds resolved and how long they lasted. No completed review from that protocol is indexed in PubMed or Europe PMC.

Other reviews

A 2009 review by Suzuki and colleagues searched two Japanese databases for papers published in Japanese between 1979 and 2006, most of which Medline does not index. It found 34 papers on acupuncture and moxibustion for respiratory disease, among them two trials of treating the common cold and eight of preventing it, and asked for more rigorous randomised trials.

For children who catch one respiratory infection after another, Lee, Kwon and Chang at the Korea Institute of Oriental Medicine reviewed acupoint herbal patching, a herbal preparation stuck on points with tape (Point application covers the method), in 2020. They found 22 randomised trials with 3,579 children. Compared with placebo, the review reported fewer infections and shorter illness per year at follow-ups of one, two and three years, and no serious adverse events. The infections counted were respiratory infections of any kind, not colds alone.

The Japanese prevention trials

The research department of the Japan Society of Acupuncture and Moxibustion ran a series of randomised trials from 1999 to 2003 among students and staff of acupuncture schools, excluding anyone with influenza. Kawakita and colleagues reported the five-school needling trial in 2004 and summarised the whole series in 2008. Every trial compared treatment with no treatment; none used a sham. The needling trials used the Y point, a point on the neck about 1.5 cm either side of the midline that the Japanese acupuncturist Yoneyama used for throat pain, with fine needles manipulated for 15 seconds on each side (Japanese acupuncture describes the style).

The 2004 paper concluded that needling on the neck was effective and safe and that placebo-controlled trials were needed. The 2008 summary, written after the later trials, found the treatments safe but concluded that the series could not offer convincing evidence to recommend them for preventing the common cold. A final stage, two n-of-1 trials of indirect moxibustion in elderly women at a nursing centre, detected no clear effect.

In Guangzhou, Liu and colleagues at the Second Affiliated Hospital of Guangzhou University of Chinese Medicine randomised 114 people with chronic kidney disease who had had more than two respiratory infections in the previous year. Half had usual care; half had usual care and pressed six points themselves every day for two years: LI20 (Yingxiang), XH05 (Taiyang, which the trial writes EX-HN5), GB20 (Fengchi), GV16 (Fengfu), GV14 and ST36. Over a median of 24.4 months the time to a first infection did not differ on the trial’s main analysis. The acupressure group had 1.65 infections per person per year against 2.19 (rate ratio 0.75, 95% CI 0.62 to 0.92), and adverse events were similar in both groups. The infections counted included bronchitis and pneumonia as well as upper airway infections, and there was no sham pressure.

Sore throat

At the University of Munich, Fleckenstein and colleagues gave 60 people with acute tonsillitis or pharyngitis one acupuncture treatment along the large intestine meridian between LI08 (Xialian) and LI10 (Shousanli), or sham laser acupuncture aimed at the same stretch. Fifteen minutes later, pain on swallowing a sip of water had fallen from 5.6 to 3.0 on a visual analogue scale with acupuncture and from 5.6 to 3.8 with sham, a difference the trial could not separate from chance (P = 0.12). Patients were satisfied in both groups, and the trial stopped early for lack of suitable patients.

At a US Air Force family medicine clinic, Moss and Crawford randomised 54 adults with acute sore throat and pain of at least 5 out of 10 to standard treatment, ibuprofen with an antibiotic when a rapid strep test was positive, or the same with battlefield acupuncture: up to 10 small gold-plated needles at five points on the ears, left in to fall out by themselves (Ear acupuncture covers the technique). The trial reported pain 15 minutes later averaging 2.6 out of 10 with the ear needles and 6.0 without, and stayed lower at 6 and 24 hours; the acupuncture group took fewer doses of pain medication up to 48 hours. Time missed from work did not differ. Neither patients nor the staff who recorded pain were blinded.

A sore throat after a breathing tube during general anaesthesia is a separate condition from a cold. Jau and Chang’s 2022 meta-analysis pooled four randomised trials and one comparative study with 1,478 adults that compared stimulation at points, by needles, electrical pads or capsicum plasters, with no stimulation or sham. It reported a lower incidence of sore throat at 24 hours (risk ratio 0.32, 95% CI 0.18 to 0.55) and no significant adverse events.

What guidelines say

NICE’s NG84, published on 26 January 2018, covers antibiotics and self-care for acute sore throat in England. For self-care it recommends considering paracetamol or ibuprofen, advises adequate fluids, and says medicated lozenges may reduce pain by a small amount; it does not mention acupuncture. NICE’s NG120 on acute cough, published on 7 February 2019, says such a cough is most often caused by a viral infection such as a cold or flu and lists honey, pelargonium and over-the-counter cough medicines as self-care with limited evidence; it does not mention acupuncture either.

What the reviews could not settle

No review has pooled trials of acupuncture or moxibustion for the common cold, so there is no pooled estimate and no GRADE rating of certainty. The Japanese trials compared treatment with no treatment and relied on symptom diaries and questionnaires that participants knew were being kept, so they cannot separate the needling from the attention that came with it, and the 2008 summary records results that differed from one school to the next. The one sham-controlled trial in sore throat had 60 people and stopped early, and the ear acupuncture trial was unblinded. Lee’s review and Liu’s trial counted respiratory infections of every kind rather than colds, in children with repeated infections and adults with kidney disease. The Chronic cough and Allergic rhinitis pages report the trials in a cough that persists and in a runny nose caused by allergy.

AcuiQ’s common cold and sore throat pages list the protocols individual studies prescribed, each with its citation.