Difficulty swallowing

Dysphagia is difficulty swallowing, and after a stroke it raises the risk of death, according to the 2026 Cochrane review of swallowing therapy by Wilkinson, Bath and colleagues. The acupuncture trials in the largest review limited to acupuncture were all run in China and added acupuncture to swallowing training, comparing it with the training alone, so the people in them knew whether they were being needled. The Cochrane review rates the evidence that acupuncture reduces dysphagia, against usual care, at moderate certainty; one multicentre trial with a sham arm, published in 2026, reports a benefit at two weeks. Reviews of dysphagia in Parkinson’s disease and after radiotherapy for nasopharyngeal cancer exist, but rest on smaller and less blinded trials.

The Cochrane reviews

The first Cochrane review of acupuncture for dysphagia, by Yue Xie and colleagues for the Cochrane Stroke Group in 2008, looked for trials against placebo, sham or no acupuncture within 30 days of a stroke. It found one trial of 66 people: 12 of 34 given acupuncture and 7 of 32 controls returned to normal feeding (relative risk 1.61, 95% CI 0.73 to 3.58), not a statistically significant difference, and the authors concluded there was not enough evidence for any conclusion. The Cochrane Library still lists the 2008 version as current, not withdrawn and never updated.

The 2026 review, searched to July 2025, updates a review first published in 1999 and covers every swallowing therapy given within six months of a stroke, each compared with usual care. Acupuncture was its largest group: 53 trials with 5,138 people, pooled as one intervention although the methods varied. Against usual care, it reported that acupuncture:

• may reduce swallowing impairment, though the effect is uncertain (standardised mean difference −1.20; 37 trials, 3,335 people; very low certainty), with heterogeneity, the disagreement between trials beyond chance, at I² 93% and visible publication bias;
• probably reduces the number of people still dysphagic at the end of the trial, from 73 in 100 to 52 in 100 (odds ratio 0.40; 36 trials, 3,647 people; moderate certainty);
• probably reduces the penetration-aspiration score, which rates on videofluoroscopy or endoscopy how far food or liquid enters the airway (mean difference −0.90 on a 1 to 8 scale; 8 trials, 496 people; moderate certainty);
• may reduce chest infection or pneumonia, from 20 in 100 to 10 in 100 (odds ratio 0.47; 4 trials, 426 people; low certainty).

No acupuncture trial reported death, dependency or length of hospital stay. Keeping only the trials at low risk of bias left 5 trials of 432 people, and in them acupuncture still reduced dysphagia at the end of the trial (odds ratio 0.58), which the authors rated at high certainty. They also noted that “usual care” in some trials itself included routine acupuncture, which blurs the comparison. Stroke recovery places these results beside the Cochrane reviews of acupuncture for the rest of stroke care.

Later reviews

None of the reviews below is a Cochrane review, and none reports a separate comparison with sham acupuncture. In the two that describe their trials in full, Zhong 2021 and Yue 2026, every trial added acupuncture to rehabilitation or usual treatment and compared it with the same treatment alone.

The 2021 review by Lida Zhong and colleagues found that the points most often used across its trials were GB20 (Fengchi), XH12 (Jinjin), XH13 (Yuye), CV23 (Lianquan) and TB17 (Yifeng), chosen mainly by symptoms and traditional pattern diagnosis. Xu and colleagues, who appraised the meta-analyses, concluded that the overall quality of evidence remains low.

Trials with a sham arm

• Acute ischaemic stroke, 2026. The largest sham-controlled trial, by Liu, Fan and colleagues at the First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, ran at 23 hospitals in China from 2020 to 2023. It randomised 300 people with dysphagia after an acute ischaemic stroke, scoring 2 to 4 on the Functional Oral Intake Scale, to 10 sessions of real or sham acupuncture over 14 days. At day 14, 78.0% with real acupuncture and 57.0% with sham reached level 6 or above on the same scale, which grades what a person can eat by mouth (relative risk 1.37, 95% CI 1.16 to 1.61). Treatment-related adverse events, all mild, numbered 4 and 3. The abstract does not describe the sham or report the secondary outcomes or any follow-up after day 14.
• Neurogenic dysphagia, 2012. A trial by Chan and colleagues randomised 39 people already receiving routine swallowing management to 20 sessions of real or sham acupuncture over about six weeks, with 48 non-randomised patients from other wards as a routine care group. On the Royal Brisbane Hospital Outcome Measure for Swallowing, both needled groups improved more than routine care; food and fluid consistencies improved more with real acupuncture than in either control group. The authors called the sample insufficient.

The 2021 European guideline below analysed 27 acupuncture trials separately and reported that removal of a feeding tube was more likely with acupuncture than with sham treatment (risk ratio 1.79, 95% CI 1.27 to 2.53), while the incidence of pneumonia showed no effect (risk ratio 0.40, 95% CI 0.08 to 1.98). Sham acupuncture explains what different shams can and cannot rule out.

Other causes

Parkinson’s disease. A 2023 meta-analysis by Jing Wu and colleagues at Chengdu University of Traditional Chinese Medicine, searched to October 2022, found 10 trials with 724 people. Eight added acupuncture to conventional management and compared it with the management alone, one compared it with sham acupuncture and one with neuromuscular electrical stimulation. Acupuncture plus control treatment scored better on videofluoroscopy (mean difference 1.48) and the Standardized Swallowing Assessment, and three trials reported fewer lung infections (risk ratio 0.29). Only the sham-controlled trial blinded its patients, and the authors judged most trials at high or unclear risk of bias. Parkinson's disease covers the trials of other symptoms.

After radiotherapy for head and neck cancer. A 2026 meta-analysis by Zhanying Lin and colleagues in Tianjin, searched to March 2026, found 12 trials with 863 people with dysphagia after radiotherapy or chemoradiotherapy for nasopharyngeal carcinoma, all run in China, each adding acupuncture to background treatment and comparing it with the background treatment alone. Acupuncture groups scored better on the water swallow test (mean difference −0.78), videofluoroscopy and the Standardized Swallowing Assessment; safety reporting was too sparse for conclusions. The one sham-controlled trial in this group, a 2016 pilot by Lu and colleagues, randomised 42 people to 12 sessions of real or sham acupuncture during and after chemoradiation. Swallowing-related quality of life on the MD Anderson Dysphagia Inventory improved in both groups by 12 months, and the intention-to-treat analysis found no difference between them; the trial was designed to test feasibility, not efficacy. Dry mouth after radiotherapy covers a related effect of the same treatment.

What guidelines say

• The European Stroke Organisation and European Society for Swallowing Disorders guideline on post-stroke dysphagia, by Dziewas and colleagues, published in September 2021, suggests that acupuncture may be used to rehabilitate swallowing function (moderate quality of evidence, weak recommendation), and judged the scientific quality of most studies low. AcuiQ found no update to it in Europe PMC by October 2026.
• The 2026 American Heart Association/American Stroke Association guideline for the early management of acute ischaemic stroke, by Prabhakaran and colleagues, published in January 2026, replaces the 2018 guideline and its 2019 update. Its dysphagia section recommends screening and pharyngeal electrical stimulation and does not mention acupuncture.
• The 2020 Hong Kong Chinese medicine guideline for stroke, by Zhong and colleagues, states that there is evidence for acupuncture in dysphagia but that higher-level studies are still needed (grade B, level of evidence IIa).
• A 2025 review of stroke guidelines by Zhu and colleagues appraised 19 stroke rehabilitation guidelines: most mention acupuncture for dysphagia after stroke, and all that do recommend it weakly. Three of them suggest four weeks of needling at GV26 (Renzhong), GB20, XH12, XH13 and CV23 added to swallowing training. The reviewers attribute the weak grading to short follow-up, small samples and missing cost data.

Clinical guidelines sets out other bodies’ positions on acupuncture.

What the reviews could not settle

Whether real acupuncture differs from sham rests mainly on one trial, of 300 people, whose abstract reports an outcome at 14 days only; the pooled comparisons in every review are against rehabilitation or usual care, where the people treated knew they were being needled. The Cochrane estimates come from trials whose methods, points and outcome scales vary, with heterogeneity above 90% for swallowing impairment and visible publication bias, and the 2025 overview rated most of the meta-analyses that pooled them of critically low quality. No review reports whether a benefit lasts beyond the end of treatment, or any effect on death, dependency or time in hospital. Outside stroke, the evidence in Parkinson’s disease and after radiotherapy comes from small, unblinded trials in China, and the one sham-controlled pilot after chemoradiation found no difference.

AcuiQ’s dysphagia, post-stroke dysphagia, difficulty swallowing and swallowing difficulty pages list the protocols individual studies prescribed, each with its citation.