---
title: "Thread embedding"
url: "https://acuiq.com/wiki/techniques/thread-embedding"
updated: 2026-10-09
last_verified: 2026-10-09
license: CC-BY-4.0
license_url: "https://creativecommons.org/licenses/by/4.0/"
section: "techniques"
basis: "Modern research"
audience: "Anyone"
published: "2026-10-09"
reading_minutes: 9
sources: 20
---

# Thread embedding

_Catgut and absorbable sutures implanted at acupuncture points: how it is done and repeated, the threads used, what reviews of the obesity trials found against sham, and the nodules, granulomas and infections reported._

Thread embedding (穴位埋线, _xuewei maixian_) pushes a short length of absorbable suture under the skin at an acupuncture point through a hollow needle, withdraws the needle and leaves the thread to dissolve. The thread stays in the tissue for days to weeks, so one session stands in for several needling sessions, and courses repeat it every one to four weeks. A [2026 review](https://doi.org/10.1111/jocd.70718) by Xu and colleagues dates the method to Chinese acupuncturists in the 1960s, who used it to extend stimulation and shorten courses. A [2012 bibliometric survey](https://pubmed.ncbi.nlm.nih.gov/23259283/) by Zhang and colleagues counted 1,075 Chinese papers over 40 years; the conditions treated most often were stomach pain (102 papers), low back and leg pain (79) and obesity (74). This page reports how the thread is placed, what it is made of, what reviews of the trials found, and the complications reported.

## How it is done

The tool is a hollow needle with a stylet, a wire that fits inside it. Zhang’s survey found that the main tool was an adapted lumbar puncture needle. The method is described in detail in a [2022 multicentre trial](https://doi.org/10.1155/2022/4780019) by Chen and colleagues: 2 cm of chromic catgut was loaded into the tip of a 0.8 mm needle, the needle was inserted at the point, and the stylet pushed the thread into the tissue as the needle came out. The catgut and the firm lump around it took about two weeks to be absorbed, and the trial repeated the procedure every two weeks for 8 sessions.

Intervals vary. A [2026 safety review](https://doi.org/10.3390/biomedicines14091901) of 90 randomised trials by Hong and colleagues found an average of 11.7 days between sessions, most often 14 to 15 days and next most often weekly. A [2024 practical review](https://doi.org/10.1097/MD.0000000000038314) by Kazemi and colleagues describes a schedule of about twenty threads of 1 to 2 cm, repeated every 3 to 4 weeks, and states that the method is not used in pregnant women or children. China’s national standard for the procedure is [GB/T 21709.10-2008](https://www.chinesestandard.net/Related.aspx/GBT21709.10-2008), part 10 of the standardised manipulations of acupuncture and moxibustion, in force since July 2008.

## Catgut and synthetic threads

Catgut, the original material, is collagen from the small intestine of sheep. Kazemi’s review groups the threads into natural (catgut, chitosan), synthetic and bioactive kinds. The synthetic sutures are polyglycolic acid (PGA), polyglactin (PGLA) and polydioxanone (PDO). A [2025 review](https://doi.org/10.2147/DMSO.S525783) by Wang and colleagues gives PGA as losing half its strength within two weeks and being fully absorbed in four to six months.

The trials still mostly use catgut. Of the 75 trials in Hong’s review that named the thread, 62.7% used catgut, 17.3% PDO, 14.7% PGLA and 4% PGA. Catgut, PGLA and PGA appeared only in the Chinese trials; the Korean trials used PDO alone. Surgery in Europe had largely moved away from catgut by 2001, when the European Commission’s [Scientific Steering Committee](https://ec.europa.eu/food/fs/sc/ssc/out239_en.pdf), reviewing animal-derived materials in medical devices during the BSE crisis, judged catgut from low-risk countries safe and noted that surgeons in Europe no longer widely used it because synthetic sutures were available.

## What the reviews report

Obesity is the condition most studied; [Obesity and overweight](/wiki/evidence/obesity) sets these reviews beside those of body and ear acupuncture. The reviews pool trials that compare embedding with sham embedding, with ordinary needling, with drugs or with nothing, and the size of the result depends on the comparison. Only a sham procedure separates the thread from everything else that comes with treatment; [Sham acupuncture](/wiki/research/sham-acupuncture) explains why no sham is inert.

| Review | Condition | Trials (participants) | What it found |
| --- | --- | --- | --- |
| [Yue and colleagues, 2024](https://doi.org/10.1097/MD.0000000000036653) | Obesity, sham-controlled trials only | 6 (679), all in China | 1.68 kg more weight lost than with sham, and 2.42 cm more off the waist; adverse events no more frequent than with sham. |
| [Guo and colleagues, 2015](https://doi.org/10.1155/2015/401914) | Obesity | 43 (3,520), all in China | 3.01 kg more weight lost than with sham (2 trials); against ordinary needling (30 trials), a better “improvement rate” but no significant difference in weight. The authors rated the trials’ methods poor. |
| [Sheng and colleagues, 2019](https://doi.org/10.1155/2019/9714313) | Abdominal obesity | 15 (1,584) | Embedding alone had effects similar to other kinds of acupuncture; added to electroacupuncture, 5.2 kg more weight lost than electroacupuncture alone. All trials were judged at high risk of bias. |
| [Tang and colleagues, 2024](https://doi.org/10.1016/j.amjoto.2023.104135) | Allergic rhinitis | 17 (1,231) | A higher “total effective rate”, a composite outcome common in Chinese trials, than controls including Western medicine; the authors ask for higher-quality trials. |
| [Zhang and colleagues, 2020](https://doi.org/10.1155/2020/3872919) | Functional dyspepsia (network meta-analysis) | 35 (3,301) | Embedding was one of five methods ahead of prokinetic drugs and sham acupuncture on symptoms; manual acupuncture ranked first overall. |

## The sham-controlled obesity trials

Three trials give a sense of the size of the effect against sham. Chen’s 2022 trial in China randomised 216 middle-aged adults to 8 sessions of catgut embedding or sham over 16 weeks. Waist circumference fell by 8.80% against 4.09% with sham, and body weight by 4.17 kg against 1.85 kg; the difference in waist was still 4.94% after 24 weeks of follow-up. Women benefited significantly and men did not. In a [2018 double-blind trial in Taiwan](https://doi.org/10.1089/jwh.2017.6542), Chen and colleagues treated 90 women with abdominal obesity once a week for 6 weeks; they lost 1.65 kg against 0.38 kg with sham. In a [2014 trial in Mexico](https://pubmed.ncbi.nlm.nih.gov/25364359/), Garcia-Vivas and colleagues divided 99 obese women among six groups, about 16 in each; catgut embedding combined with moxibustion was the only treatment that reduced body weight significantly against sham, by 3.1 kg. AcuiQ’s [obesity](/symptoms/obesity) and [overweight](/symptoms/overweight) pages list the protocols individual studies prescribed, each with its citation.

## Adverse events

A [2021 systematic review](https://doi.org/10.1007/s11655-021-3443-1) by Huang and colleagues of 61 studies from China and South Korea found an adverse event rate of 11.1%: local reactions in 9.8% (480 of 4,882) and systemic reactions in 1.3%. The most common were induration, a firm lump around the thread, bleeding and bruising, redness and swelling, fever and pain. Five severe events were reported between 2013 and 2017, all with catgut. Hong’s 2026 review of 90 trials put the rate with embedding alone at 3%, with one serious event among 1,697 participants. Adverse events occurred in 7% of patients given catgut and 2% of those given synthetic thread, nodules or induration in 3.6% and 0.5%, and allergic reactions and infections only with catgut.

Case reports describe three kinds of complication:

- Nodules: [Chuang and colleagues](https://doi.org/10.1136/acupmed.2011.010084) in Taiwan reported multiple tender lumps under the skin where catgut had been embedded for obesity, appearing a month after treatment.
- Foreign body granuloma, a chronic inflammatory reaction around material the body cannot clear: Xu’s 2026 review collected 11 published complications, 10 of them granulomas, 6 after catgut.
- Infection by mycobacteria other than those that cause tuberculosis: [Zhang and colleagues](https://doi.org/10.1097/GOX.0000000000001471) reported a _Mycobacterium avium_ infection after embedding, treated without recurrence over 22 months; [Jiang and colleagues](https://doi.org/10.1001/jamadermatol.2022.6385) described an outbreak of _Mycobacterium abscessus_ skin infection with draining nodules on the abdomen after catgut implants at a cosmetic clinic; and [Xing and colleagues](https://pubmed.ncbi.nlm.nih.gov/38868873/) reported three cases after embedding for weight loss at one informal beauty institution.

[Infection and clean needles](/wiki/safety/infection-and-clean-needles) covers sterile technique and the infections reported after acupuncture, and [After a treatment](/wiki/safety/after-a-treatment) lists the signs of a skin infection that call for a doctor.

## How AcuiQ records it

Each protocol on AcuiQ records how the points were treated, from a fixed list of modalities, and an embedding study is recorded as “Thread embedding”. Its sessions and course length are recorded in the same entry, so a course of 8 embeddings over 16 weeks reads differently from 8 needling sessions over 2 weeks. [Reading a protocol](/wiki/method/reading-a-protocol) explains each field. The entry lists the points; the thread material and length are in the cited paper.

## What the sources cannot settle

Wang’s 2025 review states that there are no standard rules for which points to use, how deep to embed or how often to repeat. The trials are almost all from China, most use catgut, and the reviews rate their methods poor, so the pooled weight differences against sham, between 1.7 and 3 kg, rest on a small number of trials. The reviews report results at the end of treatment or soon after; Chen’s trial, with 24 weeks of follow-up, is the longest above. Hong’s review compared catgut and synthetic thread for adverse events, not for effect. [Where the trials come from](/wiki/research/where-the-trials-come-from) discusses the share of positive results in trials by country.

### Sources

1. Xu X, Song K, Shen Y, Jang C, Hong S, Foreign body granuloma and infection-related complications arising from acupoint embedding: a case study and literature review, Journal of Cosmetic Dermatology 2026 — https://doi.org/10.1111/jocd.70718
2. Zhang XP, Jia CS, Wang JL, et al., Acupoint catgut-embedding therapy: superiorities and principles of application, Zhongguo Zhen Jiu 2012 (in Chinese) — https://pubmed.ncbi.nlm.nih.gov/23259283/
3. Chen X, Huang W, Wei D, et al., Effect of acupoint catgut embedding for middle-aged obesity: a multicentre, randomised, sham-controlled trial, Evidence-Based Complementary and Alternative Medicine 2022 — https://doi.org/10.1155/2022/4780019
4. Hong J, Noh WH, Suh JW, Woo Y, Fregni F, Kim JH, Safety profile of thread-embedding acupuncture: a systematic review and meta-analysis of randomized controlled trials, Biomedicines 2026 — https://doi.org/10.3390/biomedicines14091901
5. Kazemi AH, Adel-Mehraban MS, Jamali Dastjerdi M, Alipour R, A comprehensive practical review of acupoint embedding as a semi-permanent acupuncture: a mini review, Medicine 2024 — https://doi.org/10.1097/MD.0000000000038314
6. GB/T 21709.10-2008, Standardized manipulations of acupuncture and moxibustion, Part 10: thread-embedding therapy, Standardization Administration of China 2008 — https://www.chinesestandard.net/Related.aspx/GBT21709.10-2008
7. Wang J, Cao K, Chen Z, et al., Application of PGA/PLGA in thread embedding acupuncture for obesity: new strategies and challenges, Diabetes, Metabolic Syndrome and Obesity 2025 — https://doi.org/10.2147/DMSO.S525783
8. European Commission Scientific Steering Committee, Updated opinion on the sourcing of ruminant materials from GBR I countries for medical devices, November 2001 — https://ec.europa.eu/food/fs/sc/ssc/out239_en.pdf
9. Yue JH, Li XL, Zhang YY, Yang GH, Mah JZ, Li A, Zhao WW, Wang YL, Zhang QH, Huang JQ, Comparing verum and sham acupoint catgut embedding for adults with obesity: a systematic review and meta-analysis of randomized clinical trials, Medicine 2024 — https://doi.org/10.1097/MD.0000000000036653
10. Guo T, Ren Y, Kou J, Shi J, Sun T, Liang F, Acupoint catgut embedding for obesity: systematic review and meta-analysis, Evidence-Based Complementary and Alternative Medicine 2015 — https://doi.org/10.1155/2015/401914
11. Sheng J, Jin X, Zhu J, Chen Y, Liu X, The effectiveness of acupoint catgut embedding therapy for abdominal obesity: a systematic review and meta-analysis, Evidence-Based Complementary and Alternative Medicine 2019 — https://doi.org/10.1155/2019/9714313
12. Tang M, Wang J, Zhang Q, Clinical efficacy of acupoint catgut embedding in the treatment of allergic rhinitis: a systematic review and meta-analysis, American Journal of Otolaryngology 2024 — https://doi.org/10.1016/j.amjoto.2023.104135
13. Zhang J, Liu Y, Huang X, et al., Efficacy comparison of different acupuncture treatments for functional dyspepsia: a systematic review with network meta-analysis, Evidence-Based Complementary and Alternative Medicine 2020 — https://doi.org/10.1155/2020/3872919
14. Chen IJ, Yeh YH, Hsu CH, Therapeutic effect of acupoint catgut embedding in abdominally obese women: a randomized, double-blind, placebo-controlled study, Journal of Women's Health 2018 — https://doi.org/10.1089/jwh.2017.6542
15. Garcia-Vivas JM, Galaviz-Hernandez C, Becerril-Chavez F, et al., Acupoint catgut embedding therapy with moxibustion reduces the risk of diabetes in obese women, Journal of Research in Medical Sciences 2014 — https://pubmed.ncbi.nlm.nih.gov/25364359/
16. Huang JJ, Liang JQ, Xu XK, Xu YX, Chen GZ, Safety of thread embedding acupuncture therapy: a systematic review, Chinese Journal of Integrative Medicine 2021 — https://doi.org/10.1007/s11655-021-3443-1
17. Chuang YT, Li TS, Lin TY, Hsu CJ, An unusual complication related to acupuncture point catgut embedding treatment of obesity, Acupuncture in Medicine 2011 — https://doi.org/10.1136/acupmed.2011.010084
18. Zhang J, Lai L, Liang L, Bai X, Chen M, Mycobacterium avium infection after acupoint embedding therapy, Plastic and Reconstructive Surgery Global Open 2017 — https://doi.org/10.1097/GOX.0000000000001471
19. Jiang Y, Lei X, Lu W, Outbreak of cosmetology-acquired Mycobacterium abscessus skin infection, JAMA Dermatology 2023 — https://doi.org/10.1001/jamadermatol.2022.6385
20. Xing Y, Li M, Jiang Y, Zhong Q, Three cases of non-tuberculosis mycobacterium skin infection outbreak in beauty institutions, Clinical Laboratory 2024 — https://pubmed.ncbi.nlm.nih.gov/38868873/