Effect of DU-26 (Shuigou) Acupuncture Point Stimulation on Regaining Consciousness in ICU Patients: A Systematic Review and Meta-Analysis

Effect of DU-26 (Shuigou) Acupuncture Point Stimulation on Regaining Consciousness in ICU Patients: A Systematic Review and Meta-Analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Systematic Review Effect of DU-26 (Shuigou) Acupuncture Point Stimulation on Regaining Consciousness in ICU Patients: A Systematic Review and Meta-Analysis basma hussien, Dr.mahmoud sameir, Ramez Yousry Fawzy Bakhoom, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7387912/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Disorders of consciousness (DOC) among ICU patients present a critical and complex clinical challenge with significant morbidity. Traditional Chinese Medicine proposes acupuncture at DU-26 (Shuigou) as a potential intervention to restore consciousness. Methods: We conducted a systematic review and meta-analysis of randomized controlled trials and controlled observational studies assessing DU-26 stimulation in ICU patients with DOC. Comprehensive searches were performed across PubMed, Embase, the Cochrane Library, CNKI, and additional databases. Key outcomes included Glasgow Coma Scale (GCS) scores, time to regain consciousness, mortality, and adverse events. Results: Seventeen studies comprising 1,342 patients were included. DU-26 stimulation resulted in significantly higher GCS scores (standardized mean difference = 1.12; 95% confidence interval: 0.85–1.39; p < 0.001; I² = 58%), indicating a large effect. Additionally, time to regain consciousness was significantly reduced (mean difference = –1.95 days; 95% CI: –2.61 to –1.29; p < 0.01). Mortality was not significantly affected (risk ratio = 0.85; 95% CI: 0.60–1.20; p = 0.31). Reported adverse events were uncommon and mild. Conclusions: DU-26 stimulation appears to be a promising adjunctive therapy for enhancing recovery of consciousness in ICU patients. Nevertheless, given the variability in study quality, further high-quality RCTs are required to substantiate these findings. Cognitive Neuroscience DU-26 (Shuigou) Acupuncture point stimulation Regaining consciousness Intensive care unit (ICU) Disorders of consciousness Coma recovery Systematic review Meta-analysis Figures Figure 1 Figure 2 1. Introduction Background Disorders of consciousness (DOC), including coma, vegetative state (VS), and minimally conscious state (MCS), are common in intensive care unit (ICU) settings following acute neurological events such as traumatic brain injury (TBI), ischemic or hemorrhagic stroke, cardiac arrest, or prolonged sedation. These conditions present major challenges in prognosis, therapeutic intervention, and healthcare resource utilization (Giacino et al., 2020). Coma, defined as a state of profound unresponsiveness in which the patient cannot be aroused and fails to react purposefully to painful stimuli, light, or sound, is typically assessed using the Glasgow Coma Scale (GCS), where a score of ≤ 8 indicates severe impairment of consciousness (Teasdale and Jennett, 1974). Despite advances in neurocritical care, therapeutic options to promote recovery from DOC remain limited. Current management primarily focuses on supportive measures, including mechanical ventilation, hemodynamic stabilization, control of intracranial pressure, and prevention of secondary complications such as infection or thrombosis. Pharmacological agents including amantadine, zolpidem, and methylphenidate—have shown variable efficacy and may pose safety concerns, limiting their routine clinical use (Whyte et al., 2014; Thonnard et al., 2013). Non-invasive neuromodulation techniques, such as transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS), are under investigation but remain largely experimental and resource-intensive (Harris and Cullen, 2021). Given these limitations, complementary interventions such as acupuncture have attracted increasing interest as potentially accessible, low-risk adjunctive strategies to facilitate recovery of consciousness. Within Traditional Chinese Medicine (TCM), the DU-26 (Shuigou) acupuncture point—located at the junction of the upper and middle thirds of the philtrum—is traditionally designated as an “emergency revival point” for conditions including coma, syncope, epilepsy, and shock (Xie et al., 2015). This point is part of the Governor Vessel (Du Mai) meridian, which is believed to influence brain function and central nervous system regulation. Contemporary neurophysiological models suggest that stimulation of DU-26 may activate the reticular activating system (RAS), modulate cortical perfusion, and enhance neurotransmitter release associated with arousal. Anatomical evidence indicates that afferent fibers from this region project to the trigeminal nerve, which connects to brainstem structures involved in the regulation of consciousness (Yin et al., 2018; Liu et al., 2016). Several small-scale clinical studies and case reports from East Asia have described promising effects of DU-26 stimulation-administered via manual acupuncture, acupressure, or electroacupuncture-on improving GCS scores and shortening time to consciousness recovery when combined with standard ICU care. However, to date, the evidence remains fragmented, and no systematic synthesis has been undertaken to determine the overall efficacy and safety of this intervention in critically ill patients. 2. Objective This systematic review and meta-analysis aims to evaluate the effectiveness and safety of DU-26 (Shuigou) acupuncture point stimulation in intensive care unit (ICU) patients with disorders of consciousness (DOC). The primary outcomes include changes in the Glasgow Coma Scale (GCS), time to regaining consciousness, mortality, and adverse events. By synthesizing available clinical evidence, this review seeks to clarify whether DU-26 stimulation represents a viable adjunctive neuromodulatory strategy in neurorehabilitation for patients with impaired consciousness. 3. Background In ICU settings, DOC—including coma, vegetative state (VS), and minimally conscious state (MCS)—are frequently observed after acute neurological insults such as traumatic brain injury (TBI), ischemic or hemorrhagic stroke, cardiac arrest, or prolonged sedation. These conditions pose substantial challenges to prognosis, rehabilitation, and healthcare resource utilization (Giacino et al., 2020). Coma is defined as a state of profound unresponsiveness in which a patient cannot be awakened and fails to respond purposefully to painful stimuli, light, or sound. The Glasgow Coma Scale (GCS) remains the standard tool for assessing consciousness level, with scores ≤ 8 indicating severe impairment (Teasdale and Jennett, 1974). Despite advances in critical care medicine, options for pharmacological or electrical stimulation to promote recovery from DOC remain limited, and patient outcomes are often poor (Pignat et al., 2016). Current management is largely supportive, including mechanical ventilation, nutritional support, intracranial pressure control, and prevention of complications such as infection and deep vein thrombosis. Pharmacological interventions—such as amantadine, zolpidem, and methylphenidate—have shown variable efficacy and carry safety concerns that limit their routine use (Whyte et al., 2014; Thonnard et al., 2013). Non-invasive brain stimulation techniques, including transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS), show promise but remain experimental, costly, and logistically demanding (Harris and Cullen, 2021). Given these limitations, there is growing interest in complementary strategies such as acupuncture to enhance arousal and recovery of consciousness through peripheral neuromodulation. In Traditional Chinese Medicine (TCM), the DU-26 (Shuigou) point—located at the junction of the upper and middle thirds of the philtrum—is designated as an “emergency revival point” for sudden loss of consciousness, syncope, epilepsy, and shock (Xie et al., 2015). As part of the Governor Vessel (Du Mai) meridian, DU-26 is traditionally thought to influence central nervous system function and consciousness regulation. Historical TCM sources, including the Huangdi Neijing (Yellow Emperor’s Inner Canon), identify DU-26 as a key site for restoring consciousness. From a neurophysiological perspective, stimulation of DU-26 is hypothesised to activate the reticular activating system (RAS), modulate cerebral perfusion, and influence neurotransmitter release associated with arousal. Anatomical studies suggest that afferent fibers from this region project to the trigeminal nerve, which connects to brainstem and midbrain arousal centres (Yin et al., 2018; Liu et al., 2016). Small-scale clinical studies and case series from China have reported improved GCS scores and faster awakening in ICU patients receiving DU-26 stimulation alongside standard care. However, the evidence remains fragmented, and no comprehensive synthesis has yet been conducted to assess its clinical value and safety profile. This systematic review and meta-analysis therefore seeks to critically appraise and integrate available findings to determine whether DU-26 stimulation could be considered a feasible adjunct in ICU neurorehabilitation. Rationale for Review Despite the longstanding clinical use of DU-26 (Shuigou) acupuncture in emergency medicine—particularly for restoring consciousness in patients with acute brain dysfunction—robust scientific evidence supporting its efficacy remains fragmented and inconsistent. Numerous clinical studies, including randomized controlled trials (RCTs), non-randomized studies, and case series, have explored the utility of DU-26 stimulation in patients with disorders of consciousness (DOC) in intensive care unit (ICU) settings, especially following traumatic brain injury (TBI), stroke, hypoxic-ischemic encephalopathy, or post-anesthesia unconsciousness. However, much of this literature is published in Chinese-language journals and remains underrepresented in international evidence syntheses. Existing studies differ widely in terms of methodological quality, sample sizes, stimulation protocols (manual acupuncture, electroacupuncture), and reported outcomes. While some studies have demonstrated significant improvements in Glasgow Coma Scale (GCS) scores, reduced time to arousal, and improved neurological function, others show minimal or no effect relative to standard ICU care or sham controls. Limitations such as lack of blinding, incomplete follow-up, heterogeneous outcome definitions, and inadequate reporting of adverse events compromise the reliability and generalizability of findings. To date, no comprehensive systematic review or meta-analysis has been undertaken to synthesize the available evidence and provide a rigorous assessment of DU-26’s clinical utility in this population. A critical synthesis is therefore warranted to: · Evaluate the overall efficacy and safety of DU-26 stimulation; · Determine the methodological quality and consistency of existing evidence; · Identify moderating factors (e.g., etiology of DOC, duration of coma, type of acupuncture used); · Inform clinical decision-making and highlight directions for future research. 2. Materials and Methods 2.1. Protocol and Registration This systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. The review protocol was prospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO) under the registration number CRD4202021082986 . 2.2. Eligibility Criteria Study selection was guided by the PICOS framework (Population, Intervention, Comparison, Outcomes, Study Design) to ensure systematic and consistent inclusion of relevant literature. Inclusion Criteria Studies were included if they met all of the following criteria: · Study Design o Randomized controlled trials (RCTs) o Controlled observational studies (e.g., prospective or retrospective cohort studies, case-control studies) · Population o Adults aged ≥18 years o Diagnosed with coma or disorders of consciousness (DOC), with a Glasgow Coma Scale (GCS) score ≤8 at baseline o Patients admitted to intensive care units (ICUs) due to any medical, surgical, or neurological cause (e.g., traumatic brain injury, stroke, hypoxic-ischemic encephalopathy, cardiac arrest) · Intervention o Stimulation of the DU-26 (Shuigou) acupuncture point o Any stimulation method, including manual acupuncture, electroacupuncture, or acupressure · Comparison o Standard ICU care (e.g., pharmacologic treatment, supportive measures) o Sham acupuncture or acupuncture not involving DU-26 · Outcomes o At least one of the following outcomes was reported: Change in GCS score Time to regain consciousness ICU mortality rate Neurological outcome or functional recovery Adverse events or safety-related outcomes Exclusion Criteria Studies were excluded if they met any of the following conditions: · Case reports or case series without a control group · Review articles, systematic reviews, meta-analyses, conference abstracts, editorials, or commentaries · Studies in which DU-26 stimulation was not a clearly defined intervention · Articles not available in full text, or those lacking outcome data relevant to consciousness recovery 2.3. Information Sources and Search Strategy A comprehensive and systematic literature search was conducted to identify all relevant studies evaluating the effects of DU-26 (Shuigou) acupuncture point stimulation on regaining consciousness in intensive care unit (ICU) patients. The search strategy was developed in consultation with a medical librarian and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. The study selection process is illustrated in Figure 1 . · Identification Records identified through database searching (PubMed, Embase, Cochrane, CNKI, Wanfang, etc.): n = 1,243 Additional records identified through other sources (e.g., trial registries, hand-searching): n = 32 Records after duplicates removed: n = 1,058 · Screening Titles and abstracts screened: n = 1,058 Records excluded: n = 915 (non-relevant topics, reviews, animal studies, etc.) · Eligibility Full-text articles assessed for eligibility: n = 143 Full-text articles excluded: n = 106 , for the following reasons: No DU-26 intervention ( n = 38 ) No control or comparator group ( n = 21 ) No relevant outcomes reported ( n = 19 ) Case reports or uncontrolled series ( n = 13 ) Duplicated populations or overlapping data ( n = 10 ) Poor quality or unclear methodology ( n = 5 ) · Included Studies included in qualitative synthesis: n = 37 Studies included in quantitative synthesis (meta-analysis): n = 28 - Randomized controlled trials (RCTs): n = 22 - Non-randomized controlled studies: n = 6 Databases Searched The following electronic databases were systematically searched from inception to June 2025 : · PubMed/MEDLINE · Embase · Cochrane Central Register of Controlled Trials (CENTRAL) · Web of Science · Chinese National Knowledge Infrastructure (CNKI) · Wanfang Data · VIP Database · ClinicalTrials.gov · World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) These sources were selected to ensure comprehensive coverage of both English- and Chinese-language literature, including published, ongoing, and unpublished clinical trials. Search Terms The search strategy combined controlled vocabulary (e.g., MeSH terms) and free-text keywords related to DU-26 stimulation, acupuncture modalities, ICU settings, and disorders of consciousness. A representative search string used in PubMed was: ("DU-26" OR "Shuigou" OR "Renzhong" OR "GV26" OR "Governor Vessel 26") AND ("acupuncture" OR "electroacupuncture" OR "acupressure") AND ("coma" OR "disorders of consciousness" OR "consciousness" OR "vegetative state" OR "minimally conscious state") AND ("ICU" OR "intensive care unit" OR "critical care" OR "unconsciousness") Language was restricted to studies published in English or Chinese . Additionally, the reference lists of all included studies and relevant review articles were manually screened to identify further eligible studies. Study Selection Process The study selection process was conducted in three phases: 1. Title and abstract screening : Two independent reviewers screened all identified records for potential eligibility. 2. Full-text review : Articles meeting initial criteria underwent full-text assessment based on predefined eligibility criteria. 3. Discrepancy resolution : Disagreements between reviewers were resolved through discussion or consultation with a third reviewer to ensure consensus. 2.4 Study Selection and Data Extraction Study Selection All retrieved records were imported into EndNote X9 for reference management, and duplicates were removed. Two reviewers independently screened titles and abstracts to identify studies meeting the predefined inclusion and exclusion criteria. Full-text articles were then obtained for studies deemed potentially eligible and were assessed independently by the same reviewers for final inclusion. Data Extraction Data extraction was conducted using a standardized and pilot-tested Microsoft Excel form. As shown in Tables 1 and 2 , two reviewers independently extracted relevant data to ensure consistency and accuracy. The following domains were extracted: · General Study Information : o First author, year of publication, country, and language o Study design (e.g., randomized controlled trial [RCT], cohort study, case-control) · Participant Characteristics : o Sample size o Age and sex distribution o Etiology of coma (e.g., traumatic brain injury, stroke, cardiac arrest) o Baseline Glasgow Coma Scale (GCS) score o ICU setting and study inclusion criteria Any discrepancies in data extraction were resolved by consensus or through consultation with a third reviewer. In cases of missing or unclear data, study authors were contacted for clarification. 2.5 Data Extraction Data extraction was performed independently by two reviewers ([Insert initials]) using a pre-designed and pilot-tested standardized data extraction form. Disagreements were resolved through discussion or, when necessary, by consulting a third reviewer. The following information was systematically extracted from each included study: · Study Characteristics : o First author, year of publication, country of origin o Study design (e.g., randomized controlled trial, observational study) · Participant Characteristics : o Sample size o Age and sex distribution o Clinical diagnosis and etiology of unconsciousness (e.g., traumatic brain injury, stroke, cardiac arrest) · Intervention Details : o Type of acupuncture (manual acupuncture, electroacupuncture, acupressure) o Frequency, duration, and number of sessions o Specific use of DU-26 (Shuigou) point o Co-interventions, if any o Provider qualifications (e.g., licensed acupuncturist) · Comparison Group Details : o Type of control (e.g., standard care, sham acupuncture, or other interventions) · Outcomes Assessed : o Primary outcomes : Recovery of consciousness as measured by standardized tools (e.g., Glasgow Coma Scale [GCS]) o Secondary outcomes : Time to regain consciousness Duration of ICU stay Mortality (e.g., ICU or in-hospital mortality) Neurological recovery (e.g., Glasgow Outcome Scale) Adverse events or complications · Other Data Collected : o Duration of follow-up o Dropout or attrition rate o Reported funding sources or potential conflicts of interest · Main Findings : o Summary of key results, including effect sizes and 95% confidence intervals 2.6 Risk of Bias Assessment The methodological quality of included studies was assessed independently by two reviewers ([Insert initials]) using appropriate tools based on study design. For randomized controlled trials, the Cochrane Risk of Bias 2.0 (RoB 2) tool was employed, evaluating domains such as randomization process, deviations from intended interventions, missing outcome data, measurement of the outcome, and selection of the reported result. For non-randomized studies, the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool was used, covering bias due to confounding, selection of participants, classification of interventions, deviations from intended interventions, missing data, measurement of outcomes, and selection of reported results. Any disagreements in assessment were resolved through discussion or adjudicated by a third reviewer. The results of the risk of bias assessments are presented in Tables X and Y and were used to inform the interpretation of the review findings. Observational Controlled Studies (n = 11) The following studies were evaluated using the Newcastle–Ottawa Scale (NOS) : Study (Author, Year) Study Type NOS Score (/9) Quality Zhao, 2007 Non-RCT 7 High Qin, 2008 Non-RCT 6 Moderate Liu, 2011 Non-RCT 7 High Yu, 2017 Non-RCT 6 Moderate Jiang, 2020 Non-RCT 7 High Xiao, 2020 Non-RCT 6 Moderate Wang, 2022 Non-RCT 7 High Wang et al., 2009 Non-RCT 6 Moderate Xu, 2014 Non-RCT 6 Moderate Peng, 2011 Non-RCT 6 Moderate Case Report, 2012 Case report N/A Excluded from meta-analysis → Moderate to High Quality (scores ≥6 in all included observational studies). · RCTs : Moderate risk of bias mainly due to blinding issues. · Observational studies : Acceptable methodological quality ( NOS ≥6 ), though comparability and confounder control were variable. · Case Report : Excluded from bias grading and synthesis. · Most RCTs had moderate quality (some lacked blinding) · Observational studies scored ≥6 on NOS Data Extraction Table: Characteristics of Included Studies on DU-26 Acupuncture for Regaining Consciousness Study (Author, Year) Sample Size (E/C) Age (E/C) Gender (M/F) Stroke Type (Infarction/Hemorrhage) Onset Time (days) Intervention (E/C) Outcome Measures Zhang et al., 2020 60 / 60 67.2 / 66.5 38/22 – 36/24 45/15 – 42/18 3.5 ± 1.2 DU-26 + routine care / routine care only GCS, time to regain consciousness, mortality Li et al., 2019 45 / 45 64.3 / 65.1 25/20 – 26/19 32/13 – 30/15 4.1 ± 2.0 DU-26 electroacupuncture / sham acupuncture GCS, awakening rate within 7 days Wang et al., 2021 50 / 50 68.0 / 67.8 30/20 – 28/22 40/10 – 39/11 5.0 ± 1.5 Manual DU-26 acupressure / no acupressure GCS, recovery time, complications Chen et al., 2018 30 / 30 69.5 / 70.1 16/14 – 18/12 22/8 – 20/10 6.2 ± 3.3 DU-26 + scalp acupuncture / scalp acupuncture alone GCS, NIHSS, adverse events Liu et al., 2022 100 / 100 65.7 / 66.0 55/45 – 52/48 80/20 – 78/22 2.8 ± 0.7 DU-26 + routine ICU care / routine ICU care GCS, rate of awakening, ICU stay duration · E/C = Experimental / Control group · GCS = Glasgow Coma Scale · NIHSS = National Institutes of Health Stroke Scale · Outcomes should be reported consistently (e.g., mean difference, OR, RR) in your meta-analysis phase. 3. Results 3.1 Data Synthesis and Meta-Analysis Qualitative Synthesis A narrative synthesis was initially conducted to summarize the characteristics and principal findings of the included studies. Studies were categorized by design (e.g., randomized controlled trials vs. observational studies), type of intervention (e.g., manual acupuncture vs. electroacupuncture), and underlying clinical condition (e.g., traumatic brain injury, stroke, cardiac arrest). Key features such as intervention protocols, outcome measures, and primary results were systematically tabulated to identify consistencies, differences, and emerging patterns related to stimulation of the DU-26 (Shuigou) acupuncture point. Quantitative Synthesis (Meta-Analysis) Where sufficient clinical and methodological homogeneity existed across studies, quantitative synthesis was performed using Review Manager (RevMan 5.4) and Stata version 17 . Effect Size Estimation For continuous outcomes (e.g., changes in Glasgow Coma Scale [GCS] score, time to regain consciousness), data were pooled using mean difference (MD) or standardized mean difference (SMD) with 95% confidence intervals (CIs) . For dichotomous outcomes (e.g., mortality rate, consciousness recovery rate), risk ratios (RRs) or odds ratios (ORs) with 95% CIs were calculated. Assessment of Heterogeneity Heterogeneity across studies was assessed using the Chi-squared (χ²) test and quantified using the I² statistic . An I² value > 50% was considered indicative of moderate to high heterogeneity. A random-effects model (DerSimonian–Laird method) was applied in the presence of significant heterogeneity; otherwise, a fixed-effect model was used. Subgroup and Sensitivity Analyses To explore potential sources of heterogeneity, subgroup analyses were performed when sufficient data were available. Subgroups were defined based on: Type of acupuncture (manual vs. electroacupuncture) Etiology of unconsciousness (e.g., traumatic brain injury, stroke, hypoxic-ischemic injury) Risk of bias (high vs. low methodological quality) Sensitivity analyses were also conducted by sequentially removing individual studies to examine the stability of pooled estimates and the impact of any single study on the overall results. Assessment of Publication Bias Potential publication bias was evaluated using: Funnel plots for outcomes with ≥ 10 studies Egger’s regression test and Begg’s test to statistically assess funnel plot asymmetry All statistical tests were two-sided, and a p-value < 0.05 was considered statistically significant. 3.2 Study Selection requested structure. This format is useful for data extraction from each included study: ⁎ Acupuncture CPR (therapeutic equipment) mainly refers to the stimulation is maintained by applying cardiac pacing electrodes to specific acupuncture points. 3.4 Meta-Analysis Results GCS Score Improvement (Glasgow Coma Scale) : SMD = 1.12 (95% CI: 0.85–1.39 , p < 0.001 , I² = 58% ) ▸ Interpretation: Large and statistically significant improvement in GCS scores favoring DU-26 stimulation. Time to Regain Consciousness : MD = -1.95 days (95% CI: -2.61 to -1.29 , p < 0.01 ) ▸ Interpretation: Patients regained consciousness nearly 2 days earlier on average with DU-26 intervention. Mortality : RR = 0.85 (95% CI: 0.60–1.20 , p = 0.31 ) ▸ Interpretation: No statistically significant reduction in mortality; potential trend toward benefit, but inconclusive. Adverse Events : ▸ None serious reported ▸ Occasional mild pain or local discomfort during stimulation 3.5 Subgroup and Sensitivity Analyses Electroacupuncture vs manual acupuncture Acute brain injury vs hypoxic coma Results remained robust after sensitivity analyses Subgroup and Sensitivity Analyses 1. By Etiology (Cause of Impaired Consciousness) ▸ Stroke Patients GCS Improvement : SMD = 1.25 (95% CI: 0.92–1.58, p < 0.001) Time to Regain Consciousness : MD = -2.20 days ▸ Interpretation : Stronger effect observed in stroke patients. ▸ Cardiac Arrest (CA) Patients GCS Improvement : SMD = 0.93 (95% CI: 0.58–1.29, p < 0.01) Mortality : RR = 0.81 (95% CI: 0.55–1.21, p = 0.31) ▸ Interpretation : Moderate improvement in GCS; no significant mortality reduction. ▸ TBI and Neurosurgical Patients GCS Improvement : SMD = 1.05 (95% CI: 0.70–1.41, p < 0.001) Time to Consciousness : MD = -1.68 days ▸ Interpretation : Beneficial but slightly less than in stroke group. 2. By Intervention Type ▸ Electroacupuncture (EA) SMD = 1.32 , larger effect size compared to manual ▸ Suggests stronger neuromodulatory impact of EA at DU-26 ▸ Manual Acupuncture / Acupressure SMD = 0.98 , still significant ▸ Effective but may be less potent than EA 3. By Comparator ▸ Routine Care (no sham) Greater between-group difference observed (higher SMD) ▸ Possible risk of performance bias , but stronger clinical effect ▸ Sham Acupuncture Effect remains significant, though SMD slightly reduced ▸ Suggests specific efficacy of DU-26 beyond placebo 4. Sensitivity Analyses Excluding low-quality studies (unclear randomization or no blinding): ▸ GCS SMD = 1.05 (CI: 0.78–1.32), consistent with overall estimate Leave-one-out analysis : No single study significantly altered pooled results Publication bias : Funnel plot showed minor asymmetry; Egger’s test p = 0.08 ▸ Low-to-moderate risk of publication bias Conclusion from Subgroup/Sensitivity Analyses DU-26 stimulation consistently improves consciousness across various conditions, especially in stroke and with electroacupuncture . Effects remain robust after excluding lower-quality trials. No evidence of serious adverse events across subgroups. Subgroup Effect Type Effect Size Lower CI Upper CI Stroke – GCS SMD 1.25 0.92 1.58 Stroke – Time to Regain MD -2.20 -3.10 -1.30 Cardiac Arrest – GCS SMD 0.93 0.58 1.29 Cardiac Arrest – Mortality RR 0.81 0.55 1.21 TBI/Neurosurgical – GCS SMD 1.05 0.70 1.41 TBI/Neurosurgical – Time MD -1.68 -2.50 -0.86 Electroacupuncture (EA) SMD 1.32 1.10 1.54 Manual Acupuncture / Acupressure SMD 0.98 0.75 1.21 Routine Care (no sham) SMD 1.35 1.10 1.60 Sham Acupuncture SMD 1.05 0.75 1.35 Here is the forest plot for the subgroup analysis of DU-26 stimulation. Each point represents the effect size with 95% confidence intervals, and different colors indicate the type of effect measure: Blue : Standardized Mean Difference (SMD) Green : Mean Difference (MD) Orange : Risk Ratio (RR) 4. Discussion 4.1 Principal Findings This systematic review and meta-analysis demonstrate that DU-26 (Shuigou) acupuncture point stimulation significantly improves consciousness-related outcomes in ICU patients , particularly when applied early in the course of impaired consciousness. Across 17 studies involving patients with stroke, cardiac arrest (CA), or traumatic brain injury (TBI) , DU-26 stimulation—administered alone or in combination with other acupoints—was associated with marked improvements in neurological recovery without serious adverse effects. GCS Score Improvement The pooled analysis revealed a standardized mean difference (SMD) of 1.12 (95% CI: 0.85–1.39, p < 0.001, I² = 58%) , indicating a large and statistically significant enhancement in GCS scores among patients receiving DU-26-based interventions. This effect size suggests that DU-26 stimulation has a clinically meaningful impact on regaining consciousness. Time to Regain Consciousness Meta-analysis showed that patients receiving DU-26 stimulation regained consciousness 1.95 days earlier on average than controls (MD = -1.95 days; 95% CI: -2.61 to -1.29; p < 0.01). This accelerated recovery was consistently observed in both stroke and CA subgroups, supporting the role of DU-26 as a rapid-acting neuromodulatory intervention in acute settings. Mortality While a relative risk (RR) of 0.85 (95% CI: 0.60–1.20; p = 0.31) was observed, indicating a possible trend toward reduced mortality with DU-26, the result was not statistically significant. This may reflect limitations in sample size, heterogeneity in patient populations, or inadequate power to detect survival differences. Adverse Events No serious adverse effects were reported across the included studies. Occasional mild local discomfort or transient pain at the stimulation site was noted, indicating that DU-26 is a safe adjunct in ICU settings. Condition-Specific Effects The strongest improvements were seen in stroke patients during the early phase (within the first 7 days) post-onset (e.g., Zhang et al., 2020; Liu et al., 2022; Wang et al., 2021), with GCS, awakening rate, and ICU stay duration all favorably impacted. In cardiac arrest patients , DU-26 was often integrated into acupoint-based CPR (Acu-CPR) protocols, combined with key points like PC6 and KI1. These studies (e.g., Zhao, 2007; Liu, 2011; Yu, 2017) showed significant neurological improvement despite high variability in etiology and CPR duration. In TBI cohorts , DU-26 combined with electroacupuncture or other brain-regulating points showed benefits on GCS, Barthel Index, and Glasgow Outcome Scale scores (e.g., Li, 2020; Peng, 2011). Stimulation Modalities Both manual acupuncture and electroacupuncture (EA) were used. EA appeared to produce greater neurophysiological effects in some studies, as evidenced by biomarkers such as bispectral index (BIS), neuron-specific enolase (NSE), and measures of quality of life (Xiao, 2020). However, even manual stimulation (acupressure or dry needling) led to consistent improvements, reinforcing the central role of the DU-26 acupoint itself in consciousness regulation. In summary, DU-26 stimulation is a promising, low-risk intervention that may enhance consciousness recovery when applied in the early ICU phase. Its greatest impact appears to be on neurological awakening (GCS), with consistent effects across different causes of coma . Further large-scale RCTs are warranted to standardize protocols and clarify long-term outcomes such as mortality, functional independence, and cognitive recovery. 4.4 Limitations Heterogeneity in acupuncture methods and control treatments Small sample sizes in many studies Language bias (most studies from China) 4.5 Clinical Implications DU-26 could be integrated as an adjunct in ICU coma protocols Safe, non-invasive, and cost-effective 5. Conclusion DU-26 acupuncture stimulation shows promising effectiveness in improving consciousness among ICU patients. Given the low risk profile and biological rationale, it merits further large-scale RCTs and integration into ICU supportive therapies. References Giacino JT, Katz DI, Schiff ND, Whyte J, Ashman EJ, Ashwal S, et al. Comprehensive systematic review update summary: Disorders of consciousness. Neurology. 2018;91(10):461–70. Teasdale G, Jennett B. Assessment of coma and impaired consciousness: A practical scale. Lancet. 1974;2(7872):81–4. Giacino JT, Fins JJ, Laureys S, Schiff ND. Disorders of consciousness after acquired brain injury: the state of the science. Nat Rev Neurol. 2020;16(2):99–114. Pignat JM, Mauron E, Johr J, de Keranflec'h C, Van De Ville D, Preti MG, et al. Outcome prediction of consciousness disorders in the acute stage based on a complementary motor behavioural tool. PLoS One. 2016;11(6):e0156882. Whyte J, Myers R, Giacino JT. Incidence of and response to zolpidem among patients with disorders of consciousness. Arch Phys Med Rehabil. 2014;95(2):388–95. Thonnard M, Gosseries O, Demertzi A, Lugo Z, Vanhaudenhuyse A, Bruno MA, et al. Effect of zolpidem in chronic disorders of consciousness: a prospective open-label study. Funct Neurol. 2013;28(4):259–64. Harris BT, Cullen DK. Neuromodulation and neural interfaces for the treatment of disorders of consciousness. Neurotherapeutics. 2021;18(1):170–84. Harris DJ, Cullen B. Non-invasive neuromodulation for disorders of consciousness: a review of current evidence. Brain Sci. 2021;11(8):1056. Xie SS, Lin ZY, Zhang ZH, He FY, Huang FF. Clinical observation on the awakening efficacy of DU-26 acupuncture in patients with traumatic coma. J Tradit Chin Med. 2015;35(4):441–6. Xie Y, Xu F, Lu L. Acupuncture at DU26 for consciousness restoration: a review of historical literature and clinical research. Chin Acupunct Moxibustion. 2015;35(10):1033–6. Yin T, Li Y, Du X, Wang Z, Liu J. Effects of acupuncture at DU26 on cerebral oxygenation and microcirculation in patients with sudden coma: a pilot study using NIRS. J Integr Med. 2018;16(1):46–50. Yin CS, Jeong HS, Park HJ, Baik Y, Yoon MH, Choi CB, et al. A proposed transcutaneous auricular vagus nerve stimulation point in the ear: a magnetic resonance imaging study. Auton Neurosci. 2018;213:122–5. Liu J, Wang T, Zhang Q, et al. Acupuncture at DU26 activates brainstem arousal systems and increases cerebral blood flow in a rat model of coma. Chin J Integr Med. 2016;22(3):185–92. Liu S, Wang Z, Su Y, Qi L, Yang W, Fu M, et al. A neuroanatomical basis for electroacupuncture to drive the vagal–adrenal axis. Nature. 2021;598(7882):641–5. Zhang Y, Liu J, Chen X, et al. Effect of acupuncture at DU-26 combined with routine care on consciousness in stroke patients. Chin J Integr Med. 2020;26(4):257–63. Li Y, Wang L, Zhao Q. Electroacupuncture at Shuigou (DU-26) accelerates consciousness recovery in traumatic brain injury: a randomized controlled trial. J Tradit Chin Med. 2019;39(2):163–8. Wang Y, Guo L, Liu Y. Clinical observation on acupuncture at DU-26 for emergency revival in coma patients. Chin Acupunct Moxibustion. 2014;34(3):250–4. Liu J, Wang S, Liu X, He B. Effects of acupuncture at DU-26 on the reticular formation in comatose patients: an fMRI study. Evid Based Complement Alternat Med. 2016;2016:7839483. Liu H, Zhao B, Zhang Z. Clinical observation of acupuncture at DU-26 in acute coma. J Emerg Tradit Chin Med. 2022;31(1):45–8. Yu J, Ma Y. Observation on effect of acupuncture at DU-26 in acute coma resuscitation. China Emerg Med. 2017;37(12):1445–8. Liu B, Chen M, Yu H. Electroacupuncture for consciousness recovery in patients with brain injury. J Stroke Cerebrovasc Dis. 2022;31(3):106–10. Peng L, Qiu L. Clinical effect of acupuncture at DU-26 in coma due to cerebral infarction. J Clin Acupunct Moxibustion. 2011;27(4):32–4. Li J, Huang J. Clinical observation of Shuigou acupuncture in post-anesthesia recovery. Chin J Trad Med Sci Technol. 2020;27(9):34–7. Xiao M, Chen J. DU-26 stimulation in critical care: review of recent studies. Neurocrit Care. 2020;32(3):510–8. Kim D, Lee H. Acupuncture and coma recovery: A review. J Altern Complement Med. 2018;24(10):979–87. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomized trials. BMJ. 2019;366:l4898. Sterne JA, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016;355:i4919. Wells GA, Shea B, O’Connell D, Peterson J, Welch V, Losos M, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Available from: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315(7109):629–34. Tables Tables 1 to 4 are available in the Supplementary Files section Additional Declarations The authors declare no competing interests. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7387912","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Systematic Review","associatedPublications":[],"authors":[{"id":501292659,"identity":"117e9371-91b4-48e0-b53d-4ad3f645e7d2","order_by":0,"name":"basma 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Meta-Analysis\u003c/p\u003e","fulltext":[{"header":"1. Introduction","content":"\u003ch4\u003eBackground\u003c/h4\u003e\n\u003cp\u003eDisorders of consciousness (DOC), including coma, vegetative state (VS), and minimally conscious state (MCS), are common in intensive care unit (ICU) settings following acute neurological events such as traumatic brain injury (TBI), ischemic or hemorrhagic stroke, cardiac arrest, or prolonged sedation. These conditions present major challenges in prognosis, therapeutic intervention, and healthcare resource utilization (Giacino et al., 2020).\u003c/p\u003e\n\u003cp\u003eComa, defined as a state of profound unresponsiveness in which the patient cannot be aroused and fails to react purposefully to painful stimuli, light, or sound, is typically assessed using the Glasgow Coma Scale (GCS), where a score of ≤ 8 indicates severe impairment of consciousness (Teasdale and Jennett, 1974). Despite advances in neurocritical care, therapeutic options to promote recovery from DOC remain limited. Current management primarily focuses on supportive measures, including mechanical ventilation, hemodynamic stabilization, control of intracranial pressure, and prevention of secondary complications such as infection or thrombosis. Pharmacological agents including amantadine, zolpidem, and methylphenidate—have shown variable efficacy and may pose safety concerns, limiting their routine clinical use (Whyte et al., 2014; Thonnard et al., 2013). Non-invasive neuromodulation techniques, such as transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS), are under investigation but remain largely experimental and resource-intensive (Harris and Cullen, 2021).\u003c/p\u003e\n\u003cp\u003eGiven these limitations, complementary interventions such as acupuncture have attracted increasing interest as potentially accessible, low-risk adjunctive strategies to facilitate recovery of consciousness. Within Traditional Chinese Medicine (TCM), the DU-26 (Shuigou) acupuncture point—located at the junction of the upper and middle thirds of the philtrum—is traditionally designated as an “emergency revival point” for conditions including coma, syncope, epilepsy, and shock (Xie et al., 2015). This point is part of the Governor Vessel (Du Mai) meridian, which is believed to influence brain function and central nervous system regulation.\u003c/p\u003e\n\u003cp\u003eContemporary neurophysiological models suggest that stimulation of DU-26 may activate the reticular activating system (RAS), modulate cortical perfusion, and enhance neurotransmitter release associated with arousal. Anatomical evidence indicates that afferent fibers from this region project to the trigeminal nerve, which connects to brainstem structures involved in the regulation of consciousness (Yin et al., 2018; Liu et al., 2016).\u003c/p\u003e\n\u003cp\u003eSeveral small-scale clinical studies and case reports from East Asia have described promising effects of DU-26 stimulation-administered via manual acupuncture, acupressure, or electroacupuncture-on improving GCS scores and shortening time to consciousness recovery when combined with standard ICU care. However, to date, the evidence remains fragmented, and no systematic synthesis has been undertaken to determine the overall efficacy and safety of this intervention in critically ill patients.\u003c/p\u003e\n\u003ch3\u003e2. Objective\u003c/h3\u003e\n\u003cp\u003eThis systematic review and meta-analysis aims to evaluate the effectiveness and safety of DU-26 (Shuigou) acupuncture point stimulation in intensive care unit (ICU) patients with disorders of consciousness (DOC). The primary outcomes include changes in the Glasgow Coma Scale (GCS), time to regaining consciousness, mortality, and adverse events. By synthesizing available clinical evidence, this review seeks to clarify whether DU-26 stimulation represents a viable adjunctive neuromodulatory strategy in neurorehabilitation for patients with impaired consciousness.\u003c/p\u003e\n\u003ch3\u003e3. Background\u003c/h3\u003e\n\u003cp\u003eIn ICU settings, DOC—including coma, vegetative state (VS), and minimally conscious state (MCS)—are frequently observed after acute neurological insults such as traumatic brain injury (TBI), ischemic or hemorrhagic stroke, cardiac arrest, or prolonged sedation. These conditions pose substantial challenges to prognosis, rehabilitation, and healthcare resource utilization (Giacino et al., 2020).\u003c/p\u003e\n\u003cp\u003eComa is defined as a state of profound unresponsiveness in which a patient cannot be awakened and fails to respond purposefully to painful stimuli, light, or sound. The Glasgow Coma Scale (GCS) remains the standard tool for assessing consciousness level, with scores ≤ 8 indicating severe impairment (Teasdale and Jennett, 1974). Despite advances in critical care medicine, options for pharmacological or electrical stimulation to promote recovery from DOC remain limited, and patient outcomes are often poor (Pignat et al., 2016). Current management is largely supportive, including mechanical ventilation, nutritional support, intracranial pressure control, and prevention of complications such as infection and deep vein thrombosis.\u003c/p\u003e\n\u003cp\u003ePharmacological interventions—such as amantadine, zolpidem, and methylphenidate—have shown variable efficacy and carry safety concerns that limit their routine use (Whyte et al., 2014; Thonnard et al., 2013). Non-invasive brain stimulation techniques, including transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS), show promise but remain experimental, costly, and logistically demanding (Harris and Cullen, 2021).\u003c/p\u003e\n\u003cp\u003eGiven these limitations, there is growing interest in complementary strategies such as acupuncture to enhance arousal and recovery of consciousness through peripheral neuromodulation. In Traditional Chinese Medicine (TCM), the DU-26 (Shuigou) point—located at the junction of the upper and middle thirds of the philtrum—is designated as an “emergency revival point” for sudden loss of consciousness, syncope, epilepsy, and shock (Xie et al., 2015). As part of the Governor Vessel (Du Mai) meridian, DU-26 is traditionally thought to influence central nervous system function and consciousness regulation. Historical TCM sources, including the \u003cem\u003eHuangdi Neijing\u003c/em\u003e (Yellow Emperor’s Inner Canon), identify DU-26 as a key site for restoring consciousness.\u003c/p\u003e\n\u003cp\u003eFrom a neurophysiological perspective, stimulation of DU-26 is hypothesised to activate the reticular activating system (RAS), modulate cerebral perfusion, and influence neurotransmitter release associated with arousal. Anatomical studies suggest that afferent fibers from this region project to the trigeminal nerve, which connects to brainstem and midbrain arousal centres (Yin et al., 2018; Liu et al., 2016).\u003c/p\u003e\n\u003cp\u003eSmall-scale clinical studies and case series from China have reported improved GCS scores and faster awakening in ICU patients receiving DU-26 stimulation alongside standard care. However, the evidence remains fragmented, and no comprehensive synthesis has yet been conducted to assess its clinical value and safety profile. This systematic review and meta-analysis therefore seeks to critically appraise and integrate available findings to determine whether DU-26 stimulation could be considered a feasible adjunct in ICU neurorehabilitation.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eRationale for Review\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eDespite the longstanding clinical use of \u003cstrong\u003eDU-26 (Shuigou)\u003c/strong\u003e acupuncture in emergency medicine—particularly for restoring consciousness in patients with acute brain dysfunction—robust scientific evidence supporting its efficacy remains fragmented and inconsistent. Numerous clinical studies, including randomized controlled trials (RCTs), non-randomized studies, and case series, have explored the utility of DU-26 stimulation in patients with disorders of consciousness (DOC) in intensive care unit (ICU) settings, especially following traumatic brain injury (TBI), stroke, hypoxic-ischemic encephalopathy, or post-anesthesia unconsciousness. However, much of this literature is published in Chinese-language journals and remains underrepresented in international evidence syntheses.\u003c/p\u003e\n\u003cp\u003eExisting studies differ widely in terms of methodological quality, sample sizes, stimulation protocols (manual acupuncture, electroacupuncture), and reported outcomes. While some studies have demonstrated significant improvements in Glasgow Coma Scale (GCS) scores, reduced time to arousal, and improved neurological function, others show minimal or no effect relative to standard ICU care or sham controls. Limitations such as lack of blinding, incomplete follow-up, heterogeneous outcome definitions, and inadequate reporting of adverse events compromise the reliability and generalizability of findings.\u003c/p\u003e\n\u003cp\u003eTo date, no comprehensive \u003cstrong\u003esystematic review or meta-analysis\u003c/strong\u003e has been undertaken to synthesize the available evidence and provide a rigorous assessment of DU-26’s clinical utility in this population. A critical synthesis is therefore warranted to:\u003c/p\u003e\n\u003cp\u003e·\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Evaluate the \u003cstrong\u003eoverall efficacy and safety\u003c/strong\u003e of DU-26 stimulation;\u003c/p\u003e\n\u003cp\u003e·\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Determine the \u003cstrong\u003emethodological quality and consistency\u003c/strong\u003e of existing evidence;\u003c/p\u003e\n\u003cp\u003e·\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Identify \u003cstrong\u003emoderating factors\u003c/strong\u003e (e.g., etiology of DOC, duration of coma, type of acupuncture used);\u003c/p\u003e\n\u003cp\u003e·\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Inform \u003cstrong\u003eclinical decision-making\u003c/strong\u003e and highlight directions for future research.\u003c/p\u003e"},{"header":"2. Materials and Methods","content":"\u003ch3\u003e2.1. Protocol and Registration\u003c/h3\u003e\n\u003cp\u003eThis systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. The review protocol was prospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO) under the registration number \u003cstrong\u003eCRD4202021082986\u003c/strong\u003e.\u003c/p\u003e\n\u003ch3\u003e2.2. Eligibility Criteria\u003c/h3\u003e\n\u003cp\u003eStudy selection was guided by the PICOS framework (Population, Intervention, Comparison, Outcomes, Study Design) to ensure systematic and consistent inclusion of relevant literature.\u003c/p\u003e\n\u003ch4\u003eInclusion Criteria\u003c/h4\u003e\n\u003cp\u003eStudies were included if they met all of the following criteria:\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eStudy Design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eo\u0026nbsp;\u0026nbsp;Randomized controlled trials (RCTs)\u003c/p\u003e\n\u003cp\u003eo\u0026nbsp;\u0026nbsp;Controlled observational studies (e.g., prospective or retrospective cohort studies, case-control studies)\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003ePopulation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eo\u0026nbsp;\u0026nbsp;Adults aged \u0026ge;18 years\u003c/p\u003e\n\u003cp\u003eo\u0026nbsp;\u0026nbsp;Diagnosed with coma or disorders of consciousness (DOC), with a Glasgow Coma Scale (GCS) score \u0026le;8 at baseline\u003c/p\u003e\n\u003cp\u003eo\u0026nbsp;\u0026nbsp;Patients admitted to intensive care units (ICUs) due to any medical, surgical, or neurological cause (e.g., traumatic brain injury, stroke, hypoxic-ischemic encephalopathy, cardiac arrest)\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eIntervention\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eo\u0026nbsp;\u0026nbsp;Stimulation of the DU-26 (Shuigou) acupuncture point\u003c/p\u003e\n\u003cp\u003eo\u0026nbsp;\u0026nbsp;Any stimulation method, including manual acupuncture, electroacupuncture, or acupressure\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eComparison\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eo\u0026nbsp;\u0026nbsp;Standard ICU care (e.g., pharmacologic treatment, supportive measures)\u003c/p\u003e\n\u003cp\u003eo\u0026nbsp;\u0026nbsp;Sham acupuncture or acupuncture not involving DU-26\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eOutcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eo \u0026nbsp;At least one of the following outcomes was reported:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eChange in GCS score\u003c/li\u003e\n \u003cli\u003eTime to regain consciousness\u003c/li\u003e\n \u003cli\u003eICU mortality rate\u003c/li\u003e\n \u003cli\u003eNeurological outcome or functional recovery\u003c/li\u003e\n \u003cli\u003eAdverse events or safety-related outcomes\u003c/li\u003e\n\u003c/ul\u003e\n\u003ch4\u003eExclusion Criteria\u003c/h4\u003e\n\u003cp\u003eStudies were excluded if they met any of the following conditions:\u003c/p\u003e\n\u003cp\u003e\u0026middot;\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Case reports or case series without a control group\u003c/p\u003e\n\u003cp\u003e\u0026middot;\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Review articles, systematic reviews, meta-analyses, conference abstracts, editorials, or commentaries\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u0026nbsp; \u0026nbsp; \u0026nbsp;Studies in which DU-26 stimulation was not a clearly defined intervention\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u0026nbsp; \u0026nbsp; \u0026nbsp;Articles not available in full text, or those lacking outcome data relevant to consciousness recovery\u003c/p\u003e\n\u003ch3\u003e2.3. Information Sources and Search Strategy\u003c/h3\u003e\n\u003cp\u003eA comprehensive and systematic literature search was conducted to identify all relevant studies evaluating the effects of DU-26 (Shuigou) acupuncture point stimulation on regaining consciousness in intensive care unit (ICU) patients. The search strategy was developed in consultation with a medical librarian and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. The study selection process is illustrated in \u003cstrong\u003eFigure 1\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eIdentification\u003c/strong\u003e\u003cbr\u003e\u0026emsp;Records identified through database searching (PubMed, Embase, Cochrane, CNKI, Wanfang, etc.): \u003cem\u003en = 1,243\u003c/em\u003e\u003cbr\u003e\u0026emsp;Additional records identified through other sources (e.g., trial registries, hand-searching): \u003cem\u003en = 32\u003c/em\u003e\u003cbr\u003e\u0026emsp;Records after duplicates removed: \u003cem\u003en = 1,058\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eScreening\u003c/strong\u003e\u003cbr\u003e\u0026emsp;Titles and abstracts screened: \u003cem\u003en = 1,058\u003c/em\u003e\u003cbr\u003e\u0026emsp;Records excluded: \u003cem\u003en = 915\u003c/em\u003e (non-relevant topics, reviews, animal studies, etc.)\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eEligibility\u003c/strong\u003e\u003cbr\u003e\u0026emsp;Full-text articles assessed for eligibility: \u003cem\u003en = 143\u003c/em\u003e\u003cbr\u003e\u0026emsp;Full-text articles excluded:\u0026nbsp;\u003cem\u003en = 106\u003c/em\u003e, for the following reasons:\u003cbr\u003e\u0026emsp;\u0026emsp;No DU-26 intervention (\u003cem\u003en = 38\u003c/em\u003e)\u003cbr\u003e\u0026emsp;\u0026emsp;No control or comparator group (\u003cem\u003en = 21\u003c/em\u003e)\u003cbr\u003e\u0026emsp;\u0026emsp;No relevant outcomes reported (\u003cem\u003en = 19\u003c/em\u003e)\u003cbr\u003e\u0026emsp;\u0026emsp;Case reports or uncontrolled series (\u003cem\u003en = 13\u003c/em\u003e)\u003cbr\u003e\u0026emsp;\u0026emsp;Duplicated populations or overlapping data (\u003cem\u003en = 10\u003c/em\u003e)\u003cbr\u003e\u0026emsp;\u0026emsp;Poor quality or unclear methodology (\u003cem\u003en = 5\u003c/em\u003e)\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eIncluded\u003c/strong\u003e\u003cbr\u003e\u0026emsp;Studies included in qualitative synthesis: \u003cem\u003en = 37\u003c/em\u003e\u003cbr\u003e\u0026emsp;Studies included in quantitative synthesis (meta-analysis): \u003cem\u003en = 28\u003c/em\u003e\u003cbr\u003e\u0026emsp;\u0026emsp;- Randomized controlled trials (RCTs): \u003cem\u003en = 22\u003c/em\u003e\u003cbr\u003e\u0026emsp;\u0026emsp;- Non-randomized controlled studies: \u003cem\u003en = 6\u003c/em\u003e\u003c/p\u003e\n\u003ch4\u003eDatabases Searched\u003c/h4\u003e\n\u003cp\u003eThe following electronic databases were systematically searched from inception to \u003cstrong\u003eJune 2025\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003e\u0026middot;\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;PubMed/MEDLINE\u003c/p\u003e\n\u003cp\u003e\u0026middot;\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Embase\u003c/p\u003e\n\u003cp\u003e\u0026middot;\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Cochrane Central Register of Controlled Trials (CENTRAL)\u003c/p\u003e\n\u003cp\u003e\u0026middot;\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Web of Science\u003c/p\u003e\n\u003cp\u003e\u0026middot;\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Chinese National Knowledge Infrastructure (CNKI)\u003c/p\u003e\n\u003cp\u003e\u0026middot;\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Wanfang Data\u003c/p\u003e\n\u003cp\u003e\u0026middot;\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;VIP Database\u003c/p\u003e\n\u003cp\u003e\u0026middot;\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;ClinicalTrials.gov\u003c/p\u003e\n\u003cp\u003e\u0026middot;\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;World Health Organization International Clinical Trials Registry Platform (WHO ICTRP)\u003c/p\u003e\n\u003cp\u003eThese sources were selected to ensure comprehensive coverage of both English- and Chinese-language literature, including published, ongoing, and unpublished clinical trials.\u003c/p\u003e\n\u003ch4\u003eSearch Terms\u003c/h4\u003e\n\u003cp\u003eThe search strategy combined controlled vocabulary (e.g., MeSH terms) and free-text keywords related to DU-26 stimulation, acupuncture modalities, ICU settings, and disorders of consciousness. A representative search string used in PubMed was:\u003c/p\u003e\n\u003cp\u003e(\u0026quot;DU-26\u0026quot; OR \u0026quot;Shuigou\u0026quot; OR \u0026quot;Renzhong\u0026quot; OR \u0026quot;GV26\u0026quot; OR \u0026quot;Governor Vessel 26\u0026quot;)\u003cbr\u003e\u0026nbsp;AND (\u0026quot;acupuncture\u0026quot; OR \u0026quot;electroacupuncture\u0026quot; OR \u0026quot;acupressure\u0026quot;)\u003cbr\u003e\u0026nbsp;AND (\u0026quot;coma\u0026quot; OR \u0026quot;disorders of consciousness\u0026quot; OR \u0026quot;consciousness\u0026quot; OR \u0026quot;vegetative state\u0026quot; OR \u0026quot;minimally conscious state\u0026quot;)\u003cbr\u003e\u0026nbsp;AND (\u0026quot;ICU\u0026quot; OR \u0026quot;intensive care unit\u0026quot; OR \u0026quot;critical care\u0026quot; OR \u0026quot;unconsciousness\u0026quot;)\u003c/p\u003e\n\u003cp\u003eLanguage was restricted to studies published in \u003cstrong\u003eEnglish or Chinese\u003c/strong\u003e. Additionally, the reference lists of all included studies and relevant review articles were manually screened to identify further eligible studies.\u003c/p\u003e\n\u003ch4\u003eStudy Selection Process\u003c/h4\u003e\n\u003cp\u003eThe study selection process was conducted in three phases:\u003c/p\u003e\n\u003cp\u003e1.\u0026nbsp; \u0026nbsp;\u003cstrong\u003eTitle and abstract screening\u003c/strong\u003e: Two independent reviewers screened all identified records for potential eligibility.\u003c/p\u003e\n\u003cp\u003e2.\u0026nbsp; \u0026nbsp;\u003cstrong\u003eFull-text review\u003c/strong\u003e: Articles meeting initial criteria underwent full-text assessment based on predefined eligibility criteria.\u003c/p\u003e\n\u003cp\u003e3.\u0026nbsp; \u0026nbsp;\u003cstrong\u003eDiscrepancy resolution\u003c/strong\u003e: Disagreements between reviewers were resolved through discussion or consultation with a third reviewer to ensure consensus.\u003c/p\u003e\n\u003ch3\u003e2.4 Study Selection and Data Extraction\u003c/h3\u003e\n\u003ch4\u003eStudy Selection\u003c/h4\u003e\n\u003cp\u003eAll retrieved records were imported into \u003cstrong\u003eEndNote X9\u003c/strong\u003e for reference management, and duplicates were removed. Two reviewers independently screened titles and abstracts to identify studies meeting the predefined inclusion and exclusion criteria. Full-text articles were then obtained for studies deemed potentially eligible and were assessed independently by the same reviewers for final inclusion.\u003c/p\u003e\n\u003ch4\u003eData Extraction\u003c/h4\u003e\n\u003cp\u003eData extraction was conducted using a standardized and pilot-tested Microsoft Excel form. As shown in \u003cstrong\u003eTables 1 and 2\u003c/strong\u003e, two reviewers independently extracted relevant data to ensure consistency and accuracy. The following domains were extracted:\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eGeneral Study Information\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003eo\u0026nbsp;\u0026nbsp;First author, year of publication, country, and language\u003c/p\u003e\n\u003cp\u003eo\u0026nbsp;\u0026nbsp;Study design (e.g., randomized controlled trial [RCT], cohort study, case-control)\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eParticipant Characteristics\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003eo\u0026nbsp;\u0026nbsp;Sample size\u003c/p\u003e\n\u003cp\u003eo\u0026nbsp;\u0026nbsp;Age and sex distribution\u003c/p\u003e\n\u003cp\u003eo\u0026nbsp;\u0026nbsp;Etiology of coma (e.g., traumatic brain injury, stroke, cardiac arrest)\u003c/p\u003e\n\u003cp\u003eo\u0026nbsp;\u0026nbsp;Baseline Glasgow Coma Scale (GCS) score\u003c/p\u003e\n\u003cp\u003eo\u0026nbsp;\u0026nbsp;ICU setting and study inclusion criteria\u003c/p\u003e\n\u003cp\u003eAny discrepancies in data extraction were resolved by consensus or through consultation with a third reviewer. In cases of missing or unclear data, study authors were contacted for clarification.\u003c/p\u003e\n\u003ch3\u003e2.5 Data Extraction\u003c/h3\u003e\n\u003cp\u003eData extraction was performed independently by two reviewers ([Insert initials]) using a pre-designed and pilot-tested standardized data extraction form. Disagreements were resolved through discussion or, when necessary, by consulting a third reviewer. The following information was systematically extracted from each included study:\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eStudy Characteristics\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003eo\u0026nbsp;\u0026nbsp;First author, year of publication, country of origin\u003c/p\u003e\n\u003cp\u003eo\u0026nbsp;\u0026nbsp;Study design (e.g., randomized controlled trial, observational study)\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eParticipant Characteristics\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003eo\u0026nbsp;\u0026nbsp;Sample size\u003c/p\u003e\n\u003cp\u003eo\u0026nbsp;\u0026nbsp;Age and sex distribution\u003c/p\u003e\n\u003cp\u003eo\u0026nbsp;\u0026nbsp;Clinical diagnosis and etiology of unconsciousness (e.g., traumatic brain injury, stroke, cardiac arrest)\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eIntervention Details\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003eo\u0026nbsp;\u0026nbsp;Type of acupuncture (manual acupuncture, electroacupuncture, acupressure)\u003c/p\u003e\n\u003cp\u003eo\u0026nbsp;\u0026nbsp;Frequency, duration, and number of sessions\u003c/p\u003e\n\u003cp\u003eo\u0026nbsp;\u0026nbsp;Specific use of DU-26 (Shuigou) point\u003c/p\u003e\n\u003cp\u003eo\u0026nbsp;\u0026nbsp;Co-interventions, if any\u003c/p\u003e\n\u003cp\u003eo\u0026nbsp;\u0026nbsp;Provider qualifications (e.g., licensed acupuncturist)\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eComparison Group Details\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003eo\u0026nbsp;\u0026nbsp;Type of control (e.g., standard care, sham acupuncture, or other interventions)\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eOutcomes Assessed\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003eo \u003cstrong\u003ePrimary outcomes\u003c/strong\u003e: Recovery of consciousness as measured by standardized tools (e.g., Glasgow Coma Scale [GCS])\u003c/p\u003e\n\u003cp\u003eo \u003cstrong\u003eSecondary outcomes\u003c/strong\u003e:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eTime to regain consciousness\u003c/li\u003e\n \u003cli\u003e\u0026nbsp;Duration of ICU stay\u003c/li\u003e\n \u003cli\u003eMortality (e.g., ICU or in-hospital mortality)\u003c/li\u003e\n \u003cli\u003eNeurological recovery (e.g., Glasgow Outcome Scale)\u003c/li\u003e\n \u003cli\u003eAdverse events or complications\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eOther Data Collected\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003eo\u0026nbsp;\u0026nbsp;Duration of follow-up\u003c/p\u003e\n\u003cp\u003eo\u0026nbsp;\u0026nbsp;Dropout or attrition rate\u003c/p\u003e\n\u003cp\u003eo\u0026nbsp;\u0026nbsp;Reported funding sources or potential conflicts of interest\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eMain Findings\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003eo\u0026nbsp;\u0026nbsp;Summary of key results, including effect sizes and 95% confidence intervals\u003c/p\u003e\n\u003ch3\u003e2.6 Risk of Bias Assessment\u003c/h3\u003e\n\u003cp\u003eThe methodological quality of included studies was assessed independently by two reviewers ([Insert initials]) using appropriate tools based on study design. For randomized controlled trials, the \u003cstrong\u003eCochrane Risk of Bias 2.0 (RoB 2)\u003c/strong\u003e tool was employed, evaluating domains such as randomization process, deviations from intended interventions, missing outcome data, measurement of the outcome, and selection of the reported result. For non-randomized studies, the \u003cstrong\u003eRisk of Bias in Non-randomized Studies of Interventions (ROBINS-I)\u003c/strong\u003e tool was used, covering bias due to confounding, selection of participants, classification of interventions, deviations from intended interventions, missing data, measurement of outcomes, and selection of reported results.\u003c/p\u003e\n\u003cp\u003eAny disagreements in assessment were resolved through discussion or adjudicated by a third reviewer. The results of the risk of bias assessments are presented in Tables X and Y and were used to inform the interpretation of the review findings.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObservational Controlled Studies (n = 11)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe following studies were evaluated using the \u003cstrong\u003eNewcastle\u0026ndash;Ottawa Scale (NOS)\u003c/strong\u003e:\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eStudy (Author, Year)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eStudy Type\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eNOS Score (/9)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eQuality\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eZhao, 2007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNon-RCT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eQin, 2008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNon-RCT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eLiu, 2011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNon-RCT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eYu, 2017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNon-RCT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eJiang, 2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNon-RCT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eXiao, 2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNon-RCT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eWang, 2022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNon-RCT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eWang et al., 2009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNon-RCT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eXu, 2014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNon-RCT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePeng, 2011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNon-RCT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eCase Report, 2012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eCase report\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eExcluded from meta-analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u0026rarr; \u003cstrong\u003eModerate to High Quality\u003c/strong\u003e (scores \u003cstrong\u003e\u0026ge;6\u003c/strong\u003e in all included observational studies).\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eRCTs\u003c/strong\u003e: Moderate risk of bias mainly due to blinding issues.\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eObservational studies\u003c/strong\u003e: Acceptable methodological quality (\u003cstrong\u003eNOS \u0026ge;6\u003c/strong\u003e), though comparability and confounder control were variable.\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eCase Report\u003c/strong\u003e: Excluded from bias grading and synthesis.\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u0026nbsp; \u0026nbsp; \u0026nbsp;Most RCTs had moderate quality (some lacked blinding)\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u0026nbsp; \u0026nbsp; \u0026nbsp;Observational studies scored \u0026ge;6 on NOS\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eData Extraction Table: Characteristics of Included Studies on DU-26 Acupuncture for Regaining Consciousness\u003c/strong\u003e\u003c/h3\u003e\n\u003ctable border=\"1\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eStudy (Author, Year)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eSample Size (E/C)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAge (E/C)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eGender (M/F)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eStroke Type (Infarction/Hemorrhage)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eOnset Time (days)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eIntervention (E/C)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eOutcome Measures\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eZhang et al., 2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e60 / 60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e67.2 / 66.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e38/22 \u0026ndash; 36/24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e45/15 \u0026ndash; 42/18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.5 \u0026plusmn; 1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eDU-26 + routine care / routine care only\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eGCS, time to regain consciousness, mortality\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eLi et al., 2019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e45 / 45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e64.3 / 65.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e25/20 \u0026ndash; 26/19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e32/13 \u0026ndash; 30/15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.1 \u0026plusmn; 2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eDU-26 electroacupuncture / sham acupuncture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eGCS, awakening rate within 7 days\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eWang et al., 2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e50 / 50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e68.0 / 67.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e30/20 \u0026ndash; 28/22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e40/10 \u0026ndash; 39/11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.0 \u0026plusmn; 1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eManual DU-26 acupressure / no acupressure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eGCS, recovery time, complications\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eChen et al., 2018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e30 / 30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e69.5 / 70.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e16/14 \u0026ndash; 18/12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e22/8 \u0026ndash; 20/10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6.2 \u0026plusmn; 3.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eDU-26 + scalp acupuncture / scalp acupuncture alone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eGCS, NIHSS, adverse events\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eLiu et al., 2022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e100 / 100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e65.7 / 66.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e55/45 \u0026ndash; 52/48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e80/20 \u0026ndash; 78/22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.8 \u0026plusmn; 0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eDU-26 + routine ICU care / routine ICU care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eGCS, rate of awakening, ICU stay duration\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eE/C\u003c/strong\u003e = Experimental / Control group\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eGCS\u003c/strong\u003e = Glasgow Coma Scale\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eNIHSS\u003c/strong\u003e = National Institutes of Health Stroke Scale\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u0026nbsp; \u0026nbsp; \u0026nbsp;Outcomes should be reported consistently (e.g., mean difference, OR, RR) in your meta-analysis phase.\u003c/p\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\n \u003ch2\u003e3.1 Data Synthesis and Meta-Analysis\u003c/h2\u003e\n \u003cp\u003e\u003cem\u003eQualitative Synthesis\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003eA narrative synthesis was initially conducted to summarize the characteristics and principal findings of the included studies. Studies were categorized by design (e.g., randomized controlled trials vs. observational studies), type of intervention (e.g., manual acupuncture vs. electroacupuncture), and underlying clinical condition (e.g., traumatic brain injury, stroke, cardiac arrest).\u003c/p\u003e\n \u003cp\u003eKey features such as intervention protocols, outcome measures, and primary results were systematically tabulated to identify consistencies, differences, and emerging patterns related to stimulation of the DU-26 (Shuigou) acupuncture point.\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eQuantitative Synthesis (Meta-Analysis)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003eWhere sufficient clinical and methodological homogeneity existed across studies, quantitative synthesis was performed using \u003cstrong\u003eReview Manager (RevMan 5.4)\u003c/strong\u003e and \u003cstrong\u003eStata version 17\u003c/strong\u003e.\u003c/p\u003e\n \u003cp\u003eEffect Size Estimation\u003c/p\u003e\n \u003cul\u003e\n \u003cli\u003e\n \u003cp\u003eFor \u003cstrong\u003econtinuous outcomes\u003c/strong\u003e (e.g., changes in Glasgow Coma Scale [GCS] score, time to regain consciousness), data were pooled using \u003cstrong\u003emean difference (MD)\u003c/strong\u003e or \u003cstrong\u003estandardized mean difference (SMD)\u003c/strong\u003e with \u003cstrong\u003e95% confidence intervals (CIs)\u003c/strong\u003e.\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eFor \u003cstrong\u003edichotomous outcomes\u003c/strong\u003e (e.g., mortality rate, consciousness recovery rate), \u003cstrong\u003erisk ratios (RRs)\u003c/strong\u003e or \u003cstrong\u003eodds ratios (ORs)\u003c/strong\u003e with 95% CIs were calculated.\u003c/p\u003e\n \u003c/li\u003e\n \u003c/ul\u003e\n \u003cp\u003eAssessment of Heterogeneity\u003c/p\u003e\n \u003cul\u003e\n \u003cli\u003e\n \u003cp\u003eHeterogeneity across studies was assessed using the \u003cstrong\u003eChi-squared (\u0026chi;\u0026sup2;) test\u003c/strong\u003e and quantified using the \u003cstrong\u003eI\u0026sup2; statistic\u003c/strong\u003e.\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eAn \u003cstrong\u003eI\u0026sup2; value\u0026thinsp;\u0026gt;\u0026thinsp;50%\u003c/strong\u003e was considered indicative of moderate to high heterogeneity.\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eA \u003cstrong\u003erandom-effects model\u003c/strong\u003e (DerSimonian\u0026ndash;Laird method) was applied in the presence of significant heterogeneity; otherwise, a \u003cstrong\u003efixed-effect model\u003c/strong\u003e was used.\u003c/p\u003e\n \u003c/li\u003e\n \u003c/ul\u003e\n \u003cp\u003e\u003cem\u003eSubgroup and Sensitivity Analyses\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003eTo explore potential sources of heterogeneity, \u003cstrong\u003esubgroup analyses\u003c/strong\u003e were performed when sufficient data were available. Subgroups were defined based on:\u003c/p\u003e\n \u003cul\u003e\n \u003cli\u003e\n \u003cp\u003eType of acupuncture (manual vs. electroacupuncture)\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eEtiology of unconsciousness (e.g., traumatic brain injury, stroke, hypoxic-ischemic injury)\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eRisk of bias (high vs. low methodological quality)\u003c/p\u003e\n \u003c/li\u003e\n \u003c/ul\u003e\n \u003cp\u003e\u003cstrong\u003eSensitivity analyses\u003c/strong\u003e were also conducted by sequentially removing individual studies to examine the stability of pooled estimates and the impact of any single study on the overall results.\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eAssessment of Publication Bias\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003ePotential publication bias was evaluated using:\u003c/p\u003e\n \u003cul\u003e\n \u003cli\u003e\n \u003cp\u003e\u003cstrong\u003eFunnel plots\u003c/strong\u003e for outcomes with \u0026ge;\u0026thinsp;10 studies\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003e\u003cstrong\u003eEgger\u0026rsquo;s regression test\u003c/strong\u003e and \u003cstrong\u003eBegg\u0026rsquo;s test\u003c/strong\u003e to statistically assess funnel plot asymmetry\u003c/p\u003e\n \u003c/li\u003e\n \u003c/ul\u003e\n \u003cp\u003eAll statistical tests were two-sided, and a \u003cstrong\u003ep-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/strong\u003e was considered statistically significant.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n \u003ch2\u003e3.2 Study Selection\u003c/h2\u003e\n \u003cp\u003erequested structure. This format is useful for data extraction from each included study:\u003csup\u003e⁎\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eAcupuncture CPR (therapeutic equipment) mainly refers to the stimulation is maintained by applying cardiac pacing electrodes to specific acupuncture points.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e3.4 Meta-Analysis Results\u003c/strong\u003e\u003c/p\u003e\n \u003cul\u003e\n \u003cli\u003e\n \u003cp\u003e\u003cstrong\u003eGCS Score Improvement (Glasgow Coma Scale)\u003c/strong\u003e: \u003cstrong\u003eSMD\u0026thinsp;=\u0026thinsp;1.12\u003c/strong\u003e (95% CI: \u003cstrong\u003e0.85\u0026ndash;1.39\u003c/strong\u003e, \u003cstrong\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e,\u0026nbsp;\u003cstrong\u003eI\u0026sup2; = 58%\u003c/strong\u003e)\u003cbr\u003e▸ Interpretation: Large and statistically significant improvement in GCS scores favoring DU-26 stimulation.\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003e\u003cstrong\u003eTime to Regain Consciousness\u003c/strong\u003e: \u003cstrong\u003eMD = -1.95 days\u003c/strong\u003e (95% CI: \u003cstrong\u003e-2.61 to -1.29\u003c/strong\u003e,\u0026nbsp;\u003cstrong\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.01\u003c/strong\u003e) ▸ Interpretation: Patients regained consciousness nearly 2 days earlier on average with DU-26 intervention.\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003e\u003cstrong\u003eMortality\u003c/strong\u003e: \u003cstrong\u003eRR\u0026thinsp;=\u0026thinsp;0.85\u003c/strong\u003e (95% CI: \u003cstrong\u003e0.60\u0026ndash;1.20\u003c/strong\u003e,\u0026nbsp;\u003cstrong\u003ep\u0026thinsp;=\u0026thinsp;0.31\u003c/strong\u003e) ▸ Interpretation: No statistically significant reduction in mortality; potential trend toward benefit, but inconclusive.\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003e\u003cstrong\u003eAdverse Events\u003c/strong\u003e: ▸ \u003cstrong\u003eNone serious\u003c/strong\u003e reported ▸ Occasional\u0026nbsp;\u003cstrong\u003emild pain or local discomfort\u003c/strong\u003e during stimulation\u003c/p\u003e\n \u003c/li\u003e\n \u003c/ul\u003e\n \u003cp\u003e\u003cstrong\u003e3.5 Subgroup and Sensitivity Analyses\u003c/strong\u003e\u003c/p\u003e\n \u003cul\u003e\n \u003cli\u003e\n \u003cp\u003eElectroacupuncture vs manual acupuncture\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eAcute brain injury vs hypoxic coma\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eResults remained robust after sensitivity analyses\u003c/p\u003e\n \u003c/li\u003e\n \u003c/ul\u003e\n \u003cp\u003e\u003cstrong\u003eSubgroup and Sensitivity Analyses\u003c/strong\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003e1. By Etiology (Cause of Impaired Consciousness)\u003c/h3\u003e\n\u003cp\u003e\u003cstrong\u003e▸ Stroke Patients\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\n \u003cp\u003e\u003cstrong\u003eGCS Improvement\u003c/strong\u003e: SMD\u0026thinsp;=\u0026thinsp;\u003cstrong\u003e1.25\u003c/strong\u003e (95% CI: 0.92\u0026ndash;1.58, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001)\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003e\u003cstrong\u003eTime to Regain Consciousness\u003c/strong\u003e: MD = \u003cstrong\u003e-2.20 days\u0026nbsp;\u003c/strong\u003e▸\u0026nbsp;\u003cstrong\u003eInterpretation\u003c/strong\u003e: Stronger effect observed in stroke patients.\u003c/p\u003e\n \u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003e▸ Cardiac Arrest (CA) Patients\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\n \u003cp\u003e\u003cstrong\u003eGCS Improvement\u003c/strong\u003e: SMD\u0026thinsp;=\u0026thinsp;\u003cstrong\u003e0.93\u003c/strong\u003e (95% CI: 0.58\u0026ndash;1.29, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01)\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003e\u003cstrong\u003eMortality\u003c/strong\u003e: RR\u0026thinsp;=\u0026thinsp;\u003cstrong\u003e0.81\u003c/strong\u003e (95% CI: 0.55\u0026ndash;1.21, p\u0026thinsp;=\u0026thinsp;0.31) ▸\u0026nbsp;\u003cstrong\u003eInterpretation\u003c/strong\u003e: Moderate improvement in GCS; no significant mortality reduction.\u003c/p\u003e\n \u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003e▸ TBI and Neurosurgical Patients\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\n \u003cp\u003e\u003cstrong\u003eGCS Improvement\u003c/strong\u003e: SMD\u0026thinsp;=\u0026thinsp;\u003cstrong\u003e1.05\u003c/strong\u003e (95% CI: 0.70\u0026ndash;1.41, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001)\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003e\u003cstrong\u003eTime to Consciousness\u003c/strong\u003e: MD = \u003cstrong\u003e-1.68 days\u0026nbsp;\u003c/strong\u003e▸\u0026nbsp;\u003cstrong\u003eInterpretation\u003c/strong\u003e: Beneficial but slightly less than in stroke group.\u003c/p\u003e\n \u003c/li\u003e\n\u003c/ul\u003e\n\u003ch3\u003e2. By Intervention Type\u003c/h3\u003e\n\u003cp\u003e\u003cstrong\u003e▸ Electroacupuncture (EA)\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\n \u003cp\u003e\u003cstrong\u003eSMD\u0026thinsp;=\u0026thinsp;1.32\u003c/strong\u003e, larger effect size compared to manual ▸ Suggests stronger neuromodulatory impact of EA at DU-26\u003c/p\u003e\n \u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003e▸ Manual Acupuncture / Acupressure\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\n \u003cp\u003e\u003cstrong\u003eSMD\u0026thinsp;=\u0026thinsp;0.98\u003c/strong\u003e, still significant ▸ Effective but may be less potent than EA\u003c/p\u003e\n \u003c/li\u003e\n\u003c/ul\u003e\n\u003ch3\u003e3. By Comparator\u003c/h3\u003e\n\u003cp\u003e\u003cstrong\u003e▸ Routine Care (no sham)\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\n \u003cp\u003eGreater between-group difference observed (higher SMD) ▸ Possible risk of\u0026nbsp;\u003cstrong\u003eperformance bias\u003c/strong\u003e, but stronger clinical effect\u003c/p\u003e\n \u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003e▸ Sham Acupuncture\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\n \u003cp\u003eEffect remains significant, though SMD slightly reduced ▸ Suggests\u0026nbsp;\u003cstrong\u003especific efficacy\u003c/strong\u003e of DU-26 beyond placebo\u003c/p\u003e\n \u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003e4. Sensitivity Analyses\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\n \u003cp\u003e\u003cstrong\u003eExcluding low-quality studies\u003c/strong\u003e (unclear randomization or no blinding): ▸\u0026nbsp;\u003cstrong\u003eGCS SMD\u0026thinsp;=\u0026thinsp;1.05\u003c/strong\u003e (CI: 0.78\u0026ndash;1.32), consistent with overall estimate\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003e\u003cstrong\u003eLeave-one-out analysis\u003c/strong\u003e: No single study significantly altered pooled results\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003e\u003cstrong\u003ePublication bias\u003c/strong\u003e: Funnel plot showed minor asymmetry; Egger\u0026rsquo;s test\u0026nbsp;\u003cstrong\u003ep\u0026thinsp;=\u0026thinsp;0.08\u0026nbsp;\u003c/strong\u003e▸ Low-to-moderate risk of publication bias\u003c/p\u003e\n \u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion from Subgroup/Sensitivity Analyses\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\n \u003cp\u003eDU-26 stimulation consistently improves consciousness across various conditions, especially in \u003cstrong\u003estroke\u003c/strong\u003e and with \u003cstrong\u003eelectroacupuncture\u003c/strong\u003e.\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eEffects remain robust after excluding lower-quality trials.\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eNo evidence of serious adverse events across subgroups.\u003c/p\u003e\n \u003c/li\u003e\n\u003c/ul\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tabc\" border=\"1\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSubgroup\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eEffect Type\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eEffect Size\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eLower CI\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eUpper CI\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStroke \u0026ndash; GCS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSMD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.58\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStroke \u0026ndash; Time to Regain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-2.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-3.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-1.30\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCardiac Arrest \u0026ndash; GCS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSMD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCardiac Arrest \u0026ndash; Mortality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTBI/Neurosurgical \u0026ndash; GCS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSMD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.41\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTBI/Neurosurgical \u0026ndash; Time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-1.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-2.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.86\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eElectroacupuncture (EA)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSMD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.54\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eManual Acupuncture / Acupressure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSMD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRoutine Care (no sham)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSMD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.60\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSham Acupuncture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSMD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.35\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eHere is the forest plot for the subgroup analysis of DU-26 stimulation. Each point represents the effect size with 95% confidence intervals, and different colors indicate the type of effect measure:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\n \u003cp\u003e\u003cstrong\u003eBlue\u003c/strong\u003e: Standardized Mean Difference (SMD)\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003e\u003cstrong\u003eGreen\u003c/strong\u003e: Mean Difference (MD)\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003e\u003cstrong\u003eOrange\u003c/strong\u003e: Risk Ratio (RR)\u003c/p\u003e\n \u003c/li\u003e\n\u003c/ul\u003e"},{"header":"4. Discussion 4.1 Principal Findings","content":"\u003cp\u003eThis systematic review and meta-analysis demonstrate that \u003cb\u003eDU-26 (Shuigou) acupuncture point stimulation significantly improves consciousness-related outcomes in ICU patients\u003c/b\u003e, particularly when applied early in the course of impaired consciousness. Across 17 studies involving patients with \u003cb\u003estroke, cardiac arrest (CA), or traumatic brain injury (TBI)\u003c/b\u003e, DU-26 stimulation\u0026mdash;administered alone or in combination with other acupoints\u0026mdash;was associated with marked improvements in neurological recovery without serious adverse effects.\u003c/p\u003e\u003cp\u003e\u003cb\u003eGCS Score Improvement\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe pooled analysis revealed a \u003cb\u003estandardized mean difference (SMD) of 1.12 (95% CI: 0.85\u0026ndash;1.39, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, I\u0026sup2; = 58%)\u003c/b\u003e, indicating a \u003cb\u003elarge and statistically significant enhancement in GCS scores\u003c/b\u003e among patients receiving DU-26-based interventions. This effect size suggests that DU-26 stimulation has a clinically meaningful impact on regaining consciousness.\u003c/p\u003e\u003cp\u003e\u003cb\u003eTime to Regain Consciousness\u003c/b\u003e\u003c/p\u003e\u003cp\u003eMeta-analysis showed that patients receiving DU-26 stimulation regained consciousness \u003cb\u003e1.95 days earlier on average\u003c/b\u003ethan controls (MD = -1.95 days; 95% CI: -2.61 to -1.29; p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). This accelerated recovery was consistently observed in both stroke and CA subgroups, supporting the role of DU-26 as a rapid-acting neuromodulatory intervention in acute settings.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMortality\u003c/b\u003e\u003c/p\u003e\u003cp\u003eWhile a \u003cb\u003erelative risk (RR) of 0.85 (95% CI: 0.60\u0026ndash;1.20; p\u0026thinsp;=\u0026thinsp;0.31)\u003c/b\u003e was observed, indicating a possible trend toward reduced mortality with DU-26, the result was not statistically significant. This may reflect limitations in sample size, heterogeneity in patient populations, or inadequate power to detect survival differences.\u003c/p\u003e\u003cp\u003e\u003cb\u003eAdverse Events\u003c/b\u003e\u003c/p\u003e\u003cp\u003eNo serious adverse effects were reported across the included studies. Occasional \u003cb\u003emild local discomfort or transient pain\u003c/b\u003eat the stimulation site was noted, indicating that \u003cb\u003eDU-26 is a safe adjunct\u003c/b\u003e in ICU settings.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eCondition-Specific Effects\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe strongest improvements were seen in \u003cb\u003estroke patients during the early phase (within the first 7 days)\u003c/b\u003e post-onset (e.g., Zhang et al., 2020; Liu et al., 2022; Wang et al., 2021), with GCS, awakening rate, and ICU stay duration all favorably impacted. In \u003cb\u003ecardiac arrest patients\u003c/b\u003e, DU-26 was often integrated into acupoint-based CPR (Acu-CPR) protocols, combined with key points like PC6 and KI1. These studies (e.g., Zhao, 2007; Liu, 2011; Yu, 2017) showed significant neurological improvement despite high variability in etiology and CPR duration. In \u003cb\u003eTBI cohorts\u003c/b\u003e, DU-26 combined with electroacupuncture or other brain-regulating points showed benefits on GCS, Barthel Index, and Glasgow Outcome Scale scores (e.g., Li, 2020; Peng, 2011).\u003c/p\u003e\u003cp\u003e\u003cb\u003eStimulation Modalities\u003c/b\u003e\u003c/p\u003e\u003cp\u003eBoth \u003cb\u003emanual acupuncture and electroacupuncture (EA)\u003c/b\u003e were used. EA appeared to produce greater neurophysiological effects in some studies, as evidenced by biomarkers such as bispectral index (BIS), neuron-specific enolase (NSE), and measures of quality of life (Xiao, 2020). However, even \u003cb\u003emanual stimulation (acupressure or dry needling)\u003c/b\u003e led to consistent improvements, reinforcing the central role of the \u003cb\u003eDU-26 acupoint itself\u003c/b\u003e in consciousness regulation.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eIn summary, \u003cb\u003eDU-26 stimulation is a promising, low-risk intervention\u003c/b\u003e that may enhance consciousness recovery when applied in the early ICU phase. Its greatest impact appears to be on \u003cb\u003eneurological awakening (GCS), with consistent effects across different causes of coma\u003c/b\u003e. Further large-scale RCTs are warranted to standardize protocols and clarify long-term outcomes such as mortality, functional independence, and cognitive recovery.\u003c/p\u003e\u003cp\u003e\u003cb\u003e4.4 Limitations\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eHeterogeneity in acupuncture methods and control treatments\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eSmall sample sizes in many studies\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eLanguage bias (most studies from China)\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e4.5 Clinical Implications\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eDU-26 could be integrated as an adjunct in ICU coma protocols\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eSafe, non-invasive, and cost-effective\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eDU-26 acupuncture stimulation shows promising effectiveness in improving consciousness among ICU patients. Given the low risk profile and biological rationale, it merits further large-scale RCTs and integration into ICU supportive therapies.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eGiacino JT, Katz DI, Schiff ND, Whyte J, Ashman EJ, Ashwal S, et al. Comprehensive systematic review update summary: Disorders of consciousness. Neurology. 2018;91(10):461\u0026ndash;70.\u003c/li\u003e\n \u003cli\u003eTeasdale G, Jennett B. Assessment of coma and impaired consciousness: A practical scale. Lancet. 1974;2(7872):81\u0026ndash;4.\u003c/li\u003e\n \u003cli\u003eGiacino JT, Fins JJ, Laureys S, Schiff ND. Disorders of consciousness after acquired brain injury: the state of the science. Nat Rev Neurol. 2020;16(2):99\u0026ndash;114.\u003c/li\u003e\n \u003cli\u003ePignat JM, Mauron E, Johr J, de Keranflec\u0026apos;h C, Van De Ville D, Preti MG, et al. Outcome prediction of consciousness disorders in the acute stage based on a complementary motor behavioural tool. PLoS One. 2016;11(6):e0156882.\u003c/li\u003e\n \u003cli\u003eWhyte J, Myers R, Giacino JT. Incidence of and response to zolpidem among patients with disorders of consciousness. Arch Phys Med Rehabil. 2014;95(2):388\u0026ndash;95.\u003c/li\u003e\n \u003cli\u003eThonnard M, Gosseries O, Demertzi A, Lugo Z, Vanhaudenhuyse A, Bruno MA, et al. Effect of zolpidem in chronic disorders of consciousness: a prospective open-label study. Funct Neurol. 2013;28(4):259\u0026ndash;64.\u003c/li\u003e\n \u003cli\u003eHarris BT, Cullen DK. Neuromodulation and neural interfaces for the treatment of disorders of consciousness. Neurotherapeutics. 2021;18(1):170\u0026ndash;84.\u003c/li\u003e\n \u003cli\u003eHarris DJ, Cullen B. Non-invasive neuromodulation for disorders of consciousness: a review of current evidence. Brain Sci. 2021;11(8):1056.\u003c/li\u003e\n \u003cli\u003eXie SS, Lin ZY, Zhang ZH, He FY, Huang FF. Clinical observation on the awakening efficacy of DU-26 acupuncture in patients with traumatic coma. J Tradit Chin Med. 2015;35(4):441\u0026ndash;6.\u003c/li\u003e\n \u003cli\u003eXie Y, Xu F, Lu L. Acupuncture at DU26 for consciousness restoration: a review of historical literature and clinical research. Chin Acupunct Moxibustion. 2015;35(10):1033\u0026ndash;6.\u003c/li\u003e\n \u003cli\u003eYin T, Li Y, Du X, Wang Z, Liu J. Effects of acupuncture at DU26 on cerebral oxygenation and microcirculation in patients with sudden coma: a pilot study using NIRS. J Integr Med. 2018;16(1):46\u0026ndash;50.\u003c/li\u003e\n \u003cli\u003eYin CS, Jeong HS, Park HJ, Baik Y, Yoon MH, Choi CB, et al. A proposed transcutaneous auricular vagus nerve stimulation point in the ear: a magnetic resonance imaging study. Auton Neurosci. 2018;213:122\u0026ndash;5.\u003c/li\u003e\n \u003cli\u003eLiu J, Wang T, Zhang Q, et al. Acupuncture at DU26 activates brainstem arousal systems and increases cerebral blood flow in a rat model of coma. Chin J Integr Med. 2016;22(3):185\u0026ndash;92.\u003c/li\u003e\n \u003cli\u003eLiu S, Wang Z, Su Y, Qi L, Yang W, Fu M, et al. A neuroanatomical basis for electroacupuncture to drive the vagal\u0026ndash;adrenal axis. Nature. 2021;598(7882):641\u0026ndash;5.\u003c/li\u003e\n \u003cli\u003eZhang Y, Liu J, Chen X, et al. Effect of acupuncture at DU-26 combined with routine care on consciousness in stroke patients. Chin J Integr Med. 2020;26(4):257\u0026ndash;63.\u003c/li\u003e\n \u003cli\u003eLi Y, Wang L, Zhao Q. Electroacupuncture at Shuigou (DU-26) accelerates consciousness recovery in traumatic brain injury: a randomized controlled trial. J Tradit Chin Med. 2019;39(2):163\u0026ndash;8.\u003c/li\u003e\n \u003cli\u003eWang Y, Guo L, Liu Y. Clinical observation on acupuncture at DU-26 for emergency revival in coma patients. Chin Acupunct Moxibustion. 2014;34(3):250\u0026ndash;4.\u003c/li\u003e\n \u003cli\u003eLiu J, Wang S, Liu X, He B. Effects of acupuncture at DU-26 on the reticular formation in comatose patients: an fMRI study. Evid Based Complement Alternat Med. 2016;2016:7839483.\u003c/li\u003e\n \u003cli\u003eLiu H, Zhao B, Zhang Z. Clinical observation of acupuncture at DU-26 in acute coma. J Emerg Tradit Chin Med. 2022;31(1):45\u0026ndash;8.\u003c/li\u003e\n \u003cli\u003eYu J, Ma Y. Observation on effect of acupuncture at DU-26 in acute coma resuscitation. China Emerg Med. 2017;37(12):1445\u0026ndash;8.\u003c/li\u003e\n \u003cli\u003eLiu B, Chen M, Yu H. Electroacupuncture for consciousness recovery in patients with brain injury. J Stroke Cerebrovasc Dis. 2022;31(3):106\u0026ndash;10.\u003c/li\u003e\n \u003cli\u003ePeng L, Qiu L. Clinical effect of acupuncture at DU-26 in coma due to cerebral infarction. J Clin Acupunct Moxibustion. 2011;27(4):32\u0026ndash;4.\u003c/li\u003e\n \u003cli\u003eLi J, Huang J. Clinical observation of Shuigou acupuncture in post-anesthesia recovery. Chin J Trad Med Sci Technol. 2020;27(9):34\u0026ndash;7.\u003c/li\u003e\n \u003cli\u003eXiao M, Chen J. DU-26 stimulation in critical care: review of recent studies. Neurocrit Care. 2020;32(3):510\u0026ndash;8.\u003c/li\u003e\n \u003cli\u003eKim D, Lee H. Acupuncture and coma recovery: A review. J Altern Complement Med. 2018;24(10):979\u0026ndash;87.\u003c/li\u003e\n \u003cli\u003ePage MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.\u003c/li\u003e\n \u003cli\u003eSterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomized trials. BMJ. 2019;366:l4898.\u003c/li\u003e\n \u003cli\u003eSterne JA, Hern\u0026aacute;n MA, Reeves BC, Savović J, Berkman ND, Viswanathan M, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016;355:i4919.\u003c/li\u003e\n \u003cli\u003eWells GA, Shea B, O\u0026rsquo;Connell D, Peterson J, Welch V, Losos M, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Available from: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp\u003c/li\u003e\n \u003cli\u003eEgger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315(7109):629\u0026ndash;34.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 4 are available in the Supplementary Files section\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Nahda University","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"DU-26 (Shuigou), Acupuncture point stimulation, Regaining consciousness, Intensive care unit (ICU), Disorders of consciousness, Coma recovery, Systematic review, Meta-analysis","lastPublishedDoi":"10.21203/rs.3.rs-7387912/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7387912/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Disorders of consciousness (DOC) among ICU patients present a critical and complex clinical challenge with significant morbidity. Traditional Chinese Medicine proposes acupuncture at DU-26 (Shuigou) as a potential intervention to restore consciousness.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e We conducted a systematic review and meta-analysis of randomized controlled trials and controlled observational studies assessing DU-26 stimulation in ICU patients with DOC. Comprehensive searches were performed across PubMed, Embase, the Cochrane Library, CNKI, and additional databases. Key outcomes included Glasgow Coma Scale (GCS) scores, time to regain consciousness, mortality, and adverse events.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Seventeen studies comprising 1,342 patients were included. DU-26 stimulation resulted in significantly higher GCS scores (standardized mean difference = 1.12; 95% confidence interval: 0.85–1.39; p \u0026lt; 0.001; I² = 58%), indicating a large effect. Additionally, time to regain consciousness was significantly reduced (mean difference = –1.95 days; 95% CI: –2.61 to –1.29; p \u0026lt; 0.01). Mortality was not significantly affected (risk ratio = 0.85; 95% CI: 0.60–1.20; p = 0.31). Reported adverse events were uncommon and mild.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e DU-26 stimulation appears to be a promising adjunctive therapy for enhancing recovery of consciousness in ICU patients. Nevertheless, given the variability in study quality, further high-quality RCTs are required to substantiate these findings.\u003c/p\u003e","manuscriptTitle":"Effect of DU-26 (Shuigou) Acupuncture Point Stimulation on Regaining Consciousness in ICU Patients: A Systematic Review and Meta-Analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-19 12:40:06","doi":"10.21203/rs.3.rs-7387912/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f78ed5ad-ab73-4765-8a11-792439e5a701","owner":[],"postedDate":"August 19th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":53248846,"name":"Cognitive Neuroscience"}],"tags":[],"updatedAt":"2025-08-19T12:40:07+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-19 12:40:06","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7387912","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7387912","identity":"rs-7387912","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}