The relationship between the treatment frequency and efficacy of acupuncture: A scoping review of clinical trials.

OBJECTIVE

To consolidate and analyze the existing evidence on the relationship between acupuncture treatment frequency and its clinical efficacy, clarify research status, trends, and core issues, and provide evidence-based insights for optimizing acupuncture treatment protocols.

METHODS

Following the Arksey and O'Malley scoping review framework and PRISMA-ScR guidelines, nine databases were searched from inception to February 15, 2025. Associations among frequency, disease, and effectiveness were visualized using heat maps and bubble charts. Between-group differences (high-frequency: more than 3 sessions/week; low-frequency: no more than 3 sessions/week) and their influencing factors were summarized.

RESULTS

Ninety-four studies were included. There was a significant disease-specific, nonlinear relationship between acupuncture frequency and efficacy. High-frequency acupuncture (> 3 sessions/week) demonstrated marked advantages in treating degenerative spinal/joint diseases, particularly during acute phases or for short-term symptom relief especially. In contrast, peripheral neuropathies showed lower sensitivity to frequency variations. Efficacy enhancement did not depend solely on increased frequency, however. Instead, we found a "J-shaped curve" and plateau effects. Significant interactions existed between frequency and other acupuncture parameters, with their importance varying by disease and treatment goals. The current literature evidence shows significant heterogeneity in its various definitions of treatment frequency, though there is an obvious a paucity of low-frequency studies.

CONCLUSION

Optimizing acupuncture frequency requires dynamic adjustments based on disease type, pathological stage, primary treatment goals, and synergistic effects with other treatment parameters. Current evidence remains limited by methodological quality and parameter interaction complexity, precluding the definition of a universally "optimal frequency." Future research should prioritize sequential factorial trials, standardized frequency criteria, and enhanced health-economic evaluations to advance the precision of acupuncture therapy.