Effects of pricking-and-cupping bloodletting therapy on pain and skin lesions in patients with herpes zoster: a systematic review and meta-analysis.

OBJECTIVE

To systematically assess the effectiveness and safety of pricking-and-cupping bloodletting therapy in relieving pain and improving skin lesion outcomes in herpes zoster (HZ) patients.

METHODS

All randomized controlled trials (RCTs) exploring the therapy's impact on HZ-related pain and skin lesions were identified through a comprehensive electronic search of CNKI, VIP, Wanfang, SinoMed, PubMed, EMBASE, Web of Science, and the Cochrane Library, with the search period ranging from each database's establishment until November 2025. Included studies were assessed for quality via Cochrane Risk of Bias tool, followed by meta-analysis with Stata MP 19.5. The evidence certainty for each outcome was graded via the GRADE framework. PROSPERO Registration: CRD420251267768。.

RESULTS

A total of 31 studies involving 2,443 patients were ultimately included in the meta-analysis. The pooled analysis demonstrated that, compared with conventional Western medicine, pricking-and-cupping bloodletting therapy yielded superior outcomes across multiple endpoints. These included Visual Analogue Scale (VAS) pain scores [SMD = -1.59, 95% CI (-2.13, -1.05), p < 0.001], overall response rate [RR = 1.12, 95% CI (1.04, 1.19), p = 0.001], time to cessation of vesicles [SMD = -0.96, 95% CI (-1.34, -0.58), p < 0.001], time to crust formation [SMD = -1.29, 95% CI (-1.74, -0.84), p < 0.001], time to pain relief [SMD = -5.93, 95% CI (-6.62, -5.25), p < 0.001], and the incidence of postherpetic neuralgia (PHN) [RR = 0.14, 95% CI (0.07, 0.27), p < 0.001].

CONCLUSION

Pricking-and-cupping bloodletting therapy shows a relative benefit in shortening the time to pain relief, accelerating skin lesion healing, and reducing the incidence of postherpetic neuralgia (PHN) in patients with herpes zoster. However, given the very low certainty of evidence as assessed by the GRADE framework, clinical interpretation should be cautious. Rigorous, large-sample, multicenter randomized controlled trials are urgently needed to validate its efficacy and strengthen the reliability of clinical evidence.

SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/search, identifier CRD420251267768.