1Innovation Research Institute of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, 250355, People’s Republic of China; 2Shandong University of Traditional Chinese Medicine, Jinan, 250355, People’s Republic of China; 3Department of Rehabilitation Medicine, Binzhou Medical University Hospital, Binzhou, Shandong, People’s Republic of China

We have carefully reviewed the article titled “Acupuncture Dosage and Its Correlation with Effectiveness in Patients with Chronic Stable Angina: A Systematic Review and Meta-Analysis of Randomized Controlled Trials” by Huang et al.1 This meta-analysis provides significant insights into the effectiveness of acupuncture for chronic stable angina (CSA), specifically examining the impact of acupuncture dosage on clinical outcomes. While we commend the authors for their comprehensive analysis, we would like to raise several points that could enhance the clinical application and scientific rigor of the study.

Firstly, the authors discuss the pivotal role of the “Deqi” response in acupuncture’s therapeutic effects. While the study mentions the importance of this response, we believe that quantifying Deqi in a more standardized and objective manner could improve the reliability of acupuncture outcomes. Given the variability in patients’ perception of Deqi, it would be valuable to explore ways of measuring this response consistently across studies.2 Additionally, could the authors elaborate on how the Deqi sensation correlates with long-term clinical outcomes, such as reduced frequency of angina attacks or improved quality of life in CSA patients?3

Secondly, while the meta-analysis includes a broad range of studies, we noted that the variability in acupuncture protocols and patient characteristics may contribute to outcome heterogeneity. It would be beneficial for future studies to focus on creating more uniform acupuncture protocols and explore the potential impact of different Deqi experiences on treatment efficacy. Standardizing protocols related to Deqi, such as specific training for acupuncturists to achieve this sensation, might help mitigate this source of variability.4

In conclusion, while Huang et al’s study offers essential insights into acupuncture’s role in managing CSA, further research on the quantification of Deqi and its relationship with treatment outcomes could enhance the precision and applicability of acupuncture therapy. We encourage future studies to address these gaps through more rigorous and standardized methodologies.

The authors report no conflicts of interest in this communication.

1. Huang D, Li Y, Zheng X, et al. Acupuncture dosage and its correlation with effectiveness in patients with chronic stable angina: a systematic review and meta-analysis of randomized controlled trial. J Pain Res. 2025;18:105–125. doi:10.2147/JPR.S489880

2. Si X, Xiang S, Zhang L, Li S, Zhang K, Ming D. Acupuncture with deqi modulates the hemodynamic response and functional connectivity of the prefrontal-motor cortical network. Front Neurosci. 2021;15:693623. doi:10.3389/fnins.2021.693623

3. Zhong Z, Yao L, Liu Y-Z, et al. Objectivization study of acupuncture deqi and brain modulation mechanisms: a review. Front Neurosci. 2024;18:1386108. doi:10.3389/fnins.2024.1386108

4. Zhao Y, Lu L, Sun L, Zhang S, Zhou S, Li Y. [Deqi(qi arrival) theory in ancient TCM books]. Zhongguo Zhen Jiu. 2017;37:90–94. Dutch. doi:10.13703/j.0255-2930.2017.01.024