Acupuncture (Especially Electroacupuncture) in the Treatment of Sepsis
針灸（尤其是電針）在敗血症治療中的應用
Medical note｜醫療提醒：
This article is for education only and does not replace medical care. Sepsis is a medical emergency—seek urgent medical help immediately.
本文僅供教育用途，不能取代醫療診斷與治療。敗血症屬急症，請立即就醫。
本文僅供教育用途，不能取代醫療診斷與治療。敗血症屬急症，請立即就醫。
Overview
Sepsis is a life-threatening systemic inflammatory response triggered by infection, potentially leading to multiple organ dysfunction and high mortality. Standard treatments include antibiotics, fluid resuscitation, and organ support, but mortality remains elevated. Acupuncture, particularly electroacupuncture (EA), has emerged as a potential adjunctive therapy in recent studies, primarily by modulating immune inflammation, protecting organs, and improving prognosis.
敗血症是一種由感染引發的全身性炎症反應，可能導致多器官功能障礙，甚至死亡。目前標準治療包括抗生素、液體復甦、器官支持等，但死亡率仍高。針灸（特別是電針，electroacupuncture）作為中醫輔助療法，在近年研究中顯示潛在益處，主要透過調節免疫炎症反應、保護器官功能來改善預後。
Primary Mechanisms (Based on Animal and Clinical Studies)
主要機制（基於動物與臨床研究）
Anti-inflammatory effects｜抗炎作用
Acupuncture reduces pro-inflammatory cytokines (e.g., TNF-α, IL-6, IL-1β) and elevates anti-inflammatory factors (e.g., IL-10), activating the cholinergic anti-inflammatory pathway involving the vagus nerve and peripheral sensory afferents (including the sciatic nerve in electroacupuncture models).
針灸可降低促炎細胞因子（如 TNF-α、IL-6、IL-1β），提升抗炎因子（如 IL-10），並激活膽鹼能抗炎途徑（cholinergic anti-inflammatory pathway），涉及迷走神經及周邊感覺傳入神經（在電針模型中包括坐骨神經）。
Immune modulation｜免疫調節
Improves T-cell subsets (CD4+/CD8+ ratio), monocyte HLA-DR expression, and reverses immunosuppression.
改善 T 細胞亞群（CD4+/CD8+ 比率）、單核細胞 HLA-DR 表達，逆轉免疫抑制。
Organ protection｜器官保護
Enhances gut barrier function, reduces intra-abdominal pressure, protects lungs, brain, heart, etc., and mitigates oxidative stress and apoptosis.
改善腸道屏障功能、降低腹內壓、保護肺、腦、心等器官，減少氧化應激與細胞凋亡。
Common acupoints｜常用穴位
Zusanli (ST36), Guanyuan (CV4/RN4), Qihai (CV6), Shangjuxu (ST37), often with EA stimulation.
足三里（ST36）、關元（CV4/RN4）、氣海（CV6）、上巨虛（ST37）等，常使用電針刺激。
Clinical Evidence Overview (Updated to 2025)
臨床證據概述（更新至 2025 年）
Multiple RCTs and systematic reviews indicate that acupuncture combined with conventional treatment outperforms conventional treatment alone:
多項隨機對照試驗（RCT）與系統綜述顯示，針灸結合常規治療比單純常規治療更有益處：
Key outcomes｜主要結果
Improves clinical indicators: reduces APACHE II scores (disease severity), shows a trend toward lower 28-day mortality (reported OR ≈ 0.61–0.69 in meta-analyses), enhances gut function (e.g., lower intestinal permeability, D-lactate levels), and decreases inflammatory markers (e.g., PCT, CRP, IL-6).
改善臨床指標：降低 APACHE II 評分（疾病嚴重度）、呈現 28 天死亡率下降趨勢（系統綜述與 meta 分析報告 OR 約 0.61–0.69）、改善腸道功能（如降低腸滲透性、D-乳酸水平）、減輕炎症標記（如 PCT、CRP、IL-6）。
Specific examples｜具體研究示例
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2016 study: EA at ST36 and Guanyuan improved immune function in sepsis patients (increased CD3+, CD4+, CD8+).
2016 年研究： 電針 ST36 與關元，提升敗血症患者免疫功能（CD3+、CD4+、CD8+ 表達增加）。
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2018 RCT: EA improved gut dysfunction and intra-abdominal pressure.
2018 年 RCT： 電針改善敗血症患者腸功能障礙與腹內壓。
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2023–2025 reviews: EA targets immune modulation (e.g., PD-1 pathway, STAT3 inhibition), alleviates inflammation and organ injury; promising as complementary strategy.
2023–2025 年綜述： 電針透過免疫調節（如 PD-1 途徑、STAT3 抑制）緩解炎症與器官損傷；作為輔助策略有前景。
Study profile｜研究概況
Most clinical trials originate from China, with moderate sample sizes (50–200 patients) and treatment durations of 1–2 weeks (daily or alternate days).
大多數臨床試驗來自中國，樣本量中等（50–200 人），療程通常 1–2 週，每天或隔天治療。
Safety
安全性
Acupuncture as an adjunctive therapy is generally safe, with rare adverse events (mild, e.g., needle-site pain or bruising, incidence <10%). No serious side effects were reported in the cited reviews; in critically ill patients, it should be considered only when performed by trained practitioners under ICU monitoring.
針灸作為輔助療法整體上安全，不良事件少見（多為輕微，如針刺部位疼痛、瘀青，發生率 <10%）。引用之綜述中未見嚴重副作用報告；對重症患者而言，需由受過專業訓練者操作並在 ICU 監測下方可考慮使用。
Current Limitations and Recommendations
目前局限與建議
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Evidence level: Preliminary benefits observed, but many trials are moderate quality (risk of bias, small samples, lack of large multicenter RCTs). Limited application in Western countries; primarily used in integrated Chinese-Western medicine hospitals in China.
證據等級： 初步有益，但多數試驗品質中等（偏倚風險、樣本小、無多中心大規模 RCT）。西方國家臨床應用較少，主要在中國中西醫結合醫院使用。
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Positioning: Currently only as adjunctive therapy; cannot replace antibiotics or supportive care. Best considered for early intervention to help prevent organ failure or manage immune dysregulation.
定位： 目前僅作為輔助療法，不能取代抗生素與支持治療。可作為早期介入的補充，以協助預防器官衰竭或改善免疫失調。
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Future outlook: 2023–2025 studies emphasize need for higher-quality, multicenter trials. Experts view it as a promising complementary option, potentially evolving into a standard adjunct. Not mentioned in Surviving Sepsis Campaign guidelines as standard care.
未來展望： 2023–2025 年研究強調需更多高品質、多中心試驗。部分專家視為有前景的補充策略，未來可能發展為標準輔助選項。Surviving Sepsis Campaign 指南中未將針灸列為標準治療。
Practical note｜實務提醒
If you or a loved one has sepsis, consult a physician for integrated care and refer to the latest guidelines (e.g., Surviving Sepsis Campaign). For acupuncture protocols, seek a qualified, licensed practitioner and coordinate with the ICU team.
若您或親友有敗血症，請在醫師指導下進行整合治療並參考最新指南（如 Surviving Sepsis Campaign）。若考慮針灸，請諮詢合格執業者並與 ICU 團隊協調。
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