This is particularly true if participants have a high number of hot flashes at baseline16 and may be more common in participants receiving treatments that are associated
with more intense attention.
Also, there was an alarming prevalence of adverse events (22%) that were not insignificant, including burns and negative physical reactions to smoke. Given the lack of proven efficacy and such toxicity, moxibustion is not something that should be recommended for clinical practice.
Nonetheless, this study raises the question of the value of acupuncture as a treatment for hot flashes. There are multiple claims suggesting that it might be beneficial for women with hot flashes in the medical literature, in the lay literature, and on the Internet.
A recent PubMed search of the following terms "hot flash" and "acupuncture" with limitations of "humans," "randomized controlled trial," and "English" revealed 11
clinical trials of interest (Table 1). These studies ranged from 18 to 267 participants. Seven of them had acupuncture and sham acupuncture arms, none of which reported any significant advantage for the purported active acupuncture
arm.(17-23) The sham acupuncture arms involved shallow needling, no needling, or using different points. Given that the mechanism of action of acupuncture is not precisely known, developing a sham that is assuredly not active has not yet been accomplished. Individual studies compared acupuncture with estrogen (22,24) and applied relaxation,(25) neither of which reported a significant advantage for the acupuncture.
One report compared transdermal estrogen versus placebo in one trial and then compared electroacupuncture versus superficial needling (sham) versus oral estrogen in another trial.(26) The authors then went on to perform a statistical analysis by combining the sham and electroacupuncture arms and compared them to the placebo arm from the other trial, something which is not considered to be
a statistically valid approach. A recently reported trial, involving 267 postmenopausal women, randomized participants to receive either acupuncture or a self-care pamphlet.27