*3.4. Pharmacopuncture*

Pharmacopuncture + Usual Conventional Therapy vs. Usual Conventional Therapy

The level of evidence and recommendations were derived based on eight RCTs [97,104–110] that observed the combined effect of pharmacopuncture and conventional treatment for LHIVD in terms of pain, function, and overall symptom improvement.

The meta-analysis showed that the combination of pharmacopuncture with conventional treatments, such as acupuncture and Tuina manual therapy, was more effective in improving the overall symptoms (RR: 1.19, 95% CI: 1.07–1.32, *p* < 0.001), pain (MD, –1.65, 95% CI: 1.70–−1.61, *p* < 0.001), and function (ODI: MD, −8.39, 95% CI: −10.50–−6.28, *p* < 0.001; ODI change: MD, 6.22, 95% CI: 3.10–9.33, *p* < 0.001; JOA: MD, 9.00, 95% CI: 7.89–10.11, *p* < 0.001) than usual conventional therapy. Since the overall number of evidence documents and the number of subjects included in studies was small, the level of evidence was lowered by one grade due to imprecision.

In conclusion, the combination of pharmacopuncture with conventional treatment should be considered for improving the overall symptoms of LHIVD (B/Moderate).
