46 acupuncture RCTs.24 A 2012 Cochrane review reported that compared with other treatment alone, acupuncture as an adjunct might marginally increase the proportion of people with improved sleep quality (OR 3.1, 95% CI: 1.9, 4.9) but concluded that the current evidence is not sufficiently rigorous to support or refute acupuncture for treating insomnia. The role of acupuncture in obesity has also been evaluated in a large number of studies; a 2012 review included 44 primarily non-PubMed indexed acupuncture RCTs.60 The review reported a risk ratio of 2.14 (95% CI: 1.58, 2.90) in favor of body weight reduction with a mean difference in body weight reduction of 2.76kg (95% CI: 1.61, 3.83) but noted that the majority of included studies was of low quality. A competing review including 31 acupuncture RCTs concluded that results suggested that acupuncture is an effective treatment for obesity; however, the amount of evidence is not fully convincing because of the poor methodological quality of trials reviewed.122 Smoking cessation has also been addressed in a large number of studies; a 2011 Cochrane review included 31 acupuncture RCTs. The review reported that compared with sham acupuncture the risk ratio for short-term effects was 1.18 (95% CI: 1.03, 1.34) and 1.05 (CI: 0.82, 1.35) for long-term effects74 but concluded there is no consistent, bias-free evidence that acupuncture, acupressure, laser therapy, or electro-stimulation are effective for smoking cessation and no firm conclusions can be drawn. A 2012 review reported positive effects of acupoint stimulation at immediate, 3- and 6-month follow-up but did not differentiate effects of acupuncture, acupressure, electroacupuncture, or percutaneous electrical nerve stimulation.53 Nausea and vomiting was addressed in a number of publications for a variety of indications and results appear to depend on the underlying condition causing the symptom. A 2009 Cochrane review included 11 acupuncture RCTs evaluating the effect of wrist acupuncture point P6 stimulation (acupressure, acupuncture, electro-acupuncture, transcutaneous nerve stimulation, laser stimulation, capsicum plaster, acustimulation device) for preventing postoperative nausea and vomiting (PONV).111 The review reported a pooled effect size of 0.65 (95% CI: 0.48, 0.89) for acupuncture trials compared to sham for nausea and 0.60 (95% CI: 0.43, 0.84) for vomiting. The review concluded that P6 acupoint stimulation prevents post-operative nausea and vomiting; however the majority of included studies evaluated acupressure or other treatments and no conclusions specific to acupuncture were presented. Evidence Map of Acupuncture Evidence-based Synthesis Program Positive effects were also reported for other clinical indications; however, the effects are based on only a small number of primary research studies. A Cochrane review on acupuncture for restless legs syndrome reported dermal needle therapy in combination with medications and massage was more effective than medications and massage alone in terms of remission of unpleasant sensation in the legs (RR 1.36, 95% CI: 1.06 to 1.75). However, the result was based on a single RCT and the review concluded that the evidence is insufficient.130 A systematic review on the efficacy of TCM for the management of constipation included 3 acupuncture RCTs.99 The RCTs comparing acupuncture treatment with patients taking lactulose or Folium Sennae reported statistically significant benefits in favor of acupuncture but no pooled effect was reported to estimate the size of the acupuncture treatment effect. The clinical effectiveness is unclear for a number of wellness-relevant indications. Several primary studies and systematic reviews have been published on cancer treatment-associated physical adverse events; a 2013 review included 41 RCTs addressing a variety of adverse events such as pain, nausea, hot flashes, fatigue, xerostomia, prolonged postoperative ileus, anxiety / mood disorders, and sleep disturbance.38 The review concluded that acupuncture is an appropriate adjunctive treatment for chemotherapy-induced nausea / vomiting but additional studies are needed, and for other symptoms efficacy remains undetermined due to the high risk of bias of existing studies. A Cochrane review specific to chemotherapy-induced nausea or vomiting reported that stimulation with needles reduced the proportion of acute vomiting (RR 0.74, 95% CI: 0.58, 0.94) but not acute nausea severity. Results were inconsistent for elector-acupuncture and manual acupuncture, and studies combining electro-acupuncture with state-of-the-art antiemetics and in patients with refractory symptoms are needed to determine clinical relevance.161 The evidence base across and within 5 additional reviews on cancer and cancer-treatment related adverse events or specific conditions such as cancer-related fatigue, hot flashes in breast cancer survivors, and hiccups in cancer patients was judged to be insufficient to draw firm conclusions by the review authors. A Cochrane review on irritable bowel syndrome (IBS) included 17 RCTs57. The review indicated that acupuncture was more effective than no specific therapy (RR 2.11, 95% CI: 1.18, 3.79) and Chinese medicine treatment alone (RR 1.17, 95% CI: 1.02, 1.33), but not sham acupuncture for