Premature ovarian insufficiency (POI) is a complex gynecological condition that poses a growing public health challenge worldwide. Recently, acupuncture combined with Chinese herbal medicine has been explored as a therapeutic strategy for POI, but its effectiveness and safety remain uncertain. This study aimed to systematically review and quantitatively analyze the impact of integrating acupuncture with Chinese herbal therapy on POI outcomes.A comprehensive search of eight electronic databases was performed to identify randomized controlled trials (RCTs) comparing acupuncture plus Chinese herbal medicine with conventional Western medical treatments for POI. The methodological rigor of the selected trials was assessed using the Cochrane Collaboration’s risk-of-bias tool. Data synthesis and meta-analysis were conducted using Review Manager 5.3 and Stata 10.0, and the overall quality of evidence was evaluated following the GRADE framework. Ten RCTs involving a total of 594 POI patients met the inclusion criteria. The combination therapy demonstrated a significantly higher overall clinical efficacy compared with Western medicine alone (relative risk [RR]: 1.21; 95% confidence interval [CI]: 1.12–1.31; P < 0.01, I² = 0%). Furthermore, patients receiving acupuncture plus herbal medicine showed reductions in luteinizing hormone (standardized mean difference [SMD]: −0.57; 95% CI: −1.06 to −0.08; P < 0.05, I² = 80%), follicle-stimulating hormone, and Kupperman index scores, along with an increase in serum estradiol levels. Overall, these findings suggest that combining acupuncture with Chinese herbal medicine is a promising and safe approach for managing POI. However, confirmation through well-designed, multicenter, and long-term randomized trials is needed to establish definitive clinical recommendations.
