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Fig 1.

The PRISMA flow diagram of the study selection process.

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Fig 2.

Forest plot for acupuncture vs. western medicine on clinical effective rate.

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Table 1.

Summary of pooled results on acupuncture vs. control for patients with vocal nodules.

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Table 2.

Summary of meta-regression and subgroup-analyses for clinical effective rate (acupuncture vs. western medicine).

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Fig 3.

Forest plot for acupuncture vs. Chinese herbal medicine on clinical effective rate.

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Fig 4.

Trial sequential analysis and penalized test for acupuncture vs. western medicine on clinical effective rate.

Notes: RIS: Required information size. This picture showed that 1) Z-curve didn’t cross the RIS, indicating that the number of included studies has not reached the amount required for meta-analysis; 2) Z-curve crossed the conventional boundary of benefit (z = 1.96), indicating that the difference of clinical effective rate between acupuncture group versus western medicine group was statistically significant, excluding the possibility of false positive; 3) Z-curve crossed trial sequential monitoring boundary for benefit, which indicated that acupuncture was not superior to western medicine.

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Fig 5.

Cluster analyses and heat map of the acupoints applied in the included trials.

KYYH: Kai yin yi hao; LI-4: He gu; EX-B2: Jia ji; ST-36: Zu san li; LU-7: Lie que; KI-6: Zhao hai; SYP: Sang yin point; LI-18: Fu tu; LU-10: Yu ji; ST-9: Ren yin; ST-40: Feng long; ST-10: Shui tu; SP-10: Xue hai.

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