**3.3 Acupuncture**

Acupuncture is a type of traditional Chinese medicine. It is commonly used in the treatment of respiratory diseases [188, 189]. Acupuncture is supposed to be an effective agent in treating the breathlessness of chronic obstructive pulmonary diseases (COPD) [190]. This encourages its utility to improve dyspnea and enhance the quality of life in COVID-19 patients [191]. Headache is a common symptom of COVID-19 infection. Acupuncture is widely used in pain and headache treatment [192, 193]. In China, it was added to COVID-19 patients' routine regimens [194]. Acupunctureinduced analgesia through opioid peptides and dopamine receptors. Where acupuncture activates dopamine and β-endorphin, which in turn downregulates cytokine production via type 1 dopamine receptors, so inhibit systemic inflammation [195–198]. This effect may help in the cytokine storm of COVID-19 infection. Despite having good potential for COVID-19 treatment, there is not enough high-quality evidence to support acupuncture [199].
