Does Acupuncture Work? Understanding Evidence Based Healthcare

One of the most common questions I hear is, ‘Does acupuncture work?’ The answer isn’t a simple yes or no—it depends on how we evaluate treatments like acupuncture, medication, or other therapies. This blog dives into the principles of evidence-based medicine, the challenges of research, and where acupuncture fits within this framework.

What does “Good Evidence” look like?

This pyramid explains it nicely. At the bottom we have ideas, opinions, editorials, anecdotal evidence; this is where your friend tells you about a treatment they had.

Right at the top of the tree are thorough studies; randomised controlled trials, systematic reviews, and meta-analysis. These trials often take years of work and lots of people – and they cost a huge amount of money! Think of them as having lots of friends who really know what they are talking about!

You might think this would give a pretty black and white picture - there’s a solution to a problem or there isn’t. But people are not mechanical objects, like cars. There’s rarely a “one size fits all “ resolution . What scientific studies show us is where there’s a noticeable difference, by clinical significance or statistical significance.

Clinical vs. Statistical Significance

Scientific studies help us to measure whether a treatment works in two key ways; statistical significance and clinical significance.

 When evaluating treatments, it’s important to understand these two key concepts that help us assess their value.

   •       Statistical significance tells us whether a treatment’s effect is unlikely to be due to chance, based on data analysis. However, this doesn’t tell us how meaningful the effect is for patients. For example, a drug may show a noticeable difference in blood pressure, but the person may not feel the benefit.

               •            Clinical significance focuses on real-world impact. It asks whether the treatment makes a meaningful difference in a patient’s health or quality of life. For example, an acupuncture treatment relieving back pain so someone can return to work.

In short, statistical significance shows that a treatment works, while clinical significance shows how much it matters. Both are crucial for making informed healthcare decisions but neither mean something works for everyone.

Who Decides What’s Scientifically Proven?

Western medicine emphasises evidence-based medicine, a concept developed by Canadian epidemiologist David Sackett.

Back in 1981 he and his colleagues at McMaster University began publishing a series of articles in the Canadian Medical Journal advising physicians how to appraise medical literature. But an evidence-based medicine approach doesn’t rely solely on “the science” Sackett also advocated using the physician’s expertise, considering the individual needs of the patient, and the patients wishes.

Challenges in Evidence-Based Medicine

Once Sackett had given us a starting point for evidence-based medicine, you’d think understanding what works would be plain sailing . But no, evidence-based medicine is a bit of a minefield.

Firstly, there needs to be a hypothesis – an assumption that can be tested to see if it’s true or not.

Secondly, those trials cost money. Lots of it. And the closer you get to the top of the pyramid, the more it costs. Rigorous trials are expensive. That means that someone must benefit from doing them, whether in terms of prestige or financially. This could be the reason for the dominance of pharmaceuticals in medicine nowadays.  It can also mean enough people will benefit from the trial. And THEN you must find a big enough chunk of similar folk to test your hypothesis on! A condition affecting a big chunk of the population is likely to attract more research funding than a rare illness.

“Evidence based medicine is not “cookbook” medicine. Because it requires a bottom up approach that integrates the best external evidence with individual clinical expertise and patients’ choice”

— David Sackett

The bottom line is that health isn’t a “one size fits all” issue. Even with rigorous research few medicines or therapies are guaranteed to work for everyone.

Addressing Misconceptions

 A clinical trial with good results doesn’t mean something is guaranteed to work for you. Nor does a lack of clinical trials or meta-analysis mean that it won’t.

Let’s imagine a treatment is tested on knee pain. That could be acupuncture, a pharmaceutical intervention, or something else. If it is successful (either clinically or statistically significant) that’s unlikely to mean it will work for every case of knee pain. Nor does it mean that a similar intervention wouldn’t work for another area. such as elbow pain.

As American astronomer Carl Sagan put it well “Absence of Evidence is not Evidence of Absence” - remember though, that if something has been tested and found wanting, that is a different matter.

The existence of an evidence base can give you some confidence to make an informed decision, based on the likelihood of a positive impact against any potential side effects.

The downside

The expense and time required for good quality research means that only a fraction of the options available to you are “evidence based”. And even evidence based treatments take time to filter into common usage – usually about 17 years, according to the British Medical Journal.  

Evidence Based Medicine in the U.K - NICE

What is NICE, and What Does It Do?

In April 1999 The National Institute for Clinical Excellence (NICE) was created to create consistent guidelines and end “postcode rationing “across the U.K. Now known as the National Institute for Health and Care Excellence, they continue to provide standard guidance for treatment of a range of conditions. This guidance is given in relation to the evidence base and to cost, but not the expertise of the physician or the individual patient, as David Sackett suggested.

“We use the best available evidence to develop guidance to improve health and social care”

— National Institute for Health & care Excellence

Limitations of NICE Guidelines

Sadly, NICE hasn’t stopped the postcode lottery as each area manages its own funds. As an example, treatment offered to people struggling with fertility varies across the country. As I write this, NICE recommends 3 cycles of IVF for women struggling to conceive, but only one cycle is offered in Harrogate and the rest of North Yorkshire.

NICE and Acupuncture

NICE recommends acupuncture as an effective treatment for chronic pain, but cost constraints limit its availability to five group sessions delivered by healthcare professionals with basic training

In reality, this is likely to be a basic generic treatment, or protocol, delivered by a healthcare professional who has done a short course specifically for that protocol.

The Big Issue - do NICE Guidelines really deliver evidence based treatment?

It’s encouraging to see NICE recommending acupuncture, but their approach raises some important questions. Clinical trials typically test specific acupuncture points. These are usually chosen based on the recommendation of an experienced acupuncturist, or from text books. The acupuncture points will differ for each condition. However, NICE guidelines apply to ALL types of chronic pain without distinguishing between conditions. This blanket recommendation of “acupuncture” is akin to advising the use of “drugs” for a wide range of ailments without specifying which drug is appropriate for each condition.

Where Does Acupuncture Fit?

Back to our pyramid - Where does acupuncture fit in this picture? Is there any research at the top of the pyramid? 

Researching Acupuncture is Tough, But….

Acupuncture is notoriously difficult to assess. Unlike drugs, there isn’t a single treatment for a specific problem . My blog about your diagnosis tells you more about this. Much depends on the skill of the acupuncturist. And there is no genuine placebo to test against. While “sham” acupuncture exists, there is still a connection with the body eliciting a response.

Yet good quality research exists for acupuncture. Despite the difficulties of assessing acupuncture’s effectiveness there is a body of evidence supporting its usefulness for a range of conditions.

Evidence For Acupuncture

Way back in 2002 the World Health Organisation reviewed clinical trials (top of the pyramid studies) researching acupuncture.  They published a paper ‘Acupuncture; review and analysis of controlled clinical trials’. This said that acupuncture had been proven to be an effective treatment for a long and diverse list of conditions ranging from reactions to cancer treatment to turning a breech baby. (The full list is at the bottom of the page)

A Growing Body of Evidence

Since then, there has been a growing body of evidence for the effectiveness of acupuncture. For example, a meta-analysis of acupuncture for chronic pain was published in 2018.

This ‘top of the pyramid’ study looked at four common causes of chronic pain:

·         nonspecific musculoskeletal pain

·         osteoarthritis

·         chronic headache

·         shoulder pain

Including 20,827 patients, it concluded that acupuncture is effective for the treatment of chronic pain, with treatment effects persisting over time. The researchers found clear evidence that the effects of acupuncture persist over time with only a small decrease, approximately 15%, in treatment effect at 1 year

Why Chronic Pain?

Chronic pain is one of those appealing research areas, due to the number of people affected. According to the Office for National Statistics, muscular skeletal pain remains one of the main reasons for sickness absence from work.

Acupuncture: A Personalised Approach to Healing

Acupuncture, like many treatments, isn’t a one-size-fits-all solution. High-quality research supports its effectiveness for certain conditions, but health is complex, and treating you as an individual truly matters. The beauty of acupuncture lies in its ability to do just that—tailoring treatment specifically to you.

While I find research fascinating, my approach blends multiple sources of expertise: the skills honed during my three-year degree, over 2,000 years of recorded clinical practice, and my own hands-on experience. This combination allows me to provide care that is both informed and deeply personal.

Treating Jane’s Shoulder

Take Jane, for example. She came to me last week with a debilitating shoulder issue—pain and restricted movement that were affecting her life. Before beginning treatment, we had a thorough conversation about her symptoms and history. I also conducted pulse and tongue diagnosis, as well as palpation.

At the start, Jane could only lift her arm to about 45 degrees. By the end of the session, she could raise it nearly to 90 degrees, and her pain had noticeably diminished. She was astonished—not just by the results, but by the fact that they were achieved with just two needles: one in her foot and another below a knuckle.

Use the link below to book your first session if you’d like to see what acupuncture can do for you.

More information

references

NICE guideline [NG193] - Chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain, April 2021

Acupuncture For Chronic Pain: Update of an Individual Patient Data Meta-Analysis, MacPherson et al, 2018

WHO conditions - .   

Muscular-skeletal & pain conditions- Low back pain, Neck Pain,Pain in dentistry (including dental pain and temporomandibular dysfunction),Knee pain, Facial pain (including craniomandibular disorders), Headache, Sciatica, Sprain, Periartritis of the shoulder (frozen shoulder), Renal colic (pain from stones in the urinary tract), Rheumatoid arthritis, Tennis elbow, Dysmenorrhoea (painful periods)

Other conditions Adverse reactions to radiotherapy and/or chemotherapy, Allergic Rhinitis (including hayfever), Biliary Colic (abdominal pain due to gallstones), Depression (including depressive neurosis and depression following stroke), Dysentary (acute bacillary) , Epigastralgia, acute (in peptic ulcer, acute and chronic gastritis, and gastroplasm), Hypertension (essential), Hypotension (primary), Induction of labour,   Leukopenia (low white blood cell count), Malposition of foetus (breech baby), Morning sickness, Nausea and vomiting, Stroke

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Your Chinese Medicine Diagnosis

Imagine a healthcare system that has been used for over 2,000 years—one that sees not just your symptoms, but the whole you. This is the essence of Chinese medicine.

Traditional Chinese Medicine (TCM) offers a holistic approach to health. It doesn't rely on lab tests or imaging, as Western medicine does. Instead, TCM uses ancient diagnostic methods like questioning, observation, and palpation to uncover the root causes of imbalances in the body. This approach doesn’t just look at physical symptoms but also considers your emotional, mental, and spiritual well-being, offering a truly comprehensive view of health.

What is a Chinese Medicine Diagnosis?

In Traditional Chinese Medicine (TCM), diagnosis revolves around understanding the functional roles of internal organs, the intricate network of channels that connect these organs to the body’s exterior AND to one another, and the “fundamental substances” that sustain them. These substances—Qi, Blood, and Jing—play a vital role in ensuring the organs operate in harmony, supporting overall health and balance.

Why is a TCM Diagnosis Different?

One of the first things many people share with me is their Western medical diagnosis. While this can be helpful, it’s not essential in TCM. This system views health and illness through a different lens.

Rather than identifying a specific disease, TCM seeks to uncover patterns of disharmony—underlying imbalances that lead to symptoms. That disharmony may manifest in one or more organs, fundamental substances may be off kilter, or both organs and fundamental substances may be involved.

The organ system

Organs are understood not just anatomically but functionally; for example, the Heart in TCM is far more than the muscular pump we think of in the West. It encompasses emotional well-being, memory, sleep and even fertility, as emotional disturbances can affect the balance of hormones.

Fundamental substances

Qi, Blood, and Jing – the “three treasures”

What is Qi?  Ask one hundred Chinese Medicine practitioners and you could get one hundred different answers! The translation can be as basic as “energy”. To me, Qi is a concept that explains how well the body is functioning. For example, if your Lung Qi is strong, you will breathe easily, if your Heart Qi is robust that important muscle is beating regularly, and you are emotionally stable.

The concept of Blood is similar to the Western understanding; a vehicle to move nutrients and oxygen around the body. TCM also sees Blood as a vehicle to house the mind. The quality of Blood is very much determined by the quality of the food we eat, and the connection between blood and the mind isn’t completely at odds with Western thinking. There is now a growing understanding of the connections between mental health and diet.

And Jing? Think of your constitution. Some lucky souls are born with a super strong constitution and seem to be able to withstand anything life throws at them, , whereas others are hit by everything that comes along. We can’t change what we’re born with, but most of us can look after our reserves of Jing with good lifestyle choices.

When things go wrong

Imagine your body as a house. The walls create a barrier between the interior and exterior protecting you from the environment. Inside, you have systems in place to make sure the atmosphere is just right; not too hot or cold, not too dry or damp. But if the heating system isn’t working well, the house can become icy or overheat, the atmosphere may become too dry or damp can breach the boundaries. And if the windows cannot withstand the elements, wind will whip through the house.

Natural metaphors such as Damp, Heat, Dryness, and Wind, help us understand how your body functions in TCM terms.

These terms may seem abstract, but they are grounded in a structured diagnostic process. And it’s not too hard to see how they came about. Before there was any understanding of bacteria and viruses, infections were seen as an invasion of Wind. And the resulting raised temperature of an infection can clearly be seen as excess Heat in the body.

“Ancient Chinese medicine had no knowledge of bacteria or viruses and acute respiratory were considered to be due to an invasion of ‘Wind’ or other climatic factors”

— Giovanni Maciocia

What to expect during your session

Your first session in TCM might surprise you with its depth. It’s all about getting to know you, your body, and your life. The process typically includes:

• Pulse Diagnosis The pulse is a treasure trove of information in TCM, far beyond just heart rate and rhythm.

 I’ll feel the pulse in three positions on each wrist and at three depths in each position. Each position corresponds to an organ and provides insights into your Qi (energy), Blood, and the health of your organs.

• Questioning: We’ll have a chat about your lifestyle, medical history, sleep, diet, digestion, emotions, and more. If you have pain, I’ll want to know when it occurs, how it feels, and what makes it better or worse.

• Tongue Examination

The tongue reflects the state of your internal organs. Its colour, shape, coating, and moisture level give clues about your overall health. Remember those climatic factors such as Damp and Dryness – they can be seen quite clearly on the tongue. If you’re brave enough to ask to examine your friends’ tongues, you’ll begin to see how different they are – you may notice how ‘dried out’ one looks, or a thick greasy coat on another showing Damp in the body.

• Palpation: Palpating acupuncture channels can uncover more information about your body’s imbalances. Channels may also seem an abstract concept, but these are real places linking the exterior of the body to the interior, with many connections between them. Channels spread throughout the body, but are usually easy to locate on the limbs, in the spaces between muscle and bone.

What am I looking for? The texture of the skin, how firm the channel is, and if there are any lumps and bumps along the way. They all help me to work out what’s going on.

“Tong bing yi zhi, Yi bing tong zhi,”

— Different Diseases, One Treatment; Same Disease, Different Treatments

Different Diseases, One treatment, Same Disease, Different Treatments

This classic saying in Chinese medicine, “Tong bing yi zhi, Yi bing tong zhi,” captures its essence.

Two people with the same Western diagnosis, for example migraines, may receive entirely different treatments because their underlying patterns differ. Conversely, two people with completely different issues might benefit from similar treatments if their patterns of disharmony are the same.

Let’s look at some examples. It’s  winter time as I write this, we’ll look at a couple of simple cough scenarios !

 1.        John has a dry tickly cough, feels thirsty, and has a hoarse voice.

He doesn’t have a temperature or any other signs of illness. John is suffering from “Lung dryness” caused by spending too much time in overheated and dry environments, such as his office and the pubs and clubs he’s gone to for Christmas parties.

  2.        Sarah also has a cough. She can’t stand the cold, she has an itchy throat, she’s breathless, has a blocked nose and her head and body aches. Sarah has an Invasion of the Lungs by Wind-Cold!

 In this case, Wind means a pathogen such as a virus or bacteria has entered the body – when Chinese Medicine was developed over 2,000 years ago, there was no knowledge of such things.

Likewise that migraine may show up as a Liver issue, or it could have more to do with the function of the Stomach. There may be some Heat or there could be Damp, or even Damp’s uglier relative, Phlegm. The possibilities are almost endless, so we need to look for and treat the underlying cause of the migraine -  “same disease, different treatments “

And the “Different Diseases, One Treatment “ side of the equation?  Let’s take Damp as an example. Damp can be caused by exposure to Damp environments or by eating a Damp-forming diet (lots of wheat, dairy, and sugar!). It can show up as a feeling of heaviness in the limbs, a fuzzy head, or it might affect the stools or urination. Either way, the treatment is likely to involve fortifying the body’s warming systems to clear the Damp, much as you would do in a damp house.

A Treatment Tailored to You

After gathering all this information and making your diagnosis, I’ll develop a treatment plan that’s unique to you. This includes selecting acupuncture points on specific channels to address the root cause of your imbalance. Everything—needle placement, depth, and technique—is carefully chosen to suit your needs.

Your acupuncture treatment plan evolves as your body responds, reflecting a dynamic and personalised approach to healing.

Helping Yourself Heal

Healing is often a collaborative effort. Alongside acupuncture, I may recommend lifestyle or dietary adjustments to support your recovery. This could include:

• Eating or avoiding certain foods to support your recovery.

• Incorporating relaxation techniques to reduce stress.

• Trying gentle movement practices like Qi Gong, or yogic breathing techniques, to enhance your treatment.

These small changes, combined with regular acupuncture, can make a big difference in restoring harmony to your body and mind.

If you're ready to explore a personalised treatment plan, I’m here to help guide you on your journey toward balance and well-being..