Manual and Electrical Needle Stimulation in Acupuncture Research: Pitfalls and Challenges of Heterogeneity

Langevin Helene M., Schnyer Rosa, MacPherson Hugh, Davis Robert, Harris Richard E., Napadow Vitaly, Wayne Peter M., Milley Ryan J., Lao Lixing, Stener-Victorin Elisabet, Kong Jiang-Ti, Hammerschlag Richard, and on behalf of the Executive Board of the Society for Acupuncture Research. The Journal of Alternative and Complementary Medicine. March 2015, 21(3): 113-128. doi:10.1089/acm.2014.0186. Published in Volume: 21 Issue 3: March 11, 2015; Online Ahead of Print: February 24, 2015


In the field of acupuncture research there is an implicit yet unexplored assumption that the evidence on manual and electrical stimulation techniques, derived from basic science studies, clinical trials, systematic reviews, and meta-analyses, is generally interchangeable. Such interchangeability would justify a bidirectional approach to acupuncture research, where basic science studies and clinical trials each inform the other. This article examines the validity of this fundamental assumption by critically reviewing the literature and comparing manual to electrical acupuncture in basic science studies, clinical trials, and meta-analyses. The evidence from this study does not support the assumption that these techniques are interchangeable. This article also identifies endemic methodologic limitations that have impaired progress in the field. For example, basic science studies have not matched the frequency and duration of manual needle stimulation to the frequency and duration of electrical stimulation. Further, most clinical trials purporting to compare the two types of stimulation have instead tested electroacupuncture as an adjunct to manual acupuncture. The current findings reveal fundamental gaps in the understanding of the mechanisms and relative effectiveness of manual versus electrical acupuncture. Finally, future research directions are suggested to better differentiate electrical from manual simulation, and implications for clinical practice are discussed.

Paradoxes in Acupuncture Research: Strategies for Moving Forward

In keeping with SAR’s mission to promote, advance and disseminate scientific inquiry into Oriental medicine systems, we have published our White Paper, highlighting current issues and setting forth proposals for the next decade of acupuncture research.  On September 22-23, 2008, SAR held a Board workshop at Georgetown University to culminate 3 months of preparations in developing this White Paper. The workshop was hosted and facilitated by a nationally recognized leader in CAM education and research, Aviad (Adi) Haramati, PhD, Professor and Director of Education in the Departments of Physiology & Biophysics and Medicine at Georgetown University School of Medicine.

Generous donations from the professional and educational acupuncture community and matching grant from the National Acupuncture Foundation made the development of the White paper possible. We are deeply grateful for everyone’s support, and we are confident that this paper will provide a very important next step in acupuncture research.


In November 2007, the Society for Acupuncture Research (SAR) held an international symposium to mark the 10th anniversary of the 1997 NIH Consensus Development Conference on Acupuncture. The symposium presentations revealed the considerable maturation of the field of acupuncture research, yet two provocative paradoxes emerged. First, a number of well-designed clinical trials have reported that true acupuncture is superior to usual care, but does not significantly outperform sham acupuncture, findings apparently at odds with traditional theories regarding acupuncture point specificity. Second, although many studies using animal and human experimental models have reported physiological effects that vary as a function of needling parameters (e.g., mode of stimulation)  the extent to which these parameters influence therapeutic outcomes in clinical trials is unclear. This White Paper, collaboratively written by the SAR Board of Directors, identifies gaps in knowledge underlying the paradoxes and proposes strategies for their resolution through translational research. We recommend that acupuncture treatments should be studied (1) “top down” as multi-component “whole-system” interventions and (2) “bottom up” as mechanistic studies that focus on understanding how individual treatment components interact and translate into clinical and physiological outcomes. Such a strategy, incorporating considerations of efficacy, effectiveness and qualitative measures, will strengthen the evidence base for such complex interventions as acupuncture.

Read more and download the White Paper.

SAR's Evidence Based Assessments
Access to SAR's library of Evidence Based Assessments for acupuncture is a key benefit of membership.  Click the image to the left for a sample of page selections. 

Current conditions include:
  • Asthma
  • Neck Pain
  • Dysmenorrhea
  • Carpal Tunnel Syndrome
  • Rhinitis/Sinusitis
  • Bell's Palsy
  • Lower Back Pain
  • Headache

Also included in the library are 1-page handouts that summarize the research related to each condition.  These handouts are designed for practitioners to give to patients or for other informational purposes. 

For access to the full EBA Library, you can either join SAR today where it is included as a benefit of membership, or you can purchase a stand-alone subscription product.  Click the "Join SAR Today" link above to learn more about both membership and available EBA subscription levels and pricing.


Journal of Alternative and Complementary Medicine  

Journal of Alternative and Complementary MedicineSAR members are entitled to a deeply discounted subscription to our official journal, The Journal of Alternative and Complementary Medicine.  The Journal is the authoritative resource for health care professionals and scientists who are seeking to evaluate and integrate alternative therapies into patient care protocols and research strategies.
SAR members receive two deeply discount subscription options, $219 for Print & Online (a $433 value) and $131 for Online Only, a savings of over 50%. The Print & Online option provides access to all the back issues of The Journal of Alternative and Complementary Medicine published since 1995; that is 20 volumes, over 152 issues, 2,800 articles of searchable content!  These subscription opportunities further enhance your SAR member benefits. This rapid peer-reviewed Journal welcomes participation and contributions from SAR members.

For further information on The Journal of Alternative and Complementary Medicine and other authoritative titles related to the field visit

Acupuncture Research: Strategies for Establishing an Evidence Base

Edited by Hugh MacPherson, Richard Hammerschlag, George Lewith, and Rosa Schnyer

Paperback: 288 pages
Publisher: Churchill Livingstone; 1 edition (October 12, 2007)
Language: English
ISBN-10: 0443100292
ISBN-13: 978-0443100291
Product Dimensions: 9.1 x 6.1 x 0.6 inches

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Read the Review by David Mayor:

Understanding research, and how to do research, is now a key part of education for most acupuncture students, and can no longer be ignored by even the most dyed-in-the-wool traditionalist practitioners. For those outside the profession, such as policy-makers or potential patients, the results of acupuncture research can also be of vital importance.

This book is the planned outgrowth of a brainstorming meeting in York in July 2006 which brought together many of those who have pioneered acupuncture research in Europe, the US and Australia. After a thought-provoking Foreword by Ted Kaptchuk and an excellent Glossary, Hugh MacPherson and Kate Thomas introduce what they call the ‘evidence mosaic’ of research (rather than the usual ‘evidence hierarchy’, with systematic reviews at the top of the pyramid and ‘anecdotes’ at the bottom). Topics expertly covered in succeeding chapters include the history of acupuncture research, patients’ use and experience of acupuncture, its safety, measuring patient-centred outcomes, the ins and outs of uncontrolled and controlled trials, the components of treatment, the importance of clinical practice as the basis for research, some physiology, evidence overviews (meta-analysis and systematic review), how to engage acupuncturists in research, and an overview of future strategies in acupuncture research. Each chapter is comprehensively referenced, and there is a reasonable, if not brilliant, Index.

All but one of the seventeen contributors to the volume have current university affiliations. Perhaps as a result, although overall it is very readable, the book is sometimes a little dry and with perhaps a surfeit of discussion, as if written by committee. In a way of course it was, only one chapter out of all thirteen being written by a single author (the last, by George Lewith). Further, given the number of contributors to the volume, each with strong track records in various aspects of acupuncture research, some of the more contentious topics – such as sham needling or placebo – are inevitably covered several times, albeit from different angles. Research is always a collaborative effort, and acupuncture research in particular is bound to be multifaceted.

However, as acupuncture research develops in the future, it is inevitably going to require considerably more funding than has been available so far. As Claire Cassidy and Kate Thomas state in Chapter 3, ‘as researchers and as a profession, we need to develop avenues for funding, whether they are federal or private; we are in need of “angels”.’ Here this book is unfortunately less than helpful. George Lewith’s is the only chapter which includes a section on funding (‘A consensus about funding emerges’), and this is sketched in very general terms, although his statement that the whole 2005 research budget for complementary and alternative medicine in the UK only amounted to 0.0085% of that for all medical research, is starkly precise...

Read the Full Review

[David Mayor is an acupuncturist in Hertfordshire, England. He is also editor of the textbooks Electroacupuncture: A Practical Manual and Resource (Churchill Livingstone) and Clinical Application of Commonly Used Acupuncture Points by Li Shizhen (Donica), both published in 2007. See for more information.]

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