Table 1: Summary of combined recommendations for future research based on the paradoxes identified in this paper.

(a) Recommendations based on paradox 1 Expected benefits for future clinical trials Understanding the physiological effects of acupuncture needling using appropriate controls Prevention of needle-specific physiological effects in sham treatment Identifying key physiological and psychological nonneedle components of acupuncture treatment Prevention of specific nonneedle effects in sham treatment Recognizing the extent to which acupuncture provided in the context of a clinical trial reflects acupuncture in real world clinical practice Increased ecological validity (b) Recommendations based on paradox 2 Expected benefits for future clinical trials Translation of physiological effects of acupuncture observed in acute animal models and healthy humans to clinical treatment of complex chronic conditions Improved correlations between needling parameters, biomarker changes and clinical outcomes Translation of basic science findings with electro-acupuncture parameters using few needles to more traditional manual needling using multiple needles Improved understanding of complex manual needling protocols as well as electrostimulation Cross-correlations between Traditional Chinese Medicine (TCM) and biomedicine syndromes Use of biomarkers to TCM entry criteria as objective outcome measures