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

(a) Recommendations based on paradox 1Expected benefits for future clinical trials

Understanding the physiological effects of acupuncture needling using appropriate controlsPrevention of needle-specific physiological effects in sham treatment

Identifying key physiological and psychological nonneedle components of acupuncture treatmentPrevention 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 practiceIncreased ecological validity

(b) Recommendations based on paradox 2Expected 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 conditionsImproved 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 needlesImproved understanding of complex manual needling protocols as well as electrostimulation

Cross-correlations between Traditional Chinese Medicine (TCM) and biomedicine syndromesUse of biomarkers to TCM entry criteria as objective outcome measures