Introduction: Acupuncture clinical research has gone through a stage of exponential growth since the NIH consensus statement published in 1998 with over 21,000 articles indexed in PubMed. However, there is still uncertainty about the scientific or biological basis of an acupuncture point. This adversely affects research making it impossible to defend what is a real or verum acupuncture point versus a sham or non-acupuncture point that could be used in a randomized controlled study as a control group. Even more problematic is related lack of certainty about the anatomic target of the inserted needle.
Discussion: The scientific community has proposed a number of possible tissue targets based on the physiological response to acupuncture stimulation from motor end points in the muscle to nerve plexuses and trunks to the fascia. Complicating this discussion is the fact that within acupuncture traditions across the world, there are many different needling styles from Japanese approaches that tend to be more superficial, to deep needle stimulation styles from China, to cutaneous needling methods developed in Germany called the Very Point technique. A subset of this debate revolves around the use of acupuncture needles to treat myofascial trigger points.