Ghislaine Morin
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Overview

It is more complicated than yes or no. Placebo plays a real role in TCM, as in any act of care, but trials comparing real and sham needles often find a gap that placebo alone does not explain.

Where this idea comes from

The argument is old and comes from the rationalist critique of Chinese medicine: if neither Qi nor meridians can be measured, only suggestion remains. The title of Colquhoun and Novella's paper (Anesth Analg, 2013), "Acupuncture is theatrical placebo", made this position famous.
It is reinforced by an uncomfortable fact for TCM: in several trials, sham acupuncture, with needles placed outside the point or retractable, also produces relief. If the imitation works, the specific technique looks superfluous.
A third source is methodological. There is no credible inert sham needle. Sham acupuncture pricks, stimulates, draws attention and occupies the patient. A placebo that acts physically is no longer a clean control.
There is a fourth source, less flattering for practitioners: some consultations really are mostly attention, silence and reassurance. When a session produces no measurable change, calling it placebo is a fair description of what happened, and an honest practitioner should be able to say so.

What Chinese medicine says

TCM does not claim a mechanism measurable in the sense of Western physiology. It describes functions: circulation, rising, descending, entering, leaving. Qi is not a substance to be dosed, it is a model of regulation.
In this logic, the care relationship is not a decorative extra, it is part of the treatment. Taking time, listening, touching and explaining are not cheating: they are what any effective consultation does, conventional medicine included.
What TCM refuses is being reduced to that. A chosen point, a needling depth, a duration are technical decisions that produce measurable effects on pain, nausea or sleep in controlled settings.

What the research says

The individual patient data meta-analysis by Vickers et al. (J Pain, 2018) compared acupuncture, sham acupuncture and no treatment. Acupuncture was superior to both, with a smaller difference against sham than against no treatment.
The network meta-analysis by Lee et al. (JAMA Netw Open, 2023) on chronic low back pain examined whether the location of sham needling changes the result. It found that sham needling location matters, which weakens the idea of a purely inert control.
Conversely, the randomised trial by Hinman et al. (JAMA, 2014) on chronic knee pain found no significant benefit of needle acupuncture over sham, a result that must be stated rather than hidden.
What is established: placebo contributes to the effect, and it is powerful. What is debated: how much of the total effect is specific. What is unknown: the biological mechanism, and why results differ so much between trials.
Registry data add a further nuance: small trials with positive results are more likely to be published than small trials with null results, so pooled estimates tend to flatter the technique. This is not specific to acupuncture, but it concerns it as much as any other field.

What to expect in practice

An honest answer is this: you may feel better, and that improvement does not by itself prove the needles acted, any more than it proves they did not. What matters is that the improvement lasts and can be measured in your daily life.
This is the stance taken at the Centre Équilibre in Grenoble: a realistic objective, a review after a few sessions, and stopping if the result is not there. Ghislaine Morin practises TCM as a complementary discipline there, including during the TCM dispensary she organises at the Centre Équilibre.

When to consult, and when not to

Consult if you are looking for complementary support for a nuisance already assessed by a doctor, and if you accept measuring the result rather than believing in it.
Do not consult, and above all do not replace a treatment, in case of cancer, infection, cardiovascular event, psychiatric emergency or any condition requiring a diagnosis. A placebo argument never justifies delay.

Frequently asked questions

If it is a placebo, is that bad?
No. The placebo effect is real, studied, and present in every consultation, including in conventional medicine. What would be dishonest is to sell it as a specific pharmacological action. What matters is informed consent, honest claims and a measurable result.
Why does sham acupuncture also work?
Because it is not inert: it pricks, stimulates nerve fibres, attracts attention and creates a ritual. That is exactly why comparing it to real acupuncture is difficult. A control that produces effects by itself cannot isolate the specific effect cleanly.
How can I tell whether it works for me?
Set a measurable goal before starting: number of nights slept, number of migraine days, distance walked without pain. Write it down, then compare after four to six sessions. Without a baseline, any improvement becomes a story rather than a result.

Frequently asked questions

Useful links

Sources

  • Vickers AJ, Vertosick EA, et al. Acupuncture for Chronic Pain: Update of an Individual Patient Data Meta-Analysis. J Pain, 2018. https://pubmed.ncbi.nlm.nih.gov/29198932/ — https://pubmed.ncbi.nlm.nih.gov/29198932/
  • Lee B, Kwon CY, et al. Needling Point Location Used in Sham Acupuncture for Chronic Nonspecific Low Back Pain. JAMA Netw Open, 2023. https://pubmed.ncbi.nlm.nih.gov/37672270/ — https://pubmed.ncbi.nlm.nih.gov/37672270/
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Ghislaine Morin
Ghislaine Morin
Praticienne en médecine traditionnelle chinoise et sophrologue à Grenoble
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