Letter: Acupuncture Clinical Trials in the Chinese Clinical Registry: Growth,Regional Disparities,and Standardization Challenges

Dear Editor:

Acupuncture, a pillar of traditional Chinese medicine (TCM), has gained global traction since the World Health Organization (WHO) endorsed its efficacy for 43 conditions in 1980.^1,2 However, methodological rigor in acupuncture trials lags behind pharmacological studies. In recent years, analyzing registration information provides evidence of future direction for different research fields.^3–5 Previously, Zhang et al. ⁶ retrieved data from the establishment of the database up to October 20, 2018, and analyzed the characteristics of clinical trials of acupuncture registered in Chinese Clinical Trial Registry. However, what changes have occurred in this trend? In this study, we performed an update study to analyze the characteristics of registered acupuncture-related clinical trials, to explore the current status and development trends of acupuncture-related clinical trial registration to reflect the quality of acupuncture trials in China.

We analyzed 77,828 ChiCTR-registered trials (2007–2024) using keywords (“acupuncture,” “electroacupuncture”) to identify 2,293 acupuncture-related studies. Excel in Microsoft Office 2019 software was used to input, deduplicate, and archive data. Descriptive analysis was performed on the included data using SPSS 26.0 software, summarizing the characteristics of registered clinical trials. All categorical data were expressed in terms of frequency and percentage.

Results were as follows:

Temporal Trends: Registrations grew exponentially, with 359 prospective trials in 2023 alone (vs. 9 in 2013), reflecting heightened awareness post-2017 policy shifts.

Geographic Bias: Trials concentrated in affluent regions (Shanghai: 28.5%, Beijing: 17.2%), while remote areas (e.g., Ningxia) contributed minimally (0.2%).

Design: 62.4% were interventional studies, predominantly RCTs (82.85%), as shown in Table 1.

Funding Sources: National (27.3%) and local (16.7%) grants dominated, mirroring economic disparities.

Intervention Diversity: Techniques spanned electroacupuncture (32%), auricular acupuncture (18%), and novel modalities such as laser acupuncture (5%).

Our analysis reveals three critical insights:

Growth Versus Fragmentation: While trial numbers rise, regional imbalance persists, driven by funding inequities and institutional capacity gaps.

Quality Challenges: Despite RCT dominance, only 12% of trials reported double-blinding, undermining validity.

Global Relevance: ChiCTR’s role as a WHO-primary registry positions China to lead acupuncture research standardization, yet alignment with platforms such as ClinicalTrials.gov remains partial.

Innovative Recommendations:

Standardization: Adopt CONSORT-TCM extensions for blinding and outcome reporting.

Equity Initiatives: Prioritize funding for under-resourced regions (e.g., Tibet) to bridge geographic gaps.

Technology Integration: Leverage artificial intelligence-driven platforms (e.g., organ-on-chip models) to enhance trial reproducibility.

Acupuncture trial registrations in ChiCTR surged from 3 in 2007 to 2,293 by 2025 yet represent only 2.95% of all registrations. Over 50% of trials cluster in Shanghai, Beijing, and Guangdong, highlighting regional inequities. Despite 82.85% of trials using randomization, standardization in blinding and outcome measures remains suboptimal.