Acupuncture is defined as an intervention involving placing thin needles into specified acupuncture points in order to relieve symptoms or promote healing. What is special about the acupoints? They are supposed to be locations where the flow of life force (chi) can be manipulated. There are a few problems with the claims made for acupuncture. First, there is no place for vitalism – belief in a life force – in modern science. There is no evidence that it exists and no reason to hypothesize that it exists. It is worse than wrong. It is unnecessary. There is also no convincing evidence, after a century of research and thousands of studies, that acupuncture works for anything.

But also, an independently fatal flaw in the notion of acupuncture is that there is no evidence that acupuncture points exist. They are a complete fiction. They have no basis in anatomy, physiology, neuroscience, biochemistry, or empirical evidence. A recent study highlights this fact – Accuracy and Precision in Acupuncture Point Location: A Critical Systematic Review. This is a review by acupuncturists in the Journal of Acupuncture and Meridian Studies. The authors reviewed the literature for any studies that looked at the precision and reliability of the location of acupoints and found:

Considerable variation in localization of acupoints was reported among qualified medical acupuncturists. Variation in point location among qualified non-medical acupuncturists is unknown due to lack of any identified study. The directional method was found to be significantly inaccurate and imprecise in all studies that evaluated the method.

So acupuncturists cannot agree upon where alleged acupoints actually are on the body, and the primary method to localize them was both inaccurate and imprecise. The simplest explanation for this fact is that acupoints don’t exist. Even if you want to hold out the illogical conclusion that acupoints do exist, even though they have no basis in theory and they cannot be detected by any objective measure, you cannot avoid the conclusion based on this evidence that acupuncturists don’t know where they are. So how, then, can they claim to be able to stick needles into acupoints? Short answer – they can’t.

Harriet Hall, who also reviews this study at SBM, points out that there is a great deal of inherent variation in human anatomy as well. I have subspecialty training in neuromuscular disease, which includes studying nerve function. I learned early on that the diagrams of typical nerve anatomy were more schematics than anything else. “Typical” might mean 60% of people have that arrangement, or perhaps it’s as high as 80%. But there is tremendous variation. Even when the arrangement is typical (which nerve branches from which other nerve where), the precise location is highly variable from person to person. Anyone trying to find a deep nerve through surface anatomy in order to stimulate it knows how frustrating this can often be. Why, then, would we expect acupoints to be more consistent from person to person? In any case, surface anatomy is highly variable, and there is no way to measure where the mythical acupoints are. Again, you have to retreat to the evidence-free position that acupuncturists can subjectively “feel” them in some way, even though no instrument can detect them. But that position has been destroyed by this review – acupuncturists cannot agree on where they are.

This assessment, by the way, is called inter-rater reliability – do different people measure the same outcome within reasonable parameters? This is generally considered an important requirement for external validity – meaning that the alleged phenomenon is real.

This result is also consistent with the history of acupuncture points. Originally, based on the oldest known texts, there were 365 acupoints – one for every day of the year. This was no coincidence, as it was believed that the heavenly forces were at work in the human body. Acupuncture is essentially astrology. How do you imagine ancient acupuncturists derived the location and number of these alleged acupoints? Do you think they did exhaustive rigorous scientific studies? Of course not. Such things did not even exist in the world at that time. At best they did anecdotal observation. But they also had no scientific theory to guide them, no knowledge base of anatomy or physiology. Acupoints are mythology. They were derived in the same way astrological beliefs were – through metaphor and narrative.

Over time acupoints also evolved in the same way that mythology evolves – different traditions branched off with different beliefs about how many acupoints there were and where they were. There are now several thousand alleged acupoints, with completely different mutually incompatible traditions, similar to the conflicts between solar astrologers and sidereal astrologers (each of which claim to be the “real” astrology). These differences go all the way down to the individual acupuncturists. It’s as if each acupuncturist is practicing their own tradition of acupuncture.

How, then, do researchers decide where to stick the needles when doing a clinical trial of acupuncture? Do they refer to a body of research providing empirical evidence for the location of specific acupoints and their effects? No – because no such body of research exists. They basically just get several acupuncturists together and they come up with an agreed upon scheme. In other words – they just make it up.

The history of acupoints makes it pretty clear – they are mythology, not science. It would, in fact, be an amazing coincidence of cosmic proportions if it turned out that acupoints actually existed, and that acupunturists discovered the “correct” ones for any specific ailment. You have to have a religious-level belief in revealed knowledge or mythical wisdom in order to maintain belief in acupoints.

Science is properly reductionist for a reason. In order to understand the world, and to have reliable empirical knowledge, you have to build your theories from the bottom up, but also confirm them from the top down. This means that we correlate ultimate effects with basic knowledge about mechanisms. Scientific knowledge does not have to flow in any particular direction. At times we discover something fundamental about the world, and then look for implications and applications. At other times we observe effects in the world, and then reverse engineer their cause. In either case real scientific phenomena become increasingly embedded in this network of knowledge. When a claim remains persistently isolated at one level, and neither leads to further applications or to more basic discoveries about the nature of reality, that is suspect.

Acupuncture has lead to nothing. It has not informed our knowledge about how biology, health, and disease work. The basic principles have not lead to any more generalizable applications. It remains a scientifically isolated belief system. The philosophical traditions of acupuncture continue to spread and splinter, and this is typical of belief systems (just think of any organized religion). But it is not based on any fundamental knowledge. It has not lead to any understanding of biology. It is not objectively advancing. There are no other applications that derive from its principles. And, unsurprisingly, thousands of studies have not demonstrated reliably that acupuncture actually has any specific health effects. At the end of all this research, the most parsimonious interpretation of all the clinical data is that acupuncture is nothing more than a theatrical placebo.

The authors of this review concluded that, “…factors such as education, training and experience were identified as topics for future studies.” No. This is not about education and training. The problem is far simpler, and far more fundamental. Acupuncture points do not exist.