in other words, if skeptics suspect the placebo effect from the patient knowing whether he is being treated, why not treat people while unconscious e.g. sleeping or sedated? That way there would be no way for the patient to know whether he got treatment or placebo.
Has this been tried? Or do practitioners claim that the patient must be conscious for it to work? If so, do our scientific theories about the mechanism of acupuncture’s action accept such a possibility?
What kind of effects of acupuncture are you talking about? For analgesia, presumably you’d need the patients to be awake to report their pain status.
For other non-pain-related stuff, you wouldn’t, but sedation still wouldn’t be a good way to go about it.
This is because the current model for acupuncture’s mechanism involves the brain–a lot. Right now it looks like it’s mostly due to the release of endorphins and other opioids in the spinal cord and brain, with some other associated activity. (See this review if you’re up for something more technical.) So it’s a really bad idea to suppress a bunch of brain activity with sedatives if you want to know what’s happening with this very brain-dependent process.
You can actually stop the pain-relieving effect by giving the patient naloxone, a drug that blocks opiate receptors in the brain (and is usually used to reverse heroin overdose). Many of the better-controlled studies out there work by giving both groups acupuncture (so that the same expectations are at work in both groups), then giving either naloxone or a placebo injection and watching to see whose pain comes back.
What this shows is that acupuncture seems to be a really good way to release endorphins and other opioids. (The placebo effect in many other situations also involves some endorphins, so whether acupuncture is some sort of superpowered uber-placebo is more of a silly philosophical question.)
The reality is that the endorphin release theory of acupuncture doesn’t have much more evidence going for it than the “release of chi” theory - which is to say, minimal to no evidence when good quality studies are done.
Acupuncture seems basically to “work” on the basis of placebo effect.
One study actually found that “sham” acupuncture (defined as the use of needles or other sharp objects that don’t actually pierce the skin but feel to the patient like penetration has occurred) worked better than “real” acupuncture.
So that’s one answer to the question in the OP - patients don’t have to be unconscious for acupuncture studies to be done - sham acupuncture can be compared to actual acupuncture.
From a Traditional Chinese Medicine perspective, there is no reason a client must be conscious during treatment. I am not aware that any such studies have been done, however. It’s an interesting idea.
It would seem possible to at least blind test whether the qi theory. Get some volunteers with a medical problem who have no knowledge of acupuncture. Insert needles in half of them at the traditional treatment points for their problem. Insert needeles into the other group at points that supposedly do not have any relation to their problem. If the two groups experience the same results, then I’d say that you’ve demonstrated it’s the insertion of needles and not any release of qi that caused the effect.