**Abstract**

Evidence-based medicine (EBM), which emphasizes that medical decisions must be based on the most recent best evidence, is gaining popularity. Individual clinical expertise is combined with the best available external clinical evidence derived from systematic research in the practice of EBM. The key and core of EBM is the hierarchical system for categorizing evidence. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system divides evidence quality into four categories: high, moderate, low, and very low. GRADE is based on the lowest quality of evidence for any of the outcomes that are critical to making a decision, reducing the risk of mislabeling the overall evidence quality, when evidence for a critical outcome is lacking. This principle is also used in acupuncture as a complementary and integrative treatment modality, but incorporating scientific evidence is more difficult due to a number of factors. The goal of this chapter is to discuss how to establish a clinical evidence system for acupuncture, with a focus on the current quality of evidence for a variety of conditions or diseases.

**Keywords:** acupuncture, evidence-based medicine, GRADE, quality of evidence, meta-analysis

## **1. Introduction**

Gordon Guyatt coined the term "evidence-based medicine (EBM)" in 1990 in an unpublished program description, and it was first published in 1992 [1]. This was the first time that an evidence-based practice has been formally established (EBP). Evidence-based practice requires making health care decisions based on the most up-to-date, valid, and relevant evidence. These decisions should be made by those receiving care, with the explicit and tacit knowledge of those providing care, and within the constraints of the available resources [2]. Clinical decision making is the culmination of a process that began with clinical reasoning, problem solving, and an awareness of the patient and health care environment [3]. Pursuing evidence-based acupuncture paves the way for the acupuncture field to fully integrate with modern health care, but there are obstacles. Acupuncture is actually classified as a complementary and alternative medicine modality but is only very rarely included in standard care guidelines, despite overwhelming evidence that it is more effective than the current guideline-based interventions for a variety of conditions [4].
