In recent years, remarkable advances have been achieved in the methodology of acupuncture clinical research. The standardized design of sham acupuncture control groups, the shift toward quantitative analysis of therapeutic effects, and the growing emphasis on blinded assessment have jointly provided critical methodological support for distinguishing between the specific and non-specific effects of acupuncture. Meanwhile, the system of exclusive reporting guidelines for acupuncture clinical research has been gradually improved, and implementation details including acupuncturist-specific effects and process evaluation indicators have been increasingly explored and refined. These progresses have collectively propelled the development of acupuncture clinical research and laid a solid methodological foundation for enhancing the scientific quality and reliability of such studies. However, the current methodological system still confronts multiple challenges: the difficulty in designing qualified sham acupuncture controls with high credibility, the lack of effective strategies for regulating acupuncturist effects, and the immaturity of standardized tools for process evaluation. Moving forward, targeted research should be conducted to address these bottlenecks, continuously optimizing and improving the methodological framework of acupuncture clinical research to further elevate its academic recognition and clinical transformation value.