From art to metrics: a closed-loop framework for quantifying dose, manipulation, and feedback

The clinical effects of acupuncture depend heavily on its physical parameters, particularly treatment dose and needling technique. Yet these parameters are still poorly standardized in both research and clinical settings. This reproducibility, hinders interpretation of findings, and complicates practitioner training. In this article we synthesize recent work together to propose a closed-loop framework for precision acupuncture, organized around three linked stages. The input stage defines dose mainly in terms of stimulation intensity and translates traditional diagnostic reasoning into a small set of measurable manipulation parameters. The process stage concerns how that stimulation is physically delivered, how it can be quantified through kinematic metrics, and how it can be taught through sensorimotor training. The control stage uses deqi as a real-time feedback signal, while candidate pretreatment biomarkers are considered as feedforward modifiers for initial dose selection. Taken together, these developments support a more quantitative and technology-assisted approach that preserve traditional clinical reasoning while making acupuncture delivery measurable and reproducible.