[Target trial emulation in acupuncture-moxibustion clinical research: from real-world data to causal inference]

In order to elucidate the application value and implementation pathway of target trial emulation (TTE) in clinical research of acupuncture and moxibustion, this article reviews the key methodological components of TTE, including data readiness assessment, target trial protocol specification, treatment strategy allocation, alignment of time zero (T0), definition of outcomes and follow-up, estimation-based target choice, control of confounding and censoring, diagnostic and sensitivity analyses, and reporting standards. Key operational points are also summarized based on real-world study (RWS) cases of acupuncture and moxibustion. Using a hypothetical randomized controlled trial (RCT) as the reference, TTE translates a research question into an executable observational study protocol, thereby helping to address pre-control design bias, enhance research transparency and strengthen causal interpretation. The application of TTE in acupuncture- moxibustion research should rely on standardized case registration system and emphasize the structured collection of real-world data. Findings from TTE studies may serve as an important complement to RCT evidence, but they remain the limitations such as data quality, unmeasured confounding factors, and the difficulty in simulating sham-acupuncture controls. Hence, these findings should be interpreted and applied with caution.