D: It is difficult to design a double-blind study for this practice.
Testing the reliability of outcomes in acupuncture is challenging because double-blind studies, where neither the participant nor the practitioner knows who is receiving the treatment versus a placebo, are hard to implement in acupuncture. This is due to the nature of the acupuncture treatment itself, where patients are aware of whether they are receiving actual acupuncture or not, as the sensation and experience differ significantly between true acupuncture and placebo treatments (such as sham acupuncture).