Abstract: This study examined the application of the Rumsfeld Matrix to acupuncture clinical trials, particularly those published in leading medical journals such as The Journal of the American Medical Association (JAMA), British Medical Journal (BMJ), The Lancet, and The New England Journal of Medicine (NEJM). The integration of randomized clinical trials (RCTs) has introduced a level of academic rigor to acupuncture research, challenging the classical deterministic model and revealing a complex landscape of known knowns, known unknowns, unknown knowns, and unknown unknowns. While RCTs have validated acupuncture’s efficacy in certain conditions, they have also highlighted considerable challenges, including the limitations of control group designs and the potential influence of placebo effects. The recurring issue of no significant differences between real and sham acupuncture in many studies underscores the need for refined control strategies and a more nuanced understanding of acupuncture’s mechanisms. This investigation calls for continued rigorous research to fully explore acupuncture’s therapeutic potential and its integration into evidence-based medicine, ultimately contributing to improved patient care and broader acceptance within the medical community.