Acupuncture
Brief history
Acupuncture is one of the oldest recognized healing techniques systems in the world, reaching back many thousands of years to its origins in China. It is likely that more people in recorded human history have been treated by acupuncture than any other healing technique we know today. When President Nixon went to China in 1972, the Western world was widely exposed to acupuncture for the first time. Interest in this approach has expanded continuously over the subsequent decades, despite the very significant differences in beliefs and attitudes about health and disease between Western and Eastern practices.

Today in the United States, there are many schools offering comprehensive acupuncture training programs, as well as more limited course offerings at several conventional medical schools. Thirty-eight states regulate the practice (either licensing, certification or registration), 22 of them with independent practice rights. It is estimated there are more than 10,000 regulated acupuncturists practicing, and acupuncture is among the top three services requested when third party payers offer coverage for alternative and complementary medicine (chiropractic and massage are the other two). There are a national certification board and a recognized accrediting agency for acupuncture (see below). It has been the subject of a 1997 NIH Consensus Conference with very positive findings on the effectiveness of acupuncture for certain conditions. (Two quotes from that report: "The data in support of acupuncture [for certain conditions] are as strong as those for many accepted Western medical therapies." And "One of the advantages of acupuncture is that the incidence of adverse effects is substantially lower than that of many drugs or other accepted medical procedures used for the same conditions.") The World Health Organization recommends acupuncture for the treatment of more than three dozen diseases and conditions, ranging from allergies to musculoskeletal complaints of many kinds, to certain heart problems, and colds and flu.

Philosophy
It can be challenging to convey the philosophies and practices of traditional Chinese medicine in terminology that is meaningful to the American consumer or practitioner of conventional Western medicine. There are concepts and words for which there are no adequate English counterparts, and even when we find words to use, their meanings may be radically different than we have been accustomed to. However, it is not difficult to understand that traditional Chinese medicine (TCM) is an individualized, holistic approach to health care - meaning that each individual is evaluated on a variety of diagnostic measures (physical signs and symptoms as well as mental, emotional and spiritual indicators), and then treatment is individualized according to the findings. This differs substantially from the conventional Western medicine approach, which identifies diseases and preferred treatments for those diseases. In TCM, it is the whole person who must be treated. The goal is always to treat the root cause of any condition by restoring balance and harmony among the patient's five major organ systems, and by helping Qi flow freely through its meridian network. TCM's ultimate task is to harmonize the individual with the energy of the greater Universe. For a more extensive discussion of the philosophy and practices of TCM, click on "Chinese Medicine" from the list of Alternative Therapies on the left side of your screen.

The primary philosophy of acupuncture treatment is that channels of energy run throughout the body in identifiable patterns (called "meridians"), and that the free flow of energy (or "Qi") along these meridians is essential for health. Qi carries both power and messages to each of the body's organs and other structures, which instruct them on how to function. If the energy is impeded or obstructed, disharmony and imbalances occur, eventually causing what we know as disease. It is believed that the meridians can be influenced through the stimulation of acupuncture points by a variety of methods (needles, pressure, heat, electricity), and that each meridian has a specific relationship with a set of bodily functions and organs. The process of identifying which meridians may need attention is a complex one, involving questions about your physical, mental and emotional state, a careful analysis of your tongue and pulses, and an examination of your skin, body odors, voice, posture and movement.

Scope of practice
Acupuncture is part of an ancient medical system (Traditional Chinese Medicine or TCM) which is based on understanding the flow of energy (Qi) in the body and normalizing or enhancing its flow to restore health by using different interventions including Qigong, needles (acupuncture), heat and touch (acupressure), Chinese herbal treatments, foods for healing and Chinese psychology. Different versions of these techniques are taught and practiced around the world. In Traditional Chinese Medicine, the most common system taught and practiced in the United States, treatments may include the use of needles, stimulated manually or electrically, moxibustion or heat on acupoints, acupressure, Qigong, Chinese herbs and specific dietary interventions. A skilled TCM practitioner will also use Chinese psychology.

An acupuncturist may offer some or all of these, depending upon his/her education and regulatory scope; all acupuncturists use needles and most have training in some other modalities. The more generic term "oriental medicine" may also include techniques of massage, movement and breathing; lifestyle counseling; and even martial arts or spiritual practices. Over time, different approaches to all these components have evolved in several countries, so consumers may experience variations in the practice of acupuncture and oriental medicine depending upon the training of the practitioner.

In most of the states that license acupuncture, the practitioner is an independent health care provider; a few states require a medical referral, prior diagnosis, and/or supervision of the practitioner. In some states, the statutory scope of practice is very broad, including all types of stimulation of the acupuncture points plus herbs and diet; however, in other states, the statutory scope is limited to point stimulation and does not specifically include the ability to prescribe herbs or dietary changes. The designation OMD, Oriental Medical Doctor, normally indicates broad training in all the modalities, but does not indicate that a practitioner holds a license; LAc (licensed acupuncturist), RAc (registered acupuncturist), and C.A. (certified acupuncturist) are the most common designations showing that a legal process authorizing the person to practice has been satisfactorily completed.

Regulatory scope
Since there are substantial differences among the statutes and practices of the regulated states, it is important to determine what your own state's regulatory environment is. Important issues include:

• Is the acupuncturist an independent practitioner? If not, determine what is required to see an acupuncturist (referral, prior diagnosis, supervision from, or consultation with, another provider).
• Ask what the scope of practice in your state is, so you will know whether your acupuncturist is limited in the modalities s/he can provide.
• If you live in an unregulated state, you may find practitioners who will do acupressure, movement or breathing techniques, herbs, dietary interventions, and in some cases needles; be sure to check their educational credentials carefully and inquire whether they have passed the national certification examination, or perhaps hold a license from a regulated state.
• "Medical acupuncture" is a term used by MDs and DOs who have added acupuncture as a specialty after completing their training and licensure as physicians. Unless they have passed the NCCAOM national certification examination (see below), and/or their own state's acupuncture licensing process, it's likely that such practitioners have much less formal acupuncture training than the 2-3 years required of non-physician acupuncturists. (For example, the American Academy of Medical Acupuncture requires only 220 hours of formal training for membership.)
• It's not unusual for acupuncture credentials to be combined with other established professional credentials, such as DC, LAc (chiropractor/acupuncturist) or ND, LAc (naturopathic physician/acupuncturist). In these cases, the scope of practice will be much broader than acupuncture alone.

Education and credentialing
The National Commission for the Certification of Acupuncture and Oriental Medicine (NCCAOM) was established in 1982 to develop and administer a national certification process based on nationally recognized standards of competence and education. Since 1985, NCCAOM has administered this examination, which tests for professional-level mastery of the knowledge and skills necessary for safe and effective acupuncture practice. Many states require passing this exam for licensure, although some states administer their own examination.

There are now more than 50 schools and programs of acupuncture in the United States, and a well-established accreditation process. The Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM) is recognized by the U.S. Department of Education as the programmatic accreditor for schools and programs of acupuncture and oriental medicine; it is wise to be sure that your provider was trained in one of these schools.

Typical first office call or visit
Depending upon your acupuncturist's training and scope of practice, your first visit will include questions about your physical, mental, and emotional patterns and concerns, only some of which will sound like a conventional medical history. Your tongue, face and skin will be examined rather closely, and pulses will be analyzed. Terms such as "Stagnant Qi," "Deficient Yin," or "Excess Heat (or Cold)" may be used to describe the findings. TCM diagnosis is a process of noting and correlating all the signs and symptoms, and relating them to one another and to the whole of your body/mind/spirit, to understand the patterns of harmony or disharmony. If you are curious about what all these terms mean and how they relate to your situation, there is more information under "Chinese Medicine" on the left of this screen. There are also many books and articles available which describe the complex vocabulary and process of TCM diagnosis in depth, or your acupuncturist may have handouts you can take home. But it is not necessary to understand these concepts in order to benefit from acupuncture.

The actual insertion of needles is generally not accompanied by pain; manipulation of the needles may sometimes cause discomfort. The number of needles used in one treatment can vary greatly (from just a few to more than a dozen), but the needles are very, very thin and most are inserted and manipulated without any discomfort at all. Most practitioners use disposable needles (often required by state law), to minimize the risk of infection. (If your acupuncturist is not using disposables, you may want to insist on their use for your own protection, or satisfy yourself that adequate sterilization is done.) Once the needles are inserted, they may be left alone, twirled manually or stimulated electrically, and then you will be asked to rest quietly with the needles in place for 15 minutes or so. Removal of the needles is painless.

Acupuncture, like other hands-on approaches such as massage, manipulation and physiotherapy, is a healing technique that usually must be repeated at intervals for a number of weeks. You may be asked to schedule visits one, two or even three times a week for a few weeks until your response to therapy can be evaluated. Generally, the longer the problem has existed and the more severe your symptoms, the more intensive a course of treatment will be. Depending upon your acupuncturist's training and scope of practice, you may also be given Chinese herbs to take, or certain dietary changes may be recommended. Energy movements (Qigong or Tai'chi) and/or breathing techniques may also be recommended. Acupressure or moxibustion may also be applied to acupuncture points in addition to, or sometimes instead of, needles.

Limitations to be aware of
Most licensed acupuncturists are not trained physicians by Western medicine standards; therefore, for most patients, they do not function as primary care providers. They do not prescribe drugs (unless they hold another license which includes that capability, such as MD, DO or, in some states, ND). Be sure all your active providers are in communication with each other, so that if treatment appears ineffective, or you experience any new or acute symptoms, a good decision can be made about whether to continue treatment or seek another opinion. Adverse events are rare with well-trained acupuncturists, but they can happen. It is critical to understand that acupuncturists deal with the body's entire energy system and can cause serious harm if they are undereducated about the ancient holistic medical philosophy and theories behind the practice of this technique. As with any health care treatment, each of us must exercise good judgment on our own behalf.

Resources
Find a practitioner near you:    For more information and additional referral options:
www.aaom.org
www.acuall.org
www.acupuncture.com
www.medicalacupuncture.org.

Publications
The National Institutes of Health Consensus Development Conference Statement, November 3-5, 1997, which contains an extensive list of scientific references, can be found online at http://odp.od.nih.gov/consensus/cons/107/107_statement.htm.

• Educational Options in Oriental Medicine. AAOM Publications.
• State Laws Regarding Acupuncture: State to State Guide to the Laws Regarding Acupuncture. AAOM Publications.
• Cohen, M.R. and Doner, K. Chinese Way to Healing: Many Paths to Wholeness.
• DeGraff, D. and Tyrol, A. The Body Owner's Manual: An Acupuncturist's Teachings on Health and Well-Being.
• Eckman, P,. In the Footsteps of the Yellow Emperor. Cypress Book Co., 1996.
• Ergil, K.V. China's traditional medicine. Chapter in: Micozzi, M.S. (Ed.), Fundamentals of Complementary and Alternative Medicine. Churchill Livingstone, 1996.
• Fleischman, G.F. and Stein, C. Acupuncture: Everything You Ever Wanted to Know but Were Afraid to Ask.
• Holland, A. Voices of Qi - An Introductory Guide to Traditional Chinese Medicine.
• Kaptchuk, T.J. The Web That Has No Weaver: Understanding Chinese Medicine, 2nd ed. Contemporary Books, 2000.
• Lu, N. Traditional Chinese Medicine: A Woman's Guide to Healing from Breast Cancer. Avon Books/ Harper Collins, 1999.
• Lu, N. Traditional Chinese Medicine: A Natural Guide to Weight Loss that Lasts. Avon Books/ Harper Collins, 2000.
• Lu, N. Traditional Chinese Medicine: A Woman's Guide to Trouble-Free Menopause. Harper Collins, 2000.
• _______Traditional Chinese Medicine World, newspaper, TCM World Foundation, New York, New York publishers.
• Molony, D. and Pan, M.M. AAOM's Complete Guide to Chinese Herbal Medicine.