Introduction

Many patients still do not have a clear idea of what the acupuncture profession involves. The term acupuncture actually refers both to the overall practice of TCM (Traditional Chinese Medicine) as well as the specific therapy of fine needle stimulation. It is a comprehensive and modern medical science rooted in thousands of years of development and experience. The scope of practice in California is broad, with inclusion of herbal and nutrient medicine, physiotherapies, and some modern technologies, such as cold-laser, as well as the well-known trigger point stimulation with fine filiform needles and electrical stimulation.

Traditional Chinese Medicine (TCM) is an integrative Complementary Medicine that combines modern medical knowledge with a core approach which utilizes a 6000 year old holistic approach to medical diagnosis and treatment. Complementary medicine refers to a branch of modern medicine that provides a medical approach and therapies that are missing from standard medical practices and thus is a helpful addition to the care that your M.D. provides, and integrates well with such care. TCM is commonly just called acupuncture and the TCM physician is called a Licensed Acupuncturist, although these terms do little to fully describe this complex medical specialty.

The term Traditional Chinese refers to the science’s roots in early Chinese naturalist thought, sometimes called Daoism, but the science is now a worldwide medical practice, with medical schools around the world teaching TCM, and integration into hospital settings and medical doctors’ practices. It is perhaps the most studied of any medical specialty today and is proven to be the safest major medical practice in world history. The abscence of harm from its practice, or iatrogenic harm, is a hallmark of this Complementary Medicine.

TCM is acknowledged as a proven evidence-based medical science by the World Health Organization (WHO) and the National Institute of Health (NIH), both of which have worked to create an accepted worldwide evidence-based set of guidelines for the practice of this Complementary Medicine. Evidence-based guidelines are also evident in California, first with the California Industrial Medical Council, and later with the adoption of evidence-based treatment guidelines for acupuncture into California law (Title 8), to guide the use of TCM in occupational medicine and Workers' Compensation coverage of effective treatment in musculoskeletal medicine. The AHRQ, or Agency for Healthcare Research and Quality, of the U.S. Department of Health and Human Services, is the lead federal agency charged with assessing evidence-based guidelines in medicines, and provides numerous professional treatment guidelines that now include acupuncture. High quality scientific proof of efficacy, even with problematic double-blinded placebo-controlled human clinical trials, are now easily accessed through the NIH PubMed database of professionally published studies.

Currently, the U.S. National Institutes of Health (NIH) has as one of its divisions the National Center for Complementary and Alternative Medicine, and highlights acupuncture as an important part of complementary and alternative medicine (CAM), providing limited access to randomized controlled trials, systematic reviews, and meta-analysis of current scientific studies accepted by standard professional medical journals in the U.S. The World Health Organization (WHO) fully supports the integration of traditional medicine into standard health systems, and reports that in 2007, 48 member states had adopted national policies on traditional medicine, and 110 member states had adopted regulations on the use of professional herbal medicines. In addition, 62 member states had created national research institutes on acupuncture and herbal medicine, or other traditional medicine, in 2007. WHO reports that 80% of the population in Germany, and 70% of the population in Canada, have now used traditional medicine, or Complementary and Alternative Medicine, at some time in their life. Currently, the U.S. is the leader in providing specialized medical colleges and universities to teach the science of acupuncture and TCM at its highest level outside of China, Korea and Japan. There are currently 49 specialized acupuncture and TCM colleges and universities in the United States, and additional programs being set up in standard medical universities.

Defining Complementary and Integrative Medicine, or the practice of acupuncture and Traditional Chinese Medicine

Complementary and Integrative Medicine refers to a branch of medicine that provides what is missing from the modern medical approach, namely conservative therapies that are without side-effects, preventative medicine, health maintenance, consideration of the whole body and mind when diagnosing and treating a particular illness or injury, and a restorative rather than altering approach to cures. This is sometimes compared to a modern allopathic medical approach, whose emphasis is on altering the body’s physiology or anatomy to treat a specific condition, using mainly pharmaceutical chemicals and surgery. Complementary Medicine presents a cure, but a cure based not on chemical dependancy, but on restoration of healthy tissues and function. Restoration of normal healthy homeostatic function as a cure or relief of symptoms and disease requires a more comprehensive approach, and a pro-active participation by the patient. This pro-active and patient-centered approach is becoming increasingly popular in the United States.

How does TCM or acupuncture work?

TCM seeks to restore normal function, or homeostasis, to effect a lasting cure. It is generally advised that patients seek conservative approaches whenever feasible before trying more radical chemical and surgical means, especially if there is risk of side effects or other harm. The degree of severity and risk of serious harm should guide the patient and phsyician in the choice of treatments. TCM offers a variety of medical treatments that are proven to be the safest form of medical treatment in the world, and strives to not just control the disease or alleviate symptoms, but to actually treat the underlying causes. Patients that are not in immediate risk of debility or death may choose to first try the safer and more conservative type of care. Patients that are relatively healthy, yet fear a risk of developing a serious health problem, should turn to Complementary Medicine to decrease this risk and prevent serious problems in the future.

Patients unfamiliar with acupuncture often ask, how does needling actually work? Of course, there are doubts, fostered by years of professional bias, and while the practice is simple, insertion of needles under the skin, and stimulation of trigger points with needle manipulation, the answer to how it works is complex. Acupuncture is the most scientifically studied manual therapy in the world, and a large variety of scientific studies document the numerous types of reactive results seen physiologically, and measured, when trigger points are stimulated properly with the needle. Practically any physiological response can be triggered with acupuncture, and much research in the last decade confirms not only a localized response, but significant modulation in the central nervous system. Neuroimaging studies with functional MRI, PET scans, electroencephalography, and magnetoencephalography have provided abundant proof of specific modulating effects in the brain, brainstem and spinal cord from acupuncture stimulation at peripheral points. But the answer to the question of how acupuncture works is even larger than this, considering that the whole practice of acupuncture is the practice of TCM, which may incorporate a dozen or so treatment modalities, including herbal prescription, nutrient medicine, physiotherapy, therapeutic advice and training, electrical stimulation, cold laser stimulation, diathermy, etc. All of these treatments are both direct and practical, as well as safe and effective, and work synergistically with each other to provide a more comprehensive effect on body homeostasis.

In the past, this was called an ‘alternative’ approach, but the word alternative has unfortunately created an unhealthy animosity towards TCM in the medical community. Today, many M.D.’s are taking up the practices of TCM or complementary medicine because it is a proven science and an effective complement to standard care. In the European Union, where Complementary Medicine is mandated for coverage, this practice is quickly expanding. Although many medical doctors are now taking up the practice of TCM, performing acupuncture and prescribing herbal and nutrient medicines, the Licensed Acupuncturist receives comprehensive education in these medical practices, including complex herbal prescription, manual physiotherapies, nutritional supplementation, needle stimulation, and patient counseling. The education of the Licensed Acupuncturist involves a four year standard of medical school that combines knowledge of modern medicine with traditional theory and practice.

TCM has always been a complementary branch of medicine, even in ancient historical times in China. China was historically an innovator in medical theory, being the first culture to use vaccines, anesthesia, narcotic pain medications, study of cadavers, and advanced surgical techniques, and the first culture to recognize the complex circulation of blood and the role of the brain in the nervous system, as well as the organ systems and their connections. China was also the first country to recognize diseases associated with nutritional deficiencies and institute treatment. The famed historian Joseph Needham has confirmed that the first organized government health care with preventative medicine, and the first organized holistic approach to public health, originated in China.

Today, the TCM physician, or ‘acupuncturist’, works with medical doctors, chiropractors, naturopaths and other medical practitioners in an integrative and complementary fashion to provide a safer and more well rounded approach to medical care. This complementary approach has given the patients more options in health care and often reduces costs by making expensive procedures and pharmaceuticals unnecessary. TCM theory is finally having a big impact on standard medical approaches, too, as evidenced by the focus on ‘Biologicals’ in the pharmaceutical industry, as well as treatment focus on hormonal balance, and holistic approaches to Metabolic Syndrome, formerly seen as a prediabetic state. Chronic diseases are now seen as homeostatic imbalances, such as the anabolic dominance of early secondary osteoarthritis. The concepts of Yin and Yang balance are pervading modern medical theory.

Recent surveys show that 70-80% of the population now utilizes complementary medicine, although this branch of medicine continues to consume only about 6% of the health dollar, while the practice of acupuncture itself consumes a fraction of one percent of health expenditure in the United States. The minute costs of acupuncture practice can be compared to the amazing benefits to demonstrate that this type of medicine is very cost effective at a time when health care costs are bankrupting the country. The long term benefits with preventive medicine may also translate into considerable savings in the future. Public awareness of this medical practice and its reputation as the safest medical practice in world history, with virtually no injury committed with standard practice, has allayed the fears of acupuncture needles and herbal prescription that persisted for many years after the legal introduction of this medicine in the 1970s by Chinese medical doctors. Today, most TCM physicians are graduates of approved medical colleges in the United States who pass a rigorous licensing examination after receiving a masters or doctoral degree. The TCM physician brings a wealth of knowledge and expertise to your care far exceeding the practice of needle stimulation. Don't let the title Licensed Acupuncturist fool you, for the actual medical care that you receive is comprehensive and multifaceted.

Public recognition of the importance of acupuncture and Complementary Medicine is very important as the administration of President Barack Obama seeks to offer the option of the federal health care insurance policies to all Americans, and expand preventive medicine in health care reform implementation. As the insurance exchanges in the health care reform are created, the public needs to demand access to, and coverage of, acupuncture and complementary medicine. Many aging Americans are also dismayed that acupuncture is still not covered under Medicare. This is not because of the lack of proof of efficacy, but purely due to politics of obstruction and lobbying by the big pharmaceutical and insurance companies, which prevents supportive votes on simple pieces of legislation that are needed to go forward with legal incorporation of the acupuncture mandate in Medicare. Support of the Hinchey Federal Acupuncture Coverage Act, which has been stuck in committee since 1991 due to lobbying efforts, is very important at this time to allow the option of insurance coverage for those Americans that desire it. This freedom of choice will not cost the federal government one cent, and may instead reduce total health care spending in the future. The voice of the public must become louder than the monetary incentives of lobbying for this to be achieved. Currently, there is almost no lobbying efforts by the professions involved in acupuncture and complementary medicine. For further information on this issue go to the sections of this website intitled approach or appointments.

Above: Acupuncture Points
— Photo by Michele Clement