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Chapter 31 Acupuncture

image Introduction

Acupuncture is arguably the most recognizable and widely practiced complementary and alternative medicine (CAM) therapy in the world today.1 Public acceptance and utilization steadily increased across the globe between 1980 and 2011. In America, where the growth of acupuncture has been most dramatic (outside of China) during these years, we have seen the numbers of licensed, mainly nonphysician practitioners expand rapidly. In Washington State, for example, the number of acupuncture licensees jumped by 227% during the 10 years from 1997 to 2007, the most of any of the CAM professions, including chiropractic. The same report showed the growth of chiropractic licenses was only 14%, whereas that of physicians was 34%. Naturopathic physician licenses also increased considerably, by 134%.2

There are several key organizations leading the growth of the acupuncture profession in America as of late 2010:

These organizations were formed during 1981 and 1982. The NCCAOM was formed to provide testing for the certification of acupuncturists across America. “The mission of the NCCAOM is to establish, assess, and promote recognized standards of competence and safety in acupuncture and Oriental medicine for the protection and benefit of the public.”3

The ACAOM was formed to provide accreditation to schools and colleges developing programs of study for the training of acupuncturists. “ACAOM’s primary purposes are to establish comprehensive educational and institutional requirements for acupuncture and Oriental medicine programs, and to accredit programs and institutions that meet these requirements.”4

The CCAOM was formed “to advance acupuncture and Oriental medicine by promoting educational excellence within the field. The philosophy of the Council is based on respect for the broad range of traditions of acupuncture and Oriental medicine and a commitment to academic freedom.”5

The AAAOM was the first major professional organization to lead this budding profession. “The AAAOM is the national professional association promoting and advancing high ethical, educational, and professional standards in the practice of acupuncture and Oriental medicine (AOM) in the U.S. The AAAOM mission statement is: To promote excellence and integrity in the professional practice of acupuncture and Oriental medicine in order to enhance public health and well-being.”6

As a result of the ongoing work of these organizations, the following milestones were achieved as of late 2010:

There are several types of providers that receive training in acupuncture as noted in Box 31-1.12 On occasion, professionals such as medical doctors, naturopathic physicians, and chiropractors undergo extensive training in acupuncture, but it is more common to receive professional specific training composed of far fewer hours.

For perspective and comparative purposes, Table 31-1 provides numbers from mainland China showing traditional Chinese medicine (TCM) statistics for the years 2007 and 2008. Acupuncture is considered a key component of the practice of “modern” TCM, along with herbal medicine, massage, nutrition, qigong, and health promotion.1316

TABLE 31-1 China Acupuncture Statistics

TCM doctors 218,044
TCM clinics 35,477
TCM hospitals 2688
Beds 350,257
Acupuncture hospitals 6
TCM doctors per 10,000 population 2.69 (0.69-0.83 USA)
Chinese investment in TCM 1.7 billion yuan

TCM, Traditional Chinese Medicine.

The World Health Organization stated in 2001 that “Chinese Medicine, particularly acupuncture, is the most widely used traditional medicine. It is practiced in every region of the world.” Although this statement has not been revised as of 2011, there is every reason to believe that this remains true.17

Western acupuncture terminology is evolving. Even the term “acupuncture” is considered ambiguous and deserves qualifiers to better guide consumers and professionals engaged in the practice. The following statement reflects this opinion: “The term ‘acupuncture’ in and of itself is ambiguous. It has been used to refer to either a specific procedure involving acupuncture needling or a multicomponent treatment that also involves history taking, physical examination, diagnosis, and education. In some cases, nonneedling procedures (e.g., laser, TENS) conducted at acupuncture points are also referred to as acupuncture.”18

Even the acupuncture credential that this author states in Textbook of Natural Medicine reflects the changing practice landscape. In 2010, the legislature of Washington State approved major scope changes and terminology concerning the licensure of acupuncturists. The widely excepted term L.Ac. (licensed acupuncturist) in the United States was removed and replaced with the term East Asian Medical Practitioner (EAMP) to reflect a long-standing opinion within the field of acupuncture practice that acupuncture is an ambiguous term “in and of itself” and is a “multicomponent treatment.”19

In the state of California, acupuncture licensure was also expanded to reflect this trend. “The theory and practice of acupuncture is based on Asian medicine (also known as traditional, classical Chinese or Oriental medicine), a comprehensive natural health care system that has been in use in Asian countries for thousands of years to preserve health and diagnose, treat, and prevent illness.”20

Contrasting biomedicine and Chinese Medicine in his 2002 article in the Annals of Internal Medicine, Kaptchuk stated that “Chinese medicine relies on the veracity of the senses, the person-centered experience either as reported by the patient or perceived by an observant practitioner.”21

The definition of acupuncture is not as firmly agreed upon as one would imagine. Acupuncture as simply “a Chinese medical practice or procedure that treats illness or provides local anesthesia by the insertion of needles at specified sites of the body” is an oversimplification of a practice that has evolved over many generations with many variations and can describe an entire field of medical practice rooted in ancient classics.22 A more comprehensive definition agreed upon by the greater acupuncture community helps in the transmission of acupuncture principles to the world at large, aiding in the support of new research and advances in the field.

As for historical perspective on the actual term, according to George Lewith’s writings, “acupuncture, or needle puncture, is a European term invented by Willem Ten Rhyne, a Dutch physician who visited Nagasaki in Japan in the early part of the seventeenth century. The Chinese describe acupuncture by the character ‘Chen,’ which literally means ‘to prick with a needle,’ a graphic description of this therapeutic technique.”23

The California Acupuncture Board, which licenses more than 8500 acupuncturists, states the following:

The practice of acupuncture, according to Business and Professions Code section 4937 (b) of California, is as follows: “to perform or prescribe the use of oriental massage, acupressure, breathing techniques, exercise, or nutrition, including the incorporation of drugless substances and herbs as dietary supplements to promote health.”25

In November 1997, the National Institutes of Health (NIH) convened a consensus development conference on the subject of acupuncture. After discussion among a board of experts, the following working definition was included in the NIH Consensus Statement:

The NIH conference has had a lasting positive impact on the growth of acupuncture in America and probably in the world. The definitions and recommendations for further research have sparked wider acceptance within the medical profession. No longer is acupuncture merely a novelty practice from the East.

image History

The historical timeline of Chinese medicine spills over thousands of years to the present. This vast expanse of history can only be captured in mere snapshots of traditional practice, some of it legend, some of it practiced to this day. A rich folk medicine survives in the dozens of minority cultures making up the whole of China. Some attempt exists today to revive an element of these practices. Chinese medicine begins with a legend about the infamous Yellow Emperor, Huangdi (approximately 2698-2598 BC).27,28 The so-called “Father of Chinese Medicine,” Huangdi reigned over a vast Chinese empire. The core of Chinese medicine, acupuncture, and pharmaceutics is traced to the greatest and oldest medical text on earth, the Yellow Emperor’s Canon of Medicine. Unknown medical scholars of the Warring States period (221 BC and 220 AD) wrote the text that is fixed to Huangdi’s name.29

Nevertheless, this book is attributed to the reign of Huangdi and is said to highlight questions and answers among the emperor and his ministers, particularly a physician named Qi Bo. Huangdi discoursed on medicine, health, lifestyle, nutrition, and religious tenets of the times. He is ascribed such a high place in Chinese history that many Chinese people consider themselves descendants. Huangdi is viewed as the “symbol of vital spirit of Chinese civilization.”30 Probably the most important text in the history of Chinese medicine, often overshadowed by the “reputation and authority of the original classic,” the Huangdi Nei Jing, was the Nan Jing (The Classic of Difficult Issues), thought to have been compiled around the first or second century AD. According to Unschuld,31 the Nan Jing

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