The Illegal and Unsafe Practice of Acupuncture 


Under the Term “Dry Needling”,


10 Facts You Should Know


Here are 10 facts you should know about the illegal and unsafe practice of acupuncture under the term “dry needling:”

1. “Dry needling” is acupuncture.

“Dry needling” was first described over 2,000 years ago in China’s earliest and most comprehensive extant medical treatise, the Yellow Emperor’s Inner Classic (Huangdi neijing), where it discusses in detail using tender or painful points, also known as “trigger points” or “motor points,” to treat pain and dysfunction, particularly of the neuromusculoskeletal system. Simply described, “dry needling” involves inserting an acupuncture needle into a tender or painful point and then appropriately manipulating (rotating and/or pistoning) it for therapeutic purposes.


2. Tender or painful points, also known as “trigger points” or “motor points,” are acupuncture points.

Tender or painful points are located in muscles and connective tissues, and, as their name suggests, are identified through tenderness or pain on palpation. This was, in fact, one of acupuncture’s earliest forms of point selection. China’s preeminent physician, Sun Si-Miao (581–682 C.E.), called these tender or painful points “ashi” points. In Chinese, ashi means Ah yes!(That’s the right spot.). So, when the tender or painful point is pressed, the patient feels an unexpected local and/or referred “wince-pain” and says Ah yes! That’s the right spot. Incidentally, in a 1977 study published in Pain (the official journal of the International Association for the Study of Pain), Melzack, Stillwell and Fox established that “every trigger point [reported in the Western medical literature] has a corresponding acupuncture point.”* A number of studies subsequently published in the Western medical literature have reached this same basic conclusion.


* Source: Melzack R, Stillwell DM, Fox EJ. Trigger points and acupuncture points for pain: correlations and implications. Pain. 1977 Feb;3(1):3–23.


3. “Dry needling” is not “manual therapy;” it is acupuncture.

It is important to emphasize that “dry needling” is an invasive, acupuncture needle intervention (that is, it is acupuncture, a specialized form of minimally invasive surgery), whereas manual therapy is a noninvasive, hands-on intervention (for example, massage, mobilization/manipulation). Manual therapy certainly does not include the practice of surgery in any form.


4. “Dry needling” is not a “technique;” it is acupuncture.

To make clear, the act of inserting an acupuncture needle into the body, under any pretense, or for any purpose whatsoever, is the practice of acupuncture.


5. Physical therapists and other allied health professionals who are not licensed by law to practice acupuncture cannot legally purchase acupuncture needles.

The Food and Drug Administration (FDA) classified acupuncture needles as Class II medical devices subject to strict regulations under the federal Food, Drug, and Cosmetic Act (FDCA) and FDA’s regulations. Individuals purchasing or receiving acupuncture needles who are not licensed by law to practice acupuncture are directly violating both civil and criminal provisions of the FDCA intended to protect public safety. 21 U.S.C. § 331(a)–(c), (g). These include the FDA’s requirements that acupuncture needles can only be sold to “qualified practitioners of acupuncture.” 61 Fed. Reg. 64616 (December 6, 1996). FDA prescription labeling requirements themselves specifically prohibit the sale of acupuncture needles to anyone who is not a qualified practitioner of acupuncture. The required FDA prescription labeling on the package from which acupuncture needles are to be dispensed states: “Caution: Federal law restricts this device to sale by or on the order of qualified practitioners of acupuncture as determined by the States.” 21 CFR § 801.109(b)(1) (emphasis added). Any individual who is not licensed by law to practice acupuncture is directly violating the FDCA and FDA’s civil and criminal prohibitions when they purchase or receive acupuncture needles for use in “dry needling.”


6. Physical therapists and other allied health professionals who are not licensed by law to practice acupuncture are using acupuncture needles to perform “dry needling.”

Physical therapists and other allied health professionals who are not licensed by law to practice acupuncture would have you believe that they are not using acupuncture needles to perform “dry needling,” when they are, in fact, using acupuncture needles, which are clearly labeled as such on the dispensing package.


7. Physical therapists and other allied health professionals who are not licensed by law to practice acupuncture are not qualified to perform “dry needling.”

“Dry needling” is far outside both physical therapists’ and other allied health professionals’ scope of practice and their scope of education and training. In most states, to become a licensed acupuncturist, an applicant must complete a minimum of 1,905 hours of education and supervised clinical training (1,245 hours of education and 660 hours of supervised clinical training). Yet physical therapists and other allied health professionals who are not licensed by law to practice acupuncture are inserting acupuncture needles (up to four inches or more in length) into unsuspecting patients with as little as a weekend workshop in acupuncture.


8. There are real risks associated with the use of acupuncture needles by physical therapists and other allied health professionals who lack the education and supervised clinical training of licensed acupuncturists.

These real risks include, but are not limited to, blood vessel, nerve and organ injury from inappropriate acupuncture needle angle and depth of insertion or from inappropriate acupuncture needle manipulation; and infection and cross infection from nonsterile acupuncture needles, poor hygiene in acupuncture needle handling, and inadequate skin preparation.


9. There have been recently reported cases of injury or harm from the use of acupuncture needles by physical therapists and other allied health professionals who lack the education and supervised clinical training of licensed acupuncturists.

In one such case, Emily Kuykendall, a high school teacher from Maryland, had suffered nerve damage from the use of acupuncture needles by a physical therapist. In another such case, Kim Ribble-Orr, a former Olympic athlete from Canada, had suffered a punctured lung and a pneumothorax (the presence of air in the cavity between the lungs and the chest wall, causing collapse of the lung) from the use of acupuncture needles by a massage therapist.

*If you or someone you know has suffered injury or harm from the use of acupuncture needles by a physical therapist or other allied health professional who lacked the education and supervised clinical training of licensed acupuncturists, we want to hear from you. Our phone number is 775-301-5255.


10. It is illegal for physical therapists or any other providers to submit claims for payment to Medicare for “dry needling” (a non-covered service) as “physical therapy” (a covered service).

Since “dry needling” is acupuncture, it is not a covered service. Use of acupuncture needles is not a covered service, whether an acupuncturist or any other provider renders the service. 42 U.S.C. § 1395y(a)(1). Its billing under Current Procedural Terminology (CPT) codes 97112 (neuromuscular reeducation) or 97140 (manual therapy techniques) is a misrepresentation of the actual service rendered and is considered fraud by Medicare. 31 U.S.C. §§ 3729–3733.

*If you suspect Medicare fraud, call the Medicare Fraud Hotline at 1-800-HHS-TIPS (1-800-447-8477). TTY users should call 1-800-377-4950.

*Information on this page is used with consent from the National Center for Acupuncture Safety and Integrity





转自  http://www.th55.cn/history/ldmy/1409/281342.html



Please say No To dry needling by PT. It is a public safety issue!
The public comment period is open now through December 30th, 2015.

Please write your comments: Physical therapist only receive less than 100 hour post graduate course for acupuncture. It is irresponsible for untrained physical therapists to practice acupuncture with the name of “dry needling”. It is illegal for Physical therapist to use acupuncture needle to practice ” dry needling”, it is illegal to bypass acupuncture law to practice “dry needling”,

The link to comment and review the document is: http://www.townhall.virginia.gov/L/comments.cfm?stageid=7246

original source: http://ashi-acupuncture.com/dry-needling-vs-ashi-acupuncture/


Dry Needling History

Dry needling is a term coined by Dr. Janet Travell in the 1980’s. This term distinguishes between trigger point injection, where an anesthetic or other substance is injected into a trigger point (a tender focal area of tension within a muscle or other soft tissue), and simply piercing the trigger point with a needle (hypodermic or filiform).

Who Uses Dry Needling?

Dry needling is now practiced by physical therapists, chiropractors, M.D.s, and acupuncturists. Is there a difference between ashi (literally “ah that’s it”) style acupuncture and dry needling? In my opinion, no. Dry needling now usually uses a filiform needle (an acupuncture needle) and tender spots are needled (classically described ashi points).


There is now a turf war going on (“scope of practice”) between various practitioners and involving the various state licensing bodies. Whoever wins in any given state is granted a monopoly to legally perform the dry needling procedure.

I think it is a tribute to the effectiveness of this therapy that many practitioners are interested in learning it. But the fact is that acupuncture needles have been used on tender spots in the body for thousands of years and it’s been called ashi acupuncture. Now certain practitioners want to perform the same therapy but call it dry needling. Isn’t this analogous to someone adjusting the spine like a chiropractor but now wanting to call it “crickety crack” to avoid licensing laws?

Two Specialties of Acupuncture

I really think that there are 2 specialties of acupuncture; “meridian” style acupuncture (maybe it could be called “distal point acupuncture”?) and ashi style acupuncture. Studying “meridian” style acupuncture really doesn’t prepare one well to practice ashi style and vice versa. Learning “meridian” style necessitates the study of the signs and symptoms of dysfunction of the internal organs as described by the ancient Chinese. Tongue and pulse reading may also be important. But with ashi style anatomy is paramount. And study of texts by M.D.s on trigger point work or pain referral patterns of the various muscles is often much more clinically useful than ancient Chinese concepts of physiology.

Would a rose by any other name smell as sweet? Regardless of what we call it, inserting a needle into the taut tender areas of the muscles is incredibly effective for treating pain.

Original article source: http://tcmaaa.org/JAMAresponse.shtml

In 2009, NHMRC funded a research grant (No. 566783; $687,239) to Dr. Rana S Hinman and her team as “ Laser acupuncture in patients with chronic knee pain: a randomised placebo-controlled trial ”. The grant resulted in a publication in the October 2014 issue of the Journal of American Medical Association (JAMA) titled “ Acupuncture for Chronic Knee Pain: A Randomized Clinical Trial ”. The authors (Hinman and her colleagues) concluded that “in patients older than 50 years with moderate or severe chronic knee pain, neither laser nor needle acupuncture conferred benefit over sham for pain or function. Our findings do not support acupuncture”. Following the publication, expert researchers called for explanations to study errors and inconsistencies. With unsatisfactory answers from Hinman and her colleagues, acupuncture organizations (23 organizations) filed three complaints with the University of Melbourne in May through July 2015, but in a letter dated 16 September 2015, the University denied all complaints without providing any reasonable supporting evidence and research documents…     Click here to read more …

Dr. Arthur Yin Fan published a series of articles poking the flaws in Hinman’s study:
► The methodology flaws in Hinman’s acupuncture clinical trial, Part I: Design and results interpretation
► The methodology flaws in Hinman’s acupuncture clinical trial, Part II: Zelen design and effectiveness dilutions
► The methodology flaws in Hinman’s acupuncture clinical trial, Part III: Sample size calculation

Article on Medical Acupuncture by Dr. Kehua Zhou:
► Acupuncture for Chronic Knee Pain: A Critical Appraisal of an Australian Randomized Controlled Trial

Response to JAMA by Dr. Qinhong Zhang et al:
► Acupuncture treatment for chronic knee pain: study by Hinman et al underestimates acupuncture efficacy

Commentary on Acupuncture in Medicine by White A and Cummings M.:
► Hinman’s Trial underestimated the acupuncture effectiveness

Article on The American Acupuncturist Summer 2015 by Jacob Godwin and Arthur Y Fan
► Evidence-Based Medicine Skills for Acupuncturists Part I: The Hinman Trial on Chronic Knee Pain…

Responses to JAMA:
► Responses to JAMA by Dr. Yong Ming Li, Lixing Lao, Hongjian He, etc.

Interview by Acupuncture Today:
► Chinese Doctors Poke Holes in Australian Study By Bill Reddy, LAc, Dipl. Ac.

Dr. Changzheng Gong’s article on International Journal of Clinical Acupuncture:
► Acupuncture Storms JAMA

By Jacob Godwin, DAOM, Dipl OM, LAc;  Arthur Fan, CMD, PhD, LAc


Evidence-based medicine (EBM) skills are critical to clinical effectiveness and to developing and maintaining an effective intellectual ecosystem of clinicians, researchers, policy-makers, and academics. One important competency within the evidence-based medicine paradigm is the ability to appraise research papers critically. The authors first discuss the value of research literacy among acupuncturists and then demonstrate the importance of this skill by critically appraising a randomized controlled trial (RCT) on chronic knee pain published by Hinman et al. in The Journal of the American Medical Association (JAMA) in 2014. Keywords: evidence-based medicine, Hinman trial, acupuncture, research literacy, acupuncture competencies Introduction Four universally accepted core competencies in EBM are required of clinicians: the ability to 1) turn clinical practice problems into focused questions, 2) systematically retrieve published literature to address their questions, 3) appraise the literature they find for applicability and scientific validity, and 4) apply their appraisal to the clinical case before them (1). This paper focuses on the third competency, the ability to appraise clinical research critically for scientific validity and applicability to a clinical question. The example described below, a small (n=282) RCT of chronic knee pain published by Hinman et al. in 2014 (2), is particularly applicable to the issue of validity.

Read more at: Godwin J, Fan AY. Evidence based medicine skills for acupuncturist part I- The Hinman Trial on Chronic Knee Pain and the Importance of Critical Appraisal Skills. J Am Acupunct 2015;70 Summer 22-29.

作西方针刺疗法(Western Acupuncture)的灵魂—激痛点(TriggerPoint),与传统针灸学的腧穴理论有太多的相似。经比较发现,147块肌肉中的255个激痛点,超过92%的激痛点腧穴在解剖上相对应。而79.5%针灸灸穴位所主治的局部疼痛与其对应的MTrP相似。二者均可以引发类似的线性感传。其中二者完全一致或基本完全一致达76%,另有14%也有部分一致。其次,二者均可主治内脏性症状,如腹泻、便秘、痛经等。因此,二者在解剖位置,临床主治,针刺引起线性感传等方面,都有着十分的相似性。


近年来,在中国传统针灸疗法的基础之上,西方提出了所谓的西方医学针灸疗法(Western Medical Acupuncture)或西方针灸疗法(WestAcupuncture)。由于其主要刺激点是激痛点(Trigger Point),所以又称之为激痛点针刺疗法(Trigger Point Acupuncture)或干针疗法(DryNeedling)。这种新针刺疗法在欧美等国家和地区迅速发展并成熟,影响越来越大。





目前,临床上以肌筋膜激痛点(Myofascial Trigger Point,MTrP)的研究最为广泛和深入。MTrP是指骨骼肌内可触及之紧绷肌带所含的局部高度敏感的压痛点。按压它时,可激发特征性的整块肌肉痛、并扩散到周围或远隔部位的感传痛(Referred Pain)或称“牵涉痛”。它不同于其它激痛点,如皮肤性、韧带性、骨膜性及非肌筋膜性的激痛点等。根据其是否伴有自发性疼痛,它可分为活性激痛点(Active Trigger Point)与隐性激痛点(Latent Trigger Point)。前者可自发地引致疼痛,而后者在受压下才会引起疼痛。


有关激痛点的经典著作——《肌筋膜疼痛与机能障碍:激痛点手册》(Myofascial pain and dysfunction:thetrigger point manual),全身存在255个激痛点。它大约是中国传统针灸经穴的2/3稍多,主要用于治疗肌筋膜炎引起的疼痛综合征等。由于MTrP所诱发的疼痛可以沿整块肌肉向远端部位传导,产生感传性疼痛,且当机械刺激如针刺它时,可长时间地减轻疼痛。这与针刺刺激穴位的效应十分相似。因此,早在1977年,提出疼痛“闸门学说”的 Melzack R等比较了二者的疼痛主治及感传痛路线,发现激痛点与传统针灸穴位具有高度的一致性,二者符合率达71%。但由于他将3cm范围内的穴位与MTrP均视为重叠,因此,这一结果遭到Travell JG.和Simons DG.的否定。Travell JG.和Simons DG认为,MTrP与传统的针灸穴位是固定的不一样,每个人的MTrP位置都不一样,只是为了叙述方便,才在书上标记出来,没有任何两个人的MTrP位置完全一样。此后,BirchS发现,传统针灸教科书中许多针灸穴位的主治中并没有提到主治局部疼痛病证,通过进一步的分析与比较,他认为,较之经穴及经外奇穴,激痛点跟阿是穴更相似。Hong CZ也认为,阿是穴与激痛点的位置相当类似,甚至重叠。但是,激痛点理论的创始人Travell等并不认同这些观点,认为MTrP不同于正常的腧穴,也不同于中医的阿是穴。

本人认为,腧穴与MTrP确有不同之处。前者不仅有病理属性,还有生理属性;而后者则仅属于病理性。但近年来的研究表明,MTrP的位置确有与其周围组织不同之处,有其独特的生理特性。其次,腧穴的位置虽然相对固定,但其具体位置也常因人而异。因此,Travell JG.和Simons DG的否定也难以令人信服。





2 针感的相似性

针刺穴位时,施针者常会感觉到针下的局部有一定的沉重感,正所谓“气之至也,如鱼吞钩饵之浮沉”(《标幽赋》)。这种沉重感主要是由于腧穴部位肌肉轻微紧张性收缩所造成的。如果针感强烈,还会出现明显的肌肉收缩现象。即《类经附翼》所形容的“气至,如摆龙尾”。这一现象与机械刺激MTrP时出现的局部抽搐现象(Local Twitch Response, LTR)完全一致。






受累的肌肉常有多个不同的固定的MTrP,而且,每一个MTrP都有自己固定的诱发感传痛区域。一个原发性MTrP可继发性地诱发另一个邻近的MTrP,第二个继发性MTrP又可诱发更远处的MTrP,从而造成远距离感传痛。这样,原发性与继发性的MTrP 便形成了一条感传线。每一个MTrP均有相对固定的感传线。Dr.Dosher研究发现,在相互对应的针灸腧穴与MTrP中,其肌筋膜疼痛感传路线与相应的经穴所在的经络分布完全或基本完全一致的占76%,另外至少有14%属部分一致。除了感传性疼痛以外,机械刺激MTrP还可诱发出相应路径的神经血管反应,这与循经感传现象也十分相似。


3 主治的相关性






4 结语

基于激痛点理论的西方针刺疗法,其治疗疼痛类疾病的疗效也十卓著,影响也越来越大。因此,近年来,西方针刺疗法不仅在理论上、临床应用方面得到了相当程度的认可,而且,其有关内容还被正式纳入到大学的正规教育。如英国的赫特福德大学(University ofHertfordshire)便开设了西方医学针刺疗法的硕士生课程。其次,有关激痛点的生理病理特征,诊断方法,产生的原因等的现代研究也越来越多,日趋丰富。从现有的研究结果来看,传统的针灸穴位与肌筋膜激痛点,无论是在解剖位置方面,还是在临床主治,反应病证,针刺引起线性感传等功能方面,都有着十分的相似性。不仅如此,二者在生理、病理特征方面有着千丝万缕的联系,作者将就此另外探讨。为何二者如此高度地相似?激痛点是针灸腧穴的一个分支?还是传统腧穴的重新发现?这些仍有待进一步深入研究与探讨。如果二者完全一致,这无疑将是传统针灸学的一个重大的发展,也将为针灸学率先走向科学迈出坚实的一步。



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