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Archive for the ‘Acupuncture in USA’ Category

J Integr Med. 2018 Jan;16(1):1-5. doi: 10.1016/j.joim.2017.12.003. Epub 2017 Dec 12.

Distribution of licensed acupuncturists and educational institutions in the United States in early 2015.

In recent decades, acupuncture has been used more widely and extensively in the United States (U.S.). However, there have been no national surveys or analyses reported in academic journals on the number of practicing or licensed acupuncturists. This study was conducted to identify the approximate number of licensed acupuncturists active in 2015. The Board of Acupuncture or Board of Medicine in each state or U.S. territory was contacted to collect data. Online license information searching was also performed in order to get accurate numbers of licensed acupuncturists for those states in which a board was unable to be contacted. The study found that the number of licensed acupuncturists in 2015 in the U.S. was 34,481. Of this, more than 50% were licensed in three states alone: California (32.39%), New York (11.89%) and Florida (7.06%). The number of licensed acupuncturists increased 23.30% and 52.09%, compared to the year 2009 (n = 27,965) and 2004 (n = 22,671), respectively; increasing about 1,266 per year. There were 62 and 10 accredited acupuncture institutions providing master and doctoral degrees, respectively. The West Coast comprised 51.39% of degree granting programs, while the East Coast comprised 29.17%; together the coastal states housed more than 80% of all programs, with the remainder sprinkled across the southern (9.72%), northern (8.33%), and the middle/central states (1.39%). Forty-four states and the District of Columbia regulated acupuncture practice by law at the time of data collection. Acupuncture continues to be a quickly growing profession in the U.S.

KEYWORDS:

Acupuncture educational institution; Acupuncture regulation; Acupuncturist; Oriental medicine; United States

PMID: 29397086  DOI:10.1016/j.joim.2017.12.003
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On Wednesday, Feb 14,2018, Acupuncture Society of Virginia (ASVA) members went to Richmond, Virginia, and attended 2018 Lobby day. Many Delegates and assistants came and tried acupuncture. There are 10 pictures here.

https://photos.app.goo.gl/JxGIYLrEeuv17Weo2

 

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Great news! This month our article”Acupuncture’s Role in Solving the Opioid Epidemic: Evidence, Cost-Effectiveness, and Care Availability for Acupuncture as a Primary, Non-Pharmacologic Method for Pain Relief and Management–White Paper 2017″ 1 (Arthur Yin Fan is the first author, and Dr.David Miller is the correspondence author, our colleague Sarah Faggert also a co-author-there are 14 authors across the United States) has been selected as one of ten articles for the November 2017 Elsevier Atlas Awards Nominations.

As is stated on the Elsevier Atlas Awards homepage: “Each month the Atlas Advisory Board are sent a selection of 10 articles to choose their winning Atlas article. The articles are shortlisted by Elsevier from across journal portfolios based on their potential social impact. We are delighted to present the entire monthly shortlist and congratulate the authors of the nominated articles.” While the voting is still in progress, we are still very excited to even be nominated. This marks the first time that an acupuncture article has been nominated for the Elsevier Atlas Award.You may click on the following link to take you the Elsevier Atlas Nominations page: https://www.elsevier.com/connect/atlas/nominations.

We will let you know should our article win!

Each month the Atlas Advisory Board are sent a selection of 10 articles to choose their winning Atlas article.
ELSEVIER.COM
Reference:
1. Fan AY, Miller DW, Bolash B, Bauer M, McDonald J, Faggert S, He H, Li YM, Matecki A, Camardella L, Koppelman MH, Stone JA, Meade L, Pang J. Acupuncture’s Role in Solving the Opioid Epidemic: Evidence, Cost-Effectiveness, and Care Availability for Acupuncture as a Primary, Non-Pharmacologic Method for Pain Relief and Management—White Paper 2017. J Integr Med. 2017; 15(6): 411–425.

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Acupuncture is good for changing American Opioids Epidemic, at https://www.youtube.com/watch?v=ug3e0FzSRAI

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  针灸在美国被点赞 中药科研亟须提上日程

近日,第三届美国中医药大会在美国首都华盛顿举行,来自美中等国的300余名中医药专家参会。

中医在美国的发展现状如何?面临着什么样的机遇和挑战?带着这些问题,《经济参考报》记者采访了与会专家。

针灸发展形势良好执照医生约4.5万人

本次会议主办方是全美中医药学会与美国中医校友联合会,两个协会的会长均由曾就读于北京中医学院(现北京中医药大学)的田海河担任。

田海河对记者介绍说,自美国前总统尼克松访华把中医带回美国,至今已45年。目前,中医在美国有了长足发展,已有46个州和华盛顿特区完成了针灸立法,目前各类有执照的针灸医生约有4.5万人。

“这是一个很好的发展形势,但是学术水平良莠不齐,中医尚未进入医学主流体系。”他说,“就像美国人选择餐馆时还是以喜欢吃西餐为主,喜欢中餐的人虽有,但仍占不是占多数。要想怎么把中医带入美国主流社会,我们还有很多工作要做。”

田海河说,作为外来医学,中医在美国“还是经常会受到一定排挤和否定”,虽然临床、科研及发表的文章为针灸提供了一些有效果的证据,但证据还不是显得非常充足,“需要我们更有效地开展临床科研工作,提供更有说服力的证据,以此来说服民众、媒体、立法、保险公司等更进一步认可中医,接受针灸。”

他表示,针灸是个好东西,确有疗效,很多人都认识到它的价值,近期出现了一些其他行业想染指针灸,“我们的态度很明确,欢迎更多的人来做针灸,惠及民众。但一些其他行业人只接受了很少的训练,就提供针灸服务,还有人把针灸改成‘干针’,试图绕过法律和各行业的执业范围限制去做针灸,非但没效,更对病人造成安全隐患。所以,我们要抗争,并教育、帮助们民众找到一个合格的针灸师。”

“我们需要对民众的安全负责,对针灸的名誉负责,需要对我们中华民族文化保护。因为‘干针’本来就源自于针灸,他们把针灸改头换面,不认祖归宗了,反倒说跟中医无关,这是一种剽窃行为。”田海河说。

针灸临床研究正规范望入美主流医学体系

谈到美国中医药大会,田海河说,该会每年举办一次,今年是第三次,美国、中国以及其他一些国家的中医领军人物都来了,几乎所有以西人为主的全国性中医组织的主要负责人也来了,参会的还有美国食品和药物管理局及美国国家卫生研究院官员,美国针灸执照考试委员会、美国中医高校联合会及资格鉴定委员会等机构的主要负责人也都到场。

“这次大会的目的是要团结更多的华裔和非华裔针灸师,大家聚集到一起共同探讨如何抓住机会,面对挑战,并同时提升整体学术水平,引领美国中医药的正确发展方向。”他说。

会上,世界针灸学会联合会主席、中国针灸学会会长刘保延教授做了题为《针灸临床疗效研究的思考与实践》的主题报告。他指出,疗效是针灸发展的根本,虽然针灸临床研究论文在1992年以后快速增长,但过去一直没有形成系统的临床评价方法,缺乏高质量研究数据,为此中医学界制定了或正在制定针灸临床研究和技术操作等一系列规范,希望按照国际通行标准,“推动针灸堂堂正正进入主流医学体系”。

大会期间,全美中医药学会副会长、美国执照针灸师樊蓥做了题为《假针灸真是假的吗?》的学术报告,对一些结论认为针灸无效的论文的研究方法提出质疑。

樊蓥在接受记者采访时解释说,美国顶尖医学期刊《美国医学会杂志》近年来发表7篇针灸研究论文,最近的一次是今年6月发表两篇论文,其中刘保延负责的一项研究显示针灸治疗女性压力性尿失禁确实有效,而另6篇临床研究结果都是阴性(无效)结论,这可能与研究方法有关系。

樊蓥说,西医的临床研究要求随机、对照、双盲,对针灸而言,随机和对照没有问题,但双盲是有问题的,因为假针灸很难瞒过针灸师和病人,造成了所谓“真针灸不真、假针灸不假”的问题。

美国国家卫生研究院的夏月博士探讨了大数据对针灸科研的指导意义,希望美国和中国在中医科研方面加强对接。

中药尚处灰色地带科研亟须提上日程

田海河强调,中医不仅是针灸,还包括中药,但因为针灸首先进入美国,所以针灸在美国成了中医的代名词。目前,中药在美国未被列入药物范畴,只能归类为食品补充剂,不能宣传治疗效果,所以还处于灰色地带,这限制了中药在美国的广泛应用和发展,“要把中药发展提到日程上来,包括推动在州层面甚至联邦层面立法。当然,这需要一个漫长的过程。”

他举例说,包括麻黄在内,有几个中药因为安全性问题被美国食品和药物管理局禁用,“因此,有些人经常拿这些药说事,说中药不安全。我担心这类事件发生多了后,对在美国开展中药工作会有负面影响。所以,我们需要做一些科研,了解中药的毒副效应,保证民众的安全服用。如果只有针灸,而没有中药,不是一个完整的中医概念。”

会上,中国国家中医药管理局政策法规与监督司原司长、世界中医药学会联合会秘书长桑滨生解读了中国中医药立法及对海外的影响。桑滨生说,《中医药法》是中国中医药领域的一部综合性、基础性法律,不仅对中国中医药发展具有里程碑意义,而且对各国中医药和传统医学立法起到引领和借鉴作用。

美国药管局植物学评审组官员李静介绍了该机构有关植物新药的评审情况。她指出,截至去年年底,共有超过650种植物药物提出或通过“新药临床试验申请”,其中绝大多数处于二期临床试验阶段,但只有2种获准上市。如果把植物药物按全新成分的药物看待,这个通过率“还不错”。

另外,还有十多位中美知名针灸专家和科研教育领域的学者做了学术报告。大会主要赞助企业同仁堂也介绍了其国际化之路,表示已在纽约、旧金山和洛杉矶开设分店,要让更多美国人知道同仁堂这个品牌。记者 林小春

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http://news.xinhuanet.com/english/2017-09/28/c_136643669.htm

WASHINGTON, Sept. 27 (Xinhua) — Although traditional Chinese medicine as a whole is struggling in the United States, acupuncture itself is in a much better situation.

The ancient Chinese practice involving the insertion of fine needles into the skin was generally thought to be brought to America in the early 1970s, thanks to then-President Richard Nixon’s ice-breaking visit to China.

About 45 years later, over 46 U.S. states have legalized acupuncture, and the number of licensed acupuncturists in the country has grown to around 45,000.

BIGGER ROLE

Now, local acupuncturists expressed hope that the ancient art of healing could play a bigger role in solving the ongoing U.S. opioid epidemic, which claims 91 American lives every single day.

“Acupuncture is an effective, safe, and cost-effective treatment for numerous types of acute and chronic pain,” wrote a white paper released this week by several organizations that promote the practice in the United States.

“Acupuncture should be recommended as a first line treatment for pain before opiates are prescribed, and may reduce opioid use.”

The white paper came about a week after the U.S. National Association of Attorneys General (NAAG) sent a letter to America’s Health Insurance Plans (AHIP), asking its insurance company members to review their payment and coverage policies in order to promote alternatives to opioids, such as acupuncture.

Cathryn Donaldson, director of communications and public affairs for the AHIP, a trade association representing 1,300 health insurers, told Xinhua that they have responded to the NAAG letter, which was signed by 37 state and territorial attorneys general.

“Plans are exploring and improving access to non-pharmacologic pain treatments that have been proven effective in reducing pain,” Donaldson said in an email.

“Depending on the individual patient, therapies like acupuncture, mind-body interventions (yoga), psychological interventions (cognitive therapy), and exercise can be an effective first line of treatment for many before moving on to pharmaceuticals when necessary,” she said.

BIG DEAL

Although millions of Americans use acupuncture each year, the practice was considered primarily to be a complementary health approach.

As a result, many American acupuncturists were excited by the NAAG letter, which was virally spread and heatedly discussed in the social media. One of them, Fan Ying, whose clinic is based in the state of Virginia, called it “a big deal” for the industry.

“The spring of acupuncture might have come,” said Fan, one of the authors of the white paper.

“The U.S. opioid crisis will allow non-pharmacologic therapies, including acupuncture, chiropractic care and medical massage, to have a place in the U.S. healthcare system,” he said, but cautioned that “we can’t say there will be no spring chill in the future.”

Li Yongming, a licensed acupuncturist in the state of New Jersey, called the U.S. fight against opioid abuse and addiction “a new opium war.”

“Acupuncture is the most effective in all kinds of non-pharmacologic therapies for pain relief and management,” Li said.

“So the opioid crisis provides the best opportunity in decades for our industry to develop and even become more of a mainstream healthcare option. This may represent a new era of acupuncture.”

Tian Haihe, president of the non-profit American TCM (traditional Chinese medicine) Association, noted that the NAAG letter is only a proposal, but it may indeed mean a turning point and that the next question could be how to grasp it.

“We must demonstrate to patients that we can help relieve their pain, so they will have no reason or excuse to use painkillers and thus avoid being addicted,” Tian said.

“Even if the NAAG proposal is adopted, we should know that many private clinics that offer acupuncture treatments are still out of the insurance system, a problem we should worry about and think how to solve.”

“If acupuncture is covered by health insurance eventually, it’s way too good, but it should be a long process,” Tian said. “We can’t just wait. We need to provide scientific evidence to prove that acupuncture is safe and effective.”

GENERALLY CONSIDERED SAFE

So, how does American academia think about the practice of acupuncture?

“Acupuncture is generally considered safe when performed by an experienced, well-trained practitioner using sterile needles. Improperly performed acupuncture can cause serious side effects,” the U.S. National Center for Complementary and Integrative Health (NCCIH) wrote in an article posted on its website.

“Results from a number of studies suggest that acupuncture may help ease types of pain that are often chronic such as low-back pain, neck pain, and osteoarthritis/knee pain. It also may help reduce the frequency of tension headaches and prevent migraine headache,” the NCCIH said.

What’s more important, the U.S. Food and Drug Administration released a draft proposal in May recommending that doctors learn about acupuncture and other non-pharmacologic therapies for pain management.

Actually, a 2015 study conducted by Kaiser Permanente Center for Health Research, found that of more than 6,000 chronic pain patients who responded to a questionnaire, 32 percent reported acupuncture use, 47 percent reported chiropractic use and 21 percent reported using both.

The peer-reviewed work, published in the American Journal of Managed Care, included members of Kaiser Permanente health plan only.

“There is a growing body of scientific evidence which supports the use of acupuncture for pain management. Often the medications we use don’t work well, or have too many side effects. Thus both doctors and patients are eager for alternatives,” Charles Elder of the Kaiser Permanente Center for Health Research, the paper’s first author, told Xinhua.

“It would make sense that the role of acupuncture should continue to grow in the context of managing chronic pain within our health care system,” he said, citing as an example the state of Oregon where complementary medicine approaches including acupuncture are required to be covered for back pain patients of Medicaid — a joint state-federal health care program.

“My guess is that we will see more of this in the future,” Elder said.

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新华社华盛顿11月20日电通讯:针灸在美迎来发展好时机  新华社记者郭一娜 林小春 胡友松

http://us.xinhuanet.com/2017-11/21/c_129746359.htm

莎伦又一次躺在熟悉的床位上,针灸师樊蓥轻、稳、准地在她肩部和颈部的重要穴位扎上了细细的针。莎伦的耳边响起了柔和温馨的轻音乐,她慢慢闭上眼,呼吸均匀,心情平和,享受着45分钟的美好时光。

樊蓥是美国弗吉尼亚州与华盛顿特区持照针灸师,他的诊所——美京中医院位于弗吉尼亚州梅克林小镇。300平方米左右的诊所内共有15个床位。身为一名职业律师的莎伦·希普勒已经忘了这是她第几十次来到诊所接受治疗。

喜欢运动的莎伦今年60岁,她与针灸的缘分始于3年前。当时她得了肌腱炎,西医告诉她最快也要几个月才能恢复。有朋友向她推荐了樊蓥,后者仔细查看了腿伤后告诉她:“两周来做一次治疗,3次后就能康复。”

西医的数个月康复和针灸的3次就好,这差距大得让莎伦有些不敢相信。面对莎伦的怀疑,樊蓥只是笑笑说,咱们试试看吧。

出乎莎伦意料,一个疗程下来,肌腱炎竟奇迹般康复,她矫健而轻盈的身姿很快又重现跑道。

“太神奇了!”她在接受新华记者采访时禁不住多次感叹。此后,莎伦对中医从信赖到依赖,身体稍有不适,首先想到的就是看中医。

律师工作压力大,导致莎伦睡眠不好。多次针灸后,她感觉睡眠明显改善;每次莎伦感觉有感冒前兆,或者美国将有流感,她就赶紧来找樊蓥。莎伦相信,针灸疗法帮她提高了免疫力。最近她肩部受伤,又是针灸让她免受了手术折磨。

如今,莎伦不仅是针灸的粉丝,更成了针灸的传播者。亲朋好友生病了,她会向大家推荐中医。85岁的老母亲经常背疼,她正力劝母亲尝试针灸疗法。

莎伦对中西医治疗差别感触很深。“樊蓥和他的助手对我十分耐心、细致,我感到很放松,恢复得也快。如果是去看西医,幸运的话,医生会给我10分钟,然后就开药,或安排更多检查。看到我肩痛或脚痛,西医会给我打止痛针。我可不喜欢打针和手术。所以,我会来针灸诊所。我虽不知道针灸原理,但我知道它有效。”

“美国的医疗体系有很大问题,”莎伦说,“不少人在寻找替代疗法。我坚信今后会有越来越多人看中医。”

正如莎伦所说,当前,美国阿片类止痛药物滥用与成瘾危机日益严重,在这方面针灸大有可为。

阿片类止痛药包括杜冷丁、吗啡等,镇痛作用强大,但有极强成瘾性。官方数据显示,每天平均有91名美国人死于过量服用阿片类药物,年均超过3万人。10月底,美国总统特朗普向阿片滥用现象宣战,称“阿片类药物滥用是美国历史乃至全世界范围内最严重的药物危机”。

严峻现实迫使西医接受非药物疗法。而在各种非药物疗法中,针灸以有效和廉价脱颖而出。中国数十年来持续进行的中医机理研究形成大量成果,此时成为有力佐证。美国国家科学、工程和医学学院7月发布题为《疼痛管理与阿片类药物流行》的报告指出,近几十年来针灸止痛已成为普遍做法,包括针灸在内的一些非药物干预手段是止痛的有力工具。

不少旅美针灸师预感,针灸在美国可能迎来了发展的好时机。目前,经过业内人士长达40多年的努力,美国50个州中有46个州以及华盛顿特区已立法让针灸行医合法化。而在这个过程中,樊蓥的诊所,从15年前的无人问津到如今每周稳定在150位左右病人。个中改变,反映了针灸在美国从举步维艰到逐步受到认可的历程。

正是看到针灸治疗的良好效果和较大的市场空间,美国一些理疗师也开始学习针灸,但这也带来了一些干扰。美国的针灸与东方医学硕士需要学习2000小时以上,而美国部分理疗师将针灸改成“干针”,只需学习50个学时就可行医,且未接受中医针灸的完整训练,更缺乏中医针灸处理多科疾病的全能知识和技能储备。所谓干针是指理疗师用针头对激痛点进行针刺的方法。

“美国国内一些理疗师的做法是在混淆视听,给针灸在美发展带来挑战。”谈起这些“干扰”,樊蓥皱起眉头。

目前,莎伦所参加的医疗保险覆盖针灸治疗,可报销80%。10月,美国参众两院议员同意在老年人与残疾人联邦医保的一个补充项目中包括针灸。如果该法案最终通过,相信将进一步推动针灸在美国的发展。

11月,多个美国中医针灸团体在学术期刊上正式发布《针灸应对阿片类药物危机白皮书2017》,樊蓥也是作者之一。这份白皮书被送交美国卫生与公众服务部,并得到积极回复。

也是在初冬,作为全美中医药学会(ATCMA)副会长的樊蓥参加了首次在美国国会举办的针灸推介会,向议员推荐和介绍针灸在止痛与治疗阿片类药物滥用与成瘾方面的作用。现场气氛热烈,40多人还尝试了耳针。“在国会和联邦政府层面,我们还将继续推动,为针灸在美迎来真正春天不懈努力。”樊蓥说。

+1

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http://news.xinhuanet.com/overseas/2017-09/27/c_1121734808.htm

如果说传统中医作为一个整体在美国还处境艰难,那么针灸的命运要好得多。经过业内人士长达40多年的努力,美国50个州中有46个州以及华盛顿特区已立法让针灸行医合法化。由于美国阿片类止痛药物滥用与成瘾危机日益严重,针灸在美国面临着大发展乃至被主流医学界所接受的良机。

一周前,美国35个州、华盛顿特区以及美属波多黎各的检察长联名发出公开信,呼吁美国健康保险计划联合会的1300个会员公司修改保险政策,将针灸等非药物止痛疗法纳入在内。此前,美国马里兰州、华盛顿州、阿拉斯加州等已将针灸纳入医疗保险体系。

美国针灸界26日发表一份21页的英文白皮书,列举一系列科研证据,表明针灸能作为一线疗法安全有效地治疗急性与慢性疼痛。

“针灸的春天也许来了,”在华盛顿特区从业的执照针灸师樊蓥对新华社记者说,“这次美国的阿片类药物危机,将让非药物疗法正式有了一席之地,包括针灸、整脊和医疗按摩,但也不能说没有春寒。”

自去年3月时任美国总统奥巴马提出止痛药物滥用问题,在新泽西州行医的执照针灸师李永明就意识到“这或许是一个针灸新时代的开始”。他第一个提出,美国正在开展“新鸦片战争”,这个说法在华人针灸师内部得到广泛认同。

“在各种非药物疗法中,针灸治疗疼痛效果最好,对替代阿片类止痛药最具特异性,所以这对针灸界无疑是个好消息和发展机遇,几十年不遇,为针灸进入主流医学提供了良机,”李永明说。

对于美国各州检察长的呼吁,他乐观地认为,美国保险公司照办的概率很大,一个原因是针灸成本不高,而“阿片类药物中毒急诊住院治疗平均每次9万多美元。够一个针灸师一年的工资。保险公司是要算成本的”。

全美中医药学会会长田海河强调,美国各州检察长的公开信只是一个提议,采纳与否不知道,但这确实可能意味着针灸在美国大发展的机遇即将来临,接下来的问题是怎么抓住机遇。

田海河说,目前美国有4.5万名针灸师,首先技术一定要过硬,能有本领去帮助病人止痛,使病人没有理由、没有借口去用止痛药,也就不会成瘾。“我们要有这个金刚钻,才能揽这个瓷器活。”

他还提醒,即使各州检察长的提议被接受,美国还有很多提供针灸治疗的私人诊所与个体医生并不在医疗保险体系内。保险体系内的一些医生也提供针灸服务,但称之为“干针”,认为这与中医无关。“干针”反而有可能抢先利用这个机遇,这是需要针灸师们解决的问题。

“如果针灸能被纳入医保范围内,这太好不过了。但这将是一个漫长的过程。结果不是等来的,需要我们提供科学证据,证明针灸止痛安全、有效,”田海河说。

对于各州检察长的提议,美国健康保险计划联合会通信与公共关系主管凯瑟琳·唐纳森告诉新华社记者,他们已在探索加强使用已被证明有效止痛的非药物疗法。

唐纳森说:“对于许多患者而言,诸如针灸、瑜伽和锻炼等疗法都是有效的一线疗法,但这视患者个体的不同情况而言,必要时再改而使用药物疗法。”

那么,美国学术界目前到底怎么看待针灸呢?

美国国家补充和综合健康中心官网在对针灸的介绍中指出,只要由有经验的、受过培训的针灸师施针,针消过毒,总体是安全的,但不当施针能引发严重副作用。一系列研究表明,针灸可能有助减轻腰痛、颈痛和骨关节炎疼痛,也有可能帮助减少紧张性头痛发生频率并预防偏头痛。

美国国家科学、工程和医学学院也于今年7月发布一份题为《疼痛管理与阿片类药物流行》的报告指出,近几十年来针灸止痛已成为普遍做法,包括针灸在内的一些非药物干预手段是止痛的有力工具。

2015年,美国医疗保健机构凯泽·珀默嫩特公司曾在6000多名会员慢性疼痛患者中开展问卷调查,结果发现,32%的患者接受了针灸治疗,47%的患者接受了整脊治疗,21%的患者说同时使用这两种疗法。

研究第一作者、凯泽·珀默嫩特公司健康研究中心的查尔斯·埃尔德对新华社记者说,针灸是帮助治疗慢性肌肉骨骼疼痛的一种重要手段,有越来越多的科学证据支持使用针灸止痛。因为慢性疼痛很难治疗,所以针灸治疗就显得很重要。

“通常我们使用的药物效果不佳或者副作用太大,所以医生和患者都期待替代疗法,”埃尔德说,“针灸的作用应该在我们的医保体系里继续增强,这将很有意义。比如,俄勒冈州现在要求医疗保险覆盖包括针灸在内的补充医学方法治疗背痛患者。我预计我们将来会看到更多这样的要求。”

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https://www.eventbrite.com/e/hill-briefing-acupuncture-a-powerful-tool-in-solving-the-opioid-crisis-tickets-38772019153

DESCRIPTION

The United States is facing a national opioid epidemic and regulatory agencies, patient advocacy groups, chronic care organizations and our medical systems are looking for non-pharmacologic strategies to join in the battle to decrease our country’s opioid dependence. Acupuncture is a powerful, evidence-based, safe, cost-effective and available treatment ready to step into this role. Licensed acupuncturists can be utilized throughout the current systems delivering first-line treatments for pain and can be employed for treatments of those suffering through the debilitative world of opioid addiction.

Join us November 8th as we discuss how acupuncture can be safely, easily and cost-effectively incorporated into hospital and rehabilitation settings across the country to help dramatically decrease health care expenditures while offering patients non-pharmacologic options for treating and preventing opioid addiction and pain.

We will begin with a complimentary session of acupuncture led by a team of experienced licensed acupuncturists. All attendees are invited to participate. There will be a Q&A session following the presentations and lunch will be served.

Speakers:

Dr. David Miller, MD, LAc

Dr. Jun Xu, MD, LAc

Dr. Arthur Yin Fan, CMD, PhD, LAc

Dr. Tracy Soltesz, DAc, LAc

Dr. Kallie Guimond, DOM, LAc

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Today, White Paper version 2.0 was published online first at the Website of Journal of Integrative Medicine

Click to access S2095-4964(17)60378-9.pdf

Acupuncture’s Role in Solving the Opioid Epidemic: Evidence, Cost-Effectiveness, and Care Availability for Acupuncture as a Primary, Non-Pharmacologic Method for Pain Relief and Management, White Paper 2017

Abstract by Arthur Yin Fan

The title of White Paper is “Acupuncture’s Role in Solving the Opioid Epidemic: Evidence, Cost-Effectiveness, and Care Availability for Acupuncture as a Primary, Non-Pharmacologic Method for Pain Relief and Management, White Paper 2017”白皮书的题目是“针灸在解决阿片类药物危机中的作用:针灸作为一线非药物疗法治疗和控制疼痛的证据、花费和医疗服务的可行性”。

There were 6 organizations as the co-publishers-参加发表该白皮书的有6个合作单位:The American Society of Acupuncturists, ASA美国针灸师联合会 、The American Alliance for Professional Acupuncture Safety, AAPAS美国执业针灸安全联盟 ,  The Acupuncture Now Foundation, ANF针灸立刻行动基金会,  The American TCM Association, ATCMA全美中医药学会 ,  The American TCM Society, ATCMS)美国中医针灸学会和全美华裔中医药总会 National Federation of TCM Organizations, NFTCMO 。

White paper  was drafted and edited based on a letter, which original authors were(白皮书起草是在一封信的基础上起步的,信的原文作者是): The Joint Acupuncture Opioid Task Force (Chair: Bonnie M. Abel Bolash, MAc, LAc. Member organizations: The Acupuncture Now Foundation (ANF) ,The American Society of Acupuncturists (ASA) ;组员: Matthew Bauer, LAc ;Bonnie Bolash, LAc ; Lindy Camardella, LAc; Mel Hopper Koppelman, MSc ;John McDonald, PhD, FAACMA ;Lindsay Meade, LAc ;David W Miller, MD, LAc .

The first (revising) author 白皮书修改稿第一作者: Arthur Yin Fan, CMD, PhD, LAc (ATCMA) ;Correspondent author通讯作者: David W Miller, MD, LAc 。Other authors参与白皮书的其他作者: Sarah Faggert, DAc, LAc; Hongjian He, CMD, LAc;Mel Hopper Koppelman, MSc; Yong Ming Li, MD, PhD, LAc ; Amy Matecki, MD, LAc*;David W Miller, MD, LAc; John Pang, MD** , etc . *Division Chief, Dept. of Medicine, Highland Hospital, Alameda Health System; **Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California, San Diego School of Medicine.

Abstract

The United States is facing a national opioid epidemic, and medical systems are in need of non-pharmacologic strategies that can be employed to decrease the public’s opioid dependence. Acupuncture has emerged as a powerful, evidence based, safe, cost-effective, and available treatment modality suitable to meeting this need. Acupuncture has been shown to be effective for the management of numerous types of pain, and mechanisms of action for acupuncture have been described and are understandable from biomedical, physiologic perspectives. Further, acupuncture’s cost-effectiveness could dramatically decrease health care expenditures, both from the standpoint of treating acute pain and through avoiding the development of opioid addiction that requires costly care, destroys quality of life, and can lead to fatal overdose. Numerous federal regulatory agencies have advised or mandated that healthcare systems and providers offer non-pharmacologic treatment options, and acupuncture stands as the most evidence-based, immediately available choice to fulfil these calls. Acupuncture can safely, easily, and cost -effectively be incorporated into hospital settings as diverse as the emergency department, labor and delivery suites, and neonatal intensive care units to treat a variety of pain seen commonly in hospitals.

Acupuncture is already being successfully and meaningfully utilized by the Veterans Administration and various branches of the U.S. Military.

摘要

美国正处于整个国家的阿片类药物流行危机,医疗系统亟需非药物的疗法、用以治疗疼痛并减少公众对阿片类药物的依赖。针灸作为强有效的、循证的、安全的、具有成本效益的治疗方式,满足这一需求。众多针灸临床试验已经证明针灸对许多类型的疼痛治疗有效,针灸的作用机制已被阐明,并且可以从生物医学和生理学角度解释。同时,从治疗急性疼痛的角度来看,针灸的成本效益可能会大大降低医疗保健支出,并避免发生昂贵的阿片类药物成瘾、破坏生命质量、并导致致命的过量。许多联邦监管机构已经建议或强制医疗保健系统和提供者提供非药物治疗选项,而针灸是最具实证性的、并立即可以采用。针灸可以安全、便利、经济有效地纳入医院设置,如急诊部门、产房以及新生儿重症监护室等,用以治疗医院里普遍见到的各种疼痛。

退伍军人管理局和美国军方的各个部门已经成功地有针对性地采用针灸。

  1. Acupuncture is an effective, safe, and cost-effective treatment for numerous types of acute and chronic pain. Acupuncture should be recommended as a first line treatment for pain before opiates are prescribed, and may reduce opioid use.

针灸疗法安全有效、经济,治疗多种急慢性疼痛有效:理应作为疼痛的一线治疗,先于阿片类药物使用,针灸疗法可以显著减少阿片类药物用量(我们在以下各分项中归纳了众多证据)。

1.1 Effectiveness/Efficacy of acupuncture for different types of pain.

针灸疗法治疗多种疼痛有效。

1.2 Safety and feasibility of acupuncture for pain management.

针灸疗法治疗疼痛安全、易行。

1.3 Cost-effectiveness of acupuncture for pain management.

针灸疗法治疗疼痛可以减少支出。

1.4 Can adjunctive acupuncture treatment reduce the use of Opioid-like medications?

结合使用针灸疗法可以减少阿片的用量。 

  1. Acupuncture’s analgesic mechanisms have been extensively researched and acupuncture can increase the production and release of endogenous opioids in animals and humans.

针灸的镇痛机制已经有大量的研究,针灸增加动物和人类的内源性阿片肽并促其释放。

  1. Acupuncture is effective for the treatment of chronic pain involving maladaptive neuroplasticity.

针灸治疗慢性疼痛涉及改善其病态的神经塑形。

  1. Acupuncture is a useful adjunctive therapy in opiate dependency and rehabilitation.

针灸是有益的治疗阿片依赖并促其康复的辅助疗法。

  1. Acupuncture has been recommended as a first line non-pharmacologic therapy by the

FDA, as well as the National Academies of Sciences, Engineering, and Medicine in coping with the opioid crisis. The Joint Commission has also mandated that hospitals provide non-pharmacologic pain treatment modalities.

针灸已被FDA、以及美国国家科学院、国家工程院和国家医科院三院应对阿片类药物危机联合委员会推荐为一线非药物疗法。医院考核联合委员会也已经把非药物治痛疗法列为医院必须包括的项目。

  1. Among most non-pharmacologic al managements for pain relief now available, acupuncture therapy is the most effective and specific for opioid abuse and overuse.

迄今为止,可用的非药物治疗疼痛的疗法,针灸疗法最为有效并对于阿片类药物滥用和过用使用针对性最强。 

  1. Acupuncture is widely available from qualified practitioners nationally.

美国有足够的合格的针灸师

Click to access S2095-4964(17)60378-9.pdf

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Acupuncture’s Role in Solving the Opioid Epidemic

Part 1: Effective and Safe

Evidence, Cost-Effectiveness, and Care Availability for Acupuncture as a Primary, Non-Pharmacologic Method for Pain Relief and Management

http://www.pacificcollege.edu/news/blog/2017/09/29/acupuncture%E2%80%99s-role-solving-opioid-epidemic-part-1-effective-and-safe

 

September 26, 2017, the release of a comprehensive white paper, “Acupuncture’s Role in Solving the Opioid Epidemic”, credited to dozens of authors and a half-dozen different organizations of acupuncturists and TCM professionals. In this series, we’ll be looking at the different reasons why and the ways in which acupuncture can help alleviate the opioid abuse epidemic wreaking havoc in America.

Over the past 20 years, pain management has become nearly synonymous with opioids. Recent data has shown that opioid prescriptions vary widely and that most surgical patients are over-prescribed, with 70% of pills going unused, leaving opioids lying around in many households.(26) About 6% of all Americans prescribed opioids after surgery become dependent upon those opioids; in head and neck cancer patients, however, it’s as high as 40%.(28) Although they do manage pain, even for those who don’t become dependent, opioids lengthen patients’ recovery times through side effects like sedation, pneumonia, and delirium.

Acupuncture, on the other hand, is a safe, affordable, and readily available non-pharmacologic approach to decreasing opioid dependence that our healthcare systems badly need. It can be used in hospital settings from the emergency room to delivery room, and it’s already in use by the Veterans Administration and the US military.

Part 1: Acupuncture is an effective and safe treatment for both acute and chronic pain.

A growing body of research supports the effectiveness of acupuncture for the relief of pain, especially chronic pain, with the strongest evidence emerging for back, neck, and shoulder pain; chronic headaches; and osteoarthritis.

The Acupuncture Evidence Project(1), which we’ve previously covered, searched the literature with a focus on the highest form of evidence available to identify the conditions for which acupuncture has been found to be most effective. They also looked for evidence of acupuncture’s safety and cost-effectiveness and reported how the evidence for acupuncture’s effectiveness has changed over an eleven-year time-frame. Overall, the study found evidence for the effectiveness of acupuncture for 117 conditions, with stronger evidence for some conditions than others. Strong or moderate evidence supported the effectiveness of acupuncture for almost fifty conditions, including IBS, many varieties of musculoskeletal pain, post-operative nausea and vomiting, some types of headaches, PTSD, obesity, and stroke, as well as the aftereffects of stroke. It was found to be particularly safe and cost-effective compared to other potential treatments for allergic rhinitis and migraine.

In another study, the largest study of its kind to date, nearly half a million patients were treated with acupuncture for headache, low back pain, and/or osteoarthritis in an open pragmatic trial; treating physicians rated it as effective in 76% of all cases. Minor side effects were seen in 8% of patients, and major side effects in only 13 patients total.(3) Other studies found acupuncture, particularly electroacupuncture, equal or superior to standard care for sciatica, joint pain, post-surgical discomfort, and the infamously difficult-to-treat fibromyalgia.

Next time: acupuncture is affordable and reduces opioid use.

26: Hill MV, McMahon ML, Stucke RS, Barth RJ. Wide Variation and Excessive Dosage of Opioid Prescriptions for Common General Surgical Procedures. Annals of Surgery. 2017: 265(4), 709-714. doi:10.1097/sla.0000000000001993.

28: Pang J, Tringale KR, Tapia VJ, Moss WJ, et al (2017). Chronic Opioid Use Following Surgery for Oral Cavity Cancer. JAMA Otolaryngol Head Neck Surgery. 2017: doi:10.1001/jamaoto.2017.0582.

1: McDonald J, Janz S. The Acupuncture Evidence Project: A Comprehensive Literature Review. Australian Acupuncture & Chinese Medicine Association Limited, Dec 19, 2016.

3: Weidenhammer W, Streng A, Linde K, Hoppe A, Melchart D. Acupuncture for Chronic Pain within the Research Program of 10 German Health Insurance Funds–Basic Results from an Observational Study. Complementary Therapies in Medicine. 2007;15(4):238-46.

Read the original white paper

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http://news.xinhuanet.com/english/2017-09/27/c_136643493.htm

WASHINGTON, Sept. 26 (Xinhua) — In the wake of an opioid epidemic, acupuncturists in the United States issued a white paper on Tuesday, recommending acupuncture as a primary non-pharmacologic method for pain relief and management.

“The United States is facing a national opioid epidemic, and medical systems are in need of non-pharmacologic strategies that can be employed to decrease the public’s opioid dependence,” said the 21-page white paper.

Official figures showed that opioid overdoses kill 91 Americans every single day and more than half of those deaths involve prescription opioids.

Titled “Acupuncture’s Role in Solving the Opioid Epidemic,” the white paper said “acupuncture has emerged as a powerful, evidence-based, safe, cost-effective, and available treatment modality suitable to meeting this need.”

Organizations that contributed to this paper included the American Society of Acupuncturists, the American Alliance for Professional Acupuncture Safety, the Acupuncture Now Foundation, the American Traditional Chinese Medicine (TCM) Association, and the American TCM Society and National Federation of TCM Organizations.

The white paper said acupuncture has been shown to be effective for treating various types of pain, with the strongest evidence emerging for back pain, neck pain, shoulder pain, chronic headache, and osteoarthritis.

It said mechanisms of action for acupuncture have been extensively researched, which found the ancient Chinese practice increase the production and release of endogenous opioids in animals and humans.

“Acupuncture should be recommended as a first line treatment for pain before opiates are prescribed, and may reduce opioid use,” it wrote.

“Further, acupuncture’s cost-effectiveness could dramatically decrease health care expenditures, both from the standpoint of treating acute pain and through avoiding the development of opioid addiction that requires costly care, destroys quality of life, and can lead to fatal overdose.”

The white paper came about a week after the U.S. National Association of Attorneys General sent a letter to America’s Health Insurance Plans, asking its insurance company members to review their payment and coverage policies in order to promote alternatives to opioids such as acupuncture.

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Reporting Error Revealed in Knee Pain Acupuncture Study, Catastrophe Avoided

June 2016 | by Jonathan Gilbert

http://thegilbertclinic.com/reporting-error-revealed-in-knee-pain-acupuncture-study

On October 1st, 2014, the prestigious Journal of the American Medical Association (JAMA) published a study entitled “Acupuncture for Chronic Knee Pain: A Randomized Clinical Trial”[1]. It was a major study whose results stated that neither acupuncture nor laser acupuncture was useful to patients aged 50 and older with moderate-to-severe knee pain. Enter Dr. Arthur Fan…

In March of 2016 Dr. Fan and associates published a reevaluation of this study. It found serious flaws in its methodology and analysis. Not only that, but when properly evaluated, it appears that the study actually showed significant improvement in patients undergoing acupuncture and laser acupuncture in the clinical trial.

Dr. Fan is a consultant and long term researcher in Traditional Chinese Medicine who has been published in many of the world’s foremost medical journals. He has received numerous awards and commendations including a letter of thanks from the President himself. And thanks to him a grave reporting error was averted and an catastrophe avoided.

What is of interest to this writer is how such a mistake could have been made by one of the most respected, peer reviewed, medical publications in the world? I leave that, along with the link to Dr. Fan’s paper, “Acupuncture is Effective for Chronic Knee Pain: A Reanalysis of the Australian Acupuncture Trial”[2] to your discerning minds. Be well. ♥

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46 reviews of McLean Center for Complementary and Alternative Medicine, about Dr.Arthur Yin Fan, from http://www.bookfresh.com
Simply Amazing
3/2/2016
Deborah L. says: Dr. Fan is simply amazing. Regular PT failed my daughter and both. Dr. Fan far exceeded expectations. Love the atmosphere in the office
Thankful
12/30/2015
Kay S. says: Dr Fan is a super amazing Acupuncturist.. His Chinese Herbs have helped to save my life.. Dr Fan’s acupuncture opened up my meridian to the point where I even got pregnant. I had a healthy baby girl. Dr Arthur Fan knows exactly what he is doing when it comes to treating his patients with Acupuncture . He not only listens , but he treats his patients according to their diagnosis w his super excellent Chinese Herbs💗
PERFECT
11/28/2015
Gwen D. says: Dr. Fan is wonderful. He listens and is very patient and understanding of your issues. I highly recommend him.
Amazing
10/19/2015
Abdou Y. says: I have just started a treatment for a knee pain that has been threatening my ability to work out. Just after 2 visits to Dr. Fan’s center, I can only say that I feel way better than before as I don’t feel anymore about 70% of the pain. I can’t wait for the next sessions as I now hope for a complete healing. I was skeptical at first since I was stranger to acupuncture but not I can say it works.
Excellent
9/1/2015
Lynn D. says: I saw Dr. Fan yesterday for the first time and already feel like I have some improvement in my mood and stress level. Wonderful.
Doctor who cares
8/26/2015
Kasandra M. says: I just started seeing Dr Fan and I appreciate that he is looking at finding the cause of medical issues rather than masking symptoms. I have seen countless doctors and this one finally gives me hope. I have started feeling some relief with my various conditions and I know I have a long road ahead but Dr Fan is very kind, explains things and really targets where the issues are. I am so happy to have found him.
Great insight
7/24/2015
Barbara B. says: Dr. Fan listens more than most conventional doctors and is more attuned with what is going on with your health. His treatments are specialized and individualized to you. He has addressed specific concerns ranging from back discomfort, swollen joints, headaches, and colds, to helping to guide you to an overall sense of quiet and calm. Regardless of what ails you, a cupping session is a must.
Dr Fan Is Amazing
7/3/2015
Yuuna K. says: Dr. Fan is an outstanding doctor. He is trained in both western medicine as well as Chinese traditional medicine. He brings years of experience practicing both disciplines. He is amazing with acupuncture, diagnosis, and treatment suggestions. My body responded very positively to his acupuncture treatment. I would recommend him to other patients considering Chinese Traditional Medicine.
Post-Stroke Dystonia
6/9/2015
Sameer Y. says: I have an odd condition, and Dr. Fan is handling it with patience and success.
Excellent Doctor
4/7/2015
Robin S. says: I am fortunate to have found Dr. Fan who has helped me with a variety of issues: poison ivy, arthritis and allergies among them. His medical expertise is evident as he explains what is happening in the body and how acupuncture can support healing. His knowledge is balanced with kindness and compassion supported by an office environment that provides positive energy. I highly recommend Dr. Fan, particularly if other approaches to a problem have not brought relief.
Incredible!
4/6/2015
Eileen W. says: I was diagnosed with dystonia which affects my neck movement ability. Specialists such as neurologists, rehabilitation doctors suggest Botox injections which has side affect and not a long term solution. I had acupuncture in nearby NYC area and not much improvement. I found Dr. Fan and had great improvement under his treatment. And Dr. Fan is extremely kind and patient. Many thanks to Dr. Fan! Eileen
Very Helpful
4/6/2015
Gwen D. says: Dr. Fan amazes me with his ability to help me with multiple things. I have seen him in the past on other issues, and he has helped me greatly. I tend to be very stressed out and when I am with Dr. Fan, I feel my anxiety level drop. He is kind, understanding and extremely knowledgeable. Dr. Fan his assistant, Sarah, are excellent.
Very astute in diagnosis and treatment
2/8/2015
Scott B. says: I daresay, Dr. Fan has added years to my life. Very early in my chronic lymphocytic leukemia Dr. Fan intervened with a combination of herbs and acupuncture that has kept my cell counts stabilized since 2009–and at a juncture where it is too early for western medicine to intervene. From my vantage, Dr. Fan is most astute for both his skills of diagnosis and week-by-week treatment. Incidentally, for anyone with an interest, I recommend the book “Between Heaven and Earth: A Guide to Chinese Medicine,” by Beinfield and Korngold.
Magical Doctor
1/23/2015
Deborah L. says: I have been going to Dr. Fan now for years when I have a medical issue I’m confident he can treat. When I experienced back issues years ago, I saw a orthopedic doctor, tried a chiropractor, physical therapy and pain medication. It was then I decided to give acupuncture a try. How fortunate that I found Dr. Fan. A very informed physician who was gentle and caring. After only a few treatments which included cupping, I was cured. To this day years later, I have not had any back issues. He is now treating me for acid reflux. I so recommend his treatment – just amazing.
Alternative medicine treatment for hypertension,insomnia and others
11/26/2014
May T. says: Dr Fan treated my hypertension and a myriad of other aches and pains. His knowledge of western and Chinese medicine blends a wholistic approach in his treatment. He is patient and gentle as a doctor. Determined to avoid getting on medication to treat hypertension, I started a diet and exercise regime but only to limited results. Only after I began accupuncture did my blood pressure begin to normalize. My husband also sees him for insomnia which has helped.
Dr. Fan has done wonders!
11/2/2014
Al P. says: Dr. Fan has done wonders for both my wife and me. My wife had lingering multiple small blood clots in her lower leg area. Her vascular surgeon had told she needed to be on blood thinners for the rest of her life. Plus, she would have to wait for the clots to reobsorb back into her blood. Inside two weeks of treatment from Dr. Fan, the clots were gone. After my knee replacement the swelling was not going down. I was told that at my age it would take a much longer time frame. Three weeks of visits to Dr. Fan the swelling was completely reversed. We both whole heartedly recommend Dr. Fan.
Larry A
9/12/2014
Larry A. says: I believe I am very fortunate to have found Dr. Fan. I could not be happier and I am a severe critic, so I believe Dr. Fan is tops. Dr. Fan took his time to explain the procedures before they happened and made sure I understood the message he was telling me. Thank you Dr. Fan
Feeling much better
9/4/2014
Phannee W. says: Having been a patient of Dr. Fan for a while, I am very grateful that he has cured most of my ailments and I would highly recommend him to other patients for acupuncture treatment..
Great Service and Very good doctor
9/2/2014
Maryam Z. says: I have really bad leg pain and I went to see Dr. Fan and explained him my situation. He took great interest in my leg pain and overall health issues and gave me a treatment plan which will help me to deal with my pain until its treated completely. He was not interested in money aspect of my treatment but was more keen to find a cure for my leg pain. I am very happy with his treatment strategy and after 3 sessions, I already to start feeling better.
Great!
8/13/2014
Gwen D. says: Dr. Fan is a wonderful doctor. He is interested in his patients, listens carefully to your issue, and proceeds with the treatment. I have seen Dr. Fan before and he was concerned about the symptoms I had experienced previously; making sure that was cleared up. His assistant is also very committed to the patients and practice. The office has a lovely peaceful aura, I felt good just walking in.
Good oriental medicine and doctor
7/23/2014
Eric T. says: I had went to see Dr. Fan because of pain and numbness in my hands, elbow, and wrist. The doctor at urgent care could not do anything but give my anti-inflammatory. But after seeing Dr. Fan and being treated with acupuncture and medicine he gave me, the symptoms have lighted and is decreasing daily. I would recommend that people with issues that most western medical doctors cannot treat to at least pay Dr. Fan a visit to see if anything can be done.
Five Star
4/27/2014
Al P. says: Both my wife and I have been seeing Dr. Fan for almost a year. He has been able to allow me to delay a total knee replacement for almost a year. And I am certain he will allow me to delay the operation until I am in a better position to have the operation on my terms. He also, in one treatment cleared my Carole tunnel node that was sticking out over an inch and stop the pain entirely. Dr. Fan has saved me from a repetitive operation on my wrist.
Professional and curteous
4/25/2014
Dr. Jerome W. says: Just started, so far everything is fine. I will have more to say when I an further into my treatment.
Made huge difference!
4/23/2014
Takeo Y. says: I had a great experience with Dr. Fan. Aggravated shoulder pain due to lifting heavy stuff on top of the old pain I had been suffering for a while was removed mostly after 3 sessions of acupuncture and cuppings. Will definitely go back to seek for his treatment if the needs arises.
Excited to finally experience alternative medicine
4/22/2014
Carmela & Brent B. says: For me and my husband, it was all positive energy and results. I can’t wait to complete the recommended treatment (2 times a week for 4 weeks), I know Dr. Fan will make a difference! My husband was satisfied after his first time treatment yesterday (4/21/14). After his 40 mins session, he felt like he slept for days and no pain all day.
Always awesome
2/7/2014
Diane H. says: Dr. Fan is wonderful. He has helped me overcome a paralyzed leg (skiing accident), increased the mobility of a surgically repaired shoulder, relieved migraines, and relieved vertigo induced by a concussion. He’s amazing!
Highly recommended!
1/16/2014
Meschelle L. says: I have been seeing Dr. Fan regularly for about 8 months. Acupuncture and Chinese herbs were new to me and I have greatly appreciated Dr. Fan’s knowledge, skills, and approach/demeanor. He and his office team are highly professional and organized as well. Dr. Fan has helped me tremendously with both benzodiazepine withdrawal and rheumatoid arthritis. I plan to make acupuncture and Chinese herbs a regular accompaniment to my healthcare from now on.
Outstanding
12/19/2013
Caron D. says: Dr. Fan has been successfully treating me for something western medicine hasn’t been able to achieve. He is very knowledgable, gentle, thorough and runs a very sanitary and organized office. I highly recommend Dr. Fan.
Outstanding !!!!
10/20/2013
Phil S. says: My wife and I have been going to Dr. Fan for years off and on for various treatments, proof is in the treatment when the pain associated with the condition, goes away. Dr. Fan is extremely helpful and knowledgeable about how to treat a problem. Very compassionate and takes the time to explain the his treatment plan.
Great Experience
10/19/2013
Gwen D. says: This was my first visit, I too was impressed with Dr. Fan’s compassion, understanding and patience with me. Both Dr. Fan and his assistant were wonderful. I am so glad that my friend recommended him.
The best doctor of Chinese medicine in the DC areas
10/9/2013
Jane C. says: I had shingles and the pain was awful. After a brief antivirus treatment my primary doctor at Kaiser Permanente could only give me strong pain killers (generic Percocet) to dull the pain. I was warned that the pain could last for months. So I turned to Dr. Fan for help. Within a week, my pain was gone under Dr. Fan’s care. I am very grateful to Dr. Fan!
Professional and attentive
9/25/2013
Dianna P. says: I have seen Dr. Fan only once so far, but can report that my experience was very good. I had acupuncture and felt better afterwards. I will continue to see him as I believe in the holistic approach to staying well.
More than accupuncture…
9/3/2013
Bill S. says: I have been seeing Dr. Fan for amost 2 years. The accupuncture has helped in so many ways. But, Dr. Fan will talk to you and get to know you. He has recommended teas, herbs and lifestyle changes that have been so benefitial to me. He is a wonderful wholistic healer. WRS
Chinese Medicine works
7/21/2013
Ruth B. says: Dr. Fan’s thoughtful analysis of our conditions each week help us with everything from swollen ankles to allergies to getting greater function in a hip replacement area to blood abnormalities. He and his office staff are pleasant, welcoming, and reassuring.
Dr. Fan is the best!
6/8/2013
Karen D. says: I feel very fortunate to have met Dr. Fan; he is very knowledgeable and skilled in his art. I sought Dr. Fan’s care for what a previous doctor diagnosed as facial nerve damage. Dr. Fan assessed the situation as chronic inflammation, and I have had a remarkable reversal. I couldn’t be more pleased with my transformation, and I highly recommend Dr. Fan. His staff is awesome too; thank you so much, Dr. Fan!
A Real Treasure
4/17/2013
George L. says: I have been a patient of Dr. Fan’s for some time now, and consider him to be a real treasure. Based on the effectiveness of his treatment, he is obviously a master acupuncturist and herbalist. He takes care to explain the nature of the treatment and to answer any questions related to it. I can wholeheartedly recommend Dr. Fan to anyone interested in acupuncture.
Great, compassionate doctor
3/30/2013
Anastasia C. says: Dr. Fan understood my problem and approached it with the utmost care. I’m very appreciative of the wonderful experience being his patient has been.
Mike B says:
3/5/2013
Michael B. says: I have seen Dr. Fan but one time, received accupuncture and something new to me, cupping. The cupping seems to have made my lower back pain, that I have been experiencing 24/7 for about four months, disappear. I have no fantasies about this being a forever thing, but I am optimistic that future visits will have nothing but positive effects on the many trouble spots of my body. Thank you Dr, Fan!
Keeps me balanced
3/1/2013
Jan Y. says: Dr. Fan keeps me balanced and when I have congestion he opens up my sinuses. Doesn’t matter what I go in for, he always seems to have a solution.
Great Dr of alternative medicine
12/22/2012
Sarah T. says: Sarah T. says: Dr Fan is very professional and extreamly knowledgeable about alternative and conventional medicine. He takes time to fully interview me each time I see him, regarding my symptoms and progress. Dr Fan fully understands herbal medicines and I trust his recommendations. I am seeing some success for my balance issues and expect to see additional progress. Thank you Dr Fan.
Thank You Dr. Fan !!
12/3/2012
William S. says: Both I and my wife have been seeing Dr. Fan for most of 2012. We are thoroughly satisfied with Dr. Fan’s kindness, awareness and manner in which he works with us. We could not think of a better environment in which to receive this kind of help. I have recommended Dr. Fan to others and, they are very well satisfied as well. Thank you Dr. Fan!!!
Richard & Arlene
10/16/2012
Arlene R. says: Dr. Fan was recommended to us and my husband went first. Richard came home relieved of his pain so he than he took me in to see Dr. Fan. I been having back and hip pain for 20 years and now after 3 sessions I can sleep on my right hip with no pain. The best customer service to both of us, he gives us great advice on health care. I don’t know why I waited so long to see him!! I highly recommend Dr. Fan and my husband and I always feel very relaxed while getting our treatment together and we love the music that just soothes our whole being!!!
Great !
5/29/2012
Bill S. says: WRS – I am a new patient. I have seen Dr. Fan twice. My initial evaluation was very informative. Dr. Fan discussed alternatives and diet. My first few days were much better. On the second visit, I was complaining of back pain. When I wakled to my car after the accupuncture treatment I realized… “hey!! no more pain!!”. I recommend McLean Center for Complementary & Alternative Medicine and Dr. Yin Fan.
THE BEST DOCTOR IN ALEXANDRIA
4/17/2012
Simara C. says: I have severe back pain and I have to say that everytime I come to see Dr. Fan, he really takes care of me and makes the pain go away. I usually get spasms where sometimes I can’t even move and/or walk straight. He is always concerned, he gives very good advice and is extremely skilled and helpful. His technique is amazing and I never feel whenever he puts the needles in. The cupping is also amazing- which most of the time are done by his great assisstant, April. Dr. Fan along with April give the best customer service and the best treatment. His office is very pleasant, always clean and organized and I always feel very relaxed while I’m getting my treatment with the chinese music he has in every patient room. I feel very lucky to be his patient and I plan to keep going to him as long as I need to.
Wonderful!
3/19/2012
Susan G. says: I am very happy to have found Dr. Fan over a year ago. He is very patient, gentle and understanding and uses his knowledge to help with various issues, like neck and back pain. His assistant is also kind and skilled.
Sarah & Scott
2/8/2012
Sarah L. says: I was very impressed at Dr. Fan’s level of organization and ability to handle multiple clients. He conducted a thorough interview of both my husband and myself and provided treatment. Dr. Fan was very knowledgeable and the things he suggested made sense. He and his assistant are very compassionate and thoughtful individuals and we feel fortunate to have found him.

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|http://blogs.poz.com/mikebarr/2014/12/bmj_editors_hit_and.html
BMJ Editors Hit–and Hit Hard–Over Careless Interpretation of Acupuncture for Chronic Knee Pain Study (JAMA 10/1/2014)

Let’s start with the conclusion, lest I lose you between here and the end.

Acupuncture is more likely to provide relief for chronic knee pain due to osteoarthritisthan any other modality. Pooled studies (a meta analysis) that compared physical interventions for chronic knee pain showed the following “effect sizes:”

(Electro-) Acupuncture: ES of 0.89
Warm baths: ES 0.65
Exercise: ES 0.55

To put this in perspective, the “Minimum Clinically Important Difference” or minimally significant Effect Size, according to patients suffering from chronic knee pain, is 0.39. And the Effect Size threshold the UK’s National Institute for Health and Care Excellence (NICE) uses to determine reimbursement is 0.50.

Call them acupuncture activists. And really brainy ones.

When an Australian group published (in October 1st JAMA) an impressively large (N=282, but there were 4 groups) clinical trial of 12 weeks of acupuncture for chronic (moderate to severe) knee pain in persons 50 years and older, they concluded no difference between the sham control and actual acupuncture. Editors of the premier acupuncture journal in the world (the BMJ group’s Acupuncture In Medicine), however, cried foul. And lamented the lost opportunity to help millions of chronic knee pain suffers. There were determined to set the record straight.

Their protest and clarification letter to JAMA was summarily rejected.

But guess what? They just happen to have their own journal. (Take that, AMA.) And not one of the enumerable, embarrassing American titles. As noted above, we’re talking The British Medical Journal (Even if the quality of the studies AIM publishes sometimes causes a cringe here and there, the White and his staff are doing the best with what they have to work with.) And so AIM editor and British Medical Acupuncture Society chief Mike Cummings proceeded to publish their quibbles today for inclusion, I imagine, in the January 2015 print edition, and set about to educate folks about how to consider clinically relevant results.

For expediency’s sake, I will extract the key arguments from their brilliantly prepared letter today. Then over the next week or so I will work on paraphrasing and whittling it down.

1. BACKGROUND OF THE CLINICAL PROBLEM. Patients with OA knee pain are suffering the commonest cause of pain and disability in older people. More than half have inadequate pain relief.2 They face a choice between ineffective paracetamol, non-steroidal drugs that can harm the heart, (kidneys) and gastrointestinal tract, gels that scarcely work, physiotherapy, opioids that cause dependency and lose effectiveness, arthroscopic washouts that do nothing or surgery.3 They deserve a fuller, more considered answer to their question: “Is it worth trying acupuncture?”

2. NIFTY DESIGN OF TRIAL. The neat part of the Zelen design that Hinman et al used was that the control group, who were not given acupuncture, were not even aware that their pain scores were used in a trial of acupuncture so disappointment could not influence their scores, as was claimed for other studies. This ‘no acupuncture’ group was compared with acupuncture (manual) and with sham laser (and with real laser, which is not considered here, to keep things simple).

3. WHERE THE ANALYSIS BEGINS TO STUMBLE. The problems started with the trialists’ choice of the threshold minimum clinically important difference (MCID) to estimate sample size. They chose a value based on one chosen by six self-styled ‘expert’ physicians,4 namely a 35% fall in baseline pain score (1.8/sample mean baseline 5.1). This is equivalent to an effect size (ES) of 0.6, calculated using their assumed baseline SD of 30 (the actual SD was 21, giving a higher threshold ES of 0.86). A different figure for MCID was generated by 192 patients with OA, who registered improvement scores as well as changes in pain.5 This showed a more modest MCID, equivalent to an ES of 0.39 (shown in figure 1). The National Institute for Health and Care Excellence (NICE) did not regard any value for MCID as valid6 and chose a generic value of 0.5 (see figure 1). Hinman et al chose a high threshold and also failed to discuss the effect that alternative threshold MCID values would have on the interpretation of their findings. We also note that the MCID for any treatment should be chosen to take account of acceptability, safety and cost-effectiveness,7 which would argue for a lower threshold for acupuncture for knee pain.

4. THE OLD “BETA ERROR” BUGABOO: SHORT ON STATISTICAL POWER. Hinman et alapplied this ‘clinically important’ difference to a ‘clinically irrelevant’ comparison–acupuncture versus sham laser. Sham laser is not an available therapy. The only reason for comparing acupuncture with sham would be to estimate the effects of the needles themselves, but this is already well known from the Cochrane review8 and an individual patient data meta-analysis (figure 1).9 It is known that the effect of needles alone is small, and so is unlikely to be identifiable reliably with sample sizes of less than about 800.10 The sample size in the study by Hinman et al (n=70) clearly appears to be inadequate for the question, according to the existing evidence, and not best use of resources. The resulting ES of acupuncture against sham that was actually found by Hinman is similar to that shown by the best evidence8 (see figure 1), although the wide CI means the data can only be of any importance when they are included in a meta-analysis in the future.

5. WHO DECIDES WHAT TREATMENT EFFECT IS MEANINGFUL? Hinman et al found that, after 12 weeks, knee pain was significantly reduced by acupuncture compared with no acupuncture control, with an ES of 0.6 (data from their table 2; see figure 1). The difference did not quite meet the MCID they had postulated–although the estimated ES is the same size as the MCID–but it more than meets the MCID chosen by patients themselves (ES 0.39) and that selected by NICE (ES 0.5). In interpreting this result, the secondary outcomes should also have been brought into thoughtful consideration: there were significant differences in favour of acupuncture for six out of eight secondary outcomes (see eTable 5 in their paper) and the response rate, which is the most patient-orientated measure of success,7 was 76% in the acupuncture group compared with 32% in the no acupuncture control group.

6. TO MAKE MATTERS WORSE, THE AUSTRALIANS STUDIED THE LEAST EFFECTIVE ACUPUNCTURE TECHNIQUE. Hinman et al did not apply optimal acupuncture. Use of electroacupuncture has been shown superior to manual stimulation for knee pain in 2010.8

A couple of weeks ago, I also came across a study of “needle-less” acupuncture, also for chronic knee pain of the OA variety. Basically it involved warming the knee with these stick on cones of burning mugwort–sort of like (very carefully) burning incense around your knee cap. That too showed clinical effectiveness, although now I am prompted to dig up the original study and see if we can fit that “effect size” into our acupuncture, warm baths, exercise line-up above. Stay tuned.

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