新闻分析：针灸看到了被美国主流医学接受的机遇

新华社华盛顿９月２６日电 新闻分析：针灸看到了被美国主流医学接受的机遇 （2017-09-27 20:29:36 来源： 新华社） http://www.xinhuanet.com//world/2017-09/27/c_1121734808.htm

新华社记者林小春

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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Dr. Gene Bruno: The beginning of the acupuncture profession in the United States (1969–1979) — acupuncture, medical acupuncture and animal acupuncture

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	Dr. Gene Bruno: The beginning of the acupuncture profession in the United States (1969–1979) — acupuncture, medical acupuncture and animal acupuncture  | PDF | http://www.jcimjournal.com/jim/ June 23, 2015 | Arthur Yin Fan, Sarah Faggert (doi: 10.1016/S2095-4964(15)60186-8)  | PDF |

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Nevada: the first state that fully legalized acupuncture and Chinese medicine in the Unites States

Dr. Fan’ s new article was published recently.

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Letters to JAMA Exposing Acupuncture Research Flaws Applauded by TCMAAA (from http://www.marketwatch.com)

Letters to JAMA Exposing Acupuncture Research Flaws Applauded by TCMAAA

http://www.marketwatch.com/story/letters-to-jama-exposing-acupuncture-research-flaws-applauded-by-tcmaaa-2015-02-19

Published: Feb 19, 2015 8:01 a.m. ET

TCMAAA calls for stricter adherence to research ethics and well-designed acupuncture studies among the integrative medicine community

TAMPA, Fla., Feb 19, 2015 (BUSINESS WIRE) — In five letters to the editor published in the latest issue of JAMA, the Journal of the American Medical Association, acupuncture clinicians and researchers around the world point to key flaws that call into question the validity and research methods used in a randomized clinical trial published in JAMA in October of 2014. The Australian study, Acupuncture for chronic knee pain: a randomized clinical trial, by Hinman, et al., concluded, “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 for these patients.” Many American acupuncturists were outraged when the October 2014 article was published in JAMA and have called for a review of the study’s design and protocols.

Yong Ming Li, MD, Ph.D., of New Jersey challenges that the researchers altered the aims and hypotheses of the study after the data was collected and the trial was closed. According to the original aims and hypotheses submitted to the official clinical trials registry in 2009 the objective of the study was not to evaluate the effectiveness of traditional needle acupuncture against sham laser acupuncture, but to evaluate laser acupuncture against sham laser acupuncture with needle acupuncture serving as a positive control for laser acupuncture. Protocols originally filed with the registry as well as the authors’ baseline publication do not describe sham laser acupuncture as being a control for needle acupuncture. Dr. Li’s letter furthermore debates the validity of using sham laser acupuncture as a control for needle acupuncture, as it is not generally accepted as a valid control for needle acupuncture.

Hongjian He, AP, Ph.D., of Florida also questions design choices: she specifically points to the use of non-standardized point selection for chronic knee pain. Also some patients received treatments once a week, while others got treated twice a week. This lack of consistency throws into question the validity of the statistics extrapolated from the data collected during the study.

David Baxter, TD, DPhil, MBA, and Steve Tumilty, Ph.D., questioned in their letters why the researchers chose to use laser dosages below the threshold necessary to have a therapeutic effect and why they failed to specify wavelength used in the study and why those levels were chosen.

Lixing Lao, Ph.D., MB, and Dr. Wing-Fai Yeung, BCM, Ph.D., point out in their letter that patients were assessed after 12 weeks and then again after one year, but that without treatment for chronic knee pain after one year, the condition naturally will deteriorate, so that the findings after a year are irrelevant. With these key flaws revealed the conclusion of this randomized clinical trial is clearly undermined.

No group has been more involved in this issue than the Traditional Chinese Medicine American Alumni Association (TCMAAA). Through its broad social media in the USA and around the world, TCMAAA has orchestrated a series of professional forums and discussions on research ethics and design for acupuncture studies after the Australian study was published in JAMA.

“This collection of letters represents a merging of licensed acupuncturists and integrative medicine practitioners who demand the same gold standards of ethics and design quality for clinical acupuncture research as conventional medical studies,” stated Haihe Tian, Ph.D., AP., the President of TCMAAA.

Even with the challenges acupuncture poses in gold-standard randomized clinical trials this valuable treatment method should not be overlooked. With properly designed and well-thought-out studies acupuncture can be evaluated fairly and thoroughly, with conclusions founded upon careful reasoning, accepted controls, and irrefutable evidence.

About TCMAAA:

Registered in Florida, TCMAAA (website: http://www.tcmaaa.org) is a nonprofit organization with one thousand members of licensed acupuncture practitioners formally trained in accredited medical education institutions in China. As a leading organization among Chinese Medicine practitioners, TCMAAA continues to support its members’ professional growth across the United States.

SOURCE: TCMAAA

For TCMAAA
Selene Hausman, L.Ac., 480-510-2259
seleneph@gmail.com

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Cervical Dystonia & Acupuncture, by Dr Arthur Fan in the greater Washington DC and Northern Virginia

Cervical dystonia case

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The Well Street Journal talking about Traditional Chinese Medicine today, on the Health & Wellness Section, Nov 4, 2014

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Dr. Arthur Fan’s channel on www.Youtube.com

https://www.youtube.com/my_videos?o=U

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Dr. Wu: A beautiful, moving and meditative song — In memory of Dr. Jing Nuan Wu, a pioneer of acupuncture and a Chinese medicine doctor in the United States. By Arthur Fan

Dr. Wu: A beautiful, moving and meditative song — In memory of Dr. Jing Nuan Wu, a pioneer of acupuncture and a Chinese medicine doctor in the United States.

Journal of Chinese Integrative Medicine: 2012; 10(8): 837-840

http://www.jcimjournal.com/en/showAbstrPage.aspx?articleID=jcim20120801

1.         Arthur Yin Fan (McLeanCenter for Complementary and Alternative Medicine, PLC. Vienna, VA22182, USA )

2.         Ziyi Fan (McLeanCenter for Complementary and Alternative Medicine, PLC. Vienna, VA22182, USA )

Journal of Chinese Integrative Medicine: Volume 10   August, 2012   Number 8

Received June 10, 2012; accepted June 13, 2012; published online August 15, 2012.

Full-text LinkOut at PubMed. Journal title in PubMed: Zhong Xi Yi Jie He Xue Bao.

Correspondence: Arthur Yin Fan, PhD, MD, LAc. Tel: +1-703-499-4428; Fax: +1-703-547-8197; E-mail: ArthurFan@ChineseMedicineDoctor.US

Few popular songs are titled a doctor’s name and even fewer are sung directly by the doctor’s patients. However, the song Dr. Wu might be the exception. After sung by Steely Dan[1], a well-known American jazz-rock band, Dr. Wu has been loved by many Americans for over 35 years. The beautiful, moving, and meditative song was written in 1975 after Steely Dan had abandoned touring and reconvened in Los Angles, the UnitedState[2]. As one of the best Steely Dan songs, Dr. Wu literally describes the love between Katy and a young Cuban man, and because of Dr. Wu, the girl leaves the young man. Actually, the song writer and singer Donald Fagen, wrote the song as a metaphor commemorating one of the band members’ recovery (probably himself) from drugs with the help of Dr. Wu[3]. Hence, the song is a cryptic lyrical tribute.

1  Who is Dr. Wu?

In the Steely Dan Dictionary[4], the titular doctor is identified as: “Doctor Jing Nuan Wu (1933-2002), an acupuncturist and artist based in Washington, D.C., emigrated from China to the UnitedState at a young age and graduated from Harvard to become a Wall Street venture capitalist, finally setting up a Taoist clinic in Washington, D.C. in 1973.”

I met Dr. Jing Nuan Wu (胡振南) in 2002, just one month before his death. At the time, I had only lived in the UnitedState for one year. I had just received my acupuncture license and planned to practice Chinese medicine in Washington, D.C., so I called Dr. Wu’s office to ask for some advice from him, and he agreed to see me. I did not know he was very ill. We met in one of his offices in Georgetown, located on the beautiful north bank of the Potomac River. He was very thin and wore a black traditional Chinese silk shirt. Because he could not speak Mandarin and I could not speak Cantonese, we used English to communicate. His voice was very soft due to his illness. Dr. Wu described the history of Chinese medicine in Washington, D.C. and he hoped that Chinese medicine could prosper from generation to generation. He said that he was aware that I was a young Chinese medicine doctor with several achievements and expressed that I could work with him should he recover from kidney cancer. It was a pity that the arrangement was never fulfilled. Dr. Wu passed away on December 3, 2002.

Dr. Wu was a legendary person. He was born in Guangdong, China, a province near Hong Kong, but was raised in Greenwich, Connecticut, in the United States. According to the recall of a friend of his[5], Dr. Wu came to the United States with his parents when he was five years old. His parents were laundry workers and worked hard to raise him. Their work paid off as he later graduated from HarvardUniversity with a degree in language and history. He moved to Middleburg, Virginia in the 1960s and caused a stir in Virginia hunt country when he bought the Rattlesnake Ridge retreat from Jacqueline Kennedy[6]. He had an “extreme crisis” in early 1970s before becoming a Chinese medicine doctor[5-7].

Dr. Wu was a venture capitalist in the 1960s and had interest in a firm that was developing Apollo space capsules. He had trouble with the authorities in that period; the immigration officials accused him for faking papers and the Securities and Exchange Commission suspected him of investment improprieties (he denied both wrongdoings). He was involved in a series of tiring law suits and became bankrupt. His United States citizenship was maintained, but he could no longer be a venture capitalist. During this crisis period, he visited his family in Hong Kong. During this visit, an elder relative gave him some life-changing advice — “It’s time for you to do service.” he said. It was then that Dr. Wu learned Chinese medicine from his uncle and was commissioned to write a book on Chinese medicine in English. When he realized that Chinese medicine was effective, he made a decision — instead of writing about Chinese medicine, he began to practice it.

He returned to the Washington D. C. to establish the Taoist Health Institute in 1973, and developed a stable stream of high-profile clients. Under the supervision of a medical doctor, he became one of the earliest acupuncturists/Chinese medicine doctors in the United States. At that time, Washington, D.C. was the first local authority that allowed acupuncturists to legally practice. Dr. Wu was most successful during the late 1970s to early 2000s[5-7]. At the time, when people in Washington, D.C. thought of acupuncture and Chinese medicine, the first name that came to mind was Dr. Jing Nuan Wu[7]. As his friend wrote in a book, “a Chinese idiom says, ‘death is not terrible; two decades later, he will become a hero again.’ Dr. Wu actually became a hero in Chinese medicine only several years after his ‘death in Wall Street’”[5].

2  Dr. Wu’s achievements

Dr. Wu established an acupuncture detoxification center, which is the first notable work of him in 1980s. Due to his deep concern for young American addicted to drugs and being encouraged by the initial success of his acupuncture detoxification test, Dr. Wu established a drug recovery center in 1983 or 1984 called the GreenCrossCenter for Traditional Medicine, located at 1510 U Street NW, Washington, D.C. This center was well-known because it was probably the second most successful acupuncture detoxification center in the United States. The first was established by Dr. Michael Smith in the LincolnHospital in the Bronx, New York, which saw 200 to 300 patients every day, and is financially supported by the state. In contrast, Dr. Wu did all the work on his own with great difficulty. His clinic had no funding from the city, the state, or the federal government. In an interview[7] by Dr. Redwood in early 1990s, Dr. Wu said that he and his associates at Green Cross did the work because they had hoped that it would encourage other people to do the same. However, the clinic required a great deal of money and dedication. “I know of many groups throughout the country that have tried to do what we have done, and they have not been successful because of the lack of one or the other. I can not tell you how much dedication it really does take. The staff are burnt out. We are basically on our second group of staff in seven years. Luckily, our practitioners work for very little. So what has happened is that no one works full-time except two of the administrative staff. Everybody else works part-time. They make money outside of this work, so that they can keep body and soul together. I subsidize the clinic through my personal work, and one or two of my friends have put in substantial amounts of money.” At that time, his detoxification clinic might have been the only one using Chinese herbs, alongside the acupuncture, to treat drug addiction and acquired immune deficiency syndrome[8] in the United States.

His second notable work was the push for the first acupuncture regulation in Washington, D.C., which was released in 1989. He served as the chairman of the Acupuncture Advisory Committee for the District of Columbia, which has advised the Board of Medicine, Washington, D.C., on the regulation and licensing of acupuncturists in the District for over 10 years. He did “one of the more frustrating jobs” in his career — the Washington, D.C. Board of Medicine, and Dr. Wu had agreed early on with regard to the acupuncture guidelines. It then took Dr. Wu and his colleagues three years and five lawyers to put out only 12 pages of rules and regulations. “That is because Washington, D.C. mires in a system of bureaucracy that is impossible to understand. That impossibility stems from one critical lack — that they have no one in the city bureaucracy that can type! So we ended up in a situation where the lawyers get so frustrated that after five months they quit. In dealing with this, it was not until our fifth lawyer that we finally got the rules and regulations into a piece where we could publish them. It is that type of procedure which I think is analogous to the drug situation.”[7]

Dr. Wu also played an important role in acupuncture development in the United States. In 1994, as one of three licensed acupuncturists (the other two were Dr. Lixing Lao, and Dr. Xiaoming Tian) was invited, he gave a presentation on acupuncture as a medical device and the safety of acupuncture in a workshop cosponsored by the Office of Alternative Medicine, National Institute of Health (NIH), and the United States Food and Drug Administration (FDA). Since this workshop, acupuncture needles were no longer listed as an investigational device in the FDA regulations (as it did for 20 years prior to the workshop). This was a milestone in acupuncture development and make acupuncture have broader applications in clinical practice. As a renowned acupuncturist, a Chinese medicine scholar and a practitioner, Dr. Wu was also invited to be one of the key board members listed for the Journal of Alternative and Complementary Medicine — one of main journals in the research of acupuncture and Oriental medicine, in which he published an article introducing the history of acupuncture.

His third notable work was his introduction of Taoism and promotion of Chinese medicine in GeorgetownUniversity, GeorgeWashingtonUniversity, and many other institutions all over the country. He translated and published several important classic books related to Chinese medicine, completing the “homework” that his elder relative had given him many years before. Such works were the Spiritual Pivot (Lingshu, 《灵枢》, published by University of Hawaii Press, 1993), Yi Jing (I Ching, 《易经》，published by The Taoist Center, 1999 and earlier), and An Illustrated Chinese Materia Medica with the collaboration of Dr. Qian Xinzhong, the former Minister of Ministry of Health of the People’s Republic of China (published posthumously by the Oxford University Press, 2002). These books have been widely cited by Western scholars. Before his death, Dr. Wu also completed a translation of Tao Te Ching/Lao Tzu（《道德经/老子》）, which, sadly, was not published.

Dr. Wu’s fourth notable work was the use of multiple natural remedies to treat patients. In the 1980s, there was a natural healing center located at Wisconsin Avenue and 30 Street that included acupuncture, Chinese herbology, nutrition consultation, Chinese medicine lectures, as well as an Oriental medicine book store and a small Oriental dietary therapy restaurant. One of my patients recalled that this center was also established and administered by Dr. Wu. Dr. Wu invited several renowned practitioners to take part in the center’s work. The center was unique and attracted many people. However, because of financial difficulties, it closed after several years.

Dr. Wu was involved in promoting Chinese herbology. He said that among Chinese medicine therapies, Chinese herbology is the major one. He was one of the earliest well-known Chinese herbalists in the Washington, D.C. area. Besides his daily clinical work, he carried out a clinical study for women going through menopause using Jia Wei Xiao Yao San, also called Free and Easy Wanderer Plus Powder under a NIH funding. His work was recommended by FDA to the public as an alternative therapy for menopausal women.

3  Dr. Wu, the artist for healing

In the 1980s, Dr. Wu began creating abstract art that embodies the holistic ideas of the traditional Chinese healing system, and had an exhibition at the National Botanical Gardens (Washington, D.C., USA). “My vision for the artwork grew when a patient who was ill with cancer asked me to paint a picture for him. Suddenly I realized that I had found a way to heal many more people than the number I could see in my office every day,” he said. His paintings and sculptures eventually evolved into therapeutic devices, used to promote health, balance, and relaxation by evoking responses from the inner aspects of our being (see Figure 1). Once upon a time, Dr. Wu mentioned that “visual art can and should be celebrated not only for its aesthetic and decorative value and as a record of historical events but also for its potential to help us express, understand and heal ourselves”. He said: “The quest for the transcendental experience has been a popular trip for mystics, and religious persons through the ages. They have followed the paths of meditation and spiritual practice. In the empirical vision and methods of traditional Chinese medicine, entry to the transcendental is an every day experience. The most significant outward manifestation of the transcendental state is relaxation of the physical body. I attempt with my art to change and to reset the clockwork of our inner being to the most beneficial and health-inducing rhythm. When reset and unburdened from the tics of anxiety and social pressure, one is being entered a calm field where new patterns of behavior can develop and take hold within. These quiet inner fields are my new medical country and my artwork is the way of passage.” Ten years after his death, his paintings are still available for purchase online[9].

Figure 1  Dr. Jing Nuan Wu is painting the impressionist paintings about Chinese medicine

This photo was taken in 1990s and was afforded by Ann Miller, Dr. Wu’s former assistant.

Dr. Wu passed away at age of 69, after almost 30 years of acupuncture and Chinese medicine working in Washington, D.C. During his practice, many patients were amazed by him and his work. “He was a genius,” Elizabeth Drew (an author and journalist, and a patient of Dr. Wu) recalled: “He thought beyond the normal ranges.” In a 1985 profile of Dr. Wu published in the Washington Post, the author observed that “there is something about this man. You believe him. His smile defuses skepticism. His Chinese slippers make no noises. In a city founded on convention, Wu is a soothing reminder that there is another way”.[6]

Dr. Wu did many beautiful things; people will remember him. His life of promoting acupuncture and Chinese medicine was just like the beautiful, moving and meditative song that shares his name.

4  Acknowledgements

The authors would like to thank Ms. April Enriquez for English editing; Ms. Ann Miller, a former assistant of Dr. Wu’s clinic, provided information about Dr. Wu, and permitted the use of the picture. The interviewer was Dr. Arthur Yin Fan.

5  Competing interests

The authors declare that they have no competing interests.

References

1.         Steely Dan. ［2012-05-12］. http://en.wikipedia.org/wiki/Steely_Dan.

2.         Steely Dan. Katy Lied. ［2012-05-12］. http://www.amazon.com/Katy-Lied-Steely-Dan/dp/B00000IPAB/ref=sr_1_1?s=music&ie=UTF8&qid=1336954673&sr=1-1.

3.         Craig Middletown CT, etc. Comments. ［2012-05-12］. http://www.songfacts.com/detail.php?id=6519.

4.         Steely Dan. Doctor Wu. (2012-03-05) ［2012-05-12］. http://www.steelydandictionary.com/.

5.         Chen C. Acupuncture practice in the United States. Taibei: Blue Swan Co. 1987. Chinese.

6.         Zielinski G. Acupuncturist and artist Wu Jing-Nuan at 69. The Washington Post. 2002-12-6. ［2012-06-12］. http://www.highbeam.com/doc/1P2-403078.html.

7.         Redwood D. Chinese medicine in modern America: Interview with Jing Nuan Wu LAc. (1995)［2012-05-12］. http://www.healthy.net/scr/interview.asp?Id=224.

8.         AIDS and the traditional healer. AIDS Action. 1990; 12: 7.

9.         Wu’s Healing Art. The healing art of Jing Nuan Wu. ［2012-05-12］. http://www.wushealingart.com.

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Oregon State Acupuncture history, By Gene Bruno

For Oregon Acupuncturists

http://oaaom.com/wp-content/uploads/2009/09/For-Oregon-Acupuncturists-Gene-Bruno-March-2009.pdf

I came to Oregon in 1975, and passed the acupuncture licensing exam given by the Board of Medical Examiner’s Acupuncture Committee. At that time, only Oregon and Nevada had licensing laws allowing acupuncturists to practice who were not medical doctors.

I then moved to Oregon in late 1976 and began practicing in Portland. Not knowing any better, I left an extremely lucrative human and veterinary practice in California, because I wanted raise my children in Oregon. It just seemed to me to be a much better place for children to grow up.

You might imagine that things were a bit different in those days. We could only treat patients that were referred to us by an M.D. Also, the Medical Board had a regulation at the time that restricted those referrals. The referrals could only come from  “in-house” MD who was also approved by the Board of Medicine, and assigned to a specific acupuncturist.

So patients could not come to us if referred by their own doctor.

In 1978 I presented an argument to the Board of Medicine for changing this restriction and asked that acupuncturists be able to accept patients referred from any Oregon licensed MD.

The BME changed their regulation.

At the time there were 6 other practitioners (all Chinese) and myself (the white guy) in Oregon. It was tough then. If you think it is “hard” for you now, you don’t really understand “difficult.” You think we are in an economic depression now, this was during the great Carter Administration when interest rates were 17% to 24%! No insurance coverage at all — only cash patients. Most people didn’t have extra money for alternative care of any kind. Plus, this was back in the beginning when almost no one knew about  acupuncture and its benefits.

Then one day in early 1979, while I was probably daydreaming about salmonfishing, Dr.WaiTak Cheung comes storming into my office and says, with his thick accent, “OK Gene, now we get busy…we need to get the law changed.” At this time the OAA existed, but in name only,and the dues were spent on several very nice Chinese dinners each year. They never undertook any legislative projects, nor did they communicate with the Board of Medical Examiners. Dr. Cheung explained to me that since 3 of the other 4 Chinese Doctors had either left town or died, and since he was in now in charge of the OAA, it was time to make the OAA a real functioning organization. I hadn’t seen Dr. Cheung in 8 or 9 months, but I knew that he and the others heard about my results in getting the Board of Medicine to get rid of the old supervision by “one MD rule.” And at my one and only attendance at the 1977 OAA Dinner For Elderly Chinese Practitioners and One White Guy, I spent a long time trying to convince the members to be active in legislative issues and Board of Medicine oversight issues. They seemed completely uninterested at the time, but it turns out that Dr. Cheung was the exception.

So together, he and I set out [alone] to rid ourselves of the MD referral requirement that was in the original legislation. It took a year and a half, but it got done. By 1980-81MalvinFinklestein and Eric Stephens and Jerry Senogles had arrived in Oregon. So I wasn’t the lone white guy anymore.

In just a few years, a small group of about 5 of us, with very, very, very limited funds, managed to get rid of the referral requirement, and to write and get passed the first insurance parity law in the U.S. And on top of this, the naturopaths were trying each year to pass legislation giving them the power to do acupuncture with little or no training. So we had to fight their lobbying efforts. Lucky for us, no one ever told us how naïve we were to try and do all this in four years with no manpower and almost no money. I don’t believe that any one of us thought we could do it alone. Somehow, even just two or three of us together gave us the courage to try. With 5 or 6 of us….well, we felt invincible.

So…this a very brief summary of a part of my experience in the early, beginning years of our profession here in Oregon. Some of you may be aware that in most states, insurance companies do NOT pay for acupuncture at all. You are probably also aware that most states do not have herbal medicine as a part of their scope of practice.

And I am sure you are all aware that in over 20 other states Chiropractors can legally do acupuncture ….as long as they have the 50 to 200 of required ‘training.’

Thank you for taking a few minutes to let me reminisce and ramble –on about the good old days. And I want to wish you the best for your future, as individual practitioners and as a state organization.

An old friend of mine used to always say, “It’s good to have a plan for the future.”

The first time I heard him say that, I said to him, “You’re such an idiot. How can you plan for the unknown?”

He just smiled and replied, “That’s the easy part. You simply visualize the future you want.

It’s simple.”

I said, “Simple? You’re nuts. How can it be simple?”

He said, “Remember that photo you showed me of that small sailboat you built?”

I answered, “Yes.”

He continued, “So you simply begin to form a picture of your next project, or your next goal, or your entire next year, and you hold it before your minds eye as you would the picture of the sailboat.”

I was quiet for a minute or two, and then asked, ”So if that’s the easy part, wise guy, what’s the hard part?”

He sat up, his eyes looked directly into mine and then he said, “Actually doing it.” I looked at him for a long time. I actually had the makings of a plan that I hadn’t told him about, and I wasn’t sure how to make it work. I finally said, “I have a plan, but it’s too big for me to do alone right now!

He started laughing and laughing, and then finally became calmer, and he smiled and said,

“Who said anything about doing it all alone?”

So, what’s your plan for the future? Are you headed there alone?

by Gene Bruno, OMD, LAc

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Gene Bruno, Who is him?

Gene Bruno

http://wikibin.org/index2.php?option=com_content&do_pdf=1&id=19501

Gene Bruno, OMD, LAc, FNAAOM, was a staff acupuncturist of the National Acupuncture Association’s research
team. Acupuncture arrived on the scene in the United States in the early 1970’s, shortly after information about
this medicine became available to the general public. James Reston’s surgery in China with the use of
acupuncture was the notable event that brought acupuncture to the public’s attention. Te National Acupuncture
Associaion, located in Westwood, California, was instrumental in training acupuncturists and research in acupuncture.
While acupuncture had been a part of the Chinese communities in the US, most of the public were uninformed of its
existence and its use in treating diseases. The National Acupuncture Association (NAA) was the first national
association to introduce acupuncture into the United States in the late 1960’s. One of the first major projects of
the NAA was to establish an Acupuncture Pain Clinic at UCLA medical school in 1972. The NAA also began several
research projects and sponsored the first medical seminars on acupuncture.
In 2007, the American Association of Oriental Medicine (AAOM) recognized this seminal work by NAA acupuncturists by
awarding its first Founders of the Profession Lifetime Achievement Awards, and creating the Pioneers Honor Roll. Dr.
Gene Bruno and Dr. William Prensky were awarded the first “Pioneers of the Field Lifetime Achievement Awards.
Dr. Steven Rosenblatt, Dr. James Tin Yau So and Dr. Ju Gim Shek were added to the Founders Honor Roll.
From 1971 until 1974, Dr. Bruno was part of the NAA’s two-man team that introduced veterinary acupuncture into the
United States for the first time. As a part of the first national organization to introduce acupuncture to western medicine
and the public in the US, Dr. Gene Bruno was one of the pioneers in this field in the US. From 1972 to 1974 he worked
at the UCLA Acupuncture Pain Clinic. From 1971 until 1974, Dr. Bruno was part of the NAA’s two-man team that
introduced veterinary acupuncture into the United States for the first time.

As one of the directors of the research team that introduced veterinary acupuncture into the United States, Dr. Bruno and
Dr. John Ottaviano were the only two practitioners who were allowed to treat animals in California in the 1970s who were
not licensed in veterinary medicine. The result of this work of the NAA’s veterinary research team led to the trainging of
veterinarians and to the establishment of the International Veterinary Acupuncture Association (IVAS) in 1974. The IVAS
is international and now has members in many countries including Italy. The IVAS is a non-profit educational organization.
As a practitioner of Acupuncture and Chinese Medicine for nearly 40 years, Dr. Bruno has received many awards. In
2006, the American Association of Oriental Medicine (AAOM) recognized his achievements in the field of Acupuncture
and Oriental Medicine in the US by presenting him with the first Founders of the Profession Lifetime Achievement Award.
In 2007, Dr. Bruno was elected to the Executive Board of the World Federation of Chinese Medicine Societies (WFCMS).
This is the largest group of professional acupuncture and Oriental medicine societies in the world. As a member of
the Executive Board of the WFCMS, Dr. Bruno represents the American Association of Acupuncture and Oriental
Medicine (AAAOM), which is the largest and oldest national acupuncture organization in the United States.
Awards
Pioneers and Leaders Award October 2007
:Presented by American Association of Acupuncture & Oriental Medicine
Founders of the Profession Lifetime Achievement Award October 2006
:Presented by American Association of Oriental Medicine
Special Award for Advancing Oriental Medicine in the State of Oregon October 1993
:Presented by the Oregon Acupuncture Association
Special Merit Award for Contributions that led to the Founding of
Veterinary Acupuncture in the US July 1975
:Presented by the National Acupuncture Association
Personal life
Gene Bruno (born April 13, 1948) grew up in the West Los Angles area, spent a year in Boston, and has lived with his

wife. He still has a medical office in Salem, Oregon.

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History of Acupuncture & Oriental Medicine In the State of Oregon Since 1973. By Dr. Wai Tak Cheung

By: Acupuncture & Oriental Medicine Society of Oregon, Inc.

Dr. Wai Tak Cheung

http://www.oaaom.com/wp-content/uploads/2011/12/History-of-Acupuncture-By-Dr.-Cheung.pdf
____________________________________________________________

President of Acupuncture and Oriental Medicine Society of Oregon

July 23, 1994

____________________________________________________________

June 11, 1994.

I have heard from some of my colleagues that today many of the younger generation of

practitioners of Oriental medicine may not be aware of the history of their profession in Oregon.

I hope that after reading what follows, all will know. If even one person who did not know this history begins to understand the importance of our professional roots and of our professional future together in Oregon,  then writing this will have been worthwhile.

Hard work, luck and coincidence have made the legal practice of acupuncture in the United States possible.  When President Nixon visited China in 1972, he opened many cultural as well as political doors.  Acupuncture and Oriental medicine were introduced to Americans in late 1972 as reports of acupuncture began to appear in the news media and in books.

Many Americans were having health problems for which they could not find successful

treatment in the United States.  Dorothy Barrett of Oregon had multiple sclerosis.  She heard of Dr. Michael Yau Ferng and went to Taiwan in 1972 to seek treatment from him.  Ms Barrett experienced such tremendous success that she wanted to make Dr. Ferng’s skill available to others in the United States.  Dr. Ferng came to the United States with a traveling visa in 1973 and began treating patients many of whom were Oregon residents.

Also, in 1972, two other doctors, Dr. Duke K. Won and his son Wing S. Won, both DCs and NDs, already living in Oregon before having obtained American citizenship, began treating growing numbers of Americans seeking Oriental medical care (before it was legal in Oregon). These doctors became well known as they successfully continued treating many patients in the state.

The Board of Medical Examiners (BME) soon heard news of their activities. The BME secretary had these three doctors arrested.  Attorney had the doctors freed from jail within twelve hours, since there were no laws in existence pertaining to the practice of acupuncture in Oregon. The judge dismissed the case after issuing a warning to the doctors and made it clear that the practice of acupuncture was illegal in Oregon, except when done by MDs or DOs.

By this time many Oregonians had received acupuncture and benefited from the treatments.  In 1973, many supporters, as well as patients (in particular Dorothy Barrett,  Mary Wilson, Irma Silvon and Mary Lotina), took action by circulating a petition for the legalization of acupuncture in Oregon.  They took the petition to Salem and talked to their state representatives to introduce such a bill to the Legislature.  In order to have the bill pass, it had to be written with specific conditions. An acupuncturist had to work under supervision of a single MD. This meant that anyone seeking acupuncture treatment

in Oregon had to first see an MD who would officially refer them to an acupuncturist.  Every acupuncturist had to work with one supervising MD or DO. The use of moxa was originally excluded from the scope of practice, as the legislature felt its inclusion could prevent the bill from passing.  I think moxa was too new or too exotic for them.  Acupuncture was put under the control of the BME.  There was no lobbying for this bill. The Oregon medical Association did not object to the practice of acupuncture by acupuncturists because it was under the MDs control.  The bill became law on November 15, 1973.

The first legal private acupuncture clinic in the United States was opened in Lincoln City, Oregon.

It was a very busy practice and patients had to book far in advance.  Professor Kok Yeun Leung was the first acupuncturist at the clinic.  He was later joined by Professor Shui Wan Wu and later by Dr. Wai Tak Cheung.  Three of the first seven acupuncturists in Oregon were from Vancouver, B.C. and practiced acupuncture between 1973 and 1975. These early Chinese acupuncturists established the foundation in the Northwest for the growth and development of acupuncture in Oregon.

Dr. James Tin Yau So practiced acupuncture successfully for over 35 years in Hong Kong. Dr. So was brought to the United States by the National Acupuncture Association to work in the clinic at the UCLAMedical  School. This clinic started in 1972 and was the first clinic in the United States.  Dr. So arrived in 1973. In October 1974, Dr William Prensky, Sr. Steven Rosenblatt and Dr. Gene Bruno took Dr.  So to Boston, Mass., where they opened a clinic for him.  Dr. Rosenblatt ad Dr. Bruno then established the New England School of Acupuncture for Dr. So and worked with him closely as instructors and also translated his two books into English.  Dr. Rosenblatt and Dr. Bruno returned to Los Angeles in 1975 where they established the CaliforniaAcupunctureCollege.

Dr, Cheung visited Dr. So in Boston in 1989, by which time Dr. So was retired.  During the visit Dr. So asked if Dr. Cheung had any students.  Dr. So believed passing on Oriental medical knowledge and continuing the education of new generations was vital to long term success of the professions. Dr. Cheung replied that he had no school, although he had 15 inters. Many hundreds of people, many DOs, MDs, and other professionals studied with Dr. So. This was the first acupuncture school in the United States.  Later, many of his students opened acupuncture and Oriental medicine colleges and helped

legalize the practice in many states.

One Chinese doctor was upset with Dr. So, feeling that he was selling out the Chinese people by teaching Oriental medicine to Americans. But Dr. So was proud of himself and he believed that the Chinese had very god knowledge to pass on to Americans. His teachers passed the knowledge to him, and now he wanted to pass it on to others.  Dr. So could have made a good living in private practice, but he chose to open a school and to educate people about Oriental medicine.  He told Dr. Cheung he hoped the proverbial stone tossed into the pond would send out endless ripples so his students, which would influence education and legislation throughout North America.

________________________________________________________________________

CHRONICLE OF ACUPUNCTURE AND ORIENTAL MEDICINE

In the State of Oregon Since 1973

1973:

Acupuncture became legalized in Oregon. An acupuncturist could only practice under a single MD’s supervision. This law passed without opposition. BME regulated the licensing of the acupuncturists in the state. It was the acupuncturist’s responsibility to find the supervisor.  If no MDs were willing to accept them, then the acupuncturist could not practice. Moxibustion was not allowed. The BME licensing examination was established and offered twice a year.

1975:

The OAA was formed.  Professor Mi Po Shu was the OAA president and the first member on the BME acupuncture committee.

Moxibustion was allowed by the BME as a heat therapy by acupuncturists.  NDs and DCs tried through their board to get permission to practice acupuncture.  Their reasoning was that they, too, are physicians and should be able to practice acupuncture.  Their request was denied.  There have been repeated lobbies since then to accomplish this goal.  So far all the attempts have failed.  There were only about seven acupuncturists, all Chinese, practicing in Oregon.  We did not have any lobbyist to promote our profession.

1976:

Dr. Gene Bruno moved from California to Oregon.  He was the first Caucasian to practice acupuncture in Oregon.  Later Dr.  So’s students moved from Boston.  The practice of acupuncture became more widespread and our profession as a whole became stronger.  The need for a more determined and united OAA became even more critical to the future of our profession.

1977:

The OAA consisted of Professor Kok Nung, President; Professor Yet Sun Chan, Vice-President; Tize Kwok Tai, Treasurer/Secretary.

1978:

Dr. Gene Bruno requested privately from the BME that any MD or DO be able to make referrals. This was granted by the BME so that the single supervisor/physician was no longer needed.

Professor Kok Nung had a heart attack. Shortly later he moved back to Vancouver, B.C.

The OAA now consisted of Professor Yet Sun Chan, President; Professor Kok Yeun Leong, Vice-President;

Dr. Wai Tak Cheung, Board member.

1979:

Professor yet Sun Chan had a stroke. Professor Kok Yuen Leung refused the position of president.  He asked Dr. Wai Tak Cheung to take over the position, which he accepted. It took six months to obtain the OAA records and documents (because of the health condition of Prof. Yet Sun Chan).

1980:

OAA members joined with other American practitioners. The OAA members increased in numbers and strength.

1981:

OAA introduced two  bills to the Legislature to:

1. Allow acupuncturists to see patients if they first obtained a diagnosis from an MD, DO, PC, ND or NP.

2. Have equal rights for insurance payment; to pay acupuncturists the same way that the MDs are paid for acupuncture treatment of the same conditions.

The first bill passed.  At this point, we hired a part time lobbyist to help us pass our legislation.  Dr. Gene Bruno, Eric Stephen and our lobbyist did most of the lobbying and other needed procedures.  We were short of money, so Dr. Cheung asked all the members and others to donate money for the OAA objectives.  About $800.00 was collected. Dr. Cheung added $2000.00 of his money for the OAA expenses.

Dr. Cheung proposed to open an acupuncture school under the OAA. Dr. Cheung wanted the school to be under OAA so more financial support from the public could be obtained to run the school more efficiently, and so more research could be done for the advancement of acupuncture in Oregon.

Eric Stephen helped a great deal in finding a part time lobbyist.  Jim Hauser,  Gerald Senogles , Stuart Greenleaf,  Malvin Finkelstein, Betty Chen, and Dirk Friedt were also involved in the process.

I thank all of them for their efforts. Our greatest appreciation is given to Dr. Robert Schwartz.

Without his efforts we might not have been free to do what we do today. Special thanks to Dr. Gene Bruno for his hard work toward achieving our goals. I hope that Dr. Gene Bruno will also write a brief history of events that occurred from 1976 to present. The Equal Right bill for insurance payment was proposed again and failed.  OAA members did not work on this bill, as they thought it would not pass. I tried to convince everybody that it is like the root of a cancer that has to be eradicated, otherwise it would always be an impediment to our practice,  Dr. Gene Bruno was no able to lobby since he was on the BME Acupuncture Committee. In the 1989 Dr. Gene Bruno, Dr. Robert Schwartz and our new lobbyist Steven Kafoury joined forces and successfully passed our insurance bill and convinced the Governor to sign it into law.

Last, but not least, I want to thank John Ulwlling, former BME Executive Director and Dr. Joel Sere, MD,  BME Acupuncture Committee Chairman, for all their help and support during our struggle along the way.  I also thank all the members of the Acupuncture Committee for the work they have done over the years.

After the introduction of our scope of practice bill signed by the Governor of Oregon, Barbara Roberts, No additional opposition from OMA was attempted. The insurance companies fought us in our attempts to pass our insurance bill. Also naturopaths and chiropractors argued against our scope of practice Bill. We came to a friendly agreement with the lobbyist for the chiropractors.

However, the lobbyist for naturopaths and their legislative spokesmen did not want our bill to pass.

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內州議會決議褒揚陸易公博士

內州議會決議褒揚陸易公博士 http://www.lvcnn.com/news.php?id=4081 新聞日期: 2011/07/12

紀念本州首位針灸師陸易公博士   內華達州一位領先的醫療領袖，陸易公博士於2004年1月17日在拉斯維加斯逝世，內華達州頓失一位卓越的醫療前輩與領導者。 內華達州第76屆會議立法機關大會通過表揚及紀念這位醫療界領袖，議員決議這是本州一巨大損失，並予以哀悼，行政書記大會並將會議決議之副本轉交陸易公博士夫人。 追溯內華達州直至1972年12月，中醫的針灸還被認為是“在藥品的使用實踐中沒有充分得到理解”。遲至1973年4月20日，內華達州議會才簽署了參議院第448號法案，成為全美國首個州授權實踐中醫藥和針灸，這法案方成為法律，自此以後，多個其他州才紛紛效尤。 這法案使中醫的針灸之聲譽起了巨大變化，這個功勞，應該很大的程度上歸功於陸易公博士，Dr. Yee-Kung Lok。 陸博士1913年6月17日出生於中國上海，並於上海研習針灸，陸博士來美後，到了內華達州，努力傳揚實踐中醫針灸的服務，並與他的病人及學生Steingerg一齊向中醫針灸合法化之目標努力，他與妻子內華達州的立法者，約有半數的國會議員和公眾人士施行中醫的針灸治療及示範，每天幾乎向100名患者進行針灸治療，而多數的患者病情成功得到改善，其中一位國會議員經陸博士針灸治療後，20年病患的鼻竇炎完全治癒了。這位內華達州的中醫針灸開創者及先行者，的確為中國的中醫針灸在美國開闢了一片天地。 今天，內州議會為陸博士的功績作出正式的決議通過，雖是遲來的榮譽，但畢竟是公正的、是光榮的，對陸博士的夫人、後人，繼續對中醫針灸的發揚光大，總是有所認可及鼓勵。

陸易公博士

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Acupuncture in Veterinary Medicine,by John A. Amaro D.C., FIAMA, Dipl.Ac., L.Ac.

Acupuncture in Veterinary Medicine January, 2005 .http://www.iama.edu/Articles/Acu_VeterinaryMedicine.htm John A. Amaro D.C., FIAMA, Dipl.Ac., L.Ac. Dr. Amaro treats Siberian Tiger with Laser for Spasmodic Torticollis In the fall of 1979 I was fortunate to be included on one of the first State Department approved list of observers to visit the People’s Republic of China (PRC). One of my very first acupuncture experiences was to assist in the performance of acupuncture on a hog in rural Liaoning Province in the Dongbei region of northeast China. Two thousand years ago the ancient city of Mukden now known as Shenyang had become a major trading post to peoples living north of the Great Wall. Shenyang would ultimately become the court of the Manchu (the “Masters”) and the capital of Manchuria. It sits in a pivotal position as it is on the land route to both Korea and upper Mongolia. During the procedure it was explained the acupuncture points of large animals are primarily based on human anatomical transposition of human points onto animals. In other words, just place the human in the all four position much like an animal. The acupuncture points are virtually in the same location. Since the cow, pig, horse, camel and donkey were of vital importance to the ancient Chinese, veterinary acupuncture was developed and texts were written dealing with these animals. Even though through history there have been more than 70 texts on animal acupuncture, only 16 exist today. Most of the information on veterinary medicine comes from the T’ANG Dynasty which is usually recognized to be from approximately 600 A.D. to 900 A.D. During this period due to the military requirements on the northern front many horses were raised specifically for the ever increasing military presence and purpose. Recognizing the tremendous importance attached to the health and welfare of the horse, the T’ANG Dynasty established an actual Department and School of Veterinary Medicine. This was the first formal education of this type in the history of China and the world. Even though the T’ANG Dynasty is credited with the formalization of veterinary acupuncture, the Spring and Autumn Warring States which was approximately 400 B.C. to 200 B.C., produced the historic practitioner who to this day is considered the Father of Chinese Veterinary Medicine Shun Yang. However, the earliest recorded practitioner of veterinary medicine was during the Chou Dynasty around 950 B.C. Chinese medicine was first introduced into Korea in the Chou Dynasty and then into Japan by way of Korea. Numerous contributions to both human and animal acupuncture have been made by both countries especially during the years 1100 to 1600. The Jesuits of France were a presence in Macao and as far as Peking (Beijing) as early as 1582. It was the French Jesuit Harvieu who published the first work in a European language on human acupuncture in 1671. However it was not until 1836 that the first mention of veterinary acupuncture appeared in print in France. The case reported was of a paralyzed ox that was treated by implanted needles 3 inches long in two rows bilateral to the lumbar spine. The needles were described as being driven in with a mallet and left in place for two days. In England a passage from the British Veterinary Journal of 1828 stated “two things however are sufficiently evident, that the sudden and magical relief which the human being has sometimes experienced has not been seen in the horse; and that, probably from the thickness of the integument, the animals suffered extreme torture during the insertion of the needles”. During the last Dynasty to be recorded in China’s long history, the “CH’ING Dynasty (1644 to 1912) there was a countrywide epidemic which had been catastrophic to pigs. As a result of veterinary acupuncture, the disease process had been cured and eliminated. In 1900 the book “A Complete Collection of Pig Diseases” was published. It was the information from this book which was being shared with me on that rural farm in Northeastern China in 1979. It was not until 1917 the first “School for Chinese Medicine” for humans patterned after western medical schools was established in Shanghai. The school was privately financed and was the first school of its kind to offer a formal program and diploma in Chinese Medicine. There were no schools at this time of Chinese veterinary medicine only western style schools awarding degrees in Veterinary Medicine. In 1944 Chairman Mao Tse Tung issued a directive of historical proportions when he wrote “…if the modern practitioners of human and veterinary medicine do not unite with the more than one thousand traditional practitioners in this region and help them progress in knowledge and ability, they are in fact helping evil and letting many humans and animals die of diseases”. In 1947 the formation of the beginning of modern Chinese Veterinary Medicine developed with the establishment of the School of Agriculture of the Northern University. This entire school was devoted solely to Chinese Veterinary Medicine which only focused on large animal applications. There has never been a development of small animal practice in the history of China as there is literally no demand for its use due to the cultural differences between the East and West regarding the owning of pets. Acupuncture anesthesia was first developed in humans in 1958 and first applied to horses and donkeys in 1969. Analgesia was first used outside of China on humans in 1972 in Austria where the first surgery for a tonsillectomy in the Western world was performed. The history of American veterinary acupuncture had its root beginnings following the national public interest shown in China and acupuncture in 1971-72. Whereas, unknown to most in the profession, acupuncture’s history in the US is quite startling when one considers just a few of its inclusions in the American medical scene. Acupuncture for human applications have appeared in American medical texts since 1822 when the “Treatise on Acupuncturation” appeared in print which was a review of a British booklet. In 1825 the French book “Memoir on Acupuncture” appeared in the US. By 1829 a three page section on acupuncture appeared in the surgical text “Elements of Operative Surgery”. In the July 28, 1888 issue of Scientific American a two page article on Electric Acupuncture appeared. Perhaps the most famous 20th Century reference to acupuncture outside of the 1971 New York Times article by James Reston on “Now about my Operation” came from the 1907 book “Principles and Practice of Medicine” and the 1917 book by the same name whereby famed surgeon and medical practitioner Sir William Osler stated “….for lumbago acupuncture is, in acute cases, the most efficient treatment. Needles of from 3-4 inches in length (ordinary bonnet needles. Sterilized, will do) are thrust into the lumbar muscles at the seat of the pain, and withdrawn after 5-10 minutes. I many instances, the relief is immediate, and I can corroborate fully the statements of Ringer, who taught me this practice, as to its extraordinary and prompt efficacy in many instances….”. Ringer would be recognized to this day as one of the greatest physicians in history having discovered the isotonic electrolytic infusion solution still used today and known as “Ringers Solution”. A side note is that Dr. Sydney Ringer was British however his two brothers amassed great fortunes in Asia one in Shanghai and the other in Nagasaki Japan. One brother was so successful he was given the name “King of Nagasaki”. Dr. Ringer obviously learned acupuncture through one or both of his brothers and taught it to Osler. The 1910 book “The Principles and Practice of Chiropractic” by D.D. Palmer the founder of Chiropractic, also made specific reference to acupuncture. Throughout the political history of all professions who have pioneered acupuncture in North America, it has been a very rocky and tumulus road for the veterinary profession. Following interest in acupuncture by a few DVM’s in 1972, Dr. David Bressler of UCLA was contacted and acupuncture procedures were initiated in Southern California on a variety of cases that had been deemed hopeless as they had all failed to respond with conventional Western medicine. The response with the variety of these test cases were overwhelmingly successful. This project was under the guidance of the National Acupuncture Association which Dr. Bressler had founded and presided at UCLA. The National Association for Veterinary Acupuncture was formed in 1973 and the International Veterinary Acupuncture Society was founded in 1974. By 1975 symposiums were being conducted by the Chinese Academy of Medicine and held at the University of Cincinnati, University of Georgia, Purdue University, The University of California School of Veterinary Medicine and others. The American Veterinary Medical Association took a very cautious position in the early formative years of acupuncture and in 1974 issued a formal statement that stated “the AVMA has serious concern about acupuncture regarding it as entirely experimental until strong evidence is available that the procedure has therapeutic value in animals and additional cases have been evaluated”. Since those early days in the United States, veterinary acupuncture has become increasingly popular with more than 500 certified Doctors of Veterinary Medicine (DVM) practitioners in North America alone. Its clinical use ranges from equine to feline to canine and avian. The success rate borders on the astonishing in a variety of conditions known and unknown to the human patient. Most licensed Acupuncturists State licenses deal only with the treatment of the human it does not include animal applications. However as an acupuncture practitioner it behooves us to know of a qualified veterinary doctor utilizing acupuncture and refer to them as necessary. You will find the DVM using acupuncture will reciprocate the referral. Veterinary Acupuncture has come a long way in America from the vision of the original three DVM’s who started it, Dr. R.S. Glassberg, Dr. Marvin Cain and Dr. H. Grady Young. I am proud to say I knew these individuals and was honored to have studied with them at the first official symposium on “Acupuncture for the Veterinarian” in Kansas City in 1974. They are to be commended for following their vision. As a result the Siberian Tiger which is shown with me being treated with laser beam did not have to be euthanised as originally planned. Incidentally, there are no known acupuncture charts in the history of the world for a Siberian tiger. Just treat the points of the animal as if it were a human with the same protocols. Best Wishes for a phenomenal 2005 in the Year of the Rooster! I wonder how you find the points on a rooster? John A. Amaro D.C., FIAMA, Dipl.Ac., L.Ac. Carefree, Arizaona DrAmaro@IAMA.edu

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A brief history of acupuncture A. White and E. Ernst

A brief history of acupuncture…….by A. White and E. Ernst

http://rheumatology.oxfordjournals.org/content/43/5/662.full

Rheumatology Volume 43, Issue 5,Pp. 662-663

Complementary Medicine, Peninsula Medical School, Universities of Exeter and Plymouth, 25 Victoria Park Road, Exeter EX2 4NT UK.

Acupuncture is generally held to have originated in China, being first mentioned in documents dating from a few hundred years leading up to the Common Era. Sharpened stones and bones that date from about 6000BCE have been interpreted as instruments for acupuncture treatment [1,2], but they may simply have been used as surgical instruments for drawing blood or lancing abscesses [3]. Documents discovered in the Ma-Wang-Dui tomb in China, which was sealed in 198 BCE, contain no reference to acupuncture as such [3], but do refer to a system of meridians, albeit very different from the model that was accepted later [4]. Speculation surrounds the tattoo marks seen on the ‘Ice Man’ who died in about 3300 BCE and whose body was revealed when an Alpine glacier melted [5]. These tattoos might indicate that a form of stimulatory treatment similar to acupuncture developed quite independently of China.

The first document that unequivocally described an organized system of diagnosis and treatment which is recognized as acupuncture is The Yellow Emperor’s Classic of Internal Medicine, dating from about 100 BCE. The information is presented in the form of questions by the Emperor and learned replies from his minister, Chhi-Po [6]. The text is likely to be a compilation of traditions handed down over centuries [7], presented in terms of the prevailing Taoist philosophy, and is still cited in support of particular therapeutic techniques [8]. The concepts of channels (meridians or conduits [3]) in which the Qi (vital energy or life force) flowed are well established by this time, though the precise anatomical locations of acupuncture points developed later [9].

Acupuncture continued to be developed and codified in texts over the subsequent centuries and gradually became one of the standard therapies used in China, alongside herbs, massage, diet and moxibustion (heat) [2]. Many different esoteric theories of diagnosis and treatment emerged, sometimes even contradictory [3], possibly as competing schools attempted to establish their exclusiveness and influence. Bronze statues from the fifteenth century show the acupuncture points in use today, and were used for teaching and examination purposes (Fig. 1) [2]. During the Ming Dynasty (1368–1644), The Great Compendium of Acupuncture and Moxibustion was published, which forms the basis of modern acupuncture. In it are clear descriptions of the full set of 365 points that represent openings to the channels through which needles could be inserted to modify the flow of Qi energy [7]. It should be noted that knowledge of health and disease in China developed purely from observation of living subjects because dissection was forbidden and the subject of anatomy did not exist.

This bronze figure showing acupuncture points is a reproduction of one cast inAD 1443. (Reproduced fromAn outline of chinese acupuncture published by Foreign Languages Press, Peking 1975.)

Interest in acupuncture among the Chinese declined from the seventeenth century onwards as it came to be regarded as superstitious and irrational [2, 6]. It was excluded from the Imperial Medical Institute by decree of the Emperor in 1822. The knowledge and skill were retained, however, either as an interest among academics or in everyday use by rural healers. With China’s increasing acceptance of Western medicine at the start of the twentieth century, final ignominy for acupuncture arrived in 1929 when it was outlawed, along with other forms of traditional medicine [2]. After the installation of the Communist government in 1949, traditional forms of medicine including acupuncture were reinstated, possibly for nationalistic motives but also as the only practical means of providing even basic levels of health to the massive population. Chairman Mao is quoted as saying, in relation to traditional medicine, ‘Let a thousand flowers flourish’ although he himself rejected acupuncture treatment when he was ill [3]. The divergent strands of acupuncture theory and practice were brought together in a consensus known as traditional Chinese medicine (TCM) [8], which also included herbal medicine. Acupuncture research institutes were established in the 1950s throughout China and treatment became available in separate acupuncture departments within Western-style hospitals. Over the same period, a more scientific explanation of acupuncture was sought by Prof. Han in Beijing who undertook ground-breaking research on acupuncture’s release of neurotransmitters, particularly opioid peptides [10].

The spread of acupuncture to other countries occurred at various times and by different routes. In the sixth century, Korea and Japan assimilated Chinese acupuncture and herbs into their medical systems [6]. Both countries still retain these therapies, mostly in parallel with Western medicine. Acupuncture arrived in Vietnam when commercial routes opened up between the eighth and tenth centuries. In the West, France adopted acupuncture rather sooner than other countries [7]. Jesuit missionaries first brought back reports of acupuncture in the sixteenth century, and the practice was embraced by French clinicians fairly widely. Berlioz, father of the composer, ran clinical trials on acupuncture and wrote a text in 1816 [11]. French acupuncture today has been deeply influenced by a diplomat, Souliet du Morant, who spent many years in China and published a number of treatises about acupuncture from 1939 onwards.

The first medical description of acupuncture by a European physician was by Ten Rhijne, in about 1680, who worked for the East India Company and witnessed acupuncture practice in Japan [6, 11]. Then, in the first half of the nineteenth century, there was a flurry of interest in both America and Britain, and a number of publications appeared in the scientific literature including a Lancet editorial article entitled ‘Acupuncturation’ [12]. By mid-century, acupuncture had fallen into disrepute and interest lay dormant, though it was briefly resurrected in one edition of Osler’s textbook in which he describes dramatic success in the treatment of back pain with hat-pins [13]. Interestingly, this comment was deleted from subsequent issues [14].

In 1971, a member of the US press corps was given acupuncture during recovery from an emergency appendectomy in China, which he was visiting in preparation for President Nixon’s visit. He described the experience in the New York Times [15] and subsequently teams of US physicians made fact-finding tours of China to assess acupuncture, particularly its use for surgical analgesia [16]. Despite initial excitement at the operations they witnessed, acupuncture proved to be utterly unreliable as an analgesic for surgery in the West. Acupuncture finally reached its present level of acceptability in the USA when an NIH consensus conference reported that there was positive evidence for its effectiveness, at least in a limited range of conditions [17].

The traditional theories of acupuncture have been challenged in the West, most notably by Mann in the UK [18] and Ulett in the USA [19]. Ancient concepts of Qi flowing in meridians have been displaced in the minds of many practitioners by a neurological model, based on evidence that acupuncture needles stimulate nerve endings and alter brain function, particularly the intrinsic pain inhibitory mechanisms [10]. The first magnetic resonance imaging study of acupuncture may also prove to be a landmark [20]. Other workers have noted the marked similarity between the trigger points of Travell [21] with their specific pain referral patterns, and the sites of traditional acupuncture points with their associated meridians [22]. There is a plethora of suggested mechanisms of action of acupuncture, but little valid data on which, if any, mechanisms are relevant to clinical practice. Evidence of clinical effectiveness is also still elusive for many conditions such as chronic pain [23], but in the last decade of the twentieth century systematic reviews have provided more reliable evidence of acupuncture’s value in treating nausea (from various causes), dental pain, back pain and headache [24].

Next Section

Footnotes

• Heberden Historical Series/Series Editor: M. I. V. Jayson

• Rheumatology Vol. 43 No. 5 (c) British Society for Rheumatology 2004; all rights reserved

Previous Section

References

1. ↵
   Huang KC. Acupuncture: the past and the present. New York: Vantage, 1996.
2. ↵
   Ma KW. The roots and development of Chinese acupuncture: from prehistory to early 20th century. Acupunct Med 1992;10(Suppl):92–9.
3. ↵
   Basser S. Acupuncture: a history. Sci Rev Altern Med 1999;3:34–41.
4. ↵
   Chen Y. Silk scrolls: earliest literature of meridian doctrine in ancient China.Acupunct Electrother Res 1997;22:175–89.

   Medline
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   Dorfer L, Moser M, Bahr F et al. A medical report from the stone age? Lancet1999;354:1023–5.

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6. ↵
   Baldry PE. Acupuncture, trigger points and musculoskeletal pain. Edinburgh: Churchill Livingstone, 1993.
7. ↵
   Kaplan G. A brief history of acupuncture’s journey to the West. J Altern Complement Med 1997;3:5.

   Medline
8. ↵
   Birch S, Kaptchuk T. History, nature and current practice of acupuncture: an East Asian perspective. In: Ernst E, White A, eds. Acupuncture: a scientific appraisal.Oxford: Butterworth Heinemann, 1999:11–30.
9. ↵
   The Academy of Traditional Chinese Medicine. An outline of Chinese acupuncture. Peking: Foreign Languages Press, 1975.
10. ↵
    Han J, Terenius L. Neurochemical basis of acupuncture analgesia. Annu Rev Pharmacol Toxicol 1982;22:193–220.

    CrossRefMedlineWeb of Science
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    Bivens RE. Acupuncture, expertise and cross-cultural medicine. Manchester: Palgrave, 2000.
12. ↵
    Anon. Acupuncturation. Lancet 1823;November 9:200–1.
13. ↵
    Osler W. The principles and practice of medicine. New York: Appleton & Co.,1912.
14. ↵
    Ulett GA. Conditioned healing with electroacupuncture. Altern Ther Health Med1996;2:56–60.

    Medline
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    Reston J. Now about my operation in Peking. New York Times 1971;1:6.
16. ↵
    Dimond EG. Acupuncture anesthesia. Western medicine and Chinese traditional medicine. J Am Med Assoc 1971;218:1558–63.

    Abstract/FREE Full Text
17. ↵
    Marwick C. Acceptance of some acupuncture applications. J Am Med Assoc1997;278:1725–7.

    Abstract/FREE Full Text
18. ↵
    Mann F. Reinventing acupuncture. Oxford: Butterworth Heinemann, 1992.
19. ↵
    Ulett G. Beyond Yin and Yang: how acupuncture really works. St Louis: Warren H Green, 1992.
20. ↵
    Cho ZH, Chung SC, Jones JP et al. Proc Natl Acad Sci, USA 1998;95:2670–3.

    Abstract/FREE Full Text
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    Travell JG, Rinzler SH. The myofascial genesis of pain. Postgrad Med1952;11:425–34.

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    Melzack R, Stillwell DM, Fox EJ. Trigger points and acupuncture points for pain: correlations and implications. Pain 1977;3:3–23.

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    Ezzo J, Berman B, Hadhazy V, Jadad AR, Lao L, Singh BB. Is acupuncture effective for the treatment of chronic pain? A systematic review. Pain 2000;86:217–25.

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24. ↵
    Ernst E, White AR, eds. Acupuncture: a scientific appraisal. Oxford: Butterworth Heinemann, 1999.

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A Comparison of Acupuncture History, Education Practice and Licensing in Europe and the United States. (Published in 2000).

http://orientalharmonicmedicine.com/articles/AcupunctureHistory.php

Andreas Sandner-Kiesling, MD¹,
David E. Molony, L.Ac., Dipl. Ac., Dipl. C.H. (NCCAOM)²,
Susan B. Goldstone, L.Ac., Dipl. Ac., MSOM, MA³

¹ Dept. of Anesthesia, Wake Forest University School of Medicine, Winston-Salem, NC
² Executive Director, AAOM, Catasauqua, PA
³ NCALB Member, Past President of the North Carolina Acupuncture Association, Winston-Salem, NC

Abstract

This review contrasts the provision of acupuncture in the United States versus the practice in Europe (focusing on Germany and Austria). A brief history of acupuncture is provided along with current practice trends. Information regarding educational preparation, licensing and provider groups is highlighted. Efforts of practitioners on both continents to seek acceptance and integration of acupuncture in their national health care systems are outlined. The article concludes with a review of research studies being funded in the United States to determine the efficacy of acupuncture as a viable treatment modality.

Acupuncture history in Europe

Acupuncture and Oriental Medicine comprise a system of health care, which originated in China more than 3,000 years ago. It was introduced to neighboring countries in Asia in the 6^th Century, being readily accepted, and by the early 16^th Century it had reached Europe. The source of acupuncture information was transmitted to Europe in the 17^th through the 19^th centuries via Latin translations by Portuguese, French, Dutch, and Danish missionaries, traders, and physicians travelling and working in China and Japan. There was a flurry of primitive acupuncture experimentation by physicians in France, England, Germany, Italy, Sweden, and the United States in the first decades of the 19^th century, which did not renew itself in Europe until a century later and in the United States until the 1970’s. The most influential impact on the development of 20^th century European acupuncture was the work of George Soulie de Morant, a scholar-diplomat engaged in the French diplomatic service in China between 1901 and 1917. Soulie de Morant published articles and French translations of Chinese and Japanese texts to French physicians. He systematically introduced acupuncture theory from the classical texts to the French and European medical community. The commonly used terms “meridian” and “energy” both originated in his texts as translations for the two fundamental tenets of acupuncture: anatomy and physiology. At about the same time, the German University Professor Dr. Franz Hübotter, who had spent quite some time in China, published a voluminous work on Chinese medicine. Unfortunately, his work did not become well known to the public, because there were no German acupuncturists or practitioners of Traditional Chinese Medicine to utilize his very detailed knowledge. Thus, his work attracted scholars of Chinese studies and historians of medicine. With a background of Chinese studies, he translated the above mentioned terms as “vessels” and “pneuma” [1].

In the 20^th century France and throughout much of Europe since the 1950’s, clinical acupuncture has codeveloped with biomedical science. Europe has thus served as another influence for acupuncture approaches that integrate into the practice of conventional Western medicine [2]. In the 1950’s, the German medical doctor (MD) Georg Bachmann, himself a student of French acupuncture, brought acupuncture to Germany. One of his students, University Professor Dr. Johannes Bischko, a surgeon from the Viennese School of Medicine, began to reestablish acupuncture as medical treatment in Austria. With his experiments and scientific explanations for the effects of acupuncture on the human body, the acceptance and the curiosity into this Traditional Chinese treatment increased among his medical colleagues. Since the early 1970’s the demand for acupuncture educational programs has increased.

Education in Europe

In Europe a wide spectrum of Traditional Chinese Medicine is offered today including different kinds of Acupuncture, Herbal Medicine, Tuina, Qi Gong, Tai Ji Quan, Acupoint Meridian Massage, Acupressure, and more. The acupuncture training is offered only (e.g. in Austria) or mainly (e.g. in Germany) for physicians. Great Britain and the Netherlands tend to offer longer acupuncture curricula like in the United States. In Europe usually a standard of at least 120 theoretical and 25 practical hours is required for physicians, held on weekends or more seldom in weekly lecture blocks. After passing one written, oral and practical exam the first Diploma in Acupuncture and Auriculotherapy is earned. The Physicians’ Associations and Chambers of most European countries accept these diplomas, which allow offering acupuncture to patients and earning money as an acupuncturist. In Austria, three acupuncture associations this way accredit approximately 1500 out of 5000 acupuncturists. In contrast to Austria, in Germany the Physicians’ Associations so far have not accredited acupuncture so any MD, who wanted to, could offer acupuncture. Since the 1980’s, insurance companies began to reimburse acupuncture, mainly due to public pressure. After an inflationary increase in acupuncturists (1998: approximately 30,000 MD’s practicing acupuncture; the two biggest German medical associations of acupuncture – the DÄGfA , the German Medical Association of Acupuncture, and the DAA, the German Academy of Acupuncture and Auriculotherapy – have approximately 23,000 members) a restriction to practice and a higher educational level was needed. Since the fall of 1999, the Health Insurances require a MD’s diploma after 140 hours of theoretical and practical education. Probably, a longer education of 350 hours (Diploma B) in acupuncture will be required in Germany in the year 2001, but that is still shorter than for most other postgraduate education, e.g. psychotherapy.

Acupuncture history and background in the United States

In the United States Benjamin Franklin started to work with acupuncture in the middle of the 17^th century. Since the appearance of one article about Acupuncture Treatment of postappendectomy pain and its success in Beijing, China, written in the New York Times in 1971 by the journalist J. Reston, and the visit of President Richard Nixon in China in 1972, there has been widespread enthusiasm for acupuncture. Before that time, acupuncture had been practiced only in Asian communities, discreetly and primarily by and for Asians. In the past two decades, acupuncture has grown in popularity in American medical and scientific communities. In 1993, the U.S. Food and Drug Administration (FDA) estimated that Americans made 9-12 million visits per year to acupuncture practitioners and spent as much as 500 million US Dollars (USD) on acupuncture treatments [3]. At the same time Dr. Eisenberg, a Harvard researcher and MD, published the results of his survey that revealed Americans spent a conservatively estimated 14.6 billion USD on visits for alternative medical treatments like acupuncture, osteopathy, or massage therapy in 1990. Two thirds of that amount was not covered by insurance [4]. Then, in 1998, Eisenberg released another survey, showing that spending on alternative therapies increased 45.2% between 1990 and 1997, to 21.2 billion USD, with at least 12.2 billion paid out-of-pocket. He estimated that people paid 629 million visits to alternative practitioners in 1997, more than the total number of visits to U.S. primary-care physicians that year. He concluded that the use and the expenditures of alternative medicine increased substantially between 1990 and 1997, attributable primarily to an increase in proportion of the population seeking alternative therapies, rather than increased visits per patient [5].

The introduction of acupuncture as a choice of treatment modalities readily available to the public is in its early stages. Battered by tight-fisted managed care companies and increased competition, more and more physicians are being lured by alternative health treatments – which patients usually pay for out of their own pockets, in cash. It remains difficult to find acceptance for acupuncture or Traditional Chinese Medicine at medical universities. Of 117 American medical schools, 64% teach alternative medicine, either as stand-alone electives or as a part of required courses. Some of the country’s most prestigious educational institutions such as Harvard, Stanford, Columbia, and Duke have developed alternative medicine centers at their teaching hospitals [6]. In 1995, an estimated 10,000 nationally certified acupuncturists were practicing in the United States. More than 1,000 new practitioners are certified each year. By the year 2000, that number is expected to double. Currently, an estimated one-third of certified acupuncturists in the United States are MD’s [7]. About half of all acupuncturists can be found in California. The high population of individuals with Chinese heritage may explain the wide spread number of acupuncturists and acupuncture schools in that state.

Education and accreditation of acupuncture in the United States

Since the 1970’s, guidelines for education, practice, and regulation in acupuncture have been established and implemented. State, regional, and international societies have evolved to represent the interests of affinity groups of practitioners. In 1989, the World Health Organization (WHO) convened a Scientific Group of more than 50 international experts, which developed a series of statements and guidelines on acupuncture relating the basic training, safety in clinical practice, indications and contraindications, and clinical research for physician and nonphysician providers. The training guidelines reflect the minimum hours expected in most member nations and are consistent with regulations enacted in the United States: 2500 hours for nonphysician acupuncturists and 200 hours for physicians. The basic curriculum is founded on the classical tradition of acupuncture requiring a firm knowledge of the acupuncture points and channels and the traditional models of diagnosis and treatment. A basic knowledge of Western biomedical science is also encouraged in the curriculum [8]. It is the responsibility of the accrediting bodies for each profession to establish those guidelines for either group.

In the United States, physician as well as nonphysician practitioners perform acupuncture showing a dichotomy in its medical value system. In 37 American states and the Canadian District of Columbia, the practice of acupuncture is included in the scope of a physician’s medical or osteopathic license, and no regulations or restrictions are imposed on medical practitioners. This means they are allowed to perform acupuncture with no additional training. The 15 other states require physicians practicing acupuncture either to demonstrate evidence of participation in training programs of 200 to 300 hours or simply to register with the board of medicine with evidence of formal training. From these loose regulations of physician practitioners, it is clear that the degree of acupuncture training and experience among physicians varies from state to state and individual to individual. Compared to the expected 2500 hours of education for nonphysician acupuncturists it sounds for this group demeaning that 200 hours or no education for physicians is enough to offer Oriental Medicine.

The AAMA with approximately 1,800 members represents the education, legislation, and professional interests of physicians trained in acupuncture. Full membership in the AAMA requires 220 hours of formal training (including 150 hours of video education) and 2 years of clinical experience not stating if this means full or part time. These standards follow the physician-training guidelines established in the constitution of the World Federation of Acupuncture-Moxibustion Societies, an international society guided by the World Health Organization. The AAMA has established a proficiency examination as the first of a two-part board certification examination. Membership eligibility in the AAMA has become the standard of physician credential for state registration, hospital privileges, liability insurance, and third party reimbursement [9].

The practice of nonphysicians is regulated in at least 33 states, and another dozen states have statutes pending. The educational prerequisites and training requirements vary widely from state to state. More than 50 schools of acupuncture exist in the United States. Till today the ACAOM(Accreditation Commission of Acupuncture and Oriental Medicine) accredited approximately 30 colleges. To start an education in Acupuncture and Oriental Medicine an individual must be at least 21 years of age and a baccalaureate degree from a college or university (BA/Bachelor of Arts, BS/Bachelor of Science, Ph.D./Doctor of Philosophy) is required. The training consists of approximately 2200-2800 hours and is completed within 2-5 years depending on part time or full time studies. The total costs of completing the full-time program are usually about 24,000 USD (16,000-43,000 USD). The training consists of Acupuncture, Moxibustion, Biomedical or Western Sciences (Anatomy, Physiology, and Nutrition), Chinese Herbology, Acupuncture Clinic and Adjunctive Courses like Tuina, Shiatsu, Medical Qi Gong, Oriental Nutrition, Magnet Therapy, Electrotherapy, Business and Ethics. Some schools offer additional education in countries such as Vietnam, China, Korea, or Japan. There are various titles and degrees offered in the United States. Depending on the accreditation of the school by the ACAOM the training ends with a Master’s Degree (MAC/Master of Acupuncture, MTOM/Master of Traditional Oriental Medicine, MSOM/Master of Science in Oriental Medicine) or a Diploma (Dipl. Ac./Diploma of Acupuncture) after a NCCAOM (National Commission for the Certification of Acupuncture and Oriental Medicine) competency or state licensing exam. The NCCAOM was organized in 1984 to establish nationally recognized standards of excellence in the practice of acupuncture. It’s exam includes acupuncture, herbal, point location, and clean needle technique sections [7]. All states except California and Nevada that license nonphysician acupuncturists recognize the national examination developed by the NCCAOM. Procedures for licensure in each state begin upon completion of the educational and examination requirements. A licensed acupuncturist (L.Ac.) is not a degree, but a title granted by the individual states. So for instance in North Carolina, the law states that the use of the title acupuncturist can only be used by licensed acupuncturists, not by MD’s, Doctor of Osteopathy (DO) or Doctor of Chiropractic (DC). The licensed New Mexico acupuncturist is granted the title “Doctor of Oriental Medicine”/DOM and enjoys many privileges available to the allopathic physician, such as the ability to order X-rays, CT scans, and various other diagnostic tests for their patients. Rhode Island issues a Doctor of Acupuncture (DA) to its licensees. Some states like Florida consider licensed acupuncturists as Acupuncture Physicians. The abbreviated education programs typically offered to MD’s, DO’s, DC’s, or drug detox technicians are not accredited by the ACAOM. There are two main national societies (the American Association of Acupuncture and Oriental Medicine/AAOM in Catasauqua, PA, and the National Acupuncture and Oriental Medicine Alliance in Olalla, WA, each approximately 1300 members), together with many regional, state, and local organizations that represent the interests of the licensed acupuncturist communities.

Acupuncture and the Health Care System of the United States

More than 1 million Americans currently receive acupuncture treatment each year. The number of patients seeking acupuncture treatment in the US is increasing substantially. Because many individuals seek health care treatment from both an acupuncturist and physician, the National Institutes of Health (NIH) recommends that communication between these providers should be improved and coordinated. There is evidence that some patients have limited access to acupuncture services because of inability to pay. The NIH recommends, too, that insurance companies decrease or remove financial barriers to access depending on their willingness to provide coverage for appropriate acupuncture services [10]. An increasing number of insurance companies are either considering this possibility or now provide coverage for acupuncture services. For instance, the insurance company Blue Cross/Blue Shield covers acupuncture treatment in several states. Medicaid, a state health insurance plan, covers acupuncture treatment for substance abuse in several states. [11]. Reflecting public demand, an estimated 70 to 80 percent of the nation’s insurers covered some acupuncture treatments in 1996. The cost per treatment typically ranges between 30 and 100 USD but it may be more. MD’s performing medical acupuncture may charge more than nonphysician practitioners [12].

Research in the United States

After reviewing the existing body of knowledge, the FDA removed acupuncture needles from the category of “experimental medical devices’ in 1996 and now regulates them just as it does for other devices, such as surgical scalpels and hypodermic syringes, under good manufacturing practices and single-use standards of sterility. The FDA requires manufacturers of acupuncture needles to label them for single use only [13].

Over the years, the NIH has funded a variety of research projects on acupuncture with more than 1 Million USD that have been awarded by its National Center of Complementary and Alternative Medicine (NCCAM), National Institute on Alcohol Abuse and Alcoholism, National Institute of Neurological Disorders and Stroke, and National Institute on Drug Abuse. It included studies on the mechanism by which acupuncture may produce its effects, as well as clinical trials and other studies [10]. Originally founded in 1992 as the Office of Alternative Medicine, the NCCAMfacilitates the research and evaluation of unconventional medical practices and disseminates this information to the public. The NCCAM, reestablished in 1998, supports 13 Centers, where researchers conduct studies on complementary and alternative medicine for specific health conditions and diseases [14].

Acknowledgments

We thank Pamela A. Wilson, MS, TRS/CTRS, Recreation Therapist and Co-Chair of the Integrative Medicine Workgroup at Wake Forest University School of Medicine for reviewing this manuscript, sharing her knowledge, and adding a lot of positive input.

References

1. Hübotter F, Die chinesische Medizin zu Beginn des XX. Jahrhunderts und ihr historischer Entwicklungsgang. Verlag der Asia Major. Leipzig, 1929
2. Helms JM, Acupuncture Energetics: A Clinical Approach for Physicians. Berkeley, California, Medical Acupuncture Publishers, 1995
3. Lytle CD, An Overview of Acupuncture. United States Department of Health and Human Services, Health Sciences Branch, Division of Life Sciences, Office of Science and Technology, Center of devices and Radiological Health, Food and Drug Administration. Washington, DC, 1993
4. Eisenberg DM, Kessler RC, Foster C, Norlock FE, Calkins DR, Delbanco TL, Unconventional Medicine in the United States. NEJM 1993; 328(4): 246-52
5. Eisenberg DM, Davis RB, Ettner SL, Appel S, Wilkey S, van Rompay M, Kessler RC, Trends in alternative medicine use in the United States, 1990-1997: results of a follow-up national survey. JAMA 1998; 280(18): 1569-75
6. Wetzel MS, Eisenberg DM, Kaptchuk TJ, Courses involving Complementary and Alternative Medicine at US Medical Schools. JAMA 1998; 280(9): 784-7
7. Culliton RD, Current Utilization of Acupuncture by United States Patients. National Institutes of Health Consensus Development Conference on Acupuncture, Program & Abstracts, National Institutes of Health, Bethesda, MD, 1997, Nov 3-5
8. Guidelines on basic training and safety in acupuncture. World Health Organization, 1999
9. Helms JM, An Overview of Medical Acupuncture. American Academy of Medical Acupuncture, 1998,http://medicalacupuncture.org/helmsarticle.htm
10. Acupuncture, NIH Consensus Statement. 1997, Nov 3-5; 15(5): 1-34 (also presented in JAMA 1998; 280(17): 1518-24)
11. Educational Options in Oriental Medicine, 5^th edition. American Association of Oriental Medicine, 1999
12. National Institute of Health, Frequently Asked Questions About Acupuncture. Bethesda, MD: National Institute of Health, 1997
13. U.S. Food and Drug Administration, Acupuncture Needles No Longer Investigational. FDA Consumer Magazine, 1996, Jun, 30(5)
14. NCCAM, Acupuncture Information and Resource Package. National Institute of Health, National Center for Complementary and Alternative Medicine Clearinghouse, http://www.medicalacupuncture.org/nccaminfo.htm

Published 2000.

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