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

http://www.jcimjournal.com/articles/publishArticles/pdf/S2095-4964(17)60378-9.pdf

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

Abstract by Arthur Yin Fan

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

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

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

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

Abstract

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

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

摘要

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

退伍军人管理局和美国军方的各个部门已经成功地有针对性地采用针灸。

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

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

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

针灸疗法治疗多种疼痛有效。

1.2 Safety and feasibility of acupuncture for pain management.

针灸疗法治疗疼痛安全、易行。

1.3 Cost-effectiveness of acupuncture for pain management.

针灸疗法治疗疼痛可以减少支出。

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

结合使用针灸疗法可以减少阿片的用量。 

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

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

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

针灸治疗慢性疼痛涉及改善其病态的神经塑形。

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

针灸是有益的治疗阿片依赖并促其康复的辅助疗法。

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

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

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

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

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

  1. Acupuncture is widely available from qualified practitioners nationally.

美国有足够的合格的针灸师

http://www.jcimjournal.com/articles/publishArticles/pdf/S2095-4964(17)60378-9.pdf

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Title: The earliest acupuncture school of the United States incubated in a Tai Chi Center in Los Angeles
Authors: Arthur Yin Fan
Abstract | Full text | PDF |

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To date, there are 1,035 active acupuncturists in MD. Acupuncture Today indicated the members in Maryland is 752(72.6%). And currently VA active acupuncturists  about 485. In Acupuncture Today, is 352(72.6%).

Total acupuncturists in Acupuncture Today is about 25,000. So in 2014, actual active acupuncturists in USA should be 34,435.

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美国针灸大事年表

[日期:2012-06-20] 来源:  作者: http://book.th55.cn/a/201206/8138.html ]

    图书馆目录中的针灸记载

美国l802~1871年的医学杂志目录中曾经列出过针灸[213]

早期针灸临床试验记载

1825年在宾夕法尼亚州的监狱里,针灸曾经作为实验治疗方法,用于治疗犯人患者的各种疼痛病症,取壬导较好的疗效。当时监狱的犯人还经常接受药物实验疗效,此类临床试验后来被抨击为违反人权的典型事件,受到广泛的批评[214]。1826年出版的《费城医学和物理科学》杂志曾经发表过针灸治愈风湿性心脏病的病例报道[215]

早期使用针灸著名案例

哈维.库兴(Harvey Cushin9,1869~1939年)在《奥斯勒传》中提到,美国现代医学教育之父奥斯勒医生曾尝试用针灸为一位加拿大麦吉尔大学(McGill University)的董事治疗腰痛,结果失败,没能争取到这位蒙特利尔富有的糖业加工大亨为学校的捐款[216]

早期美国医学教科针灸书记载

1876年,詹姆斯.哈亲森在费城出版的名为《医学理论和实践》的教科书中提到针灸疗法[217]

1892年,奥斯勒医生曾经在他编著的《内科教科书》中建议用针灸治疗坐骨神经痛和腰痛[218]

最早报道中国针灸的美国记者

《观察》画报于1957年10月1日发表了摄影记者菲利浦·哈瑞顿 (Phillip Harrington)的配图文章,题目为“红色中国墨守古老医学”,其中提到作者在访问北京儿童医院时,看到中国医生使用针灸治疗疾病,文中还刊出针灸照片[88]

第一位赴新中国采访的美国电视记者罗伯特·科恩(Robert Carl Cohen)于1958年拍摄了一部题为“红色中国的内幕”纪录片,在介绍中国医疗状况时,其中有现代医院和传统针灸的内容[219]

真正第一篇实地报道中国广泛使用针灸治疗各种疾病的,是美国记者杜尔丁,他在采访美国乒乓球队访华的同时,于l971年4月24日在《纽约时报》发表了“天津医生说他用针灸治好了很多病”一文[220]

  第一个美国记者发自新中国的针刺麻醉报道

托平于1971年5月24日在《纽约时报》发表了“中国人使用针刺麻醉进行心脏手术”的报道[221]

第一个美国科学家代表团访问新中国并参观针灸

1971年5月,耶鲁大学的高尔斯顿(Arthur Galston)教授和麻省理工学院的西格纳(Ethan Signer)教授在访问越南时,获得访问中国的邀请,成为新中国第一批应邀访华的美国科学家,2人在访华期间参观了针刺麻醉手术[21]

第一个美国杂志报道针刺麻醉

1971年6月7日,美国《新闻周刊》报道了耶鲁大学的高尔斯顿教授和麻省理工学院的西格纳教授访问中国,参观了针刺麻醉手术。文章刊登了经络穴位图,解释为“神经中心图” [21]

第一个美国记者在新中国接受针灸治疗

1971年7月17 日,《纽约时报》记者赖斯顿于北京“反帝医院”(协和医院)因阑尾炎住院并接受常规阑尾切除手术,第二天(18日),赖斯顿因术后腹胀腹痛接受了李占元医生的针刺和艾灸治疗。赖斯顿住院期间,将自己的治疗经历写成“现在让我告诉你们我在北京的阑尾切除手术”一文,发表在1971年7月26日的《纽约时报》上,此文被公认为美国针灸热的导火索[9]

第一个美国医生代表团访问新中国并参观针刺麻醉

1971年9月,应中国中华医学会邀请,由4位知名美国医生及他们的夫人组成的美国医学代表团首次访问新中国,受到中国医学界的高规格接待。4人是美国前总统艾森豪威尔的私人医生,世界著名的心脏病专家,麻省总医院和哈佛大学的教授怀特(Paul Dudley White)医学博士;密苏里大学健康科学院院长达蒙德(Grey Dimond)医学博士;纽约爱因斯坦医学院社区健康教授赛尔德(Vietor Sidel)医学博士;纽约西奈山医学院耳鼻喉科退休名誉教授罗森(Samuel Rosen)医学博士。代表团在中国多家医院参观了针刺麻醉手术[29]

《美国医学会会刊》第一次报道针刺麻醉

1971年12月,达蒙德医生在《美国医学会会刊》(JAMA)发表了“针刺麻醉”一文,美国正统医学杂志首次报道中国针刺麻醉[26]

《科学》杂志第一次报道针刺麻醉

美国科学界的顶级学术杂志《科学》于1972年1月发表关于中国针灸和针刺麻醉的报道[54]。《科学》杂志在1972~1975年间至少发表过9篇关 于针灸的报告和评论文章。

 美国第一家针灸中心

由纽约执照西医师本森(Benson)医生于1972年夏在纽约曼哈顿开设名为“曼哈顿针灸中心”。中心雇用了数位亚裔针灸师,当时需求针灸的患者众多,来自美国及世界各地的患者预约排到一年之后。但因为当时针灸师在纽约州尚未取得合法地位,政府管理部门以“非法行医”下令取缔,“曼哈顿针灸中心”于当年ll月关闭[69]

 美国第一次针刺麻醉手术

美国第一次针刺麻醉试验手术于l972年4月由专业麻醉医师刘医生(wei Chi Liu)在芝加哥威斯医院(Weiss Memorial Hospital)完成。患者是一位31岁的麻醉护士,他自愿请医生采用针刺代替常规药物麻醉切除自己的扁桃体,手术十分成功。手术病例报道发表于l972年《美国医学会会刊》[222]

第一本针灸杂志

《美国针灸》杂志(American Journal ofAcupuncture)于1973年创刊。

第一本中医杂志

《美洲中医》杂志(American Journal of Chnese Medicine)于1973年创刊。

第一个中医针灸立法

1973年4月内华达州通过了美国第一个法案承认中国医学为“专业职业”,州立法委员会几乎全票通过将针灸、中草药及其他中医疗法合法化。此法案出自州参议院448号提案,经由参众两院通过,州长签字生效。法案要求成立独立的州中医管理委员会,允许没有医生执照的专业人士申请针灸、中草药和中医执照,合法行医[115,116]

第一个官方机构承认针灸为医学治疗方法

在美国各官方机构中,国家税务局(IRS)最先于1973年承认针灸治疗为医学治疗方法,规定纳税人用于针灸治疗的费用可以作为医疗花费报税。

 美国针灸热的最高潮

美国大众画报《人物》周刊于1974年4月15日图文并茂刊登了一组包括电影明星、节目主持人和大牌运动员在内的多位美国家喻户晓的名人照,文章的题目为:“名人和平民都得到了针灸的帮助”,《人物》荟萃名人针灸故事的报道被认为是美国针灸热历史最高潮的标志[118,119]

 美国第一个针刺麻醉评估报告

“美国针刺麻醉研究组”于l974年5月1日赴中国参观考察3周,访问了北京、上海、广州等城市,参观了l6家中国医院,考察观摩了48台针刺麻醉外科手术。1976年,美国科学院正式出版了题为《针刺麻醉在中华人民共和国》的评估报告[124]

第一个针灸戒毒中心

1972年香港医生温祥来(Hsian9—Lai wen)等首先发明耳针戒毒疗法,其研究论文于l973年发表于《亚洲医学》杂志。1974年纽约林肯医院史密斯(Michael 0.Smith)医学博士建立了第一个设立在美国医院的耳针戒毒中心。

第一个美国针灸学校

美国第一个针灸学校“新英格兰针灸学校”(New England School of Acupuncture)于1975年创办。

第一个全美针灸资格考试

美国第一个被广泛接受的全国统一针灸资格考试由非盈利机构“全国针灸资格考试委员会”(NCCA)举办,该机构创办于1982年,后更名为“全国针灸及东方医学资格考试委员会”(NCCAOM)。

 第一次官方承认针灸针为医疗器具

美国国家食品药品管理局(FDA)于1996年正式将针灸针列为医疗器具,在此之前,针灸针被归为医疗实验用器具。

第一个国家补充替代医学机构

按照美国国会的要求,美国国家健康研究院于l991年成立替代补充医学办公室(OCAM),是美国建国以来第一个官方补充替代医学机构。该机构于l991年升级为补充替代医学中心(NCCAM),在中心资助和研究的项目中,中医针灸和中药一直占有很大比例。

第一次国家科学评估——健康研究院针灸听证会

美国国家健康研究院于l997首次召开“针灸听证会”(Concensus conference,即“共识讨论会”),对针灸疗法作出了科学评估。专家评审委员会最后得出结论:针灸治疗一些病症确实有效[165]

 

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The Practice of Acupuncture: Who Are the Providers and What Do They Do?

doi: 10.1370/afm.248   Ann Fam Med March 1, 2005 vol. 3 no. 2 151-158

Karen J. Sherman, Daniel C. Cherkin, David M. Eisenber

CORRESPONDING AUTHOR: Karen J. Sherman, PhD, Center for Health Studies, Group Health Cooperative, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, sherman.k@ghc.org

Abstract

PURPOSE This study provides basic information about the training and practices of licensed acupuncturists.

METHODS Randomly selected licensed acupuncturists in Massachusetts and Washington state were interviewed and asked to record information on 20 consecutive patient visits.

RESULTS Most acupuncturists in both states had 3 or 4 years of academic acupuncture training and had received additional “postgraduate” training as well. Acupuncturists treated a wide range of conditions, including musculoskeletal problems (usually back, neck, and shoulder) (33% in Massachusetts and 47% in Washington), general body symptoms (12% and 9%, respectively) such as fatigue, neurological problems (10% and 12%, respectively) (eg, headaches), and psychological complaints (10% and 8%, respectively) (especially anxiety and depression). Traditional Chinese medicine (TCM) was the predominant style of acupuncture used in both states (79% and 86%, respectively). Most visits included a traditional diagnostic assessment (more than 99%), regular body acupuncture (95% and 93%, respectively), and additional treatment modalities (79% and 77%, respectively). These included heat and lifestyle advice (66% and 65%, respectively), most commonly dietary advice and exercise recommendations. Chinese herbs were used in about one third of visits. Although most patients self-referred to acupuncture, about one half received concomitant care from a physician. Acupuncturists rarely communicated with the physicians of their patients who were providing care for the same problem.

CONCLUSIONS This study contributes new information about acupuncturists and the care they provide that should be useful to clinicians interested in becoming more knowledgeable about complementary or alternative medical therapies available to their patients.

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Monday, October 6, 2008;

 

James Tin Yau So

Dr. James Tin Yau So, N.D., LAc., also known as Dr. So, was one of the most influential individuals of the 20th Century in bringing acupuncture to the United States.

Dr. So’s teacher was Tsang Tien Chi who studied under Ching Tan An. He graduated from Dr. Tsang’s College of Scientific Acupuncture in , China, in 1939. During the same year Dr. So opened his medical office in Hong Kong. In 1941 he opened his own school, The Hong Kong College Acupuncture. For the next thirty years, Dr. So established himself as one of the most successful and well-respected acupuncturists throughout Asia. Practitioner came from all over Asia and Europe to study at his college.

Several acupuncturists from the National Acupuncture Association sought Dr. So’s assistance in 1972. At the time the NAA offered Dr. So a position as acupuncturist at the UCLA Acupuncture Pain Clinic, the only legal acupuncture clinic in California at that time. Dr. So accepted and joined the NAA staff of acupuncturists and the UCLA Acupuncture Pain Clinic in 1973.

In 1974, Dr. So was part of the NAA group that traveled to Massachusetts and opened the first acupuncture clinic in Boston and a second clinic in Worcester. In the fall of 1974, Dr. So founded the New England School of Acupuncture. Karen Freede and John V. Braga assisted Dr. So in the translation of his three books on the points of acupuncture, the techniques acupuncture and treatment of disease by acupuncture. . Dr. So, with the help of his students Arnie Freiman and Steven Breeker, founded the first school of acupuncture in the US, the New England School of Acupuncture , in 1974 With his approval Dr. Gene Bruno and Dr. Steven Rosenblatt founded a second school in the US, which became the California Acupuncture College, located in West Los Angeles.

A majority of the acupuncture schools in the U.S. were founded by students of Dr. So. This legacy of acupuncture in North America is unparalleled.

Dr. So was awarded the Acupuncturist of the Year in 2001 by the American Association of Oriental Medicine. In 2007, Dr. So Tin Yau was among the first four acupuncturists to be inscribed on the Founders of the Profession Honor Roll by the American Association of Oriental Medicine.

Posted by at 8:27 PM

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Dr. Fan notes: Someone asked me which school is good in the  field of acupuncture and Chinese medicine. Here is a online article which picked “top 10”. For what is best school, actually different people may have different criteria. From my personal perspective, the best one is that most fit you—fit your taste(most attract you), and affordable, also close to you. So, before choosing a school, you must conduct a research by yourself. And actually in Acupuncture and Chinese medicine, there are different academical schools (different in style), such as traditional Chinese medicine (TCM), five elements, etc., everyone may have something good in “taste”, it is difficult to say which is the best in one word.

Here is the article: http://www.thebestschools.org/blog/2012/09/11/10-acupuncture-schools-u-s/

Prospective students may begin their search with schools accredited by the Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM).http://www.acaom.org/find-a-school/default.aspx?state=All&dicipline=undefined&programtypes=                                  

The Council of Colleges of Acupuncture and Oriental Medicine as well as the American Association of Oriental Medicine established ACAOM in 1982 as a not-for-profit organization. ACAOM is recognized by the U.S. Department of Education as a “specialized and professional” accrediting agency.

ACAOM has more than 60 schools and colleges with accreditation or candidacy status. All of the schools we selected for our list have received accreditation from the ACAOM.

Below is our ranking of the 10 best acupuncture schools in the United States. Factors that influenced our choice of schools making this list as well as their relative order include the following:

  1. quality of faculty not only as practitioners of acupuncture but also as researchers advancing the field;
  2. success in training students who can lead the field;
  3. having not merely a masters but also a doctoral program in acupuncture;
  4. comprehensiveness of the training program;
  5. how long the school has been in existence and its reputation for excellence during that time.

http://www.thebestschools.org/blog/2012/09/11/10-acupuncture-schools-u-s/

1. Oregon College of Oriental Medicine (Portland, OR)

2. Pacific College of Oriental Medicine (San Diego, CA)

3. New England School of Acupuncture (Watertown, MA)

4. Bastyr University (Kenmore, WA)

5. American College of Traditional Chinese Medicine (San Francisco, CA)

6. Southwest Acupuncture College (Santa Fe, NM)

7. American College of Acupuncture & Oriental Medicine (Houston, TX)

8. AOMA Graduate School of Integrative Medicine (Austin, TX)

9. New York College of Traditional Chinese Medicine (New York, NY)

10. Academy of Chinese Culture and Health Sciences (Oakland, CA)

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