Friday, May 6, 2011

Be Wary of Acupuncture, Qigong, and "Chinese Medicine"

Stephen Barrett, M.D.

"Chinese medicine," often called "Oriental medicine" or "traditional Chinese medicine (TCM)," encompasses a vast array of folk medical practices based on mysticism. It holds that the body's vital energy (chi or qi) circulates through channels, called meridians, that have branches connected to bodily organs and functions. Illness is attributed to imbalance or interruption of chi.. Ancient practices such as acupuncture, Qigong, and the use of various herbs are claimed to restore balance.
Traditional acupuncture, as now practiced, involves the insertion of stainless steel needles into various body areas. A low-frequency current may be applied to the needles to produce greater stimulation. Other procedures used separately or together with acupuncture include: moxibustion (burning of floss or herbs applied to the skin); injection of sterile water, procaine, morphine, vitamins, or homeopathic solutions through the inserted needles; applications of laser beams (laserpuncture); placement of needles in the external ear (auriculotherapy); and acupressure (use of manual pressure). Treatment is applied to "acupuncture points," which are said to be located throughout the body. Originally there were 365 such points, corresponding to the days of the year, but the number identified by proponents during the past 2,000 years has increased gradually to about 2,000 [1]. Some practitioners place needles at or near the site of disease, whereas others select points on the basis of symptoms. In traditional acupuncture, a combination of points is usually used.
Qigong is also claimed to influence the flow of "vital energy." Internal Qigong involves deep breathing, concentration, and relaxation techniques used by individuals for themselves. External Qigong is performed by "Qigong masters" who claim to cure a wide variety of diseases with energy released from their fingertips. However, scientific investigators of Qigong masters in China have found no evidence of paranormal powers and some evidence of deception. They found, for example, that a patient lying on a table about eight feet from a Qigong master moved rhythmically or thrashed about as the master moved his hands. But when she was placed so that she could no longer see him, her movements were unrelated to his [2]. Falun gong, which China banned several years ago, is a Qigong varient claimed to be "a powerful mechanism for healing, stress relief and health improvements."
Most acupuncturists espouse the traditional Chinese view of health and disease and consider acupuncture, herbal medicine, and related practices to be valid approaches to the full gamut of disease. Others reject the traditional approach and merely claim that acupuncture offers a simple way to achieve pain relief. The diagnostic process used by TCM practitioners may include questioning (medical history, lifestyle), observations (skin, tongue, color), listening (breathing sounds), and pulse-taking. Six pulse aspects said to correlate with body organs or functions are checked on each wrist to determine which meridians are "deficient" in chi. (Medical science recognizes only one pulse, corresponding to the heartbeat, which can be felt in the wrist, neck, feet, and various other places.) Some acupuncturists state that the electrical properties of the body may become imbalanced weeks or even months before symptoms occur. These practitioners claim that acupuncture can be used to treat conditions when the patient just "doesn't feel right," even though no disease is apparent.
TCM (as well as the folk medical practices of various other Asian countries) is a threat to certain animal species. For example, black bears—valued for their gall bladders—have been hunted nearly to extinction in Asia, and poaching of black bears is a serious problem in North America.

Dubious Claims

The conditions claimed to respond to acupuncture include chronic pain (neck and back pain, migraine headaches), acute injury-related pain (strains, muscle and ligament tears), gastrointestinal problems (indigestion, ulcers, constipation, diarrhea), cardiovascular conditions (high and low blood pressure), genitourinary problems (menstrual irregularity, frigidity, impotence), muscle and nerve conditions (paralysis, deafness), and behavioral problems (overeating, drug dependence, smoking). However, the evidence supporting these claims consists mostly of practitioners' observations and poorly designed studies. A controlled study found that electroacupuncture of the ear was no more effective than placebo stimulation (light touching) against chronic pain [3]. In 1990, three Dutch epidemiologists analyzed 51 controlled studies of acupuncture for chronic pain and concluded that "the quality of even the better studies proved to be mediocre. . . . The efficacy of acupuncture in the treatment of chronic pain remains doubtful." [4] They also examined reports of acupuncture used to treat addictions to cigarettes, heroin, and alcohol, and concluded that claims that acupuncture is effective as a therapy for these conditions are not supported by sound clinical research [5].
Acupuncture anesthesia is not used for surgery in the Orient to the extent that its proponents suggest. In China physicians screen out patients who appear to be unsuitable. Acupuncture is not used for emergency surgery and often is accompanied by local anesthesia or narcotic medication [6].
How acupuncture may relieve pain is unclear. One theory suggests that pain impulses are blocked from reaching the spinal cord or brain at various "gates" to these areas. Another theory suggests that acupuncture stimulates the body to produce narcotic-like substances called endorphins, which reduce pain. Other theories suggest that the placebo effect, external suggestion (hypnosis), and cultural conditioning are important factors. Melzack and Wall note that pain relief produced by acupuncture can also be produced by many other types of sensory hyperstimulation, such as electricity and heat at acupuncture points and elsewhere in the body. They conclude that "the effectiveness of all of these forms of stimulation indicates that acupuncture is not a magical procedure but only one of many ways to produce analgesia [pain relief] by an intense sensory input." In 1981, the American Medical Association Council on Scientific Affairs noted that pain relief does not occur consistently or reproducibly in most people and does not operate at all in some people [7].
In 1995, George A. Ulett, M.D., Ph.D., Clinical Professor of Psychiatry, University of Missouri School of Medicine, stated that "devoid of metaphysical thinking, acupuncture becomes a rather simple technique that can be useful as a nondrug method of pain control." He believes that the traditional Chinese variety is primarily a placebo treatment, but electrical stimulation of about 80 acupuncture points has been proven useful for pain control [8].
The quality of TCM research in China has been extremely poor. A 1999 analysis of 2,938 reports of clinical trials reported in Chinese medical journals concluded that that no conclusions could be drawn from the vast majority of them. The researchers stated:
In most of the trials, disease was defined and diagnosed according to conventional medicine; trial outcomes were assessed with objective or subjective (or both) methods of conventional medicine, often complemented by traditional Chinese methods. Over 90% of the trials in non-specialist journals evaluated herbal treatments that were mostly proprietary Chinese medicines. . . .
Although methodological quality has been improving over the years, many problems remain. The method of randomisation was often inappropriately described. Blinding was used in only 15% of trials. Only a few studies had sample sizes of 300 subjects or more. Many trials used as a control another Chinese medicine treatment whose effectiveness had often not been evaluated by randomised controlled trials. Most trials focused on short term or intermediate rather than long term outcomes. Most trials did not report data on compliance and completeness of follow up. Effectiveness was rarely quantitatively expressed and reported. Intention to treat analysis was never mentioned. Over half did not report data on baseline characteristics or on side effects. Many trials were published as short reports. Most trials claimed that the tested treatments were effective, indicating that publication bias may be common; a funnel plot of the 49 trials of acupuncture in the treatment of stroke confirmed selective publication of positive trials in the area, suggesting that acupuncture may not be more effective than the control treatments. [9]
Two scientists at the University of Heidelberg have developed a "fake needle" that may enable acupuncture researchers to perform better-designed controlled studies. The device is a needle with a blunt tip that moves freely within a copper handle. When the tip touches the skin, the patient feels a sensation similar to that of an acupuncture needle. At the same time, the visible part of the needle moves inside the handle so it appears to shorten as though penetrating the skin. When the device was tested on volunteers, none suspected that it had not penetrated the skin [10].
In 2004, a University of Heidelberg team proved the worth of their "sham acupuncture" technique in a study of postoperative nausea and vomiting (PONV) in women who underwent breast or gynecologic surgery. The study involved 220 women who received either acupuncture or the sham procedure at the acupuncture point "Pericardium 6" on the inside of the forearm. No significant difference in PONV or antivomiting medication use was found between the two groups or between the people who received treatment before anesthesia was induced and those who received it while anesthetized [11]. A subgroup analysis found that vomiting was "significantly reduced" among the acupuncture patients, but the authors correctly noted that this finding might be due to studying multiple outcomes. (As the number of different outcome measures increases, so do the odds that a "statistically significant" finding will be spurious.) This study is important because PONV reduction is one of the few alleged benefits of acupuncture supported by reports in scientific journals. However, the other positive studies were not as tightly controlled.
Harriet Hall, a retired family practitioner who is interested in quackery, has summed up the significance of acupuncture research in an interesting way:
Acupuncture studies have shown that it makes no difference where you put the needles. Or whether you use needles or just pretend to use needles (as long as the subject believes you used them). Many acupuncture researchers are doing what I call Tooth Fairy science: measuring how much money is left under the pillow without bothering to ask if the Tooth Fairy is real.

Risks Exist

Improperly performed acupuncture can cause fainting, local hematoma (due to bleeding from a punctured blood vessel), pneumothorax (punctured lung), convulsions, local infections, hepatitis B (from unsterile needles), bacterial endocarditis, contact dermatitis, and nerve damage. The herbs used by acupuncture practitioners are not regulated for safety, potency, or effectiveness. There is also risk that an acupuncturist whose approach to diagnosis is not based on scientific concepts will fail to diagnose a dangerous condition.
The adverse effects of acupuncture are probably related to the nature of the practitioner's training. A survey of 1,135 Norwegian physicians revealed 66 cases of infection, 25 cases of punctured lung, 31 cases of increased pain, and 80 other cases with complications. A parallel survey of 197 acupuncturists, who are more apt to see immediate complications, yielded 132 cases of fainting, 26 cases of increased pain, 8 cases of pneumothorax, and 45 other adverse results [12]. However, a 5-year study involving 76 acupuncturists at a Japanese medical facility tabulated only 64 adverse event reports (including 16 forgotten needles and 13 cases of transient low blood pressure) associated with 55,591 acupuncture treatments. No serious complications were reported. The researchers concluded that serious adverse reactions are uncommon among acupuncturists who are medically trained [13].
In 2001, members of the British Acupuncture Council who participated in two prospective studies reported low complication rates and no serious complications among patients who underwent a total of more than 66,000 treatments [14,15]. An accompany editorial suggested that in competent hands, the likelihood of complcations is small [16]. Since outcome data are not available, the studies cannot compare the balance of risks vs benefit. Nor do the studies take into account the likelihood of misdiagnosis (and failure to seek appropriate medical care) by practitioners who use traditional Chinese methods.
There is also financial risk. Online information suggests that the cost per visit ranges from about $50 to $100 per treatment, with the first visit to a practitioner costing more. Herbal products, which many practitioners commonly prescribe, could range anywhere from a few dollars to a few hundred dollars per month.

Questionable Standards

In 1971, an acupuncture boom occurred in the United States because of stories about visits to China by various American dignitaries. Entrepreneurs, both medical and nonmedical, began using flamboyant advertising techniques to promote clinics, seminars, demonstrations, books, correspondence courses, and do-it-yourself kits. Today some states restrict the practice of acupuncture to physicians or others operating under their direct supervision. In about 20 states, people who lack medical training can perform acupuncture without medical supervision. The FDA now classifies acupuncture needles as Class II medical devices and requires labeling for one-time use by practitioners who are legally authorized to use them [17]. Acupuncture is not covered under Medicare. The March 1998 issue of the Journal of the American Chiropractic Association carried a five-part cover story encouraging chiropractors to get acupuncture training, which, according to one contributor, would enable them to broaden the scope of their practice [18].
The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) has set voluntary certification standards and offers separate certifications on Oriental medicine, acupuncture, Chinese herbology, and Asian bodywork therapy. In 2007, it reported that its certification programs or exams were be recognized for licensure in 40 states and the District of Columbia and that more than 20,000 practitioners are licensed in the United States [19]. (The Acupuncture.com Web site provides information on the licensing status of each state.) The credentials used by acupuncturists include C.A. (certified acupuncturist), Lic. Ac. (licensed acupuncturist), M.A. (master acupuncturist), Dip. Ac. (diplomate of acupuncture), Dipl.O.M. (diplomate of Oriental medicine), and O.M.D. (doctor of Oriental medicine). Some of these have legal significance, but they do not signify that the holder is competent to make adequate diagnoses or render appropriate treatment.
In 1990, the U.S. Secretary of Education recognized what is now called the Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM) as an accrediting agency. However, such recognition is not based on the scientific validity of what is taught but upon other criteria [20]. Ulett has noted:
Certification of acupuncturists is a sham. While a few of those so accredited are naive physicians, most are nonmedical persons who only play at being doctor and use this certification as an umbrella for a host of unproven New Age hokum treatments. Unfortunately, a few HMOs, hospitals, and even medical schools are succumbing to the bait and exposing patients to such bogus treatments when they need real medical care.
The National Council Against Health Fraud has concluded:
  • Acupuncture is an unproven modality of treatment.
  • Its theory and practice are based on primitive and fanciful concepts of health and disease that bear no relationship to present scientific knowledge
  • Research during the past 20 years has not demonstrated that acupuncture is effective against any disease.
  • Perceived effects of acupuncture are probably due to a combination of expectation, suggestion, counter-irritation, conditioning, and other psychologic mechanisms.
  • The use of acupuncture should be restricted to appropriate research settings,
  • Insurance companies should not be required by law to cover acupuncture treatment,
  • Licensure of lay acupuncturists should be phased out.
  • Consumers who wish to try acupuncture should discuss their situation with a knowledgeable physician who has no commercial interest [21].

The NIH Debacle

In 1997, a Consensus Development Conference sponsored by the National Institutes of Health and several other agencies concluded that "there is sufficient evidence . . . of acupuncture's value to expand its use into conventional medicine and to encourage further studies of its physiology and clinical value." [22] The panelists also suggested that the federal government and insurance companies expand coverage of acupuncture so more people can have access to it. These conclusions were not based on research done after NCAHF's position paper was published. Rather, they reflected the bias of the panelists who were selected by a planning committee dominated by acupuncture proponents [23]. NCAHF board chairman Wallace Sampson, M.D., has described the conference "a consensus of proponents, not a consensus of valid scientific opinion."
Although the report described some serious problems, it failed to place them into proper perspective. The panel acknowledged that "the vast majority of papers studying acupuncture consist of case reports, case series, or intervention studies with designs inadequate to assess efficacy" and that "relatively few" high-quality controlled trials have been published about acupuncture's effects. But it reported that "the World Health Organization has listed more than 40 [conditions] for which [acupuncture] may be indicated." This sentence should have been followed by a statement that the list was not valid.
Far more serious, although the consensus report touched on Chinese acupuncture theory, it failed to point out the danger and economic waste involved in going to practitioners who can't make appropriate diagnoses. The report noted:
  • The general theory of acupuncture is based on the premise that there are patterns of energy flow (Qi) through the body that are essential for health. Disruptions of this flow are believed to be responsible for disease. The acupuncturist can correct imbalances of flow at identifiable points close to the skin.
  • Acupuncture focuses on a holistic, energy-based approach to the patient rather than a disease-oriented diagnostic and treatment model.
  • Despite considerable efforts to understand the anatomy and physiology of the "acupuncture points," the definition and characterization of these points remains controversial. Even more elusive is the scientific basis of some of the key traditional Eastern medical concepts such as the circulation of Qi, the meridian system, and the five phases theory, which are difficult to reconcile with contemporary biomedical information but continue to play an important role in the evaluation of patients and the formulation of treatment in acupuncture.
Simply stated, this means that if you go to a practitioner who practices traditional Chinese medicine, you are unlikely to be properly diagnosed. Very few publications have mentioned this, which strikes me as very strange. Even Consumer Reports magazine has advised readers who want acupuncture treatment to consult a practitioner who is NCCAOM-certified. I advise people to avoid "certified" practitioners. Because the training needed for certification is based on nonsensical TCM theories, the safest way to obtain acupuncture is from a medical doctor who does research at a university-based medical school and does not expouse such theories.

Diagnostic Variability

In 1998, following a lecture I attended at a local college, an experienced TCM practitioner diagnosed me by taking my pulse and looking at my tongue. He stated that my pulse showed signs of "stress" and that my tongue indicated I was suffering from "congestion of the blood." A few minutes later, he told a woman that her pulse showed premature ventricular contractions (a disturbance of the heart's rhythm that could be harmless or significant, depending on whether the individual has underlying heart disease). He suggested that both of us undergo treatment with acupuncture and herbs—which would have cost about $90 per visit. I took the woman's pulse and found that it was completely normal. I believe that the majority of nonmedical acupuncturists rely on improper diagnostic procedures. The NIH consensus panel should have emphasized the seriousness of this problem.
Subsequent research has confirmed that TCM diagnosis has very little to do with people's real health problems. At least six studies have found that when multiple practitioners see the same patient, their TCM diagnoses vary considerably.
In a study published in 2001, a 40-year-old woman with chronic back pain who visited seven acupuncturists during a 2-week period was diagnosed with "Qi stagnation" by 6 of them, "blood stagnation" by 5 , "kidney Qi deficiency" by 2, "yin deficiency" by 1, and "liver Qi deficiency" by 1. The proposed treatments varied even more. Among the six who recorded their recommendations, the practitioners planned to use between 7 and 26 needles inserted into 4 to 16 specific "acupuncture points" in the back, leg, hand, and foot. Of 28 acupuncture points selected, only 4 (14%) were prescribed by two or more acupuncturists. [24]. The study appears to have been designed to make the results as consistent as possible. All of the acupuncturists had been trained at a school of traditional Chinese medicine (TCM). Six other volunteers were excluded because they "used highly atypical practices," and three were excluded because they had been in practice for less than three years. The study's authors stated that the diagnostic findings showed "considerable consistency" because nearly all of the practitioners found Qi or blood stagnation. However, the most likely explanation was that these are diagnosed in nearly everyone.
In another study, six TCM acupuncturists evaluated the same six patients on the same day. Twenty diagnoses and 65 acupoints were used at least once. The diagnosis of "Qi/Blood Stagnation with Kidney Deficiency" and the acupoint UB23 were used for every patient by most acupuncturists. However, consistency across acupuncturists regarding diagnostic details and other acupoints was poor. No diagnoses, and only one acupoint, were used preferentially for a subgroup of patients. Some diagnoses and treatment recommendations were dependent more on the practitioner than on the patient. Fine-grained diagnoses and most acupoints were unrelated to either patient or practitioner. The researchers concluded that TCM diagnoses and treatment recommendations for specific patients with chronic low back pain vary widely from one practitioner to another [25].
Another study examined TCM diagnoses and treatments for patients with chronic low-back pain using two separate sets of treatment records. Information from more than 150 initial visits was available for analysis. A diagnosis of "Qi and Blood Stagnation" or "Qi Stagnation" was made for 85% of patients. A diagnosis of kidney deficiency (or one of its three subtypes) was made for 33%-51% of patients. Other specific diagnoses were made for less than 20% of the patients. An average of 12-13 needles was used in each treatment. Although more than 85 different acupoints were used in each data set, only 5 or 6 acupoints were used in more than 20 of the treatments in each data set. Only two of those acupoints (UB23, UB40) were the same for both sources of data. More than half of the patients received adjunctive treatments, including heat (36%-67%), and cupping (16%-21%). There was substantial variability in treatments among providers [26].
In a larger study published in 2004, three TCM practitioners examined the same 39 rheumatoid arthritis (RA) patients separately at the University of Maryland General Clinical Research Center. Each patient filled out a questionnaire and underwent a physical examination that included tongue and pulse diagnosis. Then each practitioner provided both a TCM diagnosis and a herbal prescription. Agreement on TCM diagnoses among the 3 pairs of TCM practitioners ranged from 25.6% to 33.3%. The degree to which the herbal prescriptions agreed with textbook recommended practice of each TCM diagnosis ranged from 87.2% to 100%. The study's authors concluded:
The total agreement on TCM diagnosis on RA patients among 3 TCM practitioners was low. When less stringent, but theoretically justifiable, criteria were employed, greater consensus was obtained. . . . The correspondence between the TCM diagnosis and the herbal formula prescribed for that diagnosis was high, although there was little agreement among the 3 practitioners with respect to the herbal formulas prescribed for individual patients [27].
The University of Maryland researchers then repeated the above study using 40 RA patients and three practitioners who had had at least five years of experience. The results were nearly identical to the previous findings [28].
In another study, 37 participants with frequent headaches were independently evaluated by three licensed acupuncturists said to be highly trained in TCM. The acupuncturists identified the meridians and type of dysfunction they believed were contributing to the participants' symptoms. The acupuncturists also ascribed one or more TCM diagnoses to each participant and selected eight acupuncture points for needling. Some variation in TCM pattern diagnosis and point selection was observed for all subjects. "Liver Yang" and "Qi dysfunction" were diagnosed in more than two thirds of subjects. Acupuncture points Liver 3, Large Intestine 4, and Governing Vessel (DU) 20 were the most commonly selected points for treatment [29].
It would be fascinating to see what would happen if a healthy person who needed no medical treatment was examined by multiple acupuncturists.

The Bottom Line

TCM theory and practice are not based upon the body of knowledge related to health, disease, and health care that has been widely accepted by the scientific community. TCM practitioners disagree among themselves about how to diagnose patients and which treatments should go with which diagnoses. Even if they could agree, the TCM theories are so nebulous that no amount of scientific study will enable TCM to offer rational care.

For Additional Information

References

  1. Skrabanek P. Acupuncture: Past, present, and future. In Stalker D, Glymour C, editors. Examining Holistic Medicine. Amherst, NY: Prometheus Books, 1985.
  2. Kurtz P, Alcock J, and others. Testing psi claims in China: Visit by a CSICOP delegation. Skeptical Inquirer 12:364-375, 1988.
  3. Melzack R, Katz J. Auriculotherapy fails to relieve chronic pain: A controlled crossover study. JAMA 251:1041­1043, 1984.
  4. Ter Reit G, Kleijnen J, Knipschild P. Acupuncture and chronic pain: A criteria-based meta-analysis. Clinical Epidemiology 43:1191-1199, 1990.
  5. Ter Riet G, Kleijnen J, Knipschild P. A meta-analysis of studies into the effect of acupuncture on addiction. British Journal of General Practice 40:379-382, 1990.
  6. Beyerstein BL, Sampson W. Traditional Medicine and Pseudoscience in China: A Report of the Second CSICOP Delegation (Part 1). Skeptical Inquirer 20(4):18-26, 1996.
  7. American Medical Association Council on Scientific Affairs. Reports of the Council on Scientific Affairs of the American Medical Association, 1981. Chicago, 1982, The Association.
  8. Ulett GA. Acupuncture update 1984. Southern Medical Journal 78:233­234, 1985.
  9. Tang J-L, Zhan S-Y, Ernst E. Review of randomised controlled trials of traditional Chinese medicine. British Medical Journal 319:160-161, 1999.
  10. Streitberger K, Kleinhenz J. Introducing a placebo needle into acupuncture research. Lancet 352:364-365, 1998.
  11. Streitberger K and others. Acupuncture compared to placebo-acupuncture for postoperative nausea and vomiting prophylaxis: A randomised placebo-controlled patient and observer blind trial. Anesthesia 59:142-149, 2004.
  12. Norheim JA, Fennebe V. Adverse effects of acupuncture. Lancet 345:1576, 1995.
  13. Yamashita H and others. Adverse events related to acupuncture. JAMA 280:1563-1564, 1998.
  14. White A and others. Adverse events following acupuncture: Prospective surgery of 32,000 consultations with doctors and physiotherapists. BMJ 323:485-486, 2001.
  15. MacPherson H and others. York acupuncture safety study: Prospective survey of 24,000 treatments by traditional acupuncturists. BMJ 323:486-487, 2001.
  16. Vincent C. The safety of acupuncture. BMJ 323:467-468, 2001.
  17. Acupuncture needle status changed. FDA Talk Paper T96-21, April 1, 1996
  18. Wells D. Think acu-practic: Acupuncture benefits for chiropractic. Journal of the American Chiropractic Association 35(3):10-13, 1998.
  19. NCCAOM 25th Anniversary Booklet. Burtonsville, MD: NCCAOM, 2007.
  20. Department of Education, Office of Postsecondary Education. Nationally Recognized Accrediting Agencies and Associations. Criteria and Procedures for Listing by the U.S. Secretary For Education and Current List. Washington, D.C., 1995, U.S. Department of Education.
  21. Sampson W and others. Acupuncture: The position paper of the National Council Against Health Fraud. Clinical Journal of Pain 7:162-166, 1991.
  22. Acupuncture. NIH Consensus Statement 15:(5), November 3-5, 1997.
  23. Sampson W. On the National Institute of Drug Abuse Consensus Conference on Acupuncture. Scientific Review of Alternative Medicine 2(1):54-55, 1998.
  24. Kalauokalani D and others. Acupuncture for chronic low back pain: Diagnosis and treatment patterns among acupuncturists evaluating the same patient. Southern Medical Journal 94:486-492, 2001.
  25. Hogeboom CJ and others. Variation in diagnosis and treatment of chronic low back pain by traditional Chinese medicine acupuncturists. Complementary Therapies in Medicine 9:154-166, 2001.
  26. Sherman KJ and others. The diagnosis and treatment of patients with chronic low-back pain by traditional Chinese medical acupuncturists. Alternative and Complementary Medicine 7:641-650, 2001.
  27. Zhang GG and others. The variability of TCM pattern diagnosis and herbal prescription on rheumatoid arthritis patients. Alternative Therapies in Health and Medicine 10:58-63, 2004.
  28. Zhang GG and others. Variability in the traditional Chinese medicine (TCM) diagnoses and herbal prescriptions provided by three TCM practitioners for 40 patients with rheumatoid arthritis. Alternative Therapies in Health and Medicine 11:415-421, 2005.
  29. Coetaux RR and others. Variability in the diagnosis and point selection for persons with frequent headache by traditional Chinese medicine acupuncturists. Alternative and Complementary Medicine 12:863-872, 2006.

Acupuncture Training Programs and Requirements


The Chinese art of acupuncture has been used for centuries to treat a variety of health issues, like back pain, fertility, addiction, depression, anxiety and headaches, using sterile needles in different pressure points. Only a licensed professional in healthcare with an understanding of the bodily systems and anatomy may perform acupuncture treatments. Entry into the field requires a master's degree in acupuncture and state licensing.

Training Requirements and Recommendations

This type of alternative medicine requires in-depth study of the human body and the physiological effects of the treatment on the body, so many students seeking enrollment into an acupuncture program have a background in medicine, biology, psychology or neurobiology. Applicants to acupuncture programs should have an undergraduate degree; an associate's degree is common, because a bachelor's degree in acupuncture is not typically available.
Other prerequisites for acupuncture programs include current Hepatitis B and tuberculosis skin tests and CPR certification, because students participate in clinical internships. An essay, a letter of recommendation and GRE scores are other common program requirements. The ideal candidate for the acupuncture training program should demonstrate excellent observation, communication and motor skills, be comfortable working independently and have compassion for others.

Formal Education

A master's degree program begins the core educational training for an acupuncturist. Most master's-level acupuncture programs require 3-4 years of study. Eventual licensure in most states is partially dependent on the completion of an acupuncture training program accredited by the Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM), so it's important that prospective students seek out an accredited program.

Master of Science in Acupuncture

The master's degree program trains students in the use of acupuncture instruments and the application of different treatment methods, like cupping, needles, gua sha and moxibustion. For example, when using needles, students learn how to insert the needle into the correct nerve pathway to produce a muscle spasm to relax the muscle; students practice this and other techniques during supervised clinical internships. The Master of Science in Acupuncture program also involves a comprehensive study of the history of traditional Chinese medicine, herbal medicine, pathology, biochemistry, Western medicine, different therapies, nutrition, diagnosis and treatments.

Job Experience

Most of the job experience that a future acupuncturist receives prior to graduation is through the clinical internship portion of the academic program. Interns, under supervision of an experienced professional, learn to consult with a patient, perform a physical examination and arrive at a treatment plan. As an intern in the Master of Science in Acupuncture program, students gain critical thinking skills and problem-solving abilities through clinical rotations in areas such as immune disorders, stress and chronic pain. Acupuncturists often work in health clinics, hospitals, medical centers, private practices and veterinary offices.

Licenses and Certifications

The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) is the certifying body for acupuncturists and also the developer of licensure exams. Acupuncturist licenses are state-administered, but most states use the NCCAOM exams; many states also require that applicants achieve NCCAOM certification in order to earn their licenses. Typically, applicants must also fulfill minimum experience requirements to become licensed.
For certification, NCCAOM requires graduation from an ACAOM-accredited program, transcripts and an examination. An official certificate of completion in clean needle technique is also required, but not before taking the examination. Receipt and approval of the documents then certifies the graduate to be a Diplomate in Acupuncture. Recertification takes place every ten years and requires a fee, recertification examination, continuing education courses and a current license in good standing.

Workshops and Seminars

The American Association of Acupuncture and Oriental Medicine (www.aaaomonline.org) hosts an annual conference where acupuncture professionals can view live demonstrations, attend lectures from physicians and network with other professionals. The Society for Acupuncture Research (www.acupunctureresearch.org) hosts a research conference for practitioners to educate them on strategies for care, effective techniques and new research findings. The conference involves interactive demonstrations, symposiums and keynote lectures.

Additional Professional Development

Acupuncture students may also chat with other students and professionals through online forums, such as the one on the Acupuncture Today website (www.acupuncturetoday.com). The Acupuncture Network (www.acupuncturenetwork.org) is another online resource for industry news and discussion.

Studying acupuncture

Acupuncturists come from all walks of life. Many people choose to study acupuncture as a second career after experiencing for themselves the life-changing health benefits of acupuncture.


You don't need any previous healthcare experience to study traditional acupuncture as accredited training courses provide a thorough grounding in Chinese medicine theory together with some western medicine. The training requires considerable commitment on your part, not just time and effort but a willingness to embrace a very different way of looking at health and dis-ease.

Within the next few years it is likely that the acupuncture profession will become statutorily regulated. Only practitioners trained to the legally required standard will be allowed to practise as acupuncturists in the UK. We are certain that the standards set by the British Acupuncture Accreditation Board (BAAB) and the BAcC already more than meet any future requirements.

Most BAAB accredited courses award either BSc (Hons) or BA (Hons) degrees involving at least 3,600 hours study. All courses require you to attend university or college for lectures, tutorials, seminars and practical work. They include a considerable amount of home study as well as clinical hours working with patients in a teaching clinic. Full-time study lasts at least three years. Part-time study will take longer.

You will learn Chinese medicine diagnostic and treatment skills including the different qualities of a pulse, how to read the tongue, the location of acupuncture points and how to needle them. You will also study appropriate elements of western medicine including anatomy, physiology and pathology.

On graduating you will be eligible to join the BAcC provided you study at a teaching institution that has achieved BAAB accreditation.

Acupuncture Careers and the Wellness Boom

Learn How Acupuncture History Meets Present Acupuncture Practice

Find Acupuncture Schools | Acupuncture Career and School Guide
acupuncture suction technique
Acupuncture is one of the brightest lights in the constellation of natural healing approaches, all of which are shining brighter today than ever before.

People are responding to rising health care costs by seeking out more effective and less expensive forms of medicine. In 2007, Americans spent $33.9 billion out-of-pocket on complementary and alternative medicine (CAM). About $11.9 billion of that was on natural health practitioners, primarily acupuncture, massage and chiropractic care.
Because it is over 2,000 years old and has been studied extensively by Western medical experts, acupuncture is one of the most popular CAM therapies. Visits to acupuncturists tripled between 1997 and 2007. Graduates of acupuncture school are in high demand, and there's never been a better time to embark on a thriving acupuncture career.
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History of Acupuncture in the United States

Veteran acupuncturists remember the early days when acupuncture was not respected or accepted in the United States. Forty years ago, acupuncture was a little known niche that was actually illegal in most states. How did acupuncturists come so far so fast? It all started with our 37th President.
It was President Nixon's trip to China in 1972 that brought the ancient Chinese art and science of acupuncture to the United States. After one of his advisors on the trip underwent emergency surgery with acupuncture as the only form of anesthesia, the President helped organize a cultural exchange of medical practitioners between the United States and China. That was the beginning of acupuncture education in the United States and the first step toward the booming popularity of acupuncture today.
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Advances in Acupuncturist Licensing & Regulation

When the first acupuncture clinic opened in the Washington, D.C. in 1972, there was tremendous press coverage and hundreds of patients came for treatment every day. Despite the public's interest in it, the mainstream medical establishment tried to close the clinic down by taking the city to court. Fortunately they lost—and the rest is history:
  • In 1978, California became the first U.S. state to license acupuncturists.
  • In the mid-1980's, national accreditation standards were established for acupuncture education programs in acupuncture colleges and schools.
Today acupuncture and Chinese medicine are now legal and regulated in 46 states. There are over 45 accredited acupuncture colleges and schools in the United States, and over 19,000 licensed acupuncturists.
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Public Demand for Qualified Acupuncturists

Approximately 38 percent of adults and 12 percent of children use some form complementary and alternative medicine. Women and people with higher levels of education and income are the most frequent users, but people of all backgrounds are interested in effective and affordable health care alternatives.
Acupuncture continues to gain ground as one of the most popular CAM therapies. In 2007, people made approximately 17.6 million visits to acupuncturists. This increase is partly a simple matter of accessibility to qualified practitioners—there are more acupuncture schools than there were 10 years ago, and acupuncturists are licensed in more states. In addition, thousands of articles and news segments over the past decade have increased public awareness about the many benefits of acupuncture.
Another factor in the growing popularity of acupuncture is the fact that many insurance companies now cover leading CAM therapies including massage, chiropractic and acupuncture. According to Dr. Kenneth Pelletier, author of The Best Alternative Medicine: What Works? What Does Not?, virtually every major insurance carrier offers some form of CAM coverage. "It's a very clear trend," Pelletier says. "Once they begin to offer CAM benefits, most companies tend to continue and expand and add on other services."
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The Future of Acupuncture Careers

Research shows that Americans, on average, are getting sicker. Both the aging population and the lengthening of the average life span are contributing to rising rates of chronic illness. According to the Partnership for Solutions, more than half of the American population already suffers from at least one chronic condition. At the same time, Americans are more stressed and overworked than ever before.
These unsettling trends point to a critical and growing need for the patient-centered approach that acupuncturists offer. Acupuncturists provide more than just relief from symptoms associated with disease. They offer a proactive focus on balance and wellness that many see as a welcome alternative to mainstream medicine. If you embark on a new acupuncture career today, you can be confident that your chances of success will continue to multiply for years to come.

Acupuncture Schools and Career Resources

Get the facts about the field of acupuncture and alternative medicine to decide whether it's a good career fit for you...
acupuncturist and patient
Acupuncture is a procedure adapted from Chinese medicine that treats illness and provides anesthesia by the insertion of needles at specific points in the body. This special technique of inserting and manipulating fine needles into the body's meridians, or vessels of energies—along which vital energy flows—is an ancient healing and therapeutic practice.

Although acupuncture is an ancient medicine technique, it has become popular mainstream, making it a promising career choice. Read the sections below to learn more about acupuncture careers and schools to determine whether it's the right career choice for you.
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Acupuncture Career Opportunities

The field of acupuncture has become increasingly popular. If you are interested in becoming an acupuncturist, you can gain insight into this intriguing profession by reading the Oriental and Chinese Medicine sections below. Here are some other helpful acupuncture career and education articles to help you decide whether acupuncture is part of your career Zen:
Acupuncture School and Career Information
So if you enjoy the natural healing arts and are interested in Oriental Medicine's ancient healing art, acupuncture may be just the profession for you. Begin your journey to helping clients reach improved health and well-being and find the acupuncture school that's right for you.
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Research on Acupuncture


Acupuncture is the practice of inserting thin needles into specific body points to improve health and well-being. It originated in China more than 2,000 years ago. American practices of acupuncture use medical traditions from China, Japan, Korea and other countries. In the United States, the best-known type involves putting hair-thin, metallic needles in your skin.

Research has shown that acupuncture reduces nausea and vomiting after surgery and chemotherapy. It can also relieve pain. Researchers don't fully understand how acupuncture works. It might aid the activity of your body's pain-killing chemicals. It also might affect how you release chemicals that regulate blood pressure and flow.
Over the past 10 years, NCCAM has supported extensive research on acupuncture. Studies have looked at its effect on specific health conditions and how it affects the brain and nervous system; the neurological properties of meridians and acupuncture points; and methods for improving the quality of acupuncture research.
Recent studies have found that acupuncture:
  • Helps alleviate nausea in cancer patients undergoing chemotherapy.
  • Relieves pain and improves function for some people with osteoarthritis of the knee and complements standard medical care.
  • Helps in treating chronic lower back pain.
  • Can be useful in treatment of post-traumatic stress disorder (PTSD) symptoms.
  • May improve pregnancy rates following in vitro fertilization (IVF).
  • May or may not be of value for many other conditions, including irritable bowel syndrome and some neurologic disorders.

Acupuncture used for Reflex Sympathetic Dystrophy


Chief Complaint: Pain in left lower extremity, unable to walk or bear weight on that extremity
Western Diagnosis: Reflex sympathetic dystrophy
Medical History: The patient had been very active in running, jogging activities. He sustained a mild injury to his left lower leg and foot. This developed into severe pain with swelling, discoloration. The pain was so severe that he sought the attentions of a renown orthopedic surgeon in the area. He was diagnosed with reflex sympathetic dystrophy. Despite regular Western treatment, the disability continued with the patient being less able to weight bear. He needed crutches to walk, and even with the crutches had continual pain. The orthopedic specialist recommended acupuncture for pain control and sent him to our clinic. Within five treatments the pain was relieved, and the patient was walking without the crutches or any assistive devices. He restarted jogging activities without pain within about a month.
Questioning exam: What were the symptoms the patient presented? Pain , swelling, loss of function.
What was the result of the treatment? Decreased pain, return to full preinjury activity levels.
Did the recovery last? Yes, this treatment was performed in about 1984, and the patient occasionally calls us, but has had no recurrence of his symptoms to date.
Pulse exam: Did not do pulse examination on this patient.
Tongue exam: Did not evaluation on initial evaluation.
OM Diagnosis: Chi blocked on liver, kidney meridians.
Treatment Principle: Unblock energy flows in involved meridians. Decrease pain, swelling , and return to weight bearing status.
Point Prescription: Liver 2, St. 41,42, Gb 38, 39, UB 59,60,54, 57, 50, St. 36, Sp 11, 5, Kidney 1
Lifestyle Prescription: Patient also encouraged to begin tai chi exercise program
Results: Good results in 5-8 visits. Patient without pain residuals , swelling decreased, returned to preinjury functional levels.
Synopsis: Excellent results. Patient has not had recurrence of problems since treatment in 1984. He contacts us periodically, but has not needed followup treatment for this problem.

Chinese Medicine for Fatigue


Chief Complaint: Candida
Western Diagnosis: Candida and fatigue
Medical History: 26 year old female Caucasian of A Blood type and high simple carbo diet and recent prolonged use of antibiotics for both URTI and bladder infections. Very noticeable “Geographic Tongue” with thick white coating in the areas that were not peeled. Patients pulse showed a locked and “Slippery” pattern only in the middle jiao both left and right.
OM Diagnosis: A: Damp Heat affecting the spleen organ due to diet, stress and antibiotics. B: Secondarily, Liver heat because of sensitive nature and highly intellectual nature and liver type voice.
Treatment Principle: A: Clear damp heat and Qi Stag in both the Earth and Wood
B: Modify the diet as per Dr. Luc De Shepper’s protocol for candida
C: Use both Qi Gong and Tai Qi exercises to reduce the daily stress of the patient.
Point Prescription: Sp 9, Sp 6 Sp 4 and Sp 3= These depended upon the time of day and whether the patient was premenstrual.
Liv 3, 4 and 8: Clear heat and reg Qi etc.
L.I. 4, 7 and 11
P.C. 6
Ren 12, 6 and Liv 13 and St 25
Herbal Formula:
A: Phellostatin from Health Concerns
B: Candida diet as per above
C: Ionic silver at 35 ppm from Royal Blue Blood Brand.
D: AstraIsatis from Health Concerns.
Lifestyle Prescription:
Tai Qi and Qi Gong exercises.
Results: After approx 6 weeks, patient was able to go back to exercising at the gym, the tongue was normal and the energy levels during the day felt “Great” to the patient. She did have to avoid sweets during the holidays with which her friends were a great support group.
She did start to slip after the first of the year and required some additional treatment.

Chinese Medicine for Postpartum Constipation


Chief Complaint: Constipation after childbirth 31 years ago!
Western Diagnosis: Constipation
Medical History: 58 yo female,born in Switzerland; came to America with husband (business assignment)5 years ago. Upper/lower GI endoscopy revealed negative. Hysterectomy 6/01 due to uterus prolapse. Organic food, vitamins, and perform yoga exercise daily.
Questioning exam: BM once a day in the morning; however had to wait for at least 45 minutes before defecation and required great effort to empty the bowels with complete relief. Stool is formed,in the soft side, brown color with no abnormal odor. She also complains of spontaneous sweating, and low energy (fatigue); a sensation of fullness in the stomach and lower abdomen.
Pulse exam: Pulse is thin,submerged; 66 bpm. Abdomen is soft to palpate, and warm in temperature. Incision is somewhat sensitive to touch. Bowel sign is present.
Tongue exam: The tongue is light red with a thin white coating, slight puffy with scallop both sides; no sublingual vein present
OM Diagnosis: Qi Deficiency-type constipation. The constipation was due to deficient Qi after childbirth. When Qi is deficient, the Large Intestine becomes weak in transporting it’s contents, thus causes the delay to defecate. The spontaneous sweating and fatigue also indicate deficiency of Qi. The weak, slow, submerged pulse is also manifestations of Qi deficiency
Treatment Principle: Tonify the Qi and release the bowels
Point Prescription: SJ 6
LI 4, 11
St 25, 36, 37
All points are needled bilaterally
Herbal Formula: Bu Zhong Yi Qi Tang plus Tao ren in granules 2g(about 2 leveled teaspoons) twice a day
Lifestyle Prescription: Add Huang Qi(3-4 slices) to make soup base
Results: After three treatments, the patient waited 20-30 minutes to empty her bowels and less effort was needed than before. Pt now is out of town for one week and I’ll see pt after her trip

Chinese Medicine used for Hypertension


Chief Complaint: Abdominal problems and hypertension for about 3 years, due to stress.
Medical History: The patient claims that she has been under a tremendous amount of stress in the past three years, which have lead to her development of hypertension and dysrhythmias. She has been on anti-hypertensive medications, but these tend to make her feel tired and weak. She states that her stress level is high which prevents her from having a good night sleep.
She complains that she has gained weight, her facial muscle tone has decreased and has generally not felt “like herself” in almost a year now. She asserts that her appetite has increased, she is always cold and her energy level is vastly decreased. She has never sought the attention of an acupuncturist, and is open to new ideas and treatments at this point.
Questioning exam:
Medical History:
Irregular heart beat for about 3 years.
Hypertension for 3 years.
Herniated disc around L4 secondary to trauma for about 5 years.
Allergies:
No known drug allergies.
Current Medications:
Atenelol 5mg/day.
Hyzaar 100mg/day.
Multivitamins 1/day.
Emotional Status:
She claims that she is usually good at channeling negative energy, however she states that given her state of health for the past 3 years have really left her feeling rather down.
Habits:
Smoking-1 pack per day.
Alcohol-Occasional.
Coffee-Rarely.
Cravings-Denies any specific cravings.
Inquiring:
Appetite and Diet:
She claims her appetite is in excess especially in the last 3-4months. She has tried to eat healthy most of her life, but states that recently she has been more prone to snacking on junk food. She usually eats 4-5 small meals a day. She has no food allergies.
Thirst:
She drinks about 2-3 bottles (16oz) a day. She rarely drinks coffee or sodas.
Bowel Movements:
She has a bowel movement once a week, it is usually very constipated, hard and tough to pass. This is one of her complaints. She denies any bloating, gas or reflux.
Urination:
She has no difficulty urinating. Her output is about equal to her intake, and she denies nocturia.
Sleep:
She claims that she has no trouble falling sleep, but she wakes up at about 2-3am and has a hard time falling back to sleep. She gets about 6 hours of sleep/night, but has a very difficult time getting out of bed and feels tired through out the day. She occasionally drinks herbal tea to help with her sleep, but this is another area which she would like to improve by acupuncture.
Body Temperature:
More sensitive to cold recently, she feels sudden “chills” on occasion.
Perspiration:
No abnormal sweating, denies night sweats.
HEENT:
*Head-History of migraines in the past that have now resolved.
*Eyes- Declining vision.
*Ears-Declining hearing.
*Nose- Normal.
*Throat- Normal.
Pain:
Occasional leg cramps.
Menstruation/Leukorrhea:
Menarche was at the age of 14. She has had regular 28 day cycles until about a year and a half ago. At that time she began long periods of continuous bleeding that would stop for about 6 weeks and then resume. She has been on hormone therapy but claims that the bleeding is still prevalent. She states that the color is dark and light, with no clots. She denies menstrual cramps.
She had 4 pregnancies, 2 miscarriages and 2 live births.
She denies the presence of leukorrhea at this time.
Pulse exam:
Slow in general, rate of 52bpm.
Left:
Thready and hesitant, kidney is impalpable.
Right:
Thready and rolling, kidney is impalpable.
Tongue exam::
Proper (Body):
Large tongue, swollen with teeth marks. Pale reddish-purple in color.
Coating:
Thick white coating.
OM Diagnosis:
Liver qi stagnation.
She appears to be under tremendous stress, and in general seems angry, and very short in her responses. She experiences migraines, and does have high blood pressure related to her stress.
Spleen qi deficiency.
A significant difference in her appetite and energy level. She also experiences constipation.
Heart yin and blood deficiency.
She experiences arrhythmias, and night sweats.
Treatment Principle: Principal of Treatment:
Sooth liver qi.
Tonify spleen qi.
Nourish heart yin and blood.
Point Prescription:
LI4, Liv3, Liv13, Sp6, St25, Ren12, St37, PC6, K3, Ht7, GB14, Yintang.
Lifestyle Prescription: It was recommended that she try some exercise and/or relaxation techniques
to help alleviate some of the stress in her life.
Smoking cessation was also highly encouraged.
Results: The patient had 9 treatments weekly. Her constipation had resolved significantly, and her migraines had dissipated.
After consulting with her physician, with acupuncture as an adjunct she was able to reduce her hypertensive medication, leading to more energy and less stress. This was an extraordinary case of success, an an example of how TCM can be used as an adjunct therapy to improve quality of life and reduce requirements for medications that have side effects. Most of her Symptoms: constipation, lack of energy, feeling tired and headaches were side effects of the high dose of anti-hypertensive medication she was on, and by reducing her requirements her symptoms slowly dissipated. We checked her BP every week and worked on establishing a regimen her and her physician were comfortable with.

The Treatment of Occipital Neuralgia with Chinese Medicine


Chief Complaint: Shooting pains in (L) occipital and parietal regions of the head, radiates to top of the head.
Western Diagnosis: Occipital neuralgia
Medical History: 73 yr old status post surgery for throat cancer. Developed tingling and pressure sensation in occipital region which developed into severe shooting pains over a period of about 8 months. Shooting pains are rated at 9/10 level and occur 3-4 times/day. Patient has had 7 nerve blocks and surgery none of which helped to reduce symptoms.
Pertinent Medical History: Throat cancer 1997 treated with chemo therapy and radiation for 13 weeks. Developed inability to swallow due to scarring from radiation which required placement of gastric tube for feeding. Surgery to reduce scarring in the throat was unsuccessful.
Other surgeries: Hysterectomy
Hypertension
Meds: Neurontin, Darvocet, prilosec, Tylenol ES, Paxil, Catapress patch
Family History: Father died of cancer.
Patient does not exercise and has liquid diet for tube feeding.
Questioning exam: Appetite: Poor Complains of frequent bloating.
Thirst: Always thirsty with dry mouth and throat. Sips water but is not allowed to drink thin liquids.
Energy level: Poor. Worn out from the pain.
Sleep: Takes sleeping pills, otherwise wakes constantly with pain
Eyes: frequent tearing
Always feels cold, palms of hands are red and feel hot at times.
Sweat: no
Urination: Frequent
BM: usually daily, tendency towards loose bowels.
Chest: Cough with dry yellow phlegm.
Dry skin
Bruise easily
Mental / emotional: worries a lot + easily angered or irritated
Pulse exam: Pulse: Thready, Slow
Very tender on palpation along spleen, liver, and gallbladder meridians.
Reduced range of motion in cervical spine with severe scarring in (L)occipital and parietal region. Very tight upper traps and SCM muscle.
Tongue exam: Tongue: Red, yin deficiency cracks, ulceration and dark red areas in the center and on the sides.
OM Diagnosis: Liver yang rising with underlying yin deficiency. Qi / blood stagnation in GB / UB channels.
The tongue, pulse, and symptoms such as; thirst, dry throat, shooting pain in UB/GB area radiating to vertex, teary eyes, irritability, HTN, all point towards yin deficiency with yang rising. The tingling sensation and shooting / stabbing pains point towards qi and blood stagnation.
Treatment Principle: Move qi and blood in the channels. Subdue liver yang.
Point Prescription: (L) HT4, 7, GB41
® KD3, SP6
This treatment initially gave great relief with less frequent attacks + reduced pain intensity. Patient was able to reduce pain medication. However when patient got angry or went through periods of stress the pain would come back. I tried some electrical stimulation and needled ashi points in the scalp which gave further relief.
Patient claimed 70% relief of symptoms.
Herbal Formula: Herbal Formula:
Bai shao 9
ge gen 9
yan hu suo 6
qiang huo 6
wei ling xian 6
tian ma 9
gou teng 9
long dan cao 6
mai men dong 9
shi hu 9
huang lian 6
wu zhu yu 2
hai piao xiao 9
mu li 9
chen pi6
fu ling 9
bai zhu 9
gan cao 6
After about one month of just acupuncture I added the above herbal formula to open the channels, subdue LV yang, and assist the digestive system.
The herbal formula did not give much relief and in the end we just continued with acupuncture treatments.
Lifestyle Prescription: Tuina: Passive stretches neck / shoulder muscles. Loosen up scar tissue in occipital region. Traction. Taught patient to use acupressure points to control symptoms if experiencing a flare- up.
Results: Patients quality of life had much improved but she continued to have little flare-ups here and there at which time she would come back for more therapy. About 5 months after the initial start of treatment the patient had an MRI which showed a popcorn like bony tumor at the base of her skull partly in the UB channel distribution.
I started adding UB60 to her acupuncture prescription which made a big difference and she was able to go without treatment for about 5 months.
Synopsis: Recently the patient had some other medical problems after which the head pains started flaring up again.
I now use intradermals at UB60 and occasionally GB41 both on the left side. Whenever the patient has an episode she presses those points and her pain subsides within 1-2 minutes. Once every few weeks the patient comes back for an acupuncture treatment and this way she has been able to sustain a good treatment effect.
I believe the reason why this patient was unable to make full recovery is because of the tumor that is still there pressing on the occipital nerve.

The Treatment of Chinese Medicine for Scleroderma


Chief Complaint: Joints pain for over three years
Western Diagnosis: Mixed connective tissue disease, pulmonary hypertension, scleroderma.
Medical History: A 23-year-old woman was admitted to clinic on May 5, 1997, because of joints pain around all body for over three years, skin and eyes dry, thirst and wants to drink cooled water, almost joints sour and tip of fingers’ color change to purple and whit when the weather become to cold, loss hair. Her skin on arms are dry and peeled off. She used to treat by acupuncture and Chinese herbal medicine, the symptoms were reduced but that never goes away. Recent years, she has had sense of oppress in her chest, and difficult to breath, asthma attack when she walk or go up stairs, those symptoms are gradually getting worse, but nothing could help. During 12/03-12/18/1996, she had had a high fever and went to Johns Hopkins Hospital was diagnosed as mixed connective tissue disease, pulmonary hypertension, scleroderma.
Questioning exam: 06/27/97 University Maryland Clinic Center:
Total Protein 10.3(6.3-8.2)MG/DL
Albumin 4.2(3.5-5.0)MG/DL Globulin 6.1(1.8-3.7) MG/DL
ALT 65 (9-52) U/L AST 54(14-36)U/L
LDH 672 (313-618) U/L
On February 11,1998, her right heart catheterization and vasodilator trial, her baseline pulmonary arterial pressure was 66/24 mmHg with a mean of 38 mmHg. She had a CVP of 9 mmHg and a wedge of 7 mmHg. Her cardiac output was 3.2 L/min. In response to vasodilator trial with nitric oxide and subsequently prostacyclin, she had no significant change in either pulmonary arterial pressure or cardiac output. (Dr. Sean P. Gaine, MD/ University of Maryland School of Medicine)
Pulse exam: puls was thready and rapid.
On physical Examination: red face with several rashes, harder than normal skin. The color of fingers is purple and pale, press it could change color. Peel skin on arms, scratch track on back and limbs’ skin.
Blood pressure was 123/86, heart rate 110, lungs sound clear, weight 117 pounds, had no edema.
Tongue exam: red tongue with cracks in the middle
OM Diagnosis: Blood-heat, and liver, kidney Yin deficiency
Treatment Principle: Removing the heat from blood and dissipating blood stasis, nourishing the liver and kidney
Herbal Formula: Shendi 12 Chishao 10 Baishao 10 Taoren 6 Huanghua 6 Xiakucao 10 Dangkuiwei 10 Luzenzi 10 Hangliangcao 10 Zicao 12 Dangpi 10 Tufulin 20 Zhimuo 10 Shigao 20 (cook first)
Lifestyle Prescription: no spicy food, no smoking and less sea food
Results: Four years latter, Ms. Gong has had not any pain in joints, no feeling of pressure in the chest, no eyes itch. On physical examination shows that face skin is smooth, no peel skin on both arms. Blood pressure 110/80mmHg, heart rate 85, heart sounds unremarkable. Lungs sound clear. No edema.
On 4/17/01, The Johns Hopkins Bayview Medial Center: AST 20 (0-30) U/L, ALT 19 (0-30) IU/L AKP 53 (30-120) IU/L. On 11/06/2000: Tot.Prot. 9.1(6.3-8.5) G/DL, Albumin: 4.2 (3.7-5.2)G/DL, Glubulin: 4.9 (1.4-4.5) G/DL, A/G ratio: 0.9 (0.9-2.6).
On June 11, 2001, her right heart catheterization, pulmonary hypertension: absent, baseline: 1.2. (Dr. John J. Warner, MD/ DUMC)
On 08/22/01, her sonographer shows: Normal left ventricular systolic function. Normal RVSP estimate. ( S. Ganesh, MD/ John Hopkins Bayview Medicine Center)
Synopsis: When patient came to me, she was given only a few months to live. Her doctor suggested her to transplant lungs. But she would not like to do so. She is still alive. She has no any symptoms right now and her lungs are normal.

Acupuncture and Herbs for Palpitations, Insomnia, Irregular Erratic Heartbeat


Chief Complaint: palpitations, insomnia, irregular erratic heartbeat
Western Diagnosis: arrhythmia, Post Traumatic Stress Disorder
Medical History: Pt. is 37 yr. old male with history of extreme sports career (cycling) with exposure to extreme heat and cold while racing. Childhood history of multiple traumatic events. For the past 20 years Pt. has noticed gradually worsening irregular heartbeat. Has been hospitalized 2 times for acute attacks. Pt. cannot sleep well. Very difficult falling asleep, dream-disturbances, night sweats, some low back pain. Still exercises but only light to moderate because of heart condition. Endurance and stamina, energy level throughout the day very low. Risk of arrhythmia acting up.
Questioning exam: Pt. experiences tinnitus of high pitch when tired. Head rush when stands too quickly. Hx of low Bp. Also sees tunnel vision when tired.
Pulse exam: Pulse is weak and thready on left, more deep on right.
Patient seems unable to focus, very tired but can’t sleep, pulse is becoming more irregular.
Tongue exam: Tongue is pale, large, dry, with light yellow coat on the back.
Face is pale with dark purple circles under the eyes, lips are slightly bluish.
OM Diagnosis: Erratic heartbeat palpitations, insomnia, fear from PTSD, all contribute to a restless spirit and Heart Yin and blood def. Exposure to extreme temperatures while cycling/racing has injured both Yin and Yang of heart and kidneys, and Kidney Qi in general.
Treatment Principle: Calm spirit, nourish Heart, tonify kidneys
Point Prescription: Ear shenmen, Shenmen – to induce sleep
Yintang – calm mind
Guanyuan, Zhaohai – nourish Yin, Kidney Yin
Zusanli – nourish Qi and Blood
yinxi – nightsweats
Taixi -tonify Kidney
Herbal Formula: Pt. is very sensitive to any drugs. is already on depacote for mood stabilizing, zoloft as antidepressant, and synthroid to counter effects of depacote.
I prescribed low dose 1 tab/TID of Shen Gem from Health Concerns for palpitations, calming shen with good results. Later tried Nine Flavor tea to nourish Yin but Pt. felt palpitations increased correlating with herbs and discontinued use.
Lifestyle Prescription: Recommended Yin-type exercises, Qi-gong, hiking, meditation. Eat root veggies, all cooked.
Results: Results were great! Pt. slept during treatment and heartbeat regulated. Pt. was able to leave with clear mind. Pt. continued treatment weekly and energy level and stamina have improved as well as sleep. Night sweats have completely gone away.
Synopsis: Patient needs long term care but is responding well to acupuncture alone.

The Treatment of Headaches with Acupuncture and Chinese Medicine


Chief Complaint: Headache
Medical History: Patient is a 56 years old male with general normal appearance, obesity: weight: 213 Lbs, height: 5’4″, red face and strong voice.
Chief Complaint: headache on and off for about 5 months, the pain is mostly “behind the eyes” and on parietal side of head, sometimes accompanied with nausea and vertigo, usually he has from 5 to 6 attacks/week. Blood tests are unremarkable, blood pressure in the range of 140 to 145/80 to 85 mmHg. MRI and X ray shown no abnormal. He recently eating a lot of “fast food” due to lack of time for meals at work. He drinks from 2 to 5 cups of coffee/day and 1 to 2 drinks (red wine) after diner. Lack of exercise and physical activities due to very tired and heaviness sensation in body. Taking medications for pain with temporary relief but having a lot of side effects (especially stomach problems).
Questioning exam: Patient always feels warmer than others, sometimes hot sensation on face, spontaneously sweating especially upper part of his body. Very strong appetite and prefers sweet, refined foods and big dinner with a lot of meat and starch. Bowel movement has tendency to be constipated, dry stools and incomplete feeling. He has infrequent urination with dark yellow color urine and scanty amount. Thirsty and prefer cold drinks and drink large amount of water during the day. Sleeping OK unless headache. He is easy to be angry and sometimes stress triggered the headache.
Pulse exam: Pulse:
Right side: superficial wiry, slightly rapid.
Left side: superficial slippery and slightly rapid.
Palpation: no abnormal lymph node palpable on neck, sub mandible and other areas. No stiffness of neck. Palpation exam on abdominal found no tenderness or abnormal mass. Liver and Spleen in normal shape and position, slight discomfort in epigastrium area aggravate by deep pressure. Other sensitive areas found on UB 18 + UB 19 areas especially on right side.
Tongue exam: Tongue
Body: deep red, especially on sides, swollen and rough sides with red spots on tip and sides of tongue.
Coating: thick yellow greasy coating from mid to rear of tongue, slight scanty coating front.
Movement: normal. (Bad breath). Patient has a red face and said it redder with red eyes when he has headache.
OM Diagnosis: Headache due to Liver Fire uprising and stagnated of Liver Qi
Damp-Heat accumulated in Middle Jiao Deficiency of Spleen Qi
Treatment Principle: Relief the pain
Extinguish Liver Fire, soothing Liver Qi
Eliminate Damp+ cool Heat in Middle Jiao
Strengthen Spleen Qi
Point Prescription: Local/symptomatic relief points: Du 20, Tai Yang, GB 14, GB 20 (sedate)
Liver Fire: LI 4, LV 2 (sedate )
Spleen/Damp: SP 9, Ren 12 (tonify)
Acupuncture treatment schedule: 3 treatments / week for the first week, 2 treatment for the second week. From the third week he just need to come back for maintenance and preventive treatment once every other week, then once per month after that.
Herbal Formula: Long Dan Xie Gan tang 35gms
Add: Fu Ling 5gms, Ze Xie 2gms, Xia Ku Cao 8gms.
Dosage for 5 days: take 2 time/day (between meals); 5gms/time (total)
Dissolve the extract herb into room temperature water and drink.
(herbs use as extract form, ratio 5:1)
After finish take 3 days break then go to next formula:
Jia Wei Xiao Yao San 50 gms
Add: Xia Ku Cao 6gms
Dosage for 7 days: take 2 times/day (between meals); 4gms/time (total)
Dissolve the extract herb into room temperature water and drink.
(herbs use as extract form, ratio 5:1)
Lifestyle Prescription: Dietary change: Avoid fat, greasy sticky (oily) foods, cold foods (ice-cream ….) and cold drinks especially with meals or right after meals.
Alcohol, coffee, refined foods (canned foods, well preserved foods, sweets…), spicy foods. Moderate eating time (avoid eat on the run, skip meal, doing something else while eating…).
Good foods: increase vegetable, especially vegetables with bitter taste. Fruit to replace refined sweets, more fish less meat but avoid other sea foods like: shrimp, crab (and other crustaceans).
Exercises: must have a regular exercise in a daily basic. The exercises need not too much at a time but need to be everyday. Walking outdoor is consider good if the weather not too hot or too damp.
Results: Patient responded very good to the treatment: headache significantly reduced to 1 mild attack for the 1st week of treatment (instead of 5 to 6) also he didn’t have to take pain pills for the headache. Even though patient can not fully conform the lifestyle change we recommended, he keep taking the provided herbs and acupuncture treatment as scheduled. He reported slight discomfort in head and stomach the following week and no significant symptoms the weeks after that. He also loosing weight with the treatment, feels more energy and easier to control his mood under stressful situations. Patient is very happy with the result and wants to come back for maintenance and preventive treatments as recommended.
Synopsis: Patient came to the treatment with a doubting state of mind of the effectiveness of acupuncture and herbs on his conditions. However, he stated that he felt very good right after the first treatment and that changed his mind. A comprehensive exam, diagnosis and treatment combine with proper change of lifestyle: diet, exercises not just help to treat the condition but also prevent it to come back.

The Treatment of Ear Ache with Chinese Herbs and Acupuncture



Chief Complaint: Ear pain and head ache
Western Diagnosis: Ear infection and fluid accumulation
Medical History: Lower back pain(dull), inability to get pregnant for 4 months, 2 miscariages in the past.
Questioning exam: Appetite is well, sleep is well, urination bowel all normal. No cold hands feet, very seldom dizzy especially after squatting.
Pulse exam: pulse weak yet somewhat tense in deep palpitation.
Tongue exam: Tongue coat normal, material little pale.
OM Diagnosis: Long standing kidney Yang deficiency, GB liver little upset.
Treatment Principle: strengthen KD Yang and clear Liver/GB
Herbal Formula: Ren Shen by itself.
Chai Hu, Gou Teng, Bai shu, Da Zao.
Little dose of Lu Gen to keep heat in check and moisture in place used once a day for 14 days