ACUPUNCTURE
- Introduction to Acupuncture on the Backdrop of Common Conditions
- Acupuncture Regulation
- Acupuncture Education and Practice Standards
- Acupuncture and Related Modalities
Introduction to Acupuncture on the Backdrop of Common Conditions
Medicine has evolved over thousands of years.
The Silk Road derived its name from the exclusive production of silk in China at that time. Beyond the exchange of goods and ideas, the Silk Road facilitated the dissemination of medical knowledge and practices, leading to a fusion of healing traditions and the nurturing of a rich healthcare heritage. As merchants, explorers, and scholars traveled the Silk Road, they exchanged goods and shared knowledge, including medicinal practices .Chinese medicine influenced local medicinal practices, while Silk Road countries contributed their insights and remedies to the broader medical landscape.
Chinese medicine, which had already evolved over thousands of years, encountered a multitude of local medical practices rooted in diverse cultures, such as Ayurveda in India, Unani medicine in Central Asia, and Tibetan medicine in the Himalayan region. The convergence of these medical systems, influenced by cultural exchanges, trade interactions, and intellectual pursuits, created fertile ground for the growth, assimilation, and evolution of medical knowledge.
These interactions allowed practitioners from different traditions to share their knowledge, diagnostic techniques, treatment modalities, and materia medica (herbal medicine), resulting in a rich tapestry of healing practices. This cross-pollination of medical wisdom not only advanced treatments but also deepened cultural understanding, fostering a shared heritage of healing and holistic well-being.
The sharing of medical knowledge expanded into ancient Greek and Latin medicine. One Greek theory is the four humors (bodily fluids) which shares both physiologic and pathologic concepts with Chinese medical theory. The Greek system also shared pulse diagnosis, but in a more limited form.
Much of Hippocratic medicine appears to have been influenced directly by Chinese medical theory. “Hippocrates also had many of the teachings and practices in common with Confucius (c. 551-c. 479 BC) and the Yellow Emperor of China (2695-2589 BC).
SOURCE: Cheng, T (2001). Hippocrates, cardiology, Confucius and the Yellow Emperor. Int J Cardiol. Dec;81(2-3):219-33. doi: 10.1016/s0167-5273(01)00571-x. PMID: 11744140).
The most critical aspects of acupuncture are the layers of theory that establish an ideal state of health with a clear and deep understanding of illness. These theory help to establish a differential diagnosis. The medical system of acupuncture matches treatment principles with differential diagnosis.
While these theories can be taught in a systemic way, there are other theoretical nuances that are acquired through observation and experience. These nuances allow a skilled practitioner to determine variations since conception and establish a baseline of each patients’ normal ideal state and how their system might react to a pathogenic factor.
Consider that microbes are passed from mother to child. This is a factor that may influence one’s microbiome; community of microorganisms that function in the layers of gut that can influence the immune system and behavior. The microbes that are passed down have memory and possibly organisms that have survived generations. Along with genetics, these factors are part of our constitution. This coincides with the Chinese medicine theory of the four substances.
The Four Substances and Qi
- Jing (essence) resources present at birth that can be overused or built-up
- Qi (energy) impacts of air, water, and interaction with nature, food, people
- Shen (spirit or mind set) is state of mind and mental activities, intuition
- Xing (body structure) that can be affected by injury, exercise, or illness
Zhen Qi. How the body uses the substances for transformation (growth) and maintaining health, divided into Wei Qi (defense) and Ying Qi (nutritive)
Qi Ji. The function of Zhen Qi that helps with differential substance diagnosis that can emerge as Bing Ji.
Bing Ji. Collection of signs and symptoms when the immune system is activated.
Gut Health and Gut Mediated Immune System
Since this is being presented on the backdrop of common conditions, we will examine Wei Qi more closely. Zeng Qi is the energy that helps our body perform and contains all functions of transportation and transformation. Consider this like the energy created at the cellular level, specifically ATP (adenosine triphosphate), the energy currency of the cell and can be formed from the process of cellular respiration in the mitochondria of a cell through aerobic respiration, which requires oxygen, or anaerobic respiration, which does not. Aerobic respiration produces ATP (along with carbon dioxide and water) from glucose and oxygen.
Zhen Qi comes from Stomach Qi (Wei Qi) and Nutritive Qi (Ying Qi). Wei Qi is much like the biological concept of the gut mediated immune system. In addition, it is understood that for the stomach to function and break down food and drink, it needs to be warm. We can consume something cold, but our urine and bowels are warm. The function for warming our gut is our digestive fire that uses energy from the spleen, kidney, and liver.
To achieve this, the gut pushes cold away. Note that most pharmacological substances, while possibly toxic to the liver and or kidneys, are cold to the gut. A weak gut may not successfully push cold out to the surface. Thus, cold and toxins can get stuck in the derma layer. This becomes a factor in many chronic presentations.
For example, the person may not effectively sweat. This may impede healing of the skin. In addition, the derma layer may also become suspectable to the outer environment such as cold, heat, damp, and wind, which can obstruct the surface. This obstruction is referred to as Bi (obstruction) syndrome.
Modern science now recognizes the gut as a brain that processes information. A weak gut may not be able to ward off hurtful words or information. Sensitive or highly evolved microbes, passed through mothers, may take in data (those gut feelings) that are also being processed. This may explain why intuitive people often suffer a long history of gut issues.
Earth School
Known as of the Four Great Masters, Li Dong Yuan, known as Li Gao (1180 – 1251 c.e.) theorized that the etiology of most diseases was a result of injury to the digestive system: stomach and spleen, which are responsible for transforming raw material of food and drink into Qi (energy). He believed the cause of damage to the gut included:
- consuming excess amounts of cold, raw, fatty or unhealthy food
- effects of excessive worry and emotional upheaval
- overwork to the point of exhaustion
He observed this especially in people who were powerless, deprived, and unable to access proper nutrition, which often made them susceptible to opportunistic diseases and unable to fully recover physically, mentally, and spiritually.
According to the Earth School, weak digestion can result in physical exhaustion, irregular bowels, and levels of visceral prolapse. Weak digestion can contribute to difficulty on a mental level resulting in decreased ability to problem solve and use intellect since there becomes a tendency to over-ruminate on the same problem without the ability to act towards resolution. This creates the concept of yin fire.
Yin fire is a pathological state of chronic unresolved emotions or needs that are unable to be logically expressed or manifested. This leads to a noxious feedback cycle culminating in feelings of repression and suppression of negative emotions. This can result in additional heat to the liver, which can move upwards to the heart causing a busy mind, anxiety, and insomnia. This contributes to chronic inflammation or hyper-immune responses.
Five Elements
One Source; Two Dynamics (Yin/Yang); Three Jiaos; Four Levels; Five Elements; Six Syndromes; Seven Evils; Eight Principles
The Earth element is the stomach and spleen. This includes both the organs and the extended body networks. When we needle or manipulate one of the most famous acupuncture points, ST 36 (three-mile point), we can affect the big toe through the nerve pathway, to improve gate for example, or increase ATP at the cellular level for energy.
Electric Acupuncture of “ST 36 can raise the grabbing force of CFS rats, which may be related to its effects in up-regulating the expression of ATP synthase mRNA, SIRT 1 and PGC-1 α proteins and mRNAs, and p-AMPK/AMPK to reduce mitochondrial oxidative stress reaction and in increasing ATP synthesis.”
SOURCE: Dong JZ, Wei YT, Xu HY, Zhang Y, Yong RL, Xue YN, Zhang LD. [Electroacupuncture of “Zusanli” (ST 36) Raises Muscular Force by Adjusting AMPK/PGC-1 α Signaling in Rats with Chronic Fatigue Syndrome]. Zhen Ci Yan Jiu. 2018 Jun 25;43(6):335-40. Chinese. doi: 10.13702/j.1000-0607.171010. PMID: 30091537.
Looking at the five-element diagram, we can the broader influence of the gut within the system, but also the broader influences on the gut from outside factors, such as the seasons and weather.
Someone with well-developed Earth elements, tends to be well-grounded, nurturing, and compassionate. Some may depict the archetypical ‘Earth Mother’. The Earth element is about stability, nurturing, caregiving, and bounty. Often constitutional earth types are well rounded and seek activities to keep them centered and grounded.
Due to the tendency towards selflessness and the harsh world, many earth types care for others first despite struggling with digestive challenges and tend to be sensitive to damp or humid weather, and have poor muscle tone since the stomach governs muscles.
Acupuncture Regulation
In the United States, accredited acupuncture degree programs in generally incorporate a foundation that includes established frameworks that inform assessment, diagnosis, and application of acupuncture as a dynamic medical paradigm.
To ensure the safe and effective delivery of acupuncture services, each state in the U.S. has established specific regulations known as Medical Practice Acts. These acts define the legal framework within which acupuncturists can practice, outlining their scope of practice and setting guidelines for licensure, education, and patient care. In this article, we will delve into the general state acupuncture Medical Practice Acts and Scopes of Practice to help you understand the regulatory landscape surrounding acupuncture in the U.S.
Forty-seven states (and the District of Columbia) have practice acts in place to define and regulate the practice of acupuncture. Of these 47 states, 22 states require National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) Board Certification to issue an acupuncture license while 26 states use NCCAOM examinations as at least a portion of the licensure requirements.
The NCCAOM is a not-for-profit organization in the United States that aims to “establish, assess, and promote recognized standards of competence and safety in acupuncture and Oriental medicine for the protection and benefit of the public – linked to https://www.nccaom.org/
Acupuncture Education and Practice Standards
Acupuncture Institute Accreditation – the US Department of Education recognizes the Accreditation Commission for Acupuncture and Herbal Medicine (ACAHM) as a specialized accreditation agency to accredit professional non-degree and graduate degree programs, including professional doctoral programs, in the field of acupuncture and/or Oriental medicine, as well as freestanding institutions and colleges of acupuncture and/or Oriental medicine that offer such programs, including programs offered via distance education.
The ACAHM is a not-for-profit corporation in the United States charged to ensure that the accrediting body meets specific standards established by Congress. For a directory of ACAHM Accredited and Pre-accredited Programs/Institutions, visit https://acahm.org/directory-menu/directory/
The Secretary of Education is charged with reviewing accrediting bodies and providing recognition to those accrediting agencies that meet the Secretary of Education’s criteria.
Continuing Education
For Acupuncture, continuing education is consistent with the standards of other licensed medical professionals, most licensed acupuncturists must adhere to national and or state requirements of continuing education.
Licensed Independent Practitioners – the United States Bureau of Labor and Statistics classify Licensed Acupuncturists as licensed independent practitioners that diagnose and treat. Licensed acupuncturists are also recognized as preventing disorders by stimulating specific acupuncture points using acupuncture needles, nutritional supplements, therapeutic massage, and other therapeutic modalities.
Medical Practice Acts
Medical Practice Acts refer to state laws that govern the practice of medicine, including acupuncture. These acts are designed to protect public health and safety by ensuring that healthcare practitioners meet specific standards of education, training, and ethical conduct. They establish the legal requirements for licensing and outline the scope of practice for various healthcare professions, including acupuncturists.
Acupuncture Scope of Practice
The scope of practice for acupuncturists varies slightly from state to state. However, there are certain core areas commonly included in the scope of practice for licensed acupuncturists that typically encompass the following:
Diagnosis and Assessment: Acupuncturists are trained to conduct thorough patient assessments, including evaluating medical history, physical examination, and assessing the patient’s energy imbalances or disruptions.
Acupuncture Treatment: Acupuncturists are authorized to perform acupuncture techniques, which involve the insertion of fine needles into specific points on the body to promote balance and stimulate the body’s natural healing response.
Adjunctive Techniques: In addition to acupuncture, licensed acupuncturists may use other techniques such as cupping, moxibustion (heat therapy), herbal medicine, and lifestyle recommendations to support their patients’ overall well-being.
Patient Education: Acupuncturists often play a crucial role in educating patients about healthy lifestyle practices, stress management, dietary modifications, and self-care techniques that can enhance the effectiveness of treatment and promote long-term wellness.
Licensure and Education
To practice acupuncture legally, acupuncturists must meet the licensing requirements set forth by their respective state’s Medical Practice Act. These
requirements typically include completing an accredited acupuncture program, passing national board examinations, and obtaining a state license. The exact educational and training standards can vary from state to state, but they generally involve a comprehensive curriculum covering acupuncture theory, anatomy, physiology, diagnostics, and clinical training.
Importance of Medical Practice Acts
Medical Practice Acts provide a vital framework for ensuring the safety, competency, and accountability of acupuncturists. By setting clear guidelines and standards, these acts protect patients from unqualified practitioners and maintain the integrity of the profession. They also facilitate collaboration with other healthcare providers, ensuring that acupuncturists work within a broader healthcare system to provide holistic and integrated care to patients.
Understanding the Medical Practice Acts and Scopes of Practice is essential for both acupuncturists and patients seeking acupuncture services in the United States. By adhering to these regulations, licensed acupuncturists can provide safe and effective care while promoting the well-being of their patients. It is important to consult your state’s specific Medical Practice Act and seek treatment from licensed acupuncturists to ensure the highest standards of care and professionalism.
Acupuncture and Related Modalities
Acupuncture, originating from Chinese medicine, has gained recognition and popularity in the U.S as an effective form of medicine. This article aims to provide a basic overview of acupuncture and related modalities commonly practiced in the field. We will explore the benefits, techniques, and applications of acupuncture, moxibustion, infrared heat lamp therapy, low light laser therapy, injection therapy, cupping, gua sha, tui na massage, and herbal medicine.
Acupuncture
Acupuncture is the core modality and involves the insertion of thin sterile needles into areas to stimulate fluid movement, improve nerve conductivity, restore function, or enhance balance. There are a range of acupuncture techniques, such as acupuncture with electric stimulation, bloodletting, and trigger therapy release (dry needling). There is also a range of acupuncture approaches such as meridian (peripheral nervous system), microsystems, scalp, post-stroke, bone needling, and nerve release. To determine the best course of action, acupuncturists will engage in basic questions and advanced assessment to establish a differential diagnosis.
Moxibustion
Moxibustion is a technique often used in conjunction with acupuncture that involves the burning of mugwort (artemisia vulgaris) near specific areas of the body to promote healing and improve function. Moxibustion can be performed directly or indirectly, and it is particularly beneficial for conditions involving cold or stagnation.
Infrared Heat Lamp Therapy
Infrared heat lamp therapy utilizes special lamps that emit infrared radiation to penetrate the body’s tissues. This therapy can be used as a standalone treatment or in conjunction with acupuncture. The gentle heat from the lamps helps promote circulation, relax muscles, and alleviate pain and inflammation.
Low Light Laser Therapy
Low light laser therapy, also known as cold laser therapy or photobiomodulation, involves the application of low-intensity lasers to specific points or areas of the body. This non-invasive treatment stimulates cellular activity, enhances tissue repair, reduces inflammation, and relieves pain. Low light laser therapy is commonly used for musculoskeletal conditions, wound healing, and dermatological issues.
Injection Therapy
Although this adjunct modality is part of accredited programs and included in textbooks, there is a required step to involve state pharmacy boards to determine acceptable agents that licensed acupuncturists can procure. In some states, licensed acupuncturists may have the scope to offer injection therapy as an adjunct to acupuncture treatment. This involves the injection of natural substances such as vitamins, homeopathic remedies, or herbal extracts into specific acupuncture points or affected areas. Injection therapy can provide targeted support for pain management, inflammation reduction, and tissue healing.
Cupping
Cupping involves placing special cups on the skin to create suction. This therapy helps promote blood flow, release tension, and alleviate muscle soreness. Cupping is often used for musculoskeletal conditions, respiratory issues, and detoxification.
Gua Sha
Gua sha is a technique that involves scraping the skin using a smooth-edged tool. This therapeutic scraping motion helps release stagnation, improve circulation, and relieve muscle tension. Gua sha is commonly utilized for pain management, immune support, and detoxification.
Tui Na Massage
Tui na is a form of Chinese therapeutic massage that combines various manual techniques and manipulation, including, kneading, stretching, and joint mobilization. Tui na helps promote circulation, relieve muscle tension, and address dysfunction. It is often used in conjunction with acupuncture for musculoskeletal issues, stress reduction, and overall wellness.
Herbal Medicine
Herbal medicine is an integral component of traditional Chinese medicine. It involves the use of natural substances, such as plants, minerals, and animal products, to restore balance and support healing. Herbal prescriptions are tailored to individual needs and can be used internally or externally to address a wide range of conditions.
Acupuncture Practice
As the practice of acupuncture medicine unfolded in the West, mainstream medicine practitioners, researchers, and administrators formed a framework for analyzing acupuncture based on an initial and possibly inadequate interpretation of the established theories. One of the most significant results of this interpretation was the establishment of researching acupuncture as if it were a drug to treat a condition with limited parameters as opposed to utilizing the multitude of options that acupuncture medicine employs to tease out mechanisms and treat a person with a complex presentation.
Ear Acupuncture
Like many microsystems, such as feet, hands, and eyes, the ear can connect to many areas of the body and brain. The practice of using the ear as a microsystem is called auriculotherapy. The power of ear acupuncture goes beyond treating pain, feelings of stress, and behavioral problems. Due to the direct access of the brain, we can use it to neuromodulate the brain.
Anyone can practice auriculotherapy
One technique involves the application of ear seeds, or pellets to stimulate areas. These seeds are traditionally vacarria seeds (which resemble poppy seeds) and are on small bandages that hold them in place. Leaving those seeds for a few days allow the benefits of treatment to continue after the patient leaves the clinic. They are barely noticeable and don’t get in the way of normal activities.