Dermatopathology: Practical and Conceptual
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THERAPY

Acupuncture: Different Perspectives in the East and the West

Yong Ming Li, M.D.

Introduction

The word "acupuncture" is divisable in two parts, acu- and puncture. Acu- in Latin means needle and -puncture comes from Latin to pierce with a pointed instrument. The definition of acupuncture in Dorland's Illustrated Medical Dictionary (29th ed., Philadelphia: W. B. Saunders Co., 2000) reads as follows: "the Chinese practice of insertion of needles into specific exterior body locations to relieve pain, to induce surgical anesthesia, and for therapeutic purposes." Although the word "acupuncture" often is used in English to refer to a particular therapy of traditional Chinese medicine, the corresponding Chinese word "Zhen Ci" seldom is used by itself in spoken or written Chinese. In fact, acupuncture often is employed together with the word moxibustion in the Chinese expression "Zhen Jiu" (acupuncture and moxibustion). According to the Dictionary of Modern Chinese (Beijing: Business Printing House, 1992;1468), Zhen Jiu is a term that combines the therapies of acupuncture and moxibustion. Acupuncture for therapeutic purposes is performed by inserting a metal needle into a designated exterior point on the body and then twisting the needle, moving it up and down to achieve effects desired. Moxibustion is a type of thermal therapy administered by applying the burning herb Ai close to or onto a designated exterior point on the body in order to achieve anticipated effects. In China, practitioners of traditional Chinese medicine often combine both therapies in the management of most conditions. People are used to the expression Zhen Jiu. Even a patient who has just received treatment with acupuncture will say, "I had Zhen Jiu from the doctor."

Fig. 1: There are several dozens of acupuncture schools in the U.S. Most students spend 3 to 5 years in school, part-time, to prepare for the acupuncture board examination which is required by most states for licensure.

Fig. 2: A case of headache treated with acupuncture, published in General Ophthalmology by Fu Renyu (1664, Ming Dynasty). The figure on this centuries-old scroll, seemingly suffering from a headache, was incorrectly interpreted as having a cataract or a migraine in modern English and Chinese literature. In fact, it is one of the first case reports on temporal arteritis (unpublished data - Y. Li).

Fig. 3: The longer needle is commonly used in China, while the shorter one is popular in the U.S.

The history of acupuncture in China

The origin of acupuncture

In historical records of Chinese medicine it is evident that the healing art of acupuncture has existed at least for 2000 years. Some indirect evidence suggests that acupuncture may have been practiced in China for more than 4000 years. Although it is regarded as one of the oldest therapies known for human disease, until the last quarter of the twentieth century, most people in the West knew nothing about acupuncture, its history, and how it has been practiced in the East for millenia—and today.

A description of acupuncture and herbal medicine was found in records written between 100 B.C. and 200 A.D. Well-known classics written during this period include the Ma Wang Dui (Ma Wang Tomb) scripts, the Nan Jing (Na Classic), and the Huang Di Nei Jing (The Yellow Emperor's Classic). That various diseases could be treated by acupuncture, the points of which had been established, were discussed in detail in those classics.

The very first book that prepared the foundation for acupuncture, as well as of traditional Chinese medicine, was Huang Di Nei Jing, known as " the bible of Chinese medicine." It was completed somewhere around the 2nd century B.C. and probably was written by numerous authors. At the least it summarized the thoughts and experience of leading physicians of that day. The book is comprised of hundreds of articles that are divided into two volumes. Volume one, Su Wen, (Fundamental Questions), addressed many issues that pertained to the theory of medicine in a didactic way. Volume two, titled Ling Shu (Spiritual Axis), is devoted almost entirely to applications of acupuncture. These two volumes, together, not only teach rudiments of anatomic, physiologic, and pathologic aspects of the human body, but they also engage the philosophical basis of the theory of acupuncture and provide technical details about how to perform it, with particular attention paid to management of individual symptoms.

In Huang Di Nei Jing, the distribution of 12 regular meridians, both on the surface and inside of the body, and anatomic locations of 295 acupuncture points were set forth in detail. Later, in Nan Jing, two extra meridians were added to make up the so-called 14-meridians system for acupuncture. The description of meridians and of points written 2000 years ago remain the gold standard for the practice of acupuncture to this day.

The theory, traditionally, that animates treatment by acupuncture

The most important concept in traditional Chinese medicine is that of natural balance. The idea of balance comes from ancient Chinese philosophy, namely, the theory of yin and yang. That theory states that for every functional unit of human body there is dynamic change in the form of two attributes, to wit, yin and yang. They are an inseparable couple. Their proper relationship always is in balance and when that state is maintained good health is experienced. When, however, there is a disturbance in this balance, the result is disease.

The ancient Chinese philosophers and physicians both assumed and thought they observed that an essential substance in the body gives support to the life of a human. The amount and activity of this substance determines the health of a person. This substance, which probably corresponds to countless different molecules that now have been idenitifed, as well as ones yet to be identified, was named "qi," which is air in Chinese. Qi is classified further into various types according to location and function.

In Chinese medicine it is theorized that in the human body, as well as in every other living organism, qi flows naturally throughout it. Qi is said to travel the body along meridians, moving constantly up and down or circulating in these pathways, traveling among various organs. When the flow of qi is insufficient, unbalanced, or interrupted, yin and yang become unbalanced, and illness may occur. An understanding of the relationship among the body, yin and yang, and qi is necessary to understand the utility of acupuncture.

Acupuncture can be described as the insertion of fine needles, sometimes in combination with an electrical stimulus or with heat produced by burning specific herbs, called moxibustion, into the skin at specific points for the purpose of influencing the function of the body. There are 365 classic acupuncture points on the body, most of which have a specific function in regard to energy. Some are at the meeting of meridian pathways, whereas others are at the junction of an internal pathway of the meridian. There also are over 500 points located outside the meridians. The particular acupuncture points chosen varies from patient to patient and from treatment to treatment, and depends on the diagnosis, which really is a pattern of analysis of symptoms and signs. Diagnosis entails the observation of the body by looking, touching, smelling, and listening. Taking the pulse and scrutinizing the tongue are given special emphasis in Chinese medicine. Once a specific pattern has been determined, different methods, which include acupuncture, herbs, diet, massage, and physical exercises performed while meditating, may be employed to improve the flow of qi, to balance yin and yang, and, eventually, to achieve a cure.

The scientific basis of acupuncture

The search for an anatomic basis of meridians and of acupuncture points and for the biochemical basis for qi turned out to be much more difficult than had been imagined. Chinese scientists found that meridians do not correspond directly to parts of the nervous system or to pathways of circulation of the blood. Some researchers believe that the meridians are a unique system which pervades connective tissue, muscle, and soft tissue of the human body. Others do not believe that meridians and qi exist at all. These controversies remain the most vexing issues in the study of traditional Chinese medicine.

Animal studies, case reports, and controlled clinical trials all have documented the efficacy of acupuncture for many diseases and for many symptoms. Controlled studies have shown that after insertion of a needle into an acupuncture point, a blind human subject reports that the needle induces a sensation of traveling along meridians. Various instruments have been able to record the "sensation." Interestingly, the speed of conduction of the sensation along the meridians is slower than the conduction along nerves, but faster than circulation of the blood.

Several mechanisms have been proposed to explain the effects of acupuncture on pain. Acupuncture points are believed to stimulate the central nervous system to release chemicals, such as endorphins, into muscles, the spinal cord, and the brain. These chemicals either change the experience of how pain is perceived or they release second messengers that influence the systems whereby pain and sensation are regulated. The biochemical changes may stimulate the ability of the body to heal naturally and to promote physical and emotional well-being. Three main mechanisms have been proposed for this as follows:

(1) Conduction of electromagnetic signals: Scientists have found evidence that acupuncture points are strategic conductors of electromagnetic signals. Stimulating points along these pathways (meridians) by acupuncture enables electromagnetic signals to be relayed at a greater rate than under normal conditions. These signals may direct the flow of chemicals, such as pain-killers, cytokines, hormones, and of specific cells of the immune system, to the sites that are injured or are particularly vulnerable to disease.

(2) Activation of opioid systems: Research has revealed that several types of opioids may be released into the central nervous system during treatment by acupuncture, thereby reducing pain. Studies on animals showed that stimulation by acupuncture increases the expression of opioid mRNA in the central nervous system, which could explain the effects of acupuncture long term.

(3) Changes in chemistry of the brain in regard to sensation and involuntary body functions: The results of studies indicate that acupuncture may alter the chemistry of the brain by altering the release in various ways of neurotransmitters and hormones. Acupuncture has been shown to affect parts of the central nervous system that are related to sensation and involuntary body functions, such as immune reactions, blood pressure, blood flow, and body temperature.

Ample evidence exists to affirm that therapy by acupuncture has some biological basis, and it is more than enough to explain the theory and practice of this age-old treatment. Some authorities believe that meridians and acupuncture points are mere surface phenomena of the body that reflect activities of internal organs and tissues, but no one specific anatomic structure can explain all of the phenomena. Moreover, the traditional theory of acupuncture has seemed to work clinically for the last 2,000 years and it is unlikely that another better theory will soon replace it.

The History of acupuncture in the United States

Acupuncture fever in 1970s

Although Chinese medicine as a part of Chinese culture came to America with Chinese immigrants more than 150 years ago, acupuncture was not recognized officially until 1972 when President Richard M. Nixon opened the door of China and brought acupuncture back to the United States. But it was an essay published in The New York Times that led to "acupuncture fever" in the 1970s. Several versions of the story are told about how acupuncture fever began, and many details of that story are different from version to version.

One of the most popular versions goes this way: While visiting China, a young reporter in the Nixon delegation was admitted to a hospital in China because of an acute attack of appendicitis. During the appendectomy, Chinese physicians used acupuncture for anesthesia, instead of employing conventional anesthetics and painkillers. The operation was successful. After coming back to the States, this young reporter published a story about his operation in Beijing in The New York Times, and it was this story that led to excitement about acupuncture in the United States.

Among more than a dozen different versions of this story about the birth of acupuncture fever, some say that Chinese physicians secretly used acupuncture as anesthesia during the appendectomy and only told the truth to the reporter after the operation was over. Another version claims that it was the famous Henry Kissinger, the negotiator of Nixon's trip to China, who had appendicitis in Beijing and was operated on using acupuncture anesthesia.

In fact, it is easy to learn the true story because it was printed straightforwardly in The New York Times. The reporter who published the essay about acupuncture was James Reston, known also as Scotty Reston, a famous reporter then for The Times. While visiting Beijing before Nixon's trip to China, Reston wrote about his experience personally with acupuncture in China. At that time, he was the Director of the Washington Bureau of The New York Times. Reston was a gifted reporter and writer, especially in political affairs. In addition to a great deal of major professional achievements, he had interviewed many national and international leaders and personalities, including several American presidents, from Roosevelt to the first George Bush, Russia's President Nikita Sergeevich Khrushchev, and China's Prime Minister Zhou Enlai. He also had received several international awards for his reporting of the news. Later in his career, he was named vice president of The New York Times. Reston died in 1995.

What actually happened was that not long after the United States and China resumed communication, Reston was sent by The New York Times, in June 1971, to China prior to the official visit by President Nixon. He visited many places in Beijing, including hospitals where doctors demonstrated how acupuncture was practiced. During his visit in Beijing, he suffered an acute attack of appendicitis and was admitted to one of the best hospitals in Beijing for an appendectomy. During the operation, Chinese physicians used conventional drugs, not acupuncture, for anesthesia. But Reston did receive treatment by acupuncture for his abdominal distension and discomfort that followed the surgical procedure. After recovery, he published his famous essay titled, "Now, About My Operation in Peking."

In 1971, rather than being a young man, Reston already was a senior reporter more than 60-years-old. Because of his extraordinary experience and credibility, as well as the prestige of The New York Times itself, most Americans trusted deeply what he wrote. In addition, just before publishing his essay, the White House announced that President Nixon planed to visit China early in 1972. It is reasonable to assume that Americans at that time probably were very curious about what was happening in China, the largest country in the world, which had closed its door to foreigners for the past 20 years. Reston's piece came just at the right time.

Here is what Reston wrote then in The Times:

"PEKING, July 25 – There is something a little absurd about a man publishing an obituary notice on his own appendix, but for the last 10 days this correspondent has had a chance to learn a little about the professional and political direction of a major Chinese hospital from the inside, and this is a report on how I got there and what I found.

In brief summary, the facts are that with assistance of 11 of the leading medical specialists in Peking, who were asked by Premier Chou Enlai to cooperate on the case, Prof. Wu Wei-jan of the Anti-Imperialist Hospital's surgical staff removed my appendix on July 17 after a normal injection of Xylocain and Benzocain, which anesthetized the middle of my body.

There were no complications, nausea or vomiting. I was conscious throughout, followed the instructions of Professor Wu as translated to me by Ma Yu-chen of the Chinese foreign Ministry during the operation, and was back in my bedroom in the hospital in two and a half hours.

However, I was in considerable discomfort if not pain during the second night after the operation, and Li Chang-yuan, doctor of acupuncture at the hospital, with my approval, inserted three long, thin needles into the outer part of my right elbow and below my knees and manipulated them in order to stimulate the intestine and relieve the pressure and distension of the stomach.

This sent ripples of pain racing through my limbs and, at least, had the effect of diverting my attention from the distress in my stomach. Meanwhile, Doctor Li lit two pieces of an herb called ai, which looked like the burning stumps of a broken cheap cigar, and held them close to my abdomen while occasionally twirling the needles into action.

All this took about 20 minutes, during which I remember thinking that it was rather a complicated way to get rid of gas in the stomach, but there was a noticeable relaxation of the pressure and distension within an hour and no recurrence of the problem thereafter.

I will return to the theory and controversy over this needle and herbal medicine later. Meanwhile, a couple of disclaimers.

Judging from the cables reaching me here, recent reports and claims of remarkable cures of blindness, paralysis and mental disorders by acupuncture have apparently led to considerable speculation in America about great new medical breakthroughs in the field of traditional Chinese needle and herbal medicine. I do not know whether this speculation is justified, and am not qualified to judge.

Hardly a Journalistic Trick

On the other side, it has been suggested that maybe this whole accidental experience of mine, or at least the acupuncture part of it, was a journalistic trick to learn something about needle anesthesia. This is not only untrue but greatly overrates my gifts of imagination, courage and self-sacrifice. There are many things I will do for a good story, but getting slit open in the night or offering myself as an experimental porcupine is not among them." (The New York Time, June 26, 1971, page 1 and 6)

Reston, as a well-known reporter, not only told the story with humor, but also declared himself as layman unable to make any worthwhile judgment about the efficacy of acupuncture. There is no shred of evidence that he tried deliberately to exaggerate the story in order to make news. The impact historically of Reston and The Times on "acupuncture fever" in America is far beyond what either could imagine then.

At the beginning of acupuncture fever in the early 1970s, because of the lack of formal diplomatic ties between the United States and China, there was an acute shortage of acupuncturists in America and qualified acupuncturists were needed badly. Some practitioners of acupuncture in New York City still remember the remarkable "business" generated by the article that appeared in The New York Times. After Reston's report, busloads of patients began coming to Chinatown in New York City every day from Washington D.C. and other places in order to seek treatment by acupuncture. In order to deal with the sheer numbers of patients, some acupuncturists rented an entire floor of a hotel to accommodate them. The acupuncturists were so busy that they only had enough time to insert the needle into patients, one by one, and left the needles in place to be removed by their assistants. It is said that the business for acupuncturists was so good that one week's income was enough to buy a house. There was no regulation in those days on practicing acupuncture and no minimal requirements existed then for qualifying a person as an acupuncturist. Many laypersons would go to Hong Kong, take a short course in acupuncture for a month or less, and come back to the States claiming to be a full-fledged acupuncturist. For reasons that can be understood readily, acupuncture fever did not last long.

Recommendations of the World Health Organization and a consensus conference on acupuncture at the National Institute of Health

In the early 1980s, the World Health Organization (WHO) recommended over 40 conditions that it thought responded well to treatment by acupuncture, among those being allergies, colds and flu, back pain, asthma, neuromuscular disorders, gastrointestinal conditions, and vascular maladies. This list was based primarily on trials and on case reports that originated in China. The American medical community never accepted it formally.

Nevertheless, the use of acupuncture in the United States continues to increase as it has for the last 30 years. More than 40 states in the union recognize acupuncture as legitimate therapy and several more states have legislation pending in that regard. Acupuncture is used in more than 20 states for over 800 programs devoted to dependency on drugs. It is claimed that patients who go through for programs of that type which utilize acupuncture have lower re-arrest rates on drug-related charges than those not treated with it.

In 1996, the United States Food and Drug Administration (FDA) announced that an acupuncture needle should be regulated as any other medical instrument. For the first time in history, an agency of the government of the United States recognized acupuncture as authentic medical therapy.

In 1997, a quarter of century after the introduction of acupuncture to the United States, the National Institutes of Health (NIH) organized a Consensus Conference on Acupuncture. Based on review of trials predicated on evidence generated, reports concerning basic science aspects, and presentations by experts, the panel of the NIH concluded that acupuncture truly is effective for certain diseases.

Dr. Bruce Pomeranz, a physician/scientist at the University of Toronto said this:

"After review of 15 lines of evidence from over 100 papers published in refereed journals," he was compelled to conclude that, "Beyond any doubt that acupuncture stimulates peripheral nerves to release endorphin in brain and spinal cord, which blocks pain messages.

We have more evidence on this mechanism than exists for most conventional therapies."

Interestingly, the first condition for which treatment by acupuncture was recommended by the panel of the NIH happened to be gastrointestinal disorder that follows a surgical procedure, the very kind of condition for which Reston was treated in Beijing in 1971. Although he did mention in his essay in the New York Times that acupuncture worked for him, it took 25 years for medical scientists in the United States to come to agree with him.

The NIH has estimated that more than 1 million Americans receive therapy with acupuncture each year. Private and public insurance coverage for acupuncture is available in many states. One study shows that 57.2 percent of physicians in northern California have used or have recommended acupuncture to patients in what was then the last 12 months. The number of licensed acupuncturists in the United States rose from 5,528 in 1992 to 10,512 in 1998. Interestingly, a variety of research projects on acupuncture have been funded by individual institutes at the NIH, including the National Center for Complementary and Alternative Medicine (NCCAM), the National Institute on Alcohol Abuse and Alcoholism, the National Institute of Dental Research, the National Institute of Neurological Disorders and Stroke, and the National Institute on Drug Abuse. In the last 10 years, funding for research about matters pertinent to acupuncture and alternative medicine at NCCAM increased from $2 million to $114 million. The results of a study by the New York advocacy group, Patients Have Rights, indicated that 90% of the respondents had heard of Chinese medicine and acupuncture and 13% had used acupuncture, 80% of the respondents having described their experience as "favorable" and 100% believing it was important to have a choice in regard to medicine they use.

Different Practices of acupuncture in the East and the West

Since the formal introduction of acupuncture into the United States 30 years ago, acupuncture has become a popular alternative therapy, and throughout the Western world as well. In most states, it is legal to practice acupuncture as a profession as long as the practitioner holds a proper permit or certificate. Conventional medical communities and government agencies, such as NIH and FDA, began to recognize acupuncture as an effective therapy for certain painful conditions and now regard acupuncture as part of complementary and alternative medicine (CAM).

To the surprise of many, however, the technique of acupuncture being practiced in the United States today by most practitioners of it actually is quite different from the method being employed in the East. The difference not only concerns the technique itself, but also many other related aspects, such as training, education, licensing, and clinical indications for acupuncture. What follows is a list of different considerations concerning the practice of acupuncture and a comparison between them in the United States and China.

Comparison of the practice of acupuncture in the United States and China

Practitioners of acupuncture

U.S. Mainly professional acupuncturists who are not physicians and a small percentage of physicians.

China Mainly physicians devoted to practice exclusively of traditional Chinese medicine and a small percentage of physicians who practice Western medicine.

Education required for acupuncturists

U.S. 2 to 3 years of school for acupuncturists; no such requirement for physician practitioners.

China 5 years of medical school in which courses in acupuncture are taught as part of the curriculum both in colleges of traditional Chinese medicine and of Western medicine.

Students of acupuncture

U.S. Mostly part time, but a small percentage full-time; many middle aged-adults, healthcare workers, and students who seek a second career; a very different population than comprises medical schools.

China Young high school graduates, all full-time students, a similar population to that of students of medical school in the United States.

Licensure for acupuncture

U.S. Most states require a certificate or permit for practice by acupuncturists and for physicians to perform acupuncture, the certificate/permit being issued by the states.

China A license for a physician to practice medicine or equivalent qualification is required to practice acupuncture. There is no separate certificate for licensure of acupuncturists.

Requirements for acupuncturists to be licensed

U.S. These vary from state to state. For acupuncturists, 2 to 3 years of education at a recognized school for acupuncture is required, and that includes some experience clinically; for physicians and dentists, a 200 to 300 hour course from a recognized acupuncture program, including some clinical practice, is required.

China In addition to education for 5 years at medical school or an equivalent education, extensive clinical training or an apprenticeship is necessary to be qualified as an acupuncturist.

Legal regulations for acupuncture

U.S. Most states have laws that pertain to regulation of licensure and practice of acupuncture. The State Board of Acupuncture is either an independent unit or is under the supervision of the State Board of Medicine.

China No special law exists in regard to acupuncture. Acupuncture, which is a form of medical therapy, is regulated just as any other medical therapy under common law.

Medical responsibilities of acupuncturists

U.S. Study by analysis of patterns the possible points for acupuncture, select particular points, and perform acupuncture. Many states require referral from a physician or a pre-operative diagnosis before treatment by an acupuncturist can begin. Acupuncturists have no right to diagnosis or prescribe.

China Acupuncturists, being the physicians that they are, are allowed to order laboratory tests, make diagnoses, and prescribe drugs or herbs in addition to performing acupuncture treatment.

Requirements in regard to an acupuncture needle

U.S. A sterile, disposable, stainless steel needle, short and thin (length: 0.5-1.5 inch; gauge: 32-36) with a guiding tube (an aid for needle insertion) is mandatory. Only a very few types of thin needle are used. Needles are designed to induce a minimum of pain.

China Sterile, non-disposable or disposable, stainless steel, long and short, thin and thick (length: 1-5 inch; gauge: 26-28) needles without guiding tubes are permissable. Many different types of needles are used. Needles are designed to induce different levels and various strengths of stimuli.

Health professionals who actually practice acupuncture

U.S. Chiropractors, nurse practitioners, podiatrists, veterinarians and dentists.

China Professionals other than physicians rarely practice acupuncture.

Use of moxibustion and electrical stimuli in combination with acupuncture

U.S. Electrical stimuli often is used during treatment by acupuncture, but not moxibustion.

China Both moxibustion and electrical stimuli are employed often during acupuncture therapy.

Herbal treatment combined with acupuncture

U.S. Most acupuncturists do not have enough training in Chinese herbal medicine to utilize it in practice, so herbal formulas are seldom used in conjunction with acupuncture by acupuncturists trained in the United States.

China Most physician-acupuncturists have extensive training in both acupuncture and herbal medicine, and a combination of those therapies is used often.

Diseases treated most often by acupuncture

U.S. Depression, post-operation pain, nausea and vomiting, chronic pain, and detoxification are the major indications for acupuncture.

China Neuromuscular disorders, stroke, Bell's palsy, arthritis, acute and chronic pain, detoxification, and chronic conditions in general all lend themselves to treatment by acupuncture.

NIH and WHO recommendations regarding indications for acupuncture

U.S. Conditions approved by the panel of the NIH consensus conference for acupuncture therapy are based on controlled clinical trials in the United States and they include nausea and vomiting that develop post-operatively and pain that follows oral surgery, including extraction of teeth.

China Over 40 conditions are recommended for acupuncture by the WHO and they were identified on the basis of clinical experience and limited trials accumulated in China. Management of pain is only a small component of application of acupuncture therapy.

Techniques of needle manipulation during acupuncture

U.S. Standard insertion and stimulating techniques. Electrical stimuli are used often.

China Highly individualized methods of manual stimulation, mostly of those techniques being based on experience.

Sensations induced during acupuncture

U.S. Seek to induce weak sensation only, and no pain. The aim is avoidance of complaint by a patient.

China Seek to induce weak or strong sensation as it is necessary. In some patients, inducing pain by acupuncture is part of the therapy.

Frequency of treatment by acupuncture

U.S. Once or twice per week; some insurance companies limit acupuncture to 12 treatments per year.

China Treatment daily, there being no limit to the number of treatments.

Kinds of patients who seek acupuncture

U.S. Mostly white-collar persons with an above average education.

China The entire population in general, an average education being the rule.

Geographic distribution of practitioners of acupuncture

U.S. Most clinics are situated in large metropolises and in urban areas.

China The service is available in urban centers and rural areas both.

Fee per each treatment by acupuncture

U.S. $30-100 per visit.

China $0.25 - 1 per visit.

Annual income of acupuncturists

U.S. $30,000 – 120,000.

China $1,500 – 5,000.

Number of private clinics for acupuncture

U.S. Many.

China Very few.

Number of acupuncturists based in hospitals

U.S. Very few.

China Many.

Number of research institutes devoted to acupuncture

U.S. Very few.

China Most medical research institutes include research about acupuncture.

Number of professional journals devoted to acupuncture

U.S. Less than 10 journals.

China Nearly 1,000 medical journals publish articles about acupuncture.

Professional associations devoted to acupuncture

U.S. They function entirely independent of established medical associations.

China They are a part of medical associations or of associations given to traditional Chinese medicine.

Insurance coverage for patients treated by acupuncture

U.S. Few insurance companies cover acupuncture therapy. As of today, Medicare/Medicaid does not cover acupuncture.

China Most insurances and government medical benefit cover acupuncture.

Availability of liability insurance for acupuncturists

U.S. The premium is low and very few lawsuits have been filed for negligence of acupuncturists, but the trend toward litigation is increasing.

China Unheard of.

Acupuncture as business

U.S. An independent business for the purpose of making money.

China Not a business but a profession given to health care sometimes as part of hospital based service.

In the United States, acupuncture has become a business that demands, as a requisite for setting up shop, a certain amount of education, board examination, understanding of laws and regulation, licensure, management, membership in professional associations, other independent practitioners, and client/customer/patient service. The system for acupuncture therapy is relatively free from the conventional system of medicine, more like that of chiropractors and message therapists. There are, however, a significant number of physicians who practice acupuncture in the United States. Many persons choose acupuncture as a career in order to make a reasonable living. Most patients pay for the acupuncture from their own pocket. Fees from patients make possible the running of the entire acupuncture system.

By contrast, acupuncture in China is not an independent profession. It is a part of the conventional, traditional system of medicine. Traditionally, there is no special college, law, insurance, or board examination designed for acupuncture. Most practicing acupuncturists are physicians with extensive training in both acupuncture and herbal medicine. In the countryside and in remote regions, the practice of acupuncture is not strictly regulated as a medical treatment and often it is regarded as a method of primary care specialty performed by experienced practitioners who have no medical credentials. Acupuncture is hardly a profession and definitely not a moneymaking business in China.

In summary, acupuncture originated from China and now has been westernized to fit the culture, business environment, and economic market of the United States. In many respects, the practice of acupuncture in the United States is very different from that being done in China. In both the West and the East, the practice today of acupuncture depends largely on the environment culturally, the changes in society, and economic factors. Acupuncture no longer is a designed to improve the health of individuals, as an ancient people created it thousands of years ago.


Yong Ming Li, M.D., Ph.D. is an Attending Physician at Warren Hospital, New Jersey. He is also a licensed Acupuncturist and Herbalist.


Dermatopathology: Practical and Conceptual
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