We came home from a teaching trip in Great Britain and found two e-mails posted on the same day. One was an inquiry from an oil contractor who wrote: "Do you know of anyone practicing dry-needle therapy in the Houston/Galveston, Texas area? I have had great results from treatment I received while on an extended stay in Thailand."
The second was from an acupuncturist who wrote: "As a licensed acupuncturist, I have an issue with non-licensed individuals being taught how to needle patients without the proper TCM training.What is the purpose of TCM training and licensing if we allow just anyone to needle patients? I have spent thousands of dollars on my education in order to practice Chinese medicine. Pretty soon everyone is going to be needling patients and TCM is not going to have any value. I am going to see if there is anything that can be done to protect what we do as practitioners of TCM."
What a contrast! The first letter is from a patient who needs an effective treatment that is not available in Texas. The second reflects a position common to some practitioners of traditional Chinese medicine, due to the fact that more and more health care practitioners are legally allowed to practice various needling techniques.
We believe it is time to clarify the current situation. There are three points that need to be made up front. First, acupuncture is not the private property of one particular group of practitioners. Second, TCM is not the only system of medicine that uses needling. Not only are there strong needling traditions in other Asian cultures such as Japan, Korea, Vietnam and so on, but needling also has been discovered in a purely Western anatomical and physiological context. For instance, this includes the application of needles to neuromuscular trigger points from the work of Travell and Simons dating from the 60s and 70s. And third, in classical TCM, acupuncture represents only a small part of the total clinical approach - my estimate would be 20 to 30 percent.
Let's look at this in more detail. Today, "acupuncture" means different things to different practitioners. Acupuncture, as used in the TCM system, is based on ancient Chinese concepts of meridian systems, draws on TCM theories of physiology, relies on Chinese diagnostic methods such as tongue and pulse assessment and uses a variety of needle-manipulation techniques. In addition to the study of the "classics," how a student practices depends on what a particular school or master chose to emphasize.
For example, more than 80 different types of qi were mentioned in the Yellow Emperor's Canon of Internal Medicine, and more than 120 types of qi were mentioned in Nanjing. TCM acupuncture is based on the understanding of a model of the human anatomy and pathophysiology, which is rooted in Chinese philosophy from 2,500 years ago. The complexity of the TCM system, with its many concepts, is why it takes three to four years of full-time training to qualify as a TCM practitioner. Again, the acupuncture component of a TCM course is relatively small, compared to the amount of time spent in the study of different TCM theories of meridians, channels and their energetics, along with the associated energetics and therapeutic uses of food, herbal medicines and physical movements.
Despite the differences among the varied theoretical models employed in "ancient" or traditional systems, the benefits of acupuncture shine through. Similarly, modern research shows us that acupuncture is effective for many conditions, even when it is employed without reference to meridians and/or systems of connected points.
It is, therefore, a valid question to ask, why does a practitioner who wants to help patients with acupuncture have to study an entire (and irrelevant) system of medicine? TCM-trained practitioners should not forget that they study not just acupuncture, but the whole TCM system, including a deep understanding of herbal medicine. Let's be clear, we are NOT saying that TCM is irrelevant. It is an extremely valuable system, but it is far more than just acupuncture. What we have to accept is that modern research into biochemistry, physiology and neurology shows that the full-scale study of TCM is not necessary for health practitioners to practice non-TCM acupuncture.
In fact, the medical doctors, chiropractors, osteopaths and physical therapists who increasingly use acupuncture, particularly for pain management, often do not even use acupuncture terminology. For example, they refer to dry needling of myofascial or neuromuscular trigger points. This is a world-wide phenomenon, already in use in the U.S., U.K., Australia, Canada, Germany, France and many other countries.
Dry needling was introduced by Dr. Janet Travell, starting in the 1940s. Since then, numerous laboratory and clinical studies have enriched techniques of dry needling, creating different terminology. For example, terms such as trigger-point needling, dry-needling technique, medical acupuncture, intramuscular stimulation (IMS) and biomedical acupuncture are all in use.
This is not surprising when you consider that dry needling is not based on the TCM model in any way. The biomedical acupuncture model (aka Western acupuncture) is based on the 21st-century understanding of human anatomy and pathophysiology and modern scientific research into the mechanism of acupuncture, drawing heavily on leading-edge neurological research using modern imaging techniques such as functional MRIs of the brain. Not surprisingly, this form of acupuncture is practiced not by TCM practitioners but MDs, DOs, DCs and PTs, who have sufficient background in traditional Western medical sciences to enable them to understand the very different theoretical framework, diagnostic criteria and practical application of biomedical acupuncture.
Both TCM acupuncture and biomedical acupuncture work very effectively because both systems are firmly based on the indestructible and practically immortal mechanism of acupuncture. These systems do not conflict with each other, even though their theories, acupoint systems, needling techniques, technical terms and interpretations are quite different.
It is just like Chinese chopsticks and Western knives and forks, which are different in form but serve the same purpose: the effective delivery of food. Like chopsticks and forks, TCM acupuncture and non-TCM acupuncture have different historical origins and medical approaches. They require different trainings and different practitioner backgrounds.
Many of my TCM practitioner friends happily practice their TCM acupuncture and herbal medicine. However, they experience one problem - not being able to accept new patients because they are too busy.
Many MD, DC and PT practitioners build up their own modern biomedical acupuncture practice within their clinical framework on the foundation of their conventional training. They tend not to prescribe TCM herbal remedies nor try to compete with TCM practitioners. They include modern acupuncture to increase the effectiveness of their practices and do it mostly in the context of pain management, which they already practice. Years of training in the Western scientific-medical theory enables these practitioners to understand modern biomedical acupuncture.
Both Systems Work; They Are Simply Rooted in Different Cultures.
We are never tired of repeating our mantra: "The patient is the one we serve." Acupuncture first and foremost belongs to the patients. Patients will choose the practitioner who provides the most effective treatment. This is the only criterion. Some patients will go to TCM practitioners to benefit from their acupuncture and herbal remedies. Others will continue to visit MDs, DOs, DCs and PTs, and benefit from dry needling, in addition to standard treatments.
It would be helpful for TCM practitioners to understand that a practitioner using acupuncture for pain management and trauma rehabilitation is not practicing traditional Chinese medicine and would never claim to do so.
Therefore, there is no need for TCM acupuncturists to worry that TCM can lose its "market share," simply because other health care practitioners are using needles. However, there is no doubt that practitioners with better skills get the best results and will get more business. That's the way it always has been.
Progress Could Not Be Stopped
Globalization is a historical trend that no one can reverse. In the 19th century, Western medicine was brought to China, and TCM doctors refused to accept this "Western beast." As time passed, TCM doctors gradually accepted Western medicine and tried to find connections between the two systems, even though TCM had better clinical case results at that time.
Today, this trend continues. In China, 80 percent of the medical doctors practice Western medicine. All TCM hospitals have modern medical equipment. A colleague has just informed me that a month ago, the Guangzhou University of Traditional Chinese Medicine's president came to the U.S. and bought $5 million worth of the latest medical equipment, including an MRI system, and sent TCM personnel over for training. Chinese TCM authorities have a very clear understanding that modernization of TCM is inevitable. If they don't do it, someone else will.
During our biomedical acupuncture courses all around the world, MDs, DOs, DCs, PTs and TCM acupuncturists have found that they do not experience any conflict between the TCM model and the biomedical acupuncture model. In fact, they can learn from each other and after their courses, stay in touch and refer patients to each other.
We shouldn't forget that acupuncture is especially effective for soft-tissue dysfunction, especially for soft-tissue pain. Half of our body weight is soft tissue, and almost all pathological conditions influence the function of soft tissue, especially the muscles and fascia. This is why acupuncture helps such a broad spectrum of pathologic conditions, from pain management to drug abuse. You will get better therapeutic results only if you understand the mechanisms during and after the needling. Acupuncture belongs to the patients who need cure and relief.
Click here for previous articles by Yun-tao Ma, PhD, LAc.