I’m a licensed Acupuncturist (the friend in SF). In the course of my professional and social life, I often come across widely held misconceptions about acupuncture. The perception of acupuncture as a woo-woo faith healing practice of the comically weird, antiestablishment pseudo-medicine person being sought by an equally wackadoo patient is a caricature that has gotten a lot of traction. I noticed some of these same misconceptions (although not as extreme of course) in the recent piece by Roxy, and I want to address them. The thing is, acupuncture works. And if you are experiencing relief and cessation of symptoms even for a day, you’re not crazy – you’re responding to a medicine that stimulates the body to heal itself, and it’s working.
I’d like to offer up some facts about acupuncture therapies (“acupuncture therapies” refers to the variety of modalities that encompass the scope of our practice – acupuncture, cupping, gua sha, massage therapy, herbal medicine, and moxibustion) within a perhaps broader historical context, as well as a realistic representation of their acceptance and use in the current US medical system.
Licensed Acupuncturists in the US attend accredited four-year masters degree programs which consist of thousands (nationally no less than 2000, in California, 3000) of didactic and clinical hours, and pass rigorous national and state board certification qualifications and exams. Our clinical rotations are in community clinics, hospitals, and other inpatient settings, and at least half of our education is western medicine – anatomy and physiology, pathology, gynecology, obstetrics, dermatology, internal medicine, psychology, and pharmacology. Some acupuncturists opt to train for extended periods in Chinese hospitals, or do fellowships in American hospitals or apprentice with well-known providers. Some go on for additional years of formal study to obtain their Doctorate in women’s health, chronic pain management, geriatrics, oncology, sports medicine, and other specialties. Many of us are dually licensed as nurses, nurse practitioners, MD’s, chiropractors, and physical therapists. A licensed acupuncturist will have a designation of LAc, and if they have a doctorate, DAOM.
In most states in the US, an acupuncturist is a licensed primary care provider. We work in private practice, as well as institutions like addiction rehabilitation centers, hospital labor and delivery wards, neurological rehabilitation centers, homes for the aged, hospice, and a wide variety of other settings. All major insurance carriers including workman’s compensation cover acupuncture treatments.
Acupuncture and Chinese herbal medicine is relatively new to the US and is experiencing a growing familiarity thanks to community style acupuncture clinics, hundreds of which have cropped up across the country over the past 10 years. These clinics are based on a model of offering treatments in a group setting for affordable rates that are comparable to copays, out of pocket. Millions of people have been introduced to acupuncture through this model that exists largely outside of the insurance systems.
At this point there are enough legitimate studies supporting the efficacy of acupuncture therapies for a wide variety of issues and disease that acupuncturists are employed by top hospitals. Lutheran Hospital Brooklyn and Mount Sinai Beth Israel, The Cancer Treatment Centers of America, UCSF, Stanford, and Kaiser Permanente all have licensed acupuncturists on staff. The Cleveland Clinic has an entire Chinese herbal pharmacy. All of the top research and teaching hospitals, as well as the NIH, conduct ongoing research. Acupuncture is used regularly in the US military and at VA hospitals, and is on its way into the public health system.
To refer to Western biomedicine as “traditional medicine” is a misnomer. The practice of acupuncture and herbal medicine has been practiced for thousands of years starting in China and spreading in subsequent centuries to Japan, Vietnam, Korea, Taiwan, and then Europe, continuing on a course of development in each country as it’s own permutation. It was brought to the United States in the 19th century by Chinese workers building railroads across the west, and then again in the middle of the last century by Chinese and Taiwanese immigrants. In the 60’s and 70’s, several of the Black Panthers in NYC at Lincoln Hospital studied with Chinese doctors to find an effective way to detox people from the heroin and methadone ravaging their communities.
By comparison, western biomedicine as it is currently practiced is actually an extremely young medicine. Usage of the term “science based medicine” to exclusively refer to western biomedicine implies that there has been no science in the development of any other medical system, which filters the history of medicine through an orientalist lens in which acupuncture – that of “the orient” – is a source of mystery and esoterica while the medicine of the “occident” is the sole source of logic and reason. It also sets up a false dichotomy – Chinese medicine as we learn and practice it in the US is inextricable from western medicine as it has evolved to encompass advances in medical science throughout time. We learn herbal and pharmaceutical drug interactions, we treat everything imaginable that a patient can walk through the door complaining of, referring to western specialists as we see fit and as mandated by our scope of practice.
Regarding diagnosis, how important is it to be able to name “the thing” with precision? This is not exactly the forte of Western medicine. Prioritization of an exact diagnosis in western terms (which is not always possible) underscores a fundamental belief system in which European/Allopathic/Western/Biomedicine – whichever term you prefer – is the top of a hierarchy in which all other medical systems, practices, and therapies fall short. In the rush and pressure to diagnose, both by the insurance system and patients, western-based medical practice is rife with misdiagnosis and massive over-prescription of pharmaceutical medications. Research reveals that many medications for common chronic diseases slide by with a very thin margin of efficacy and carry multiple side effects which themselves cause new problems that require yet more medications. The sometimes futile search for a diagnosis generates great mental and physical stress and financial expense for patients with the accompanying tests, repeated referrals to multiple specialists, and the frequently utilized “throw a bunch of stuff at the wall to see what sticks” manner of prescribing medications.
In Chinese medicine, our therapies and medicines are relatively safe with few if any side effects when practiced by a licensed provider. They are gentle, yet can be incredibly effective. The herbs you have a prescription for are medicine. They are a prescription. There are no quotation marks.
Chinese medicine grew from the understanding of the natural world rooted in Daoism, a philosophy that most white, American born people are unfamiliar with, so understanding the diagnosis given by a practitioner doesn’t necessarily come easy. Part of our job is attempting to describe in terms that can be understood by the patient – how can we explain a pattern of disharmony that is conceptualized in a completely different paradigm? Some of us are great at bridging this gap, and some of us aren’t. Our job is to treat you and make you better, and steer you away from choices that will cause health issues. That can be done with or without your understanding of the nuances of a diagnosis. Remember, we go to school for years to understand this medicine. It’s not a realistic expectation for you to intellectually grasp it right away. Some of the terms do not translate, and some translate unfavorably. And just because it’s not easily understood or explained, doesn’t mean it’s a less legitimate course of treatment.
Here’s an example: “Blood Deficiency” sounds scary, like you’re missing something extremely important. You’re deficient. People freak out. So, maybe instead we might say “you have too much yang, not enough yin.” – That is a totally acceptable, non-scary, simplified way of describing blood deficiency because blood is yin in nature. It does sound kind of wacko to you maybe, because you’re not Chinese, you didn’t grow up with yin and yang being the basis of your entire understanding of the natural world. Generally, in China when you tell someone they need to build yin, they know exactly what soup to make, what meats to eat, and what exercises to do.
Humans collectively know a great deal about the body, but anyone who studies and practices medicine and is worth their salt will tell you that there are vast expanses of unknown information about how it all works. That is for the research scientists to sort out, and I’ll read their papers. As a clinician, rather than focusing on understanding what exactly is going on and a specific biomedical diagnosis, which isn’t always even knowable, I’d rather focus on outcomes. Alleviating your symptoms, treating the underlying causes, and restoring your body and life to a happy and functioning state with as few side effects as possible is the ideal treatment outcome, even if it means that maybe my working diagnosis sounds like a completely foreign idea to you. Even if it means the insurance companies don’t have an ICD-10 code to fit it into.
Tara Spalty LAc is a licensed acupuncturist who practices with a focus on women’s health, pediatrics and mental health/addiction recovery. She practices at Slowpoke Acupuncture in San Francisco.