|
|
Fast
Changing World of Acupuncture Medicine
|
|
Yun-tao Ma, PhD, Lic
Ac
Director American Dry Needling Institute
|
|
|
We came home from teaching Dry needling Course in Great
Britain and found two
e-mails, posted on the same
day. One was an enquiry 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 other was from
an acupuncturist: “As a licensed acupuncturist I have an
issue with non-licensed individuals (PT) being taught
how to needle patients without the proper TCM training.
What is the purpose of TCM training and licensing if we
allow 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 Dry Needling treatment which is
not available in Texas. The second reflects a position
common to some practitioners of Traditional Chinese
Medicine (TCM) due to the fact that more and more
healthcare 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, Traditional Chinese Medicine is
not only one 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 has also been discovered in a purely Western
anatomical and physiological context, for instance in
the application of needles to neuromuscular trigger
points in the work of Travell and Simons dating from the
‘60s and ‘70s. And thirdly, in classical TCM,
acupuncture represents only a small part of the total
clinical approach – my estimate would be 20-30%.
Let’s look at this in more detail. “Acupuncture” today
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 study of the “classics”, how a student actually
practices depends on what a particular school or master
chooses to emphasize.
For example, more than 80
different types of Qi were mentioned in the Yellow
Emperor’s Cannon of Internal Medicine and more than 120
types of Qi in Nan Jing. TCM acupuncture is based on
understanding of a model of human anatomy and
pathophysiology which is rooted in Chinese philosophy
2500 years ago. The complexity of the TCM system with
its many concepts is why it takes 3-4 years 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, or channels, and
their energetics; and on the associated energetics and
therapeutic uses of food, herbal medicines and physical
movements and therapies.
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 valid to question why a practitioner who
wants to help patients with acupuncture should have to
study an entire – and irrelevant to the purpose – system
of medicine. TCM trained practitioners should not forget
that they study not “acupuncture” but the whole TCM
system, including 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 to health practitioners be able
to practice non-TCM acupuncture.
In fact, the
medical doctors, chiropractors, osteopaths and physical
therapists who are increasingly using acupuncture –
particularly for pain management – often do not even use
acupuncture terminology, but refer to dry needling of
myofascial or neuromuscular trigger points, for example.
This is a world-wide phenomenon, already in use in the
USA, UK, 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
dry needling techniques and a different terminology for
these techniques have been created; for example 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 21st century understanding of human
anatomy and pathophysiology and on 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 mostly by
practitioners such as 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 by form but perfectly serve the same purpose:
effectively delivering food. Like chopsticks and forks,
TCM acupunctures and non-TCM acupunctures have different
historical origins and medical approaches. They require
different trainings and different backgrounds.
Many of my TCM practitioner friends happily practice
their TCM acupunctures and herbal medicine and
experience only 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. None claims to practice TCM; 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. Their years of
training in Western scientific medical theory enables
them to understand modern biomedical acupuncture.
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 TCM
acupuncture and herbal remedies, others will continue to
visit MDs, DOs, DCs and PTs and benefit from dry
needling in addition to standard treatments.
Both
systems work; they are simply rooted in different
cultures.
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 healthcare practitioners are using
needles. However, there is no doubt that practitioners
with better skills who get the best results, will get
more business. That’s the way it’s always 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 TCM and Western
medicine even though TCM had better clinical results in
many cases at that time.
Today this trend
continues. In China, 80% 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 president of Guanzhou TCM university came to the
US and bought $5 million worth of the latest medical
equipment, including MRI, 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,
MD, DO, DC, PT, and TCM acupuncturists have found that
they do not experience any conflict between the TCM
model and the Biomedical Acupuncture model and that in
fact they can learn from each other. After courses they
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 bodyweight is soft tissue,
and almost all pathological conditions, more or less,
influence the function of soft tissues, 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.
|
|
|
|
|
|
