l What
is Chinese Medicine? What is acupuncture?
l How
does acupuncture work?
l What
problems can be treated by acupuncture/Chinese medicine?
l Will
my insurance cover acupuncture?
l Does
acupuncture hurt? Is it safe?
l Do
I need to prepare for an acupuncture treatment? How long do
the needles stay in? What about afterwards?
l How
many treatments will I need?
l How
do I know if a practitioner is qualified?
l How
does Chinese medicine actually work?
l How
safe is Chinese medicine?
l Is
Chinese medicine a ※cure-all§?
l What
is Chinese herbal medicine good for? How is it used?
l Are
Chinese herbs safe?
l Will
my insurance cover Chinese herbal therapy?
l What
is the evidence that acupuncture/Chinese medicine is cost
effective?
l Isn*t
Chinese medicine essentially a form of folk medicine that
has been replaced by science-based Western medicine?
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l
What is Chinese Medicine? What is acupuncture?
Chinese medicine,
also called traditional Chinese medicine or TCM, is a
complete system of medicine, recognized as such by the World
Health Organization. Written records and literature
detailing the theory and practice of Chinese medicine date
back 2,300 years. Essential concepts of Chinese medicine
such as yin and yang, qi, and five-element correspondences
have been documented to 4,000 years ago, and are ultimately
based on Taoist philosophy. Over centuries, gifted scholars
and medical practitioners in China and other Asian countries
developed a complex, interrelated way of assessing and
treating the human body and its illnesses based on these
concepts.
Acupuncture
is one modality in Chinese medicine. In acupuncture
treatment, fine acupuncture needles are inserted into the
acupuncture points located on the body*s energy pathways to
regulate and balance the energy flows. Chinese medicine also
uses several other modalities to treat patients, including
Chinese herbal formulas, moxibustion, tuina massage, dietary
therapy, the energy-mobilizing practices of Qi Gong and Tai
Chi, and lifestyle counseling. The primary objective of
treatment is to create and maintain balance
and harmony within the body. Since illness and disease are
seen as an imbalanced condition of the body, restoring
balance means restoring health. Because Chinese medicine
tends to view people as the totality of their bodily
processes, including emotional, mental and spiritual
aspects, Chinese medicine is generally perceived as more
holistic than Western medicine. There is also a strong
emphasis in Chinese medicine on maintaining healthy states
and preventing illness, rather than waiting until disease
presents itself, as Western medicine tends to do.
Practitioners of Chinese medicine believe that it is
particularly useful in the treatment of chronic, functional
diseases or problems which do not respond readily to the
quick fixes of surgery or drug therapy.
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How does acupuncture work?
Acupuncture
needles are very fine 每 usually the diameter of a human
hair, although they come in different lengths and diameters.
Acupuncture needles are inserted into specific points (acupoints)
on the surface of the skin which relate either to internal
organ systems or to specific conditions. There are
approximately 365 acupoints located along the body*s
fourteen principal meridians. (There are also ※extra§
acupoints, ear acupoints, hand, foot, and scalp acupoints,
and others.) Meridians are essentially energy channels,
along which the body*s life-force energy called ※qi§ flows.
(Qi is also spelled ※chi,§ and pronounced ※chee§). The
acupuncturist will select a combination of acupoints along
one or more meridians based on the condition(s) being
treated.
By stimulating
acupoints, qi is manipulated in order to achieve therapeutic
results. Qi that is flowing in the ※wrong§ direction can be
redirected, for example in the treatment of nausea. Qi that
is ※stuck§ and therefore causing pain can be mobilized to
flow freely through the affected area. In Chinese medicine
theory, the fundamental substance of blood also flows in the
acupuncture meridians, so acupuncture can be used to
manipulate blood-related imbalances such as menstrual
discomfort.
Even though
Western science has not yet determined the mechanism by
which acupuncture works, a number of interesting
correlations have been scientifically demonstrated. For
example, if a machine that detects electromagnetic force is
dragged along a meridian, the acupoints always register a
lower electromagnetic level than the surrounding area. This
means that the acupoints which were sensed by Chinese
medicine practitioners more than 3,000 years ago are also
detectable with a scientific instrument. Blood tests have
demonstrated that acupuncture needle stimulation is
associated with increased levels of serotonin, L-dopa, and
other neurotransmitters in the brain, which could explain
the pain-reducing effects of acupuncture. And cutting-edge
research done with functional magnetic resonance imaging (fMRI)
demonstrates that acupoint stimulation at a distal point on
the body will cause a reaction in the brain. For example, if
an acupoint on the foot which traditionally addresses eye
problems is stimulated by needling, the vision area of the
brain will be demonstrably affected.
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What problems can be treated by acupuncture/Chinese
medicine?
According to the
vocabulary of Chinese medicine, treatment is aimed at
resolving imbalances of the body*s organ systems and
fundamental substances such as qi and blood. However, most
people who come to a Chinese medicine practitioner will
state their problem in Western medicine terms: ※I have a bad
back,§ ※My periods are very painful,§ ※Can you help me stop
smoking?§
Below is a list
of conditions which the World Health Organization recognizes
as being effectively treated by acupuncture. For most of
these conditions, Chinese medicine practitioners would also
prescribe Chinese herbs in addition to acupuncture to
achieve the maximum effectiveness. In addition to the
conditions listed below, Chinese medicine has proven highly
effective for weight loss; withdrawal from addictions such
as sugar, coffee, cigarettes, alcohol, and cocaine; stress
reduction; post-surgical recovery; support for individuals
undergoing radiation therapy or chemotherapy; male and
female infertility; immune system problems, and many others.
The World Health
Organization of the United Nations recognizes acupuncture's
effectiveness for over 40 common disorders, including:
1) Ear, Nose & Throat Disorders:
Toothaches,
earaches, sinusitis, rhinitis, laryngitis
2) Respiratory
Disorders:
Common cold,
bronchitis, asthma, allergies, emphysema
3)
Gastrointestinal Disorders:
Food allergies,
nausea, indigestion, diarrhea, constipation, ulcers,
colitis, Crohn*s disease
4) Circulatory
Disorders:
Hypertension,
high cholesterol, arteriosclerosis, angina pectoris
5) Urogenital
Disorders:
Cystitis, stress
incontinence, urinary tract infections, prostatitis,
prostatic hypertrophy
6) Gynecological
Disorders:
Menstrual
irregularities, endometriosis, PMS, infertility, menopausal
syndrome
7)
Musculoskeletal Disorders:
Low back pain, arthritis/joint
pain, tennis elbow, frozen shoulder, TMJ, sciatica, carpal
tunnel syndrome, fibromyalgia
8) Nervous System
& Psychiatric Disorders
Depression,
anxiety, insomnia, headache, migraine, trigeminal neuralgia,
Bell*s palsy, post-stroke paralysis, dizziness, tinnitus
9) Skin Conditions:
Acne, eczema,
herpes/shingles, psoriasis
A
ten volume acupuncture manual complied by the American
Academy of Acupuncture and Oriental Medicine and published
in China covers over seven hundred symptoms, conditions and
diseases. These conditions and diseases can be treated by
acupuncture only or in conjunction with Chinese herbal
medicine or conventional western medicine.
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Will my insurance cover acupuncture?
Insurance
companies are much more likely to cover acupuncture now than
they have been in the past, due to increasing evidence that
acupuncture works and is a very cost-effective modality. In
particular, worker*s compensation and car insurance
companies have been quite open to approving acupuncture for
their clients. There is still a long way to go, however,
before acupuncture is universally recognized by insurance
companies. Federal government programs such as Medicare and
Medicaid do not cover acupuncture across the board, although
some program participants may qualify under their particular
provider. Blue Cross/Blue Shield in some states will cover
acupuncture performed by licensed acupuncturists, but BC/BS
Minnesota will only cover acupuncture performed by M.D.s at
this point.
The best thing to
do is to call your insurance company and see if acupuncture
is included in your benefits package. You also need to ask
if your insurance company will cover acupuncture performed
by any licensed acupuncturist, or if there are restrictions
such as oversight by an M.D., etc. Keep in mind that the
medical system in this country is in flux, and benefits may
change as the advantages of acupuncture treatment are more
widely recognized by insurance companies and providers.
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Does acupuncture hurt? Is it safe?
Most of the time,
the insertion of an acupuncture needle causes a slight
pinching sensation, much like a mosquito bite. This
sensation usually lasts less than a minute, and then the
needle is not painful at all. It is difficult to explain
exactly what an acupuncture sensation is like, because
people experience it differently. There can be a tingling
sensation, heat, numbness, an electrical ※zing,§ a lifting
or spreading sensation, heaviness, and others. If a needle
continues to hurt after insertion, it may be twisted around
a muscle fiber. In that case, tell the acupuncturist and he
will reposition the needle and relieve the pain. People who
are afraid of needles because of the pain of hypodermic
needles are usually pleasantly surprised by how mild the
acupuncture needle sensation is.
Acupuncture
needles are extremely safe. They are factory-sterilized and
placed in sterile packets. They are used once and then
disposed of. There is virtually no chance of infection.
Professional acupuncturists are trained in safe needle
insertion and are always aware of the body structures lying
below the skin surface.
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Do I need to prepare for an acupuncture treatment? How long
do the needles stay in? What about afterwards?
It is better not
to have an acupuncture treatment if you are very hungry or
too full. Some practitioners also advise against a treatment
if you are extremely fatigued or emotionally upset. Wear
clothing you are comfortable in: you will probably need to
pull your pants up above your knees, and women will need to
remove pantyhose. Before treatment, make sure you understand
everything the practitioner tells you about your condition
and how s/he plans to treat you. If you are interested in
learning about your condition from a Chinese medicine
perspective, ask questions. During treatment, relax as much
as possible. Do not move suddenly or reposition yourself
without the aid of the practitioner. Many people find
acupuncture so relaxing that they fall asleep during
treatment.
After the needles
are placed, they will stay in twenty to thirty minutes. The
acupuncturist will make you comfortable and will check in
with you about halfway through the treatment. For an initial
visit, when the practitioner needs to take a detailed
history from you, you should allow one hour for the entire
procedure. Follow-up visits generally take 40 每 45 minutes.
Patient responses
after treatment are quite varied. Some people do not notice
any unusual sensations at all afterwards. Some people feel
very energized, and some feel the need to go right to bed
and sleep. Many people continue to notice sensations in
their body like energy traveling around, even after the
needles are removed. Ideally, you will notice a reduction in
your symptoms after treatment, and will feel better. Some
patients have a dramatic improvement immediately after
treatment, but most patients make steady improvements over
time.
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How many treatments will I need?
That depends on
your condition and how well you respond to treatment. As a
general rule, acute conditions with sudden onset, such as
pulling a muscle in your back, will clear up quickly,
sometimes after only one treatment. The longer you have had
a condition, the more severe it is, and the older you are,
the longer it may take to treat it. A series of 10 每 12
weekly or bi-weekly treatments can resolve many chronic
problems. A severe condition such as recovery from a stroke,
or a degenerative condition such as multiple sclerosis will
probably require ongoing treatment over time to achieve
satisfactory results. A fair test to see if acupuncture will
improve your condition is to have two treatments per week
for two to three weeks. At that point, most people can judge
whether or not they are receiving sufficient benefit from
treatment to continue with it, even if they are not cured
yet. Back
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How do I know if a practitioner is qualified?
The practice of
acupuncture is licensed in at least 43 states as of 2008.
Using Minnesota as an example, the following procedure is
similar for most states (with the exception of California,
which has its own internal examination and licensing
procedure). To become licensed, a candidate must be a
graduate of an accredited school of Chinese medicine (or a
school which is in the process of accreditation). Most
schools of acupuncture and Oriental medicine require their
graduates to complete a minimum of 2800 hours of
professional training. The candidate must also pass a series
of national board examinations administered by the National
Certification Commission for Acupuncture and Oriental
Medicine (NCCAOM). The NCCAOM will award certifications such
as Diplomate of Acupuncture (Dipl.Ac.) and Diplomate of
Chinese Herbology (Dipl.CH), depending on which national
board exams the candidate passed. In Minnesota,
acupuncturists are licensed under the Minnesota Board of
Medical Practice, and should have the title of Licensed
Acupuncturist (L.Ac.) after their name. In other states,
acupuncture may be licensed or certified by a state
Department of Regulatory Agencies. In many states,
chiropractors are allowed to perform acupuncture services
under their scope of practice, but may not be licensed or
certified specifically in acupuncture, and often have little
or no training in Chinese herbology. It is always a good
idea to ask if a practitioner is a licensed acupuncturist,
where s/he went to school, what conditions s/he specializes
in, etc. when choosing a practitioner.
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How does Chinese medicine actually work?
Although the
vocabulary of Chinese medicine is specialized, the concepts
of treatment are easily understood. It is always about
restoring balance in the body systems. If there is heat in
the system (such as getting flu), cooling techniques are
applied; if something is too cool, it will be heated up.
Moist conditions are dried, and dry conditions are
moistened. When one of the fundamental body substances such
as qi or blood is stuck, the result is pain. Therefore, the
way to treat pain is by moving qi and blood. Sometimes
energy is flowing in the wrong direction and will be
redirected. Conditions of excess are diminished, and
conditions of deficiency are built up.
In order to treat
a condition, the practitioner must first diagnose the
problem. In Chinese medicine, the diagnostic process
involves assessing the patient*s overall appearance, looking
at the tongue, palpating the pulse on both wrists, and
asking questions. All the patient*s symptoms, taken
together, will present the practitioner with a pattern of
imbalance. Weaving signs and symptoms into a coherent
picture of what is wrong is called ※pattern diagnosis§ and
is the basis of treatment.
Once a
practitioner has diagnosed the type of imbalance a patient
is suffering from, s/he will employ Chinese medicine
techniques to restore the balance. For example, if a patient
is diagnosed with the pattern of Spleen Qi Deficiency,
acupuncture and Chinese herbs will be used to warm and dry
the spleen and to nourish and move spleen qi, and a diet
will be recommended which warms and nourishes spleen energy.
Moxibustion may also be used as a warming modality. Because
the spleen is associated with the emotion of worry or ※overthinking,§
the patient would also be advised to practice
stress-relieving techniques such as tai chi or meditation.
As a result of this treatment, the patient should experience
better digestion, higher energy levels, and clearer
thinking.
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How safe is Chinese medicine?
When practiced by
trained, qualified professionals, Chinese medicine is very
safe. Acupuncture needles are packaged in sterile units and
are discarded after a single use, so there is little to no
chance of infection from needles. Chinese herbs, while
extremely effective when administered correctly, are
generally not as powerful as Western drugs and have
dramatically fewer side effects. Reported incidents of
malpractice and doctor-caused disease (iatrogenic disease)
are much higher for Western medicine than for Chinese
medicine. In fact, while malpractice insurance rates for
Western M.D.s have skyrocketed over the past decade,
malpractice insurance rates for licensed acupuncturists have
actually gone down.
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Is Chinese medicine a ※cure-all§?
Chinese medicine
as it is currently practiced in this country is not intended
to be a substitute for Western medicine. It is generally
practiced as an adjunct to more conventional forms of
treatment. Most Chinese medicine practitioners believe that
our medical system would be ideal if it truly integrated the
strengths of Western medicine with the strengths of Chinese
medicine, as they do in China. Western medicine is
especially useful for acute situations such as trauma, heart
attack, pneumonia, etc. The use of vaccines, antibiotics,
steroids, life-saving surgery, and innovations such as
advanced imaging techniques has brought extended life and
health to billions around the world. Chinese medicine puts
its focus on treating the whole patient and bringing all the
bodily systems into balance and harmony. There is more
emphasis on catching imbalances early, before they manifest
as a disease process 每 on maintaining the healthy state
instead of trying to fix something that is broken. For
countless satisfied patients, Chinese medicine provides
exceptional, cost-effective treatment for many types of
chronic and acute medical conditions.
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What is Chinese herbal medicine good for? How is it used?
Chinese herbs are
one of the therapeutic modalities of Chinese medicine.
Historically, herbs were considered to be the most critical
element in successful patient treatment by Chinese
practitioners. Most professional Chinese medicine
practitioners in this country combine herbs with acupuncture
and other modalities to achieve maximum therapeutic results.
As opposed to Western herbal therapy, which tends to use
single herbs to address a specific symptom, Chinese herbal
formulas are typically made up of six to ten different
ingredients, and are usually intended to address a pattern
of symptoms, rather than a single symptom.
Chinese herbal
formulas are both powerful and subtle in their effect, and
can be used to treat almost any health condition. A general
statement would be to say that acupuncture alone can be
effective in the treatment of musculo-skeletal problems such
as acute back pain, joint pain, stress headaches, TMJ, etc.
Herbal formulas are most effective to address internal
problems arising from organ imbalances, such as
gastrointestinal, gynecological, circulatory and respiratory
problems. Even though such conditions as allergies,
sinusitis and skin problems seem to be more superficial,
they are actually a surface reflection of deep internal
imbalances and respond well to Chinese herbs.
Chinese herbs are
administered in several ways. Standard herbal formulas which
are designed to treat common disease patterns are generally
available in capsule or pill form, called ※patents.§ Single
herbs and formulas are also available as powders, tinctures,
granules, and herbal plasters. Decoctions made from raw
herbs are the most direct and patient-specific method to
administer herbs. Decoctions involve boiling a combination
of raw herb material such as roots and leaves, straining out
the liquid and drinking it.
In China,
decoctions are the most common way to take herbs. In this
country, patients often find the process of cooking herbs to
be too time-consuming and the taste of raw herbs to be
off-putting. However, the advantages of herbal decoctions as
therapy outweigh the inconvenience of preparing them. The
principal advantage of raw herb decoctions is that the
practitioner can tailor the formula to the specific needs of
the patient, and can continue to adjust or ※tweak§ the
individual herbs as necessary. For example, if a
practitioner is working with a woman*s menstrual cycle, a
tailor-made formula can be adjusted for the pre-ovulation,
post-ovulation, and menstrual phases of the cycle.
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Are Chinese herbs safe?
This question has
several aspects. One is the safety of the individual herbs
imported into this country from other countries. All herbal
imports, both raw herbs and prepared herbs, are required to
be inspected and cleared by the U.S. Food and Drug
Administration before they can be released to purchasers in
this country. The FDA collects samples and sends them at
random to non-government testing laboratories. All
legitimate herb-import businesses should be able to provide
documentation of the origin of their herbs and certification
of FDA inspection. You can always ask your practitioner if
s/he has researched the origin of the herbs s/he is
prescribing.
Although Chinese
herbs are not as powerful or as likely to produce side
effects as most Western drugs, they are still a form of drug
therapy and need to be treated seriously. It is generally
not advisable to take any drug or herbal product just
because it worked for somebody else. When prescribed by a
qualified, professionally-trained practitioner of Chinese
medicine, Chinese herbal formulas are both safe and
effective. A practitioner needs to assess your condition in
person before being able to prescribe herbal therapy.
Chinese herbs are used safely by pregnant women, and there
are a number of pediatric formulas designed to be used by
children.
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Will my insurance cover Chinese herbal therapy?
At this point,
probably not. Although there is good scientific evidence for
the efficacy of Chinese herbal medicine, the scientific
studies have been primarily conducted in Asian countries.
Government agencies in this country have not funded
scientific studies on Chinese herbal medicine, and Western
pharmaceutical companies have no incentive to conduct such
studies. There are no insurance codes that apply to Chinese
herbs, and without a code, a treatment cannot be billed.
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What is the evidence that acupuncture/Chinese medicine is
cost effective?
The National
Acupuncture and Oriental Medicine Alliance gathered data
from various studies involving acupuncture therapy and
arrived at the following conclusions:
l
Acupuncture treatment results in avoidance of surgery (based
on subjects with knee osteoarthritis who were candidates for
arthroplasty surgery 每 1992).
l
Acupuncture treatment results in decreased days in hospital
or nursing home (based on stroke patients whose standard
rehabilitative care was combined with acupuncture 每 1994).
l
Acupuncture treatment allows low-back pain patients to
return to physical labor (based on worker*s compensation
clinic patients whose standard physical therapy or
occupational therapy was augmented with acupuncture 每 1980).
l
Acupuncture treatment results in avoidance of surgery, fewer
hospital visits and greater return to employment (based on a
study of 69 patients with severe angina pectoris 每 1996).
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Isn*t
Chinese medicine essentially a form of folk medicine that
has been replaced by science-based Western medicine?
Just as modern
Western medicine is a complete system of medicine, with a
characteristic vocabulary and methods of diagnosis and
treatment, so Chinese medicine exists as a complete medical
system with its own vocabulary and therapeutic modalities.
To Western minds, the vocabulary of Chinese medicine sounds
strange, and therapeutic modalities such as acupuncture seem
exotic or incomprehensible. But Chinese medicine is solidly
based on thousands of years of observation and
experimentation. Chinese scholars and practitioners have
recorded their theories and clinical experience in thousands
of books (30,000 每 40,000 individual books on Chinese
medicine were written before 1900). The accumulated wisdom
and observation of millions of patient treatments are
documented in these treatises. In modern times, Chinese
medicine theories and treatment modalities have been
subjected to rigorous scientific testing on the Western
model. Acupuncture and herbal therapies have been tested
using gold-standard double-blind scientific studies, and the
scientific research overwhelmingly confirms the efficacy of
Chinese medicine treatment modalities. In most large Chinese
hospitals today, Chinese medicine and Western medicine are
practiced in an integrated manner, with each patient
receiving the treatment modalities that will work best for
him, whether it is Eastern acupuncture or Western radiation
therapy. Chinese medicine is currently used by at least
one-quarter of the world*s population as their primary form
of medicine for the simple reason that it works.
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