July 2008
International News
Practice Management
Continuing Education and Events		 State Legislative Activities
AAAOM Activities
AAAOM Student Organization		 National AOM Issues
Links
Products, Services, and Member Savings

Table of Contents:

International News



State Legislative Activities


Sponsors of:

National AOM Issues



Practice Management


Sponsors of:

AAAOM Activities



Links


Sponsors of:

Continuing Education and Events



AAAOM Student Organization


Products, Services, and Member Savings

 

Greetings AOM Members and Colleagues:

Dry needling continues to be a major scope of practice issue in AOM. In this special issue of the Qi-Unity Report, we offer you two dry needling perspectives. Valerie Hobbs writes from an acupuncturist’s point of view, checking in from Colorado, where dry needling has been a concern from some time. Jan Dommerholt, an instructor and proponent of dry needling, responds to earlier AAAOM statements on the matter. Elsewhere, Qi-Unity Report interviews editor-in-chief Adam Burke about The American Acupuncturist achieving CINAHL indexing. We also offer further reflections on the importance of AOM rebuttal from Burton Kent, acupuncture marketing aficionado. Practitioner Michael Max in Seattle writes on Jade Wind Screen formula. As always we bring you more integrator blog essentials from John Weeks and the latest from our fervently growing AAAOM-SO. With so much to gain, we encourage you to spend some time with the complete issue of your Qi-Unity Report.

Once again we extend our appreciation to Golden Flower, Kan Herb, and Mayway for choosing to sponsor the Qi-Unity Report. If you are one of our business partners, wouldn’t you like to join them? Your continued support invigorates the AAAOM and serves to remind us that the AOM profession is, in many ways, the sum of our collective efforts as a community. Thank you, sponsors, for your support! We ask our practitioner members to patronize those businesses that have put themselves forward to support your profession.

We hope this edition of the Qi-Unity Report keeps you informed of the various issues that affect your life and practice in AOM. As usual, we’re here for you and would love to hear what you think.

The AAAOM is interested in your feedback. We invite you to use our General Feedback page to let us know your opinions and insights.

International News

Links to International AOM Articles

Prized ingredient used in traditional Chinese medicine is priced higher than gold.
www.rediff.com

Traditional natural medicines are used across Cuba's healthcare system today, in disease prevention as well as diagnosis and treatment. Cuba has hosted an international alternative medicine conference since 1996.
www.radionuevitas.co.cu

Promising Chinese Herbal Targets Identified For Acute Pancreatitis
www.sciencedaily.com

Swedish soccer star received acupuncture and ultrasound on his knee before match against Russia.
www.timesonline.co.uk

U.S. and China Foster Collaboration in Traditional Chinese Medicine Research
www.tcmstudent.com

Herbal Medicine: Will Practitioner Regulation Protect Consumers? New book from UK
www.medicalnewstoday.com

The Chinese approach to treating sinusitis
www.jamaica-gleaner.com

State Legislative Activities

Proposed changes to state law regarding acupuncture in Texas

Recent medical board activity in Texas has proposed new regulations that impact the AOM profession. Rules include increasing the opportunities to sit for exams and removing the medical board’s scrutiny of AOM schools (since the board no longer vets schools).

For more, please read the following section within the subsequent link:

§161.6.Committees of the Board.

texinfo.library.unt.edu


National AOM Issues

The “Dry Needling Issue”

By Jan Dommerholt, PT, MPS, FAAPM

In a recent article published in the Qi-Unity Report newsletter, Valerie Hobbs, DiplOM, LAc reviewed several pertinent issues regarding dry needling and acupuncture (1). One of the concerns of Ms. Hobbs, which is shared by the American Association of Acupuncture and Oriental Medicine (AAAOM), relates to an increasing number of states that have approved dry needling as a modality within the scope of physical therapy practice. On October 8, 2007, Leslie McGee, RN, LAc, DiplAc/CH and Martin Herbkersman, MTOM, DAc, who at the time were the AAAOM president and vice president respectively, issued a letter (PDF) on behalf of the AAAOM, stating that “so-called dry-needling has infringed upon the rights of acupuncture practitioners in the states of Virginia and Colorado.” In the same letter, they expressed that “the AAAOM opposes the use of dry-needling by physical therapists in Colorado and elsewhere in the United States” as they “consider dry-needling to fall squarely within the range of acupuncture practice.” Others have shared similar sentiments. Dr. Peter D. Lichtenstein, DC, CCSP, LAc, president of the Acupuncture Society of New York, introduced a reprint of Ms. Hobbs article as “an important article” that “may point to some challenges in the future.” He also announced that he had “instructed [the] lobbyist to be on the lookout for any such movement in PT scope of practice in NY”, as “this bodes ill for the rest of the country if dry needling is allowed with the PT scope of practice.”

In this article, I would like to present some thoughts about dry needling from my physical therapy perspective. In her article, Ms. Hobbs characterized me as “a leading researcher and proponent of the addition of dry needling to the scope of Physical Therapy.” I have been teaching trigger point dry needling courses since 1996 not only in the United States, but also in many other countries. I would like to emphasize that I do not single out physical therapists in my efforts to promote dry needling as a tool to treat our patients. Past course participants have included physical therapists, but also physicians, dentists, chiropractors, nurse practitioners, physician assistants, and acupuncturists. I agree with the AAAOM that dry needling falls within the scope of acupuncture practice, which is why acupuncture practitioners are invited to attend our courses. I do not agree however, that dry needling would fall within the exclusive domain of any discipline, including acupuncture, physical therapy, or medicine. While I have published a few articles on dry needling in the physical therapy literature, I have published many more papers and book chapters in the pain management literature, which have included information about trigger point dry needling (2-15). I would also like to emphasize that in my opinion, dry needling is just one tool in the clinical toolbox. Dry needling is not a specific approach and dry needling is not appropriate for every patient (14). In our course program we emphasize that Travell rediscovered trigger points (10, 16, 17). There is no question that some of the trigger points have been described previously as acupuncture points, a shi points, kori, myogelosis, fibrosis, etc. (18, 19). Similarly, there are close similarities in between the pathways of some acupuncture meridians and referred pain patterns of myofascial trigger points (18-21). Dorsher found similar patterns for as many as 76% of corresponding points (19). That does not mean however, that the phenomenon of a localized muscle contracture and its treatment with needles belong to one discipline only.

There are many disciplines that share similar techniques or approaches in their scope of practice. Homeopathic and naturopathic physicians share the use of herbs in their practice with acupuncturists, but neither discipline owns the exclusive rights to herbal remedies. Chiropractors have argued that spinal manipulations are within their exclusive scope of practice, although physical therapists and osteopathic physicians employ the technique all over the world (22). Yet the underlying philosophy, thought process, and decision-making may be unique to each discipline. Homeopathic physicians may prescribe herbal remedies without knowing anything about an acupuncturist’s perspective on using similar remedies. Physical therapists in the United Kingdom and the state of Maryland are legally allowed to perform trigger point injections as part of their scope of practice without being accused of practicing medicine without a license. Acupuncturists and physical therapists can collaborate even when it involves dry needling. One of our acupuncture course participants has published two books on the subject of acupuncture and dry needling and I had the distinct honor of writing the preface to his most recent publication (20, 23).

During a hearing on dry needling of the Colorado Board of Regulations in October, 2007, Ms. Hobbs and I shared the opportunity to testify. Unfortunately, my testimony was delivered via telephone from my office in Bethesda, MD, rather than in person. In addition to making it rather challenging to reply at once to several speakers opposing dry needling by physical therapists, it was a bit frustrating as there was little room for dialogue. I hope that this article will open the door for further dialogue, discussion, and satisfactory resolution. Jane Goodall is quoted as “change happens by listening and then starting a dialogue with the people who are doing something you don't believe is right.” I have listened intently to Ms. Hobbs and her acupuncture colleagues during their testimonies as well as to several other acupuncturists. Some expressed being in favor of physical therapists using the dry needling technique, while others vehemently opposed it. I hope the AAAOM, state acupuncture societies and associations, and individual acupuncture practitioners will be prepared to listen and engage in an active dialogue.

My background in using trigger point dry needling is based entirely on a medical perspective inspired by the work and publications of medical doctors Travell, Simons, Lewit, Gunn, Gerwin, Baldry, Dejung, and many others with whom I studied (10). I have not studied acupuncture nor have I ever suggested that I practice acupuncture. As Ms. Hobbs pointedly paraphrased, in some past articles I may have expressed a rather biased and simplistic opinion of acupuncture. After reviewing Ms. Hobbs’ criticism, I believe that some of my comments were partially in response to assertive efforts of particular acupuncture practitioners to prohibit any needling procedures by physical therapists, and partially due to ignorance. In retrospect, I regret that sometimes I resorted to “turf behavior” and that I did not study the various schools of acupuncture in more detail to gain a better understanding of the varied perspectives of acupuncturists. I had restricted my perspective to the energetic concepts of traditional Chinese medicine. Interestingly, acupuncturist Amado wrote that when acupuncture is defined as an effort to control energy flow, there are few if any correlations with trigger point dry needling. He maintained that traditional Chinese medicine would be based on pre-scientific ideas, rather than the scientific neurophysiologic and anatomic principles underlying dry needling (24). I would like to suggest that acupuncture practitioners study the medical and physical therapy perspective on dry needling before repeating my mistakes.

As Ms. Hobbs indicated in her article, there is debate in the scientific literature whether dry needling is a part of acupuncture practice (1). Dry needling techniques are performed with the same solid filament needles acupuncture practitioners are using, but dry needling does not require knowledge of the theoretical foundations of acupuncture (24). Travell, Simons, and Lewit were not familiar with the acupuncture literature when they published their observations and management strategies of trigger points, and there are no indications that earlier medical practitioners who described trigger point phenomena were familiar with the acupuncture literature (7). Historically, there are several examples of physicians inserting needles and even ladies’ hat pins in points of maximum tenderness without considering the concepts of traditional acupuncture (25-27). Hobbs erroneously suggested that Simons, co-author of the Trigger Point Manuals, has been teaching dry needling techniques since the 1980s. In fact, Simons did not experience dry needling until 2006 when one of our physical therapy graduates treated him with the dry needling technique.

Lewit, a physician from the Czech Republic, published one of the first reviews in the medical literature. He reported that dry needling of myofascial trigger points caused immediate analgesia in almost 87% of the needle sites, which he referred to as the “needle effect.” Nearly a third of subjects remained free of pain. About 20% of subjects experienced several months without pain, 22% several weeks, 11% several days, and approximately 14% had no pain relief. Lewit observed that the effectiveness of dry needling was directly related to the accuracy of needling (28), which in my opinion depends greatly on the ability to palpate myofascial trigger points accurately (10). In 1980, Gunn et al. published a prospective dry needling study of injured workers with low back pain and demonstrated that dry needling was an effective treatment for low back pain (29).

Whether dry needling should be considered a form of acupuncture depends to some degree on how acupuncture is defined. Seem, founder and president of the Tri-State College of Acupuncture, argued that American acupuncturists usually do not “treat tender or tight spots and, hence, never really achieve myofascial release in their recurrent and chronic pain patients” (18). I understand that not all acupuncture practitioners agree with Seem’s perspective. Even acupuncture societies and associations do not necessarily agree whether dry needling is a form of acupuncture. Where the Acupuncture Society of Virginia insisted that “dry needling is not acupuncture” when administered by physical therapists, the Acupuncture Association of Colorado maintained that “dry needling is acupuncture” (1, 30). On its website, the Acupuncture Society of Virginia does state “that the practice [of dry needling] clearly falls under the state’s definition of acupuncture, and physical therapists are not permitted by the Board of Medicine to practice acupuncture” (http://www.acusova.com/legislative.htm, accessed March 27, 2008). For the record, the Board of Medicine does not determine the scope of physical therapy practice in Virginia.

The AAAOM suggests that the dry needling education of physical therapists “constitutes a public health hazard.” The typical acupuncture education “of at least 3,000 hours” is contrasted with the hours required by the leading post-graduate education programs in trigger point dry needling. I can only hope that the AAAOM executives realize that their argument is terribly flawed. They are implying that acupuncture students would limit their studies to finding suitable points to needle without spending any time on anatomy, physiology, herbal remedies, oriental theory and diagnosis, and Western theory and diagnosis. Also, not every acupuncture program consists of at least 3,000 hours of education. For example, a quick internet search revealed that the Master of Acupuncture degree at the University of Bridgeport consists of 2,450 hours (http://www.bridgeport.edu/pages/2713.asp, accessed March 27, 2008). The program is accredited by the Accreditation Commission for Acupuncture and Oriental Medicine. According to the Council of Colleges of Acupuncture and Oriental Medicine, a professional acupuncture curriculum must consist of at least 1,950 hours, divided into at least 705 hours in Oriental medical theory, diagnosis and treatment techniques in acupuncture and related studies, 660 hours in clinical training, 450 hours in biomedical clinical sciences, and 90 hours in counseling, communication, ethics, and practice management (http://www.ccaom.org/faqs.asp, accessed March 27, 2008). Physical therapists who attend the post-graduate courses in myofascial trigger point therapy have already completed their professional training. In 2004, the average number of hours of education in entry-level doctoral physical therapy programs was 2,676. Physical therapy education emphasizes anatomical knowledge in much more depth than typical acupuncture schools. Detailed knowledge of anatomy should be one of the major regulatory concerns to protect patients undergoing dry needling procedures. The post-graduate courses build on the knowledge and skills achieved during graduate physical therapy education. I do not see how such comparable educational levels would constitute a public health hazard. Physical therapists in many countries around the world practice trigger point dry needling without any documented health hazards. From my physical therapy perspective, the United States is far behind in allowing physical therapists to use dry needling in their scope of practice compared to countries such as Canada, the United Kingdom, Ireland, the Netherlands, Norway, Switzerland, Belgium, Spain, Chile, South Africa, Australia, and New Zealand, among others, where dry needling techniques are within the scope of physical therapy practice.

Ms. Hobbs stated that “no standards are available for dry needling education and no college of physical therapy has offered a course in dry needling to date.” The standards for our post-graduate education program are developed in close coordination with the dry needling programs at many universities and other post-graduate educational programs in Europe and South Africa. For example, many universities in Spain offer specialist certification programs in myofascial trigger point therapy, which include dry needling. Again, in my humble opinion the United States is falling behind in this respect. As Ms. Hobbs indicated, Georgia State University is the first doctoral program in physical therapy that includes specific coursework in trigger point therapy and dry needling. The curriculum at Georgia State University has been developed with the same global orientation reflective of the world we live in. I share Ms. Hobbs’ concerns that accreditation agencies and state boards of physical therapy should develop standards against which post-graduate continuing programs are measured. To the best of my knowledge, there are three post-graduate education programs in the United States and one in Canada. Our program is the only U.S.-based program that welcomes acupuncture practitioners.

Ms. Hobbs reports that physical therapists are billing for dry needling procedures using CPT trigger point injection codes 20522 and 20553 and can collect as much as $180 and $400 respectively. I must admit that I was very surprised when I read this paragraph. In our course program we do not advocate using injection codes when performing dry needling techniques, although the American Academy of Family Physicians in 2004 advocated that the trigger point injection codes can be used even when performing dry needling (http://www.aafp.org/fpm/20041000/coding.html). According to the American Academy of Family Physicians, “the intent of CPT codes 20552 and 20553 is to identify the procedure of performing the trigger-point injection, regardless of whether an injectable is supplied. If an injectable is supplied, you would need to report the supply of any injectables separately by submitting the appropriate HCPCS code(s) or code 99070, "Supplies and materials (except spectacles), provided by the physician over and above those usually included with the office visit or other services rendered (list drugs, trays, supplies, or materials provided)." Note that 20552 and 20553 should not be used for acupuncture procedures, which are more appropriately reported with CPT codes 97780-97781”. However, it is illegal to bill for injections when no injectable is used in most states and under Medicare regulations. Further research revealed that the state of Colorado, Department of Labor and Employment, Division of Workers’ Compensation maintains that a “trigger point injection consists of dry needling or injection of local anesthetic with or without corticosteroid……” (31). In other words, in the state of Colorado, physical therapists are instructed by the Department of Labor to use trigger point injection codes, which would make it tempting to move to Colorado, were it not that all insurance companies in Colorado have agreed to switch to a per diem reimbursement system in which the reimbursement will be the same irrespective of which CPT code is used. There are no CPT codes for dry needling and physical therapists cannot use acupuncture codes 97780-97781.

Lastly, the AAAOM maintains that “dry needling has infringed upon the rights of acupuncture practitioners in the states of Virginia and Colorado.” Trigger point dry needling has been within the scope of physical therapy practice in the state of Maryland since 1987, and there have been no infringements of any acupuncturist’s rights in Maryland. In 2006, I was invited to testify for the Physical Therapy Board of the Commonwealth of Virginia when the Acupuncture Society of Virginia challenged the board about physical therapists using the dry needling technique. I am not aware of any evidence that the rights of acupuncture practitioners in Virginia have been infringed. The situation in Colorado was a bit more challenging. As Ms. Hobbs summarized, the Colorado Acupuncture Practice Act would potentially prohibit acupuncturists from using the technique when physical therapists are allowed to use dry needling. At the time of my testimony for the Colorado Board of Regulations I was not aware of this complication. However, I do not believe that this infringes upon the rights of Colorado acupuncturists either.

I would like to suggest that to avoid any legal or statutory complications, the term “trigger point acupuncture” may be the most appropriate term for the techniques acupuncture practitioners use to treat myofascial trigger points, a shi points, or kori. When non-acupuncture practitioners such as physical therapists or physicians treat trigger points with solid filament needles, the term “dry needling” may be preferable (7). I agree with Ms. Hobbs that physical therapists trained in trigger point therapy, including dry needing, should emphasize that they are not practicing acupuncture, perhaps through consent forms, newsletters, websites, posters in their clinics, etc. There are a few states where physical therapists are not allowed to use dry needling techniques (10). The Hawaii physical therapy statutes prohibit physical therapists from penetrating the skin. In Tennessee, a judge followed the advice of a member of the Board of Physical Therapy, who had concluded that since dry needling is not taught in academic institutions, it should be prohibited. Other states that currently prohibit dry needling by physical therapists are New York and North Carolina. In most other states, the issue has not been addressed. The Florida statutes are rather unusual. According to the Florida statutes, physical therapists are allowed to perform “acupuncture only upon compliance with the criteria set forth by the Board of Medicine, when no penetration of the skin occurs.” By differentiating between “trigger point acupuncture” and “dry needling” this may be an obsolete point.

It would seem that patients would only benefit if practitioners representing different disciplines would be skilled in using these techniques (7). I do not believe that physical therapists using dry needling techniques in their practices pose any threat to acupuncturists. A longstanding history of dry needling by physical therapists in other countries and in the state of Maryland has demonstrated that ultimately the consumer of healthcare determines which practitioner becomes the practitioner of choice. I welcome the dialogue and hope that in the end the interests of our patients will be the guiding light.

References

1. Hobbs V, Dry needling and acupuncture emerging professional issues, in Qi Unity Report. 2007, AAAOM: Sacramento.
2. Dommerholt J, Muscle pain syndromes, in Myofascial Manipulation, RI Cantu and Grodin AJ, Editors. 2001, Aspen: Gaithersburg. p. 93-140.
3. Dommerholt J, Dry needling in orthopedic physical therapy practice. Orthop Phys Ther Practice. 16(3): 15-20, 2004
4. Dommerholt J, Persistent myalgia following whiplash. Curr Pain Headache Rep. 9(5): 326-30, 2005
5. Dommerholt J, Physical therapy in an interdisciplinary pain management center, in Pain Practitioner. 2005. p. 32-36.
6. Dommerholt J, Bron C, and Franssen JLM, Myofascial trigger points; an evidence-informed review. J Manual Manipulative Ther. 14(4): 203-221, 2006
7. Dommerholt J and Gerwin R, D., Neurophysiological effects of trigger point needling therapies, in Diagnosis and management of tension type and cervicogenic headache, C Fernández de las Peñas, Arendt-Nielsen L, and Gerwin RD, Editors. 2008, in press, Jones & Bartlett: Boston.
8. Dommerholt J and Gröbli C, Knee pain, in Clinical mastery of myofascial pain syndrome, L Whyte-Ferguson and Gerwin RD, Editors. 2005, Lippincott, Williams & Wilkins: Baltimore. p. 359-389.
9. Dommerholt J and Issa T, Differential diagnosis: myofascial pain, in Fibromyalgia syndrome; a practitioner's guide to treatment, L Chaitow, Editor. 2003, Churchill Livingstone: Edinburgh. p. 149-177.
10. Dommerholt J, Mayoral O, and Gröbli C, Trigger point dry needling. J Manual Manipulative Ther. 14(4): E70-E87, 2006
11. Dommerholt J and McEvoy J, Myofascial trigger point release approach in Orthopaedic manual physical therapy: from art to evidence, CH Wise, Editor. 2008, in press, FA Davis: Philadelphia.
12. Dommerholt J, Royson MW, and Whyte-Ferguson L, Neck pain and dysfunction following whiplash, in Clinical mastery of myofascial pain syndrome, L Whyte-Ferguson and Gerwin RD, Editors. 2005, Lippincott, Williams & Wilkins: Baltimore. p. 57-89.
13. Dommerholt J and Shah J, Myofascial pain syndrome, in Bonica's Pain Management, JC Ballantyne, Rathmell JP, and Fishman SM, Editors. 2008, in press, Lippincott, Williams & Williams: Baltimore.
14. Gerwin RD and Dommerholt J, Treatment of myofascial pain syndromes, in Weiner's pain management; a practical guide for clinicians, MV Boswell and Cole BE, Editors. 2006, CRC Press: Boca Raton. p. 477-492.
15. Gröbli C and Dommerholt J, Myofasziale Triggerpunkte; Pathologie und Behandlungsmöglichkeiten. Manuelle Medizin. 35: 295-303, 1997
16. Baldry PE, Acupuncture, Trigger Points and Musculoskeletal Pain. Edinburgh: Churchill Livingstone, 2005
17. Simons DG, Muscle pain syndromes - part 1. Am J Phys Med. 54: 289-311, 1975
18. Seem M, A new American acupuncture; acupuncture osteopathy. Boulder: Blue Poppy Press, 2007
19. Dorsher P, Trigger points and acupuncture points: anatomic and clinical correlations. Med Acupunct. 17(3): 21-25, 2006
20. Cardinal S, Points détente et acupuncture: approche neurophysiologique. Montreal: Centre collégial de développement de matériel didactique, 2004
21. Cardinal S, Points-détente et acupuncture: techniques de puncture. Montréal: Centre collégial de développement de matériel didactique, 2007
22. Paris SV, A history of manipulative therapy through the ages and up to the current controversy in the United States. J Manual Manipulative Ther. 8(2): 66-77, 2000
23. Cardinal S, Points-détente et acupuncture: techniques de puncture. Montréal: Centre collégial de développement de matériel didactique, 2007
24. Amaro JA, When acupuncture becomes "dry needling", in Acupuncture Today. 2007. p. 33, 43.
25. Churchill JM, A treatise on acupuncturation being a description of a surgical operation originally peculiar to the Japanese and Chinese, and by them denominated zin – king, now introduced into European practice, with directions for its performance and cases illustrating its success. .London: Simpkins & Marshall, 1821
26. Elliotson J, The use of the sulphate of copper in chronic diarrhoea together with an essay on acupuncture. Medicochirurigical Transactions. 13(2): 451-467, 1827
27. Osler W, The principles and practice of medicine. New York: Appleton, 1912
28. Lewit K, The needle effect in the relief of myofascial pain. Pain. 6: 83-90, 1979
29. Gunn CC, Milbrandt WE, Little AS, and Mason KE, Dry needling of muscle motor points for chronic low-back pain: a randomized clinical trial with long-term follow-up. Spine. 5(3): 279-91, 1980
30. Virginia Board of Physical Therapy Task Force on Dry Needling, Meeting minutes, VBoP Therapy, Editor. 2007: Richmond.
31. Division of Workers' Compensation, Rule XVII, Exhibit A; Low back pain medical treatment guidelines. 2001, State of Colorado, Department of Labor and Employment: Denver.

The Rose Has a New Name

(A Response to Mr. Dommerholt)

By Valerie Hobbs, DiplOM, LAc

When I walked into the treatment room last Tuesday night, the last thing in my mind was whether or not the most effective treatment for my patient would be considered as dry needling or as acupuncture.

I teach in an acupuncture college, and I work in an OB-Gyn acupuncture clinic twice a week. Like most acupuncturists, even with a specialty designation, the patients I see frequently present me with musculo-skeletal complaints. One of my patients on that Tuesday was a 27 year old primigravida at 14 weeks gestation. She was seeking acupuncture treatment for the first time. Her chief complaints were fatigue, morning sickness, and back and hip pain.

While the Chinese medical diagnoses of spleen qi vacuity, liver and stomach disharmony, and qi stagnation in the taiyang and shaoyang channels were emerging, I was also assessing trigger points in the quadradus lumborum, gluteus minimus, and gluteus medius. I was thinking in both Western anatomic and Chinese medical terms because what I do, what I have been trained to do, is to practice an integrated system of medicine. Although the gluteus medius points were mildly tender to deep palpation, the gluteus minimus points were tender and taut. However the quadratus lumborum trigger points were the most tender and taut. My patient’s pelvis was normally aligned with neither an anterior or posterior tilt nor a right to left or left to right rotation. Palpation of distal meridian points and pulse diagnosis confirmed the underlying Chinese medical diagnosis of spleen qi vacuity with liver and stomach disharmony.

To needle the QL trigger points, I would need to disperse points in close proximity to the kidney organ back shu points. Because of the early pregnancy status, the moderate nature of the muscle spasm, the Chinese medical implications of the location of the points, and also because the patient was seeking treatment the first time, I chose not to deeply needle the muscle trigger points. I chose instead to use a distal point technique. A point 1 cun distal to Lung 5, which was also ropy, tight, and painful to palpation was needled ipsolateral to the back pain. The needle was inserted to a depth of 2-2.5 cm until a qi sensation was felt, and the muscle fibers in the area of needling released. The patient was standing and was asked to gently extend and flex at the waist. The pain relief in the quadratus lumborum with an increased range of motion was immediate. QL trigger points that were previously taut and tender were no longer taut and no longer painful. The rest of the treatment commenced to fortify the spleen and harmonize the liver and stomach.

The previous week a 34 year old woman with a chief complaint of lateral hip pain sought treatment in her 28th week of her second pregnancy. For years she had played softball in the catcher position and had developed hip pain in her first pregnancy, which became very problematic. It had been described as a 6/7 out of 10 on a pain scale, disrupting both activity and sleep. Trigger points were palpated bilaterally in the piriformis. Trigger points and motor points in the piriformis muscle were needled deeply into the piriformis. Fasciculation was not elicited per se. What I felt, and what I wanted to elicit, was the anatomic sensation of muscular release, with the underlying TCM “deqi” sensation. The relief was again immediate.

I had learned the techniques I used in my first diploma degree program in traditional Chinese medicine in 1994. I learned this technique from acupuncturist Jim Skioen, based on the work of Janet Travell, and learned further refinements of the technique most recently through post graduate education with acupuncturists Whit Reaves, Matt Callison, Michael Young and physical therapist Cary Gold. Had a viewer from another planet been observing the technique, it would have been indistinguishable from dry needling. Had a viewer from the psychic network been observing both my treatment and that of a physical therapist, he or she would have had an equally difficult time discerning any difference in thought pattern concerning the Western anatomical assessment and application of treatment.

The debate about the emergence of dry needling and its relationship with acupuncture continues. In my opinion, it is a highly sociological, perhaps even anthropological, but not necessarily a medical, debate. Proponents of dry needling, as well as some acupuncturists, describe a definition of acupuncture as an energetic balancing system based on classic principles.

This definition of acupuncture is a modern Western invention. Western medical non-acupuncturist practitioners seek to describe their recent “discovery” of what acupuncturists have long known, that is, that the insertion of a needle into the body can alleviate pain. Because the Western researchers describe the phenomenon in Western medical terms, skipping the complex of Asian medical diagnostics and acupuncture point and meridian energetics, they claim that they are doing something quite distinct from practitioners who trace their lineage of knowledge from Asian medical sources. In a way this Western approach is isolating the subset of acupuncture techniques that they perceive as what “really works” or that subset which can be described and measured in Western medical terminology. The contention is, then, that a single technique is being adopted, not the entire medical system. Since that technique is described in Western terms, by Western practitioners who claim no knowledge of Asian medicine, it has become a new and distinct area of medical practice.

Some modern Western acupuncturists have also embraced the trend to define themselves as practicing a medicine that encompasses an energetic balancing, and this is reflected is some state’s practice acts. This trend does not follow World Health Organization definitions, which tends to define the practice of acupuncture by technique. The most recent document on the subject from the WHO, Acupuncture: Review and Analysis of Reports on Controlled Clinical Trials by Xiaorui Zhang, describes the system of acupuncture treatment in this way: “the term ‘acupuncture’ is used in its broad sense to include traditional body needling, moxibustion, electric acupuncture (electro-acupuncture), laser acupuncture (photo- acupuncture), microsystem acupuncture such as ear (auricular), face, hand and scalp acupuncture, and acupressure (the application of pressure at selected sites).”1 The most recent successfully enacted acupuncture practice act in the U.S. is from the state of Michigan in 2006. Public Act 30 defines acupuncture in this way: “Acupuncture’ means the insertion and manipulation of needles through the surface of the human body at specific locations on the human body for the prevention or correction of disease, injury, pain, or other condition.”2

In adopting language that describes Asian medicine as an energetic balancing system, what acupuncturists may be attempting to do, independently or in response to medical practitioners who isolate and adopt single techniques, is to distinguish what they are doing as a system-based approach to health care rather than being defined by the individual technique. This more global language also embraces the larger scope of Asian medicine that extends beyond physical medicine into internal medicine. Certainly, as an acupuncturist, I know that what I did in my Tuesday night clinic was not simply to needle the piriformis muscle. The needling of the piriformis was performed in the context of a comprehensive treatment based on the presentation of the entire individual. However, if I were to define my scope of practice as providing healthcare by utilizing an ancient energetic system of balance, would I someday find myself sacrificing the scope of acupuncture defined in Western medical terms to a biomedical practitioner?

Sticking points
Articles on dry needling and its disassociation with acupuncture continue to be published3, and the ramifications from the most recent legal debate in Colorado are still emerging. What follows are a distillation of what I am calling sticking points—those areas of debate that reveal the contrast in the points of view from those promoting dry needling by biomedical practitioners based on their knowledge of Western anatomy and the acupuncture community.

Contrasting Approaches
There are inherent differences in a Western medicine approach and an Asian medicine approach when diagnosing and treating disease. Western medicine has been and continues to be focused on the single component that describes or treats a medical condition or disease. We have therefore mapped the human genome, discovered viruses, and extrapolated active ingredients to create Western pharmacology. Asian medicine, while recognizing and utilizing the single component, describes the environment in which that single component manifests. Therefore, while the physical therapist may dry needle a trigger point in the infraspinatus, the acupuncturist treats the person whose infraspinatus muscle is in spasm. Whether it is the needle in the trigger point that provides relief or it is the global needling of the entire system that provides relief remains an area of fascinating study.

Exclusive Use of Western Medical Terminology
What proponents of dry needling claim is that since they are thinking in Western anatomic terms, that their technique is distinct from techniques performed by a licensed acupuncturist even though the instrument employed, and that location on the body, and manipulation is exactly the same. In other words, dry needlers are suggesting that the scope of practice be defined by what is in the mind of the practitioner. What is most dangerous about this assertion is the subsequent drawing of a distinction in the regulatory environment that everything in Asian medicine must be couched in terms of ancient origin. This is contrary to the educational and regulatory advancements to date in the United States for the licensing of qualified trained practitioners of Asian medicine.

In discussing the need to provide clarification of authority to diagnose in Western medical terms, The Little Hoover Commission, in its 2004 report to the California legislature concluded, “interactions with other health care providers, including collaboration and referrals, as well as with many members of the public, benefit from the use of common, Western-based diagnostic terminology.”4

The move to expand the physical therapy scope by drawing a distinction through use of language and the thought process of the practitioner is quite chilling. Asian medicine has never been, nor is it now, a static system of medicine. While based in classic literature of unprecedented history, 2000 years of interpretation have resulted in many, many advancements and reinterpretations. I am quite sure that Zhang Zhongjing himself would have been fascinated by culturing bacteria in the course of what he described as an internal heat invasion and would have gone on to describe when and how to properly apply broad-spectrum antibiotic therapy, undoubtedly within the context of additional herbal medicinals to mitigate its side effects and enhance its efficacy.

At no time in human history have we had this current benefit of global instantaneous communication and integration of knowledge. The impact of this globalization is greatly felt within the practice of Asian medicine. There are many changes and advancements occurring as a result of this unprecedented integration. Some of these advancements are a direct result of Western scientific inquiry and analysis. My Tuesday night patients are absolutely safer and enjoy much more efficacious treatment than they could if I were to be restricted only to a system of healing based solely on pre-scientific Asian medical diagnostics and systems of treatment. In fact, educational and professional mandates have been promoted by the profession and embodied within the laws that govern my practice. While basic diagnoses may be derived from the medicine as it was practiced in past centuries, I work as an independent provider of health care in the United States in the 21st century. I must integrate both systems and not be relegated to only one. Janet Travell’s seminal work is as much a basis for my daily practice as it is for the physical therapist.

Equal Status in the Health Care System
The reason I characterize the debate about dry needling and its relationship to acupuncture as a sociological debate is because the debate emerges in and is highly shaped by Northern European and Northern-European derived cultures. There is certainly no confusion about the integration of Asian medicine and Western medicine or whether or not dry needling is acupuncture in the countries of origin of acupuncture, namely China, Japan, Korea, Vietnam, etc.

A concerted effort was undertaken in the 1970s by biomedical practitioners in Northern-European derived cultures to distance themselves from acupuncture and to do so by creating new descriptions in Western science terms. As Chan Gunn, a founder of dry needling, wrote in 1976, “As a first step toward acceptance of acupuncture by the medical profession, it is suggested that a new system of acupuncture locus nomenclature be introduced, relating them to known neural structures.”5

The dry needling regulatory debate has been centered in health care systems dominated by Western culture and Western medicine. The professions engaged in that debate are unfortunately in disparate positions in that health care system. Insurance parity becomes a primary issue, with physical therapists being reimbursed at 3-10x the rate of an acupuncturist for virtually identical treatments. (And that is if the insurance company will reimburse the acupuncturist at all.) In many states, the medical acupuncturist may receive payment, but the licensed acupuncturist is excluded.

The practice of Asian medicine encompasses much more than the treatment of musculo-skeletal pain. However, the proportion of practitioners in the United States that utilize trigger point therapy is 82%.6 Therefore, the impact of physical therapists entering the field with readily available insurance reimbursement (with virtually a long weekend’s worth of education) does indeed infringe on the practice of licensed acupuncturists.

Lack of Independent Certification
At the heart of this debate is the wide gulf between the receptive professions’ views of the certification criteria necessary to inform the public or ensure some measure of public safety. Acupuncturists practice under specific and widely proscriptive educational criteria. The American Physical Therapy Association does not consider dry needling an entry-level technique, and they neither promote nor intend to promote educational standards for techniques that they do not consider entry-level techniques.

In the physical therapy profession, many invasive techniques such as joint manipulation, wound debridement, and dry needling are all learned in post-graduate courses for which there is no educational standard. MyoPain Seminars, led by Mr. Dommerholt, requires extensive training in myofascial trigger point identification before they teach dry needling. A certification exam is also offered. But this is not the only course offered, and in Colorado at least two other providers have emerged who teach considerably less hours in weekend courses. No clinical hours are required on actual patients. In fact, in Colorado no registration of educators offering courses or of physical therapists using the technique is required at all.

It was recently reported to me that a Colorado physical therapist treated a patient for the pain of a partial tear of a tendon by inserting acupuncture needles near the area of pain. The Colorado physical therapy rule allows for a broad definition to insert a filiform needle to treat pain and is not relegated to trigger point therapy only. It would seem that any acupuncture technique that treats pain, as long as it does not involve distal or auricular points, is within the scope of physical therapy after a weekend of education in the technique. With no monitoring of either education or the physical therapist, who is to say what further acupuncture techniques physical therapists will apply?

True collaboration
If those who promote dry needling techniques for any medical practitioner truly believe that dry needling falls within the larger scope of acupuncture, then meeting the Institute of Medicine’s call for collaboration among providers of both conventional and complementary medicine means active collaboration and referral. This would suggest that researchers and promoters of dry needling learn, as all acupuncturists learn, why and when to refer to a practitioner with a different set of skills. In other words, when the physical therapist sees that intervention with acupuncture might be effective, but their dry needling technique is not effective or appropriate, a referral to an acupuncturist is in order. A place to start would be a call to all trainers of physical therapists to cease their exclusion of acupuncturists from dry needle training. While Dommerholt should be commended for his non-exclusion of such practitioners, many dry needling trainers in the U.S. and throughout Europe exclude acupuncturists. A second place to start would be to stop the distancing of one profession from another and a concerted effort to cease all publication about how dry needling can’t be and is not acupuncture would be reflective of a beginning of collaboration.

Continuing Concerns
The concerns about physical therapists and other Western medical practitioners who promote dry needling continue. These concerns may be summarized as:

Smelling the Roses
For the past year, I have been very engaged in the political issues surrounding physical therapy and dry needling and how to best professionally represent the concerns of Colorado acupuncturists. I am still very concerned about the impact of scope definition and whether or not practitioners of Asian medicine will be freely able to practice integrated medicine.

I have read with interest Mr. Dommerholt’s willingness to listen, and I acknowledge his openness and equally hope for a working relationship of mutuality. Yet when I walk into the treatment room next Tuesday, I have to admit I’m going to leave this debate at the door. What really matters to me, and to most practitioners I expect, is that I call upon myself to learn all that I can to the best of my ability to increase the efficacy of what I do for the benefit of my patients. I’m sure that physical therapists do this as well. Immersing oneself in one’s own profession, being very clear about educational and certification standards to protect the public, seeking to recognize and remove bias, and calling one another to accountability when we don’t is the way the professions will come to common understanding.

In treatment, this means that sometimes I’m going to choose a point that is based on pre-science, and sometimes it means I’m going to choose a point with only modern science in mind. What I know is that the medicine I have chosen to practice contains both of these paradigms and isn’t well suited to reduction into parts. I know that how it works is still immeasurable in Western terms, and that like the dao itself, to try to capture and describe it, means to move away from it.

As acupuncturists, the validation comes from our patients, not from a health care or legal system. As we gain the respect of the former, the latter will follow. We need to be sure to recognize that all the time we debating the name of a rose, we are still infused with its perfume. It’s still acupuncture, and it still works.

1. Zhang, Xiaorui Acupuncture: Review and Analysis of Reports on Controlled Clinical Trials, www.who.int
2. Michigan Public Act 30 Part 165, Section 16501.
3. See Amaro, John A, When Acupuncture Becomes Dry Needling, Dynamic Chiropractic, June 3, 2008, Vol 26, Issue 12.
4. Milton Marks “Little Hoover” Commission on California State Government Organization and Economy by the UCSF Center for the Health Professions, Acupuncture in California: Study of Scope of Practice, May 2004, pg. 13
5. Gunn, CC, Ditchburn FG, King MH, Renwick GJ, Acupuncture loci: a proposal for their classification according to their relationship to known neural structures, Am J Chin Med, 1976 Summer; 4(2): 183-95.
6. Fabrey Lawrence, Cogdill Kimberly, Kelley Jeffrey, A National Job Analysis: Acupuncture and Oriental Medicine Profession, Applied Measurement Professional, Inc, August 2003, Appendix B

Integrator Blog News & Reports

Integration, by nature, asks us to open our peripheral visions. We are served to look at the whole of the field. We need to develop new fascia, new connectivity. Opportunities crop up in new places. The Integrator Blog News and Reports is meant to provide you with information, insights and tools to enhance integrated care in the environment you serve.

- John Weeks, publisher-editor

AMA SOPP Escalates Campaign Against Nurses, Chiropractors, Naturopaths, Midwives and Others

In June meetings, the House of Delegates of the American Medical Association (AMA) kicked off an escalating round of attacks on the advancement of other healthcare professions. Targeted this year were all disciplines with doctoral-level training, as well as licensed midwives. Chiropractors, naturopathic physicians and nurses - who cited Wilk v AMA - are among those quick to challenge the AMA. The AMA actions are part of that guild's divisive AMA Scope of Practice Partnership (SOPP), announced in January 2006. Meantime, one action at the House of Delegates meeting suggests that the snake on the AMA's caduceus may be biting its own tail. Resolution 235 is an effort to keep the AMA's own specialty societies from legislative actions that seek to restrict each other's scope of practice. More ...
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How the IOM-Bravewell Integrative Medicine Summit Could Make a Difference: A Proposed Action Plan

Do you think the National Summit on Integrative Medicine can make a difference? Planning for this February 25-27, 2009 gathering, sponsored by a partnership of the Institute of Medicine of the National Academies and the Bravewell Collaborative, is under way. I organize my recommendations around areas where exploration of integrative practice could have a significant impact on the nation's health care crisis. The high notes are a health-oriented approach, outpatient services, the patient-centered medical home, respect for multiple disciplines, researching whole practices as basis for managing chronic disease, and whole cost accounting. How do you think this Summit might create possibilities which the IOM's 2005 report didn't already open? More ...
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Institute of Medicine Names Planning Team for Integrative Medicine Summit: Snyderman to Chair

The Institute of Medicine (IOM) of the National Academy of Sciences has announced a 12-person planning committee which will oversee development of the February 25-27, 2009 National Summit on Integrative Medicine and Health of the Public. The IOM is sponsoring the Summit in partnership with the Bravewell Collaborative of philanthropists. Here is a look at the 12 member team, chaired by Ralph Snyderman, MD, plus some musing on the not very integrated mix. Nine are MDs, suggesting that to the IOM, "integrative medicine" is an MD franchise. The Bravewell philanthropists have made a substantial commitment to make this happen. More ...
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IHPM/Employer Focus: Intel Explores Manual Therapies as an Onsite Musculoskeletal Pain Solution

Why would an employer want to explore a complementary therapy? How might a pilot project be established? This article describes a relationship between microprocessor giant Intel, researchers looking for onsite solutions to low-back pain at the Institute for Health and Productivity Management (IHPM), and the Dorn Companies, which hires licensed massage therapist to supply a Rolfing-based manual therapy to employees. Outcomes of this pilot project will be reported at the IHPM's fall conference in Scottsdale, October 15-17, 2008. More ...
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Columnist Levin: $24-Billion Savings through Supplement Interventions Says Lewin Group

Integrator columnist Michael Levin recently had occasion to read a series of reports, prepared by the internationally-known health care consulting firm, The Lewin Group. The subject: possible cost impact of pro-actively using a few dietary supplement interventions for a handful of conditions. The outcomes were compelling. Levin argues that this kind of work, funded by the dietary supplement industry, exemplifies forward thinking collaborative effort needed to advance the integrative and natural health fields. The story of this strategic funding will be familiar to chiropractic. More ...
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Resources

Integrator Archive by Subject for January-June 2007
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Integrator Archive by Subject for 2006: All Hot-linked
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Practice Management

Jade Windscreen Powder

By Michael Max, LAc

Jade Windscreen is for building the immune systems in those who easily get colds.

We learned about this in our first year of Chinese medicine school, and if you read through the advertisements and support materials for any of the multitude of herbal products available you will also come across this statement.

I know a lot about this particular problem because I’ve lived with it for most of my life. It was the lock for which Chinese medicine provided a key. I remember reading about Jade Windscreen and thinking my troubles with getting colds so often might be ended. But after taking it for a week or so, I woke in a panic one winter night thinking the house was on fire. It was not, but I had this odd smell of burning paper in my nose, which followed me around for a few days until I stopped taking the Jade Windscreen. It was a disappointment and a mystery, as to both the smell of burning paper and my continuous love affair with every kind of wind cold pathogen that crossed my path.

Some problems take years to resolve by applying much perseverance. It was not until I read Professor Huang Huang’s The Ten Major Formula Families in Chinese Medicine (zhong yi shí dà lèi fang) that I began to understand that Jade Windscreen Powder would be more effective for those with the astragalus constitution than it would be for other constitutional types.

Astragalus Constitution?

We are all familiar with constitution as viewed through the lens of the five elemental influences. Looking at constitution as it relates to a particular affinity to herbs is not a new idea. This way of considering the use of herbs in relation to patterns of disease can be traced back to the classic formulas of the Discussion of Cold Damage (Shang Hán Lùn) and Essentials from the Golden Cabinet (Jin Guì Yào Luè). Also, a look at modern Kampo practice in Japan will echo this particular current of tradition.

Through his study of the history of Chinese medicine and experience with “old doctors” when he was a student, Professor Huang has developed an extremely useful method of applying the jing fang, the classic formulas of Chinese medicine, to modern day clinical practice. His clinical approach is first to understand a patient’s constitutional tendency and how their pattern of illness is related to their constitution. He then prescribes herbs based on the constitutional formula family.

In another article we will discuss the benefits and clinical effectiveness of understanding how formula families give a clearer picture of constitution, how they make it much easier to see the connections between formulas, and how that affects clinical decision making. Right now we will simply look at the Astragalus constitution and use this to enhance our understanding about when to use Jade Windscreen Powder—and when not to!

Those with the Astragalus constitution tend to:

Let’s look at this from the point of view of constitution:

The primary herb in Jade Windscreen Powder is Astragali Radix (huáng qí). The body type associated with astragalus tends to be a bit on the heavy side (in Chinese medicine lingo we would say “damp”) with a bit of a fluid metabolism problem. The Atractylodis macrocephalae Rhizoma (bái zhú) in the formula is one of the main herbs that Zhang Zhong-Jing used to correct water metabolism problems. The Saposhnikoviae Radix (fáng feng) releases the exterior and expels pathogens, and it also can be a bit drying as it promotes the expulsion of water via the sweat. It is easy to see that for a patient who tends toward dryness, this formula could easily kindle an “internal fire”!

When this kind of person has a problem with allergies, easily catches colds, has an aversion to wind or headache, then Jade Windscreen Powder would indeed be the formula to use.

However, if a patient has frequent colds, aversion to wind, spontaneous sweating, a flat tight abdomen, and a red tongue with thin white coating along with a floating and lax pulse, this is more of a cinnamon twig presentation. These patients will benefit from Cinnamon Twig Decoction (Guì Zhi Tang). Those patients who are prone to frequent colds and have the bupleurum constitution signs of alternating fever and chills, or discomfort in the hypochondriac, will benefit more from one of the bupleurum family formulas. Minor Bupleurum Decoction (Xiao Chái Hú Tang) is a natural choice with which to start.

In clinical decision making, consider that different body types have affinities for different herbs and therefore need to be regulated in different ways.

As we know from experience, relying on one or two symptoms is usually not going to help us accurately target the patient’s problem. Just like binocular vision gives us the ability to perceive in three dimensions, considering constitution allows us to perceive more dimensionally into our patient’s situation.

Report from Oakland: 35th Anniversary of Wu Tao Kuan Martial Arts Institute

By Karen Reynolds, LAc, RN

On June 22nd, Wu Tao Kuan Martial Arts Institute of Oakland, California celebrated its 35th anniversary. My husband and I had what I consider the great honor of seeing vibrant, breathtaking demonstrations of more than 30 different styles of martial arts.

In his demonstration of Chen Style Tai Ji, Master Shu Dong Li appeared to be suspended and free of gravity. Even the silk of his garments remained smooth as he moved. His unwavering focus gave way to a most discreet smile at the close of his demonstration. He emanated joy from his heart, bubbling to the surface and breaking through the seriousness of forms.

Shi Fu Mark Gerry demonstrated Ryukyu Kenpo—pressure point fighting—which inspired awe and shudder as he dropped a man with one pressure point flick to the neck. It is in these moments we have evidence of the profound grasp and wisdom of traditional Chinese medicine and the human body.

To aid their understanding of the physical vehicle, the doctors of ancient China performed autopsies. They mapped out the nervous system they knew so well and graphically demonstrated nerve pathways and nodes. It is this precision and knowledge of anatomy and physiology which is imperative in pressure point fighting.

Sensei Patricia Hendricks, a 6th Dan Aikikai, tossed multiple male attackers around the mats as though she were doing a bit of light gardening. She has devoted more than 30 years to Aikido, owns her own school in San Leandro, California, has returned to Japan more than 25 times for continuing study, yet considers herself “young in this art.”

At 81 years young, Mr. Clarence Tai Gu Lee refuses to be called Master; though it is utterly disrespectful not to address him as such. Lee travels across the United States and Europe regularly to teach. He is the embodiment of health and vitality borne of a lifetime of study in Tai Ji, Kung Fu and Shorin Ryu.

Present was the graceful Fukuda Sensei. She is the last living disciple of Jigoro Kano, the founder of Judo. Born in the era of being expected to excel at Flower Arranging, the ways of the Formal Tea Ceremony and Brush Writing, Fukuda Sensei instead flowered into a renowned expert in Judo Kata (martial art offensive and defensive forms). She began her Judo lessons in 1935 at age 21. Fukuda Sensei has written several books about her rich life as a Judoka including: Born for the Mat: A Kodokan Kata Textbook for Women. Her judo motto is: "Be strong, be gentle, be beautiful." She has recently celebrated her 95th birthday.

At age 91, Professor Wally Jay continues to teach Small Circle Jujitsu™ in Alameda, California. Professor Jay is a 10th degree Black Belt in Jujitsu and a 6th degree Black Belt in Judo. He is the founder and Grandmaster of Jujitsu America and of Small Circle Jujitsu™ International.

All of these masters gathered and participated at the invitation of Shi Fu Alex Feng, founder of Wu Tao Kuan in 1973. Since that time, Shi Fu Feng has trained and inspired hundreds of students in varied marital arts. Affection towards him from his many students and teachers was evident at this celebration.

Shi Fu Feng has created a unique setting in Oakland comprised of three parts: the temple of Zhi Dao, the Clinic for Traditional Chinese Medicine, and the Wu Tao Kuan Martial Arts Institute.

The temple of Zhi Dao was inspired by Shi Fu’s father, Grand Master Wei Ren Feng. Grand Master Feng was a philosopher who passed the oral teachings of Taoism as well as instruction in traditional Chinese medicine to Shi Fu Feng. It was Grand Master Feng’s vision to share the teachings of Taoism to improve modern life.

On site as well is the Clinic for Traditional Chinese Medicine, established in 1976. it is here that Shi Fu Feng offers acupuncture, acupressure, tui na, herbs and medical qi gong. Teas, both medicinal and common, are brewed daily in the lobby of the clinic. Traditional seating affords not only an opportunity for rest and rejuvenation but also a community resource for exchange of ideas and socializing.

Wu Tao Kuan Martial Arts Institute is the most stunning dojo I have ever entered. From the qi gong alter, to the pristine wood floor, to the magnificent weapons display, it is a place for work, sweat and instruction as well as a place of honor, beauty and history. Please see the www.thetaoistcenter.com for more information on classes including: qi gong, meditation, Taoist study, tai ji, judo/jujitsu, and tai chi chih.

Reflecting on the 35th anniversary gathering of Wu Tao Kuan Martial Arts Institute, it occurred to me that the care of our bodies is often disregarded given the chaos of conventional life. As with all humans, practitioners of traditional Chinese medicine are prone to imbalance, disease, and poor health. Exercise for the physical body, meditation to calm the mind, and philosophy to nurture the spirit: all of these are imperative.

We live in a blessed world indeed where we have a medicine which readily draws each of these aspects into our reach. The many masters at this gathering are examples of and inspiration for exactly that. In closing, here is a quote from Shi Fu Alex Feng:

Every day, a little bit. To stretch your tendon, it takes the stretching of your mind. To stretch your mind, is to stretch time. To stretch time, you understand the Tao.

Karen Reynolds is co-owner of Balance Restored Center for Integrative Medicine in Mill Valley, CA. She specializes in the treatment of fertility and reproductive health, women’s health, chronic pain, and functional endocrinology. You may contact her at: www.BalanceRestored.com.


AAAOM Activities

An Interview with Adam Burke, Editor-in-Chief, The American Acupuncturist

QUR: Recently The American Acupuncturist has been indexed by CINAHL. What is CINAHL for those not familiar with it?

AB: Cumulated Index To Nursing And Allied Health Literature (CINAHL) is a highly respected database that covers nursing, allied health professions, and health sciences librarianship literature from 1982 to the present. One important area of coverage is alternative and comprehensive medicine. The database indexes approximately 2,000 journals with close to 6,000,000 citations. Certain select full text material includes journal articles, patient education materials, accreditation records, government publications, clinical innovations, research instruments and more.

QUR: What makes indexing important for a journal such as The American Acupuncturist?

AB: Databases such as CINAHL, PUBMED, and the Cochrane Reviews are used by researchers, clinicians, students, and the public to access information on a specific topic, such as TEAM. There are many types of area-oriented databases of this type, such as databases for psychology, chemistry, and museum studies. CINAHL is one of the premier health profession databases. Getting The American Acupuncturist into CINAHL is an important first step in getting our message out to a broader audience of academicians, clinicians, and students (see “Why it’s important for us to write” – link to the AA editors article).

QUR: Is there anything else you wish to share with the AAAOM membership?

AB: CINAHL is the first database to accept our journal. This is a competitive process, as there are many journals on the market (in China there are over 100 TEAM journals for example). It is an honor to be accepted by CINAHL. We are also working on getting listing in PUBMED and other major databases. This increases exposure and the probability of individuals finding our journal and its articles. This is also very important for our authors. We want their important work to reach as many readers, innovators, and decision-makers as possible. This is another important step in raising the journal to a position of greater visibility and social impact.

Writing An Effective Rebuttal, Part 2

By Burton Kent, MBA, MOB

In the May/June Issue of the Qi-Unity Report, Douglas Newton wrote about rebutting misconceptions in the media by writing informed letters to the editor. I'd like to offer some ways to give your rebuttals some power – without sounding shrill or defensive.

Perhaps one of the biggest roadblocks to an effective rebuttal is your own expertise. You, as an AOM practitioner, know “too much.” This means you'll have a tendency to use jargon and terminology that might alienate the average person reading your rebuttal.

Many people, in replying to a letter to the editor, merely refute the particular article’s point of view, but the responders then do not provide facts that specifically support their position, stated in a way that the reader can understand. Let’s actually educate patients and the general public as much as we possibly can and not just object to an article’s take on a particular subject.

To the layman, acupuncture may sound like it is little better than voodoo where the only difference is that instead of sticking pins in a doll, you stick needles in a person. (Ouch!) Herbs remedies are often viewed in a similar way; if it's in bulk form for tea, it makes only a little more sense than being given a bag of potpourri and told it's good for you.

The average person will not be able to understand the principles of Oriental medical theories unless they are presented in terms they can understand and are in relation to what they already know. This applies to most information regarding alternative and Oriental medicine, not just letters to the editor.

So what can we do instead? Two things:

Talk about results.

Present specific case studies of individuals who had a health problem related to the subject of the article. Your position will be even stronger if your patient tried Western medicine first and couldn't find relief. (Be sure to point this out.) Give specific details about a patient’s condition before and after treatment and if possible use the patient's own words. Even better, get permission to use their name or just their initials. Using a case study or testimonial is very persuasive—a real story from a real person. People can't deny results – and individual cases presented well are actually much more persuasive than research.

Use good research and rebut bad research.

This is adapted from my website: www.acupunctureclinicmarketing.com

There are always some studies that show acupuncture doesn’t work. Or show that it works only a few percentage points better than placebo but not enough to be statistically significant. These studies all have one thing in common. What almost all “acupuncture doesn’t work” studies use is a pre-determined point selection: the same points are used no matter what. Essentially it’s like “medical acupuncture” or acupuncture without a proper TCM or OM diagnosis. The only thing they use is a Western medicine-based diagnosis—based on symptoms rather than on a root cause.

For example, fibromyalgia has at least four different TCM diagnoses. Choosing points for just one of these diagnoses, or choosing points between four different diagnoses, is just plain negligent and proves nothing. This is like prescribing aspirin for headaches by default. Suppose migraine, cluster, tension, premenstrual causes, or spinal headaches were all treated the same as brain tumors, sinus infections, and aneurysms? Aspirin might work for some things but not for others.

Another common claim is that acupuncture results aren’t lasting. These studies usually use 6 to 10 treatments and then stop. When the researchers check back 6 months later, the results often didn’t persist. Most often no follow-up was conducted to determine if the underlying imbalance was ever resolved. This is similar to a patient who takes an antibiotic until they feel better and then stop taking it. The underlying infection is still there and will return.

I’ve done a lot of research looking up acupuncture studies. If you want to do the same, I suggest visiting the library of a teaching hospital. You’ll be able to locate articles galore. Also Google Scholar is awesome but incomplete unless used in the library. Usually you can get abstracts and complete articles for about 30% of all articles. (Check it out. Google Scholar at the library is very comprehensive.) If you want to mention specific articles in your rebuttals to articles, I strongly suggest using Google Scholar to find them. There are always good articles on various sites, but Google will find articles from peer-reviewed journals for you. Doing these two things – using stories and properly explaining research—will make your rebuttals more persuasive.

One last note – if you don’t like writing, an easy way to refute an article you read is to write your reply like you would write a letter to a friend. Don’t edit it when you draft it. Editing puts you in a non-creative state of mind. Write first, then edit – you'll be pleased and perhaps surprised with your effective rebuttal.

Burton Kent is the author of "Never Market Again" - a manual on using word-of-mouth to get more patients. You can find more of Burton’s work here: www.AcupunctureClinicMarketing.com

Links

July's Links

Can acupuncture help Golfer’s Elbow or Tennis Elbow? An acupuncturist in San Diego says yes.
acupuncturesandiego.org

Acupuncture for weight loss therapy is probably one of the most complex forms of needle piercing activities. Several ways can be used to conduct weight loss through acupuncture.
www.worldmedicalguide.com

An acupuncturist trained in China produces podcasts on fertility issues.
www.the-fertility-acupuncturist.com

In traditional Chinese medicine (TCM) theory, humans have seven kinds of sentiments and reactions, namely, joy, anger, anxiety, pensiveness, grief, fear, and fright.
www.chinesefoodhealth.com

New Study investigates the phenomena of medical tourism.
www.heartland.org

Concerned about the state Department of Health's oversight of licensed acupuncturists, the Washington Acupuncture and Oriental Medical Association has organized a series of meetings for its members throughout the state starting June 30.
www.theolympian.com

Video of lecture by licensed acupuncturist guest speaker on alternative and traditional Chinese medicine at University of California San Francisco’s Osher Lifelong Learning Institute.
acupuncturetcm.blogspot.com

Practice “Blood Vessel Gymnastics” with cold showers
www.chinesefoodhealth.com

Physician and Patient Attitudes towards Complementary and Alternative Medicine in Obstetrics and Gynecology
www.biomedcentral.com

Treatments of pelvic girdle pain in pregnant women: adverse effects of standard treatment, acupuncture and stabilizing exercises on the pregnancy, mother, delivery and the fetus/ neonate
www.biomedcentral.com

Duke University incorporates acupuncture to help control surgical and post-operative pain.
www.kgbt4.com



Continuing Education and Events

Academy of Oriental Medicine at Austin Earns Candidacy with Southern Association of Colleges and Schools

AUSTIN, TX - July 21, 2008 - The Academy of Oriental Medicine at Austin today announced that the school has been granted initial candidacy by The Commission on Colleges of the Southern Association of Colleges and Schools (SACS). Now in its 15th year of operation, the Academy of Oriental Medicine at Austin (AOMA) currently has 204 students studying in a four-year Master of Acupuncture and Oriental Medicine graduate program.

"Our SACS approval is a testimony to AOMA's excellence in learning, teaching, and administration," said Dr. Joylynn Reed, University of Mary Hardin-Baylor and Chair of AOMA's Board of Governors. "Our student, faculty and patients experience our first class operation, but the formal acknowledgment from an accrediting body that is known for its rigor and high standards is tremendously satisfying and rewarding."

AOMA is authorized to offer the degree of Master of Acupuncture and Oriental Medicine (MAcOM) by the Texas Higher Education Coordinating Board. In 1996, AOMA received programmatic accreditation by the Accreditation Commission for Acupuncture and Oriental Medicine. AOMA's new status allows the school to pursue membership with SACS over the next 18 to 24 months. Its staff and faculty, as a team, are completing the remainder of the documentation required to verify compliance with additional SACS requirements.

"Candidacy means that AOMA has met critical standards in several key areas," said Anne Province, AOMA vice president for institutional effectiveness.

"Areas such as faculty qualifications, academic programs, financial resources, facilities and library resources were all accepted as compliant under SACS published guidelines, validating the tremendous efforts of faculty and staff over the last two years."

The standard accreditation process involves three steps, typically spaced over several years-application, candidacy and accreditation. Thousands of pages of documentation and records are provided to the accrediting agency, which reviews them and sends a team to visit on-site and verify the submitted materials, assess facilities and interview faculty, staff and students. In March 2008, a five-member committee representing SACS visited the Austin, TX campus and filed a report to the Commission that led to this favorable vote.

Global Chinese Medicine Conference
University of East-West Medicine will be holding "The Third Annual Global Chinese Medicine Conference" on on Oct. 11-12 at the Santa Clara Convention Center in Silicon Valley, California. There will also be an exhibition along with the conference.

For further information, please consult the East-West University web site: www.uewm.edu, Office of the Herguan Universe

The 20th Anniversary of the Pacific Symposium
Since its creation in 1989, the Pacific Symposium, produced by Pacific College of Oriental Medicine, has been an annual opportunity for further education and rich interactions with experts in traditional Chinese medicine. Each year, Pacific Symposium provides those in the field of Oriental medicine to meet one another and explore healing in a beautiful setting, the Catamaran Resort Hotel in Pacific Beach, California.

Acupuncturists, chiropractors, nurses, massage practitioners, medical doctors, and patients all converge at this conference to exchange professional insights.

For more information, please contact Pacific College of Oriental Medicine at (800) 729-0941, or visit www.PacificCollege.edu

AAAOM Student Organization



AAAOM-SO National Officer Nominations
AAAOM Conference & Expo 2008, Chicago, IL

July 17, 2008

Dear Fellow AAAOM-SO Members and AOM Students:

It’s hard to believe that the AAAOM National Conference & Expo is so quickly approaching. It has been a truly amazing year of growth for the AAAOM-SO, reaching a milestone of 1200 student members from across the nation! The progression of the SO is only as strong as its members, and with numbers like this, it shows how strong the future of this profession will become!

Along with strong members, quality and talented leaders are essential, and we want your talents! We are now accepting nominations for all Student Organization Council (SOC) officer positions from now, until September 15th, 2008, 11:59PM CST. Nominations will also be taken the day of the AAAOM-SO National Student Caucus on Saturday, October 18th, 2008. All current, interested, AAAOM-SO Members from the General Membership are encouraged to run for an officer position.

Rules & Eligibility:

For detailed description of all the available SOC Officer Positions, see http://www.aaaomonline.info/soc-positions-08.pdf.

Click here for the Interactive Officer Nomination form.

Have Questions? Check out the AAAOM-SO Student Forum! Post your questions, read other members questions, and read recent updates posted by your current SOC!

We look forward to seeing you in Chicago!

Sincerely,

Your 2007-2008 AAAOM-SOC

Products, Services, and Member Savings

Dear Prospective Advertiser:

Investing your advertising dollars in The American Acupuncturist and the Qi-Unity Report makes good sense for so many reasons:

Join our current advertisers to infuse growth into the field your products and services benefit. The reunified organizational force behind the AAAOM means more power toward serving the growth of alternative medicine.

With so much to gain, what better time is there to advertise in The American Acupuncturist and the Qi-Unity Report? Please contact me to learn more at (866) 455-7999.

Yours in Health,

Douglas Newton
Manager, Program Development and Business Services, AAAOM
866-455-7999
916-443-4766 (fax)
info@aaaomonline.org

ENCLS: AA/QUR Ad Card (PDF); Adv. Contract (PDF)

In closing,

As always, your feedback serves as a useful lens through which we may look at how well we are serving our members. Please take a moment to express your thoughts to us.

General Feedback

In Health,


Rebekah Christensen,
Executive Director
Douglas Newton,
Managing Editor