Oriental medicine has been used for more than 3,000 years to prevent and treat disease by restoring balance and harmony to the total person: body, mind, and spirit. Originating in China, Oriental medicine views health as part of the natural world. Health depends on mental and physical harmony as well as harmony with nature. Acupuncture, often considered synonymous with Oriental medicine, has been practiced in the United States for more than 150 years. It is the gentle insertion of hair-fine needles into specific points on the body to stimulate the body's natural healing abilities. It is essentially painless and has been proven to treat a variety of health problems.
Philosophy
When acupuncturists work with clients, they view the body in an entirely different way from practitioners of Western medicine. First, they view symptoms as signs of a deeper problem in the body. Rather than merely treating the symptom, acupuncturists work to treat the underlying causes of a symptom. Second, they view health problems in terms of yin/ yang theory and a person's QI or life energy. They ask, “Is a person's QI blocked? weak? excessive?”, “Is there too much yin? too little yang?” The concepts of yin/yang and QI are the philosophical underpinnings of acupuncture and Oriental medicine.
Yin and yang are words used to describe the cycle of energy, harmony, and balance in all living things and events. Just as the seasons change, the body is a changing energy pattern that needs a balance of yin and yang for harmony. The concept of yin is considered the feminine principle and refers to complete, solid, and permanent states. Yang is the masculine principle referring to moving, changing, dynamic states. In the body, yin refers to tissues and organs and yang to the body's activities and functions. Even specific organs are divided into yin and yang groups. Yin organs are the more solid organs such as the heart, kidney, liver, and lungs. Yang organs are the more fluid and changing organs through which materials pass such as the stomach, bladder, and intestines. The philosophy holds that when yin and yang are out of balance, health problems occur.
QI or chi (pronounced chee) is the life energy that flows throughout the body. Illness is defined as a disharmony, blockage, deficiency, or imbalance of QI. The QI flows through the body along fourteen main pathways called meridians. Certain key points (acupuncture points) on the body correspond to organ systems. By stimulating these points, an acupuncturist seeks to increase the flow of QI to relieve pain, treat disease, and resolve problems on the most fundamental, energetic level.
Acupuncturists also treat psychological problems including depression and anxiety. People seeking help with weight control, smoking addiction, alcohol and drug addictions, and stress reduction often see acupuncturists. Relaxation, increased energy, and improved immune system are inherent benefits of acupuncture.
People of all ages, from newborns to the elderly, go to acupuncturists, although more women than men seek acupuncture as a treatment method for health problems. Some people choose acupuncture as a first step toward solving health problems. Others seek acupuncture as a last resort when traditional medicine has failed or as an attempt to avoid surgery or other invasive procedures.
Types of Treatment
There is much more to acupuncture than needles. Acupuncturists use a complex system of techniques to diagnose and treat problems. The first appointment with a patient can take from one and a half to three hours because a detailed individual and family health history is taken. Acupuncturists ask questions about digestive problems, urine color, menstrual cycle, eating habits, allergies, sleeping patterns, past attempted treatments, work and family life, stress level, and sensitivities to temperature. They understand that a patient's anxiety, anger, fear, and emotional/psychological stressors can influence health. During the interview the acupuncturist will carefully observe a patient's complexion, face, tongue, body language, and tone of voice. Finally a pulse diagnosis is used to determine treatment. In Chinese medicine there are twelve different pulses, each associated with a vital organ. The acupuncturist feels three pulses by lightly placing three fingers at each wrist. By pressing more firmly and deeply at the same three places on each wrist, three additional pulses are felt. The quality and sensations of the pulses are used to discover problems in the flow of QI and diagnose the nature of illness.
Once a diagnosis is made, acupuncturists treat patients by inserting small, hair-like needles into the skin at certain points in the body. The needles are carefully placed along the energy meridians to improve the flow of QI to specific organs and body parts. Typically ten to fifteen sterile surgical steel needles are left in for fifteen to forty-five minutes. Acupuncturists may slightly turn the needles once inserted to enhance their effect. In some instances, acupuncturists may connect the needles to a low-voltage electrical source to increase stimulation. Acupuncture does not hurt and has been described as a tingling sensation or a mild buzz.
Beyond needles, there are several additional techniques used in acupuncture and Oriental medicine. Moxibustion is a method where a small cone made from herbs is placed on the skin at acupuncture points and is ignited so that heat and herbs penetrate the skin without burning. Acupressure and Shiatsu are methods that use massage and the applying of pressure to acupuncture points. Auriculo therapy is acupuncture of the ear relying on more than the four traditional ear acu-points. Laser acupuncture is the use of laser beams to stimulate the acu-points. Japanese acupuncture is unique in its use of even thinner needles. Traditional Chinese Medicine (TCM) uses eight principles of complementary opposites to describe the patterns of disharmony and uses herbs in conjunction with acupuncture to treat illness. Although the methods vary, all share the goal of improving the flow of QI and creating balance in the body. Acupuncturists may also recommend dietary modifications, herbal and vitamin supplements, specific therapeutic exercises, and lifestyle management strategies.
Follow up acupuncture sessions usually last one hour. The length of treatment varies, but generally a course of treatment in Chinese medicine is considered ten treatments performed over several weeks. The course of treatment depends on the overall health of a person and the presenting problem. For most problems, acupuncturists see patients once a week. Patients with severe pain may require sessions a few times a week. Treatments may take longer for patients who have a poor diet, high stress, and don't get enough exercise. Acute problems such as a sprained ankle in an otherwise healthy person may need only one or two acupuncture sessions. Chronic conditions such as long-term back pain may require a series of treatments. Treatment is individualized to the patient's needs and varies greatly from person to person.
Employment Settings and Working Conditions
Almost all acupuncturists are in private practice, either individually or in a group practice. Some teach and conduct research at schools of acupuncture. Hospitals will increasingly be an employment setting for acupuncturists. More than twenty hospitals incorporate acupuncture into substance abuse programs, and some hospitals are developing holistic health departments. Acupuncturists may also work in group practices with other holistic health care practitioners. It is not unusual for an acupuncturist, massage therapist, nutritionist, and naturopathic physician to work together in one practice. Acupuncturists are also responsible for advertising and marketing their service to develop a clientele, and like any new business, it can take time to build up a practice.
This profession provides a good deal of flexibility and control. Acupuncturists work out of their homes or out of clean and comfortable offices. They are free to set their own hours, although some work evenings and weekends to accommodate patients' schedules. As entrepreneurs, there is room for creativity in structuring their work life.
"I'm not interested in working five or six days a week at acupuncture. I have a small business out of my home, so my acupuncture practice is three days per week. What is nice about being self employed is the flexibility; what is not so nice is not getting a regular pay check. There is give and take, but I wouldn't give up being self-employed. It's great!"
-Terry Goldenstein, Lie. Ac.
The Profession
There are currently more than seven thousand licensed acupuncture practitioners in the United States. This number is made up of two groups: physician and non-physician acupuncturists. Although some physicians elect to add acupuncture to their repertoire, it is not a common treatment method of M.D.s. Most licensed acupuncturists are non-physicians-people who went to school to specifically study acupuncture.
In recent years the profession has received increasing support and acceptance. The World Health Organization, the American Osteopathic Association, the American Chiropractic Association, and the Veterinary Medical Association all recognize and endorse acupuncture. More and more government funding has been appropriated for research, and in 1994 more than twelve million people received acupuncture treatment.
Training and Qualifications
Most people become acupuncturists because they want to help people. Success requires belief in Oriental medicine philosophies, academic knowledge, technical skills, manual dexterity, sensitivity, and interpersonal skills. Knowledge of acupuncture techniques combined with a caring attitude, are important qualities for this career.
Physician acupuncturists are allowed to practice acupuncture anywhere in the United States, and the licensing requirements are more lenient for M.D.s than for non-M.D.s. A few states only allow M.D.s to practice acupuncture. For physicians, the American Academy of Medical Acupuncture (AAMA) requires a minimum of two hundred hours of acupuncture training in addition to medical school training.
The majority of acupuncturists are non-physician acupuncturists. Currently there are more than fifty schools of acupuncture in the United States. At least two years of college or a bachelor degree with prerequisites such as biology, anatomy and physiology, psychology, and chemistry are required for acceptance into an acupuncture program. Programs award degrees leading to the titles of Certified Acupuncturist (C. A.), Licensed Acupuncturist (Lic.Ac.), Diplomat in Acupuncture (Dipl. Ac.), and Master's or Doctor of Oriental Medicine (D.O.M.). Training at recognized acupuncture schools takes from two to four years. A student of acupuncture takes approximately 1,500 to 3,000 hours of courses and practical clinical internships. In the first and second years of study students take courses such as: Chinese medicine theory, diagnostic skills, counseling skills and ethics, Chinese language and medical terminology, clinical skills, herbal medicine, etiology and pathology of disease, Western pharmacology, and research design. Third and fourth years include a series of clinical internships and seminars and additional courses in Eastern and Western nutrition, advanced needle techniques, specialized approaches to theory and treatment, and practice management.
Licensing, certification, and regulation of acupuncturists vary from state to state. Currently, thirty-five states and the District of Columbia license, certify, register, and officially recognize the practice of acupuncture. Twenty-four states and the District of Columbia license acupuncturists.
Other states have different forms of regulation. A few states have no regulations. Many only allow medical doctors (M.D.s), doctors of osteopathy, and chiropractors to practice acupuncture and some require acupuncturists to be supervised by a licensed physician.
Beyond licensure, the National Commission for Certification of Acupuncturists certifies acupuncturists. This is particularly useful for acupuncturists in states that don't offer licensing. The NCCA requires a minimum of two years training at an accredited acupuncture school, or a four-year apprenticeship, and a written and practical exam.
Job Outlook and Salary
"I think it is definitely a growing field because more and more people hear about acupuncture and are open to alternatives. Insurance companies are starting to cover things like acupuncture, so that's really positive."
-Aurora Medin, Lie. Ac.
The demand for acupuncture is growing with the number of people seeking acupuncture treatments increasing each year. Higher numbers of students are applying to acupuncture schools, and the acceptance of acupuncture by mainstream society and medicine is on the rise. Many insurance companies cover acupuncture, making it more accessible to patients.
The salary potential for acupuncturists varies depending on the size of practice, patients' ability to pay, geographic location, level of competition, and quality of service. Since most are self-employed, many treat patients as well as earn income from outside activities such as consulting, writing articles and books, conducting health education workshops, and teaching. A typical full-time salary can range between $25,000 and $50,000. Acupuncturists can charge $60 to $150 for a first appointment and $30 to $70 per follow-up visit. The overhead for starting a business is manageable because the cost of acupuncture equipment is relatively low.
