Objectives in CIM/TCM

Many patients still do not have a clear idea of what the acupuncture profession involves. The term acupuncture actually refers both to the overall practice of TCM (Traditional Chinese Medicine) as well as the specific therapy of fine needle stimulation. It is a comprehensive and modern medical science rooted in thousands of years of development and experience. The scope of practice in California is broad, with inclusion of herbal and nutrient medicine, physiotherapies, and some modern technologies, such as cold-laser, as well as the well-known trigger point stimulation with fine filiform needles and electrical stimulation. It is the combination of safe and effective protocols that makes CIM/TCM work well historically. By taking a more comprehensive and holistic approach to your healthcare the results will be amplified greatly and adverse 'side' effects decreased. 

Traditional Chinese Medicine (TCM) is an integrative Complementary Medicine (CIM) that combines modern medical knowledge with a core approach which utilizes a 6000 year old holistic approach to medical diagnosis and treatment. Complementary medicine refers to a branch of modern medicine that provides a medical approach and therapies that are missing from standard medical practices and thus is a helpful addition, or complement, to the care that your M.D. provides, and integrates well with such care. TCM has been well studied and found to be the safest medical practice in world history. TCM is commonly just called 'acupuncture' and the TCM physician is called a Licensed Acupuncturist, although these terms do little to fully describe this complex medical specialty. Currently there are 50 accredited specialty colleges for the profession of Acupuncture and Oriental Medicine, or TCM, with 13 in the State of California, the first state to establish accredited specialty colleges for TCM and licensed practice. Legislation for the medical practice still lags far behind the public appreciation and demand for the specialty, though, and industry lobbying still makes the practice difficult.

The term Traditional Chinese refers to the science's roots in early Chinese naturalist thought, sometimes called Daoism, but the science is now a worldwide medical practice, with medical schools around the world teaching TCM, and integration into hospital settings and medical doctors' practices, especially in China, Japan, South Korea, Australia, Europe and Brazil. It is perhaps the most studied of any medical specialty today and, as stated, is proven to be the safest major medical practice in world history. The absence of harm from its practice, or iatrogenic harm, is a hallmark of this Complementary and Integrative Medicine, and as iatrogenic harm has risen in incidence in modern medicine, the appreciation for CIM/TCM has expanded.

TCM is acknowledged as a proven evidence-based medical science by the World Health Organization (WHO) and the National Institute of Health (NIH), both of which have worked to create an accepted worldwide evidence-based set of guidelines for the practice of this Complementary and Integrative Medicine (CIM).

Evidence-based guidelines supporting acupuncture are also evident in California, first with the California Industrial Medical Council, and later with the adoption of evidence-based treatment guidelines for acupuncture into California law (Title 8), to guide the use of TCM in occupational medicine and Workers' Compensation coverage of effective treatment in musculoskeletal medicine. The Licensed Acupuncturist (L.Ac.) in Title 8 California Law is a "primary care physician". In 2010, the New York State Workers's Compensation Board furthered the legal approval and scope of acupuncture in medical treatment guidelines by stating that acupuncture “may be used as an adjunct to physical rehabilitation and/or surgical intervention to hasten the return of functional activity." This legal guideline states that evidence supports the use of acupuncture to reduce inflammation, muscle spasm and pain, and proven indications for its use in occupational medicine includes joint pain and stiffness, soft tissue pain and inflammation, paresthesia (neuropathy), post-surgical relief, muscle spasm and scar tissue pain. These guidelines went even further, though, stating that “therapeutic spinal injections may be used after initial conservative treatments such as physical and occupational medicine, medication, manual therapy, exercise, or acupuncture have been undertaken." The practice of TCM includes manual therapy and acupuncture. The AHRQ, or Agency for Healthcare Research and Quality, of the U.S. Department of Health and Human Services, is the lead federal agency charged with assessing evidence-based guidelines in medicines, and provides numerous professional treatment guidelines that now include acupuncture. High quality scientific proof of efficacy, even with problematic double-blinded placebo-controlled human clinical trials, are now easily accessed through the NIH PubMed database of professionally published studies.

Currently, the U.S. National Institutes of Health (NIH) has as one of its divisions the National Center for Complementary and Alternative Medicine, and highlights acupuncture as an important part of complementary and alternative medicine (CAM), providing limited access to randomized controlled trials, systematic reviews, and meta-analysis of current scientific studies accepted by standard professional medical journals in the U.S. Many experts now agree that the word alternative should be eliminated from the professional arena now, and replaced with the more accurate term integrative. Complementary and Integrative Medicine (CIM) would present a more accurate and positive description of this medical specialty, and this term is now largely adopted in the European Union.

The World Health Organization (WHO) fully supports the integration of traditional medicine into standard health systems, and reports that in 2007, 48 member states had adopted national policies on traditional medicine, and 110 member states had adopted regulations on the use of professional herbal medicines. In addition, 62 member states had created national research institutes on acupuncture and herbal medicine, or other traditional medicine, in 2007. WHO reports that 80 percent of the population in Germany, and 70 percent of the population in Canada, have now used traditional medicine, or Complementary and Integrative Medicine, at some time in their life. Currently, the U.S. is the leader in providing specialized medical colleges and universities to teach the science of acupuncture and TCM at its highest level outside of China, Korea and Japan. There are currently 49 specialized acupuncture and TCM colleges and universities in the United States, and additional programs being set up in standard medical universities. The only problem now is coverage and payment, which is still unfairly denied despite so much acknowledgement. A concerted effort to deny patient care with this inexpensive and effective Complementary care continues, and instead of working to make Complementary Medicine and TCM more effective in the future, these physicians are being denied the right to earn a living, and the Medical Colleges are not supported in any way. Currently, the right to return the doctoral degree to the program after a 25-year legal battle was won in California, yet almost all TCM colleges have not been able to actually win final approval for improving their educational standards and integrating with standard University medical schools. Only public support will accomplish these goals.

Defining Complementary and Integrative Medicine, or the practice of acupuncture and Traditional Chinese Medicine

Complementary and Integrative Medicine (CIM) refers to a branch of medicine that provides what is missing from the modern medical approach, namely inexpensive conservative therapies that are without side-effects, preventative medicine, health maintenance, consideration of the whole body and mind when diagnosing and treating a particular illness or injury, and a restorative rather than altering approach to cures. Standard medicine is sometimes referred to as a modern allopathic medical approach, whose emphasis is on altering the body's physiology or anatomy to treat a specific condition, using mainly pharmaceutical chemicals and surgery, while TCM and Complementary Medicine is mainly holistic, or treating all of the contributing factors to the disease or injury mainly by restoring natural homeostatic mechanisms of healing and health maintenance. Complementary Medicine often presents a cure, but a cure based not on chemical dependancy, but rather on restoration of healthy tissues and bodily function, and may be used by itself, or as an effective adjunct to allopathic medicine to promote healthy tissue regrowth after surgery, or enhance the positive effects of medication, speeding recovery and allowing avoidance of excess pharmaceutical medicine in care, thus decreasing overall adverse effects. Adverse side effects of pharmaceuticals may be countered by the protective and restorative effects in TCM and Complementary Medicine.

Much research is now showing that intelligent and professional use of herbal and nutrient medicines may improve the outcome when used with pharmaceutical medicine, and the incidence of negative contraindication is clinically minimal, despite years of propaganda to the contrary. Complementary Medicine and TCM provides a safe, benign and effective way to speed recovery when combined with standard allopathic medicine by stimulating the natural resources of the patient, utilizing Nature's evolved chemistry, and providing direct soft tissue rehabilitation, as well as time spent advising, counseling and teaching patients how to better heal themselves. Restoration of normal healthy homeostatic function as a cure and/or relief of symptoms and disease requires a more comprehensive approach than allopathic medicine, and a pro-active participation by the patient. This pro-active and patient-centered approach is becoming increasingly popular in the United States, and even adopted by standard medicine now. Such TCM concepts as mind-body medicine and a patient-centered approach are now being widely adopted in the standard medical arena. The challenge is to fully integrate the physicians in TCM, Naturopathic Medicine, Chiropractry and Osteopathy, who all graduate from approved 4-year medical colleges that are specialized, and often go on to further study as well.

How does TCM or acupuncture work?

TCM seeks to restore normal function, or homeostasis, to effect a lasting cure. It is generally advised that patients seek conservative approaches whenever feasible before trying more radical chemical and surgical means, especially if there is risk of side effects or other harm. This approach is central to the Hippocratic Oath still touted in modern medicine, but now largely ignored. The degree of severity and risk of serious harm should guide the patient and phsyician in the choice of treatments, not the profit motive. This is called the risk versus benefit consideration, and should be the primary discussion between patient and physician when choosing the proper treatment protocol. TCM offers a variety of medical treatments that are proven to be the safest form of medical treatment in the world, and strives to not just control the disease or alleviate symptoms, but to actually treat the underlying causes. Patients that are not in immediate risk of debility or death may choose to first try the safer and more conservative type of care. Patients that are relatively healthy, yet fear a risk of developing a serious health problem, should turn to Complementary Medicine to decrease this risk and prevent serious problems in the future. We see now with the numerous scientific confirmations of the efficacy and benefit from acupuncture, herbal and nutrient medicine, that the dismissal of these integrative therapies by medical doctors in the past was at best misleading, if not dishonest.

Patients unfamiliar with acupuncture often ask, how does needling actually work? Of course, there are doubts, fostered by years of professional bias, and while the practice is simple, insertion of needles under the skin, and stimulation of trigger points with needle manipulation, the answer to how it works is complex. Acupuncture is the most scientifically studied manual therapy in the world, and a large variety of scientific studies document the numerous types of reactive results seen physiologically, and measured, when trigger points are stimulated properly with the needle. Practically any physiological response can be triggered with acupuncture, and much research in the last decade confirms not only a localized response, but significant modulation in the central nervous system. Neuroimaging studies with functional MRI, PET scans, electroencephalography, and magnetoencephalography have provided abundant proof of specific modulating effects in the brain, brainstem and spinal cord from acupuncture stimulation at peripheral points. But the answer to the question of how acupuncture works is even larger than this, considering that the whole practice of acupuncture is the practice of TCM, which may incorporate a dozen or so treatment modalities, including herbal prescription, nutrient medicine, physiotherapy (Tui Na), therapeutic advice and training, electrical stimulation, cold laser stimulation, diathermy, etc. All of these treatments are both direct and practical, as well as safe and effective, and work synergistically with each other to provide a more comprehensive effect on body homeostasis. There are no simple answers to how these treatment modalities work.

Traditional Chinese Medicine (TCM), referred to simply as acupuncture, is the foremost Complementary Medicine in most of the developed world, proving to be a sensible, low-cost, and effective form of preventive medicine, as well as a safe and effective treatment for all health problems and symptoms as an Integrative Medicine, enhancing the effects of standard care

TCM is the primary Complementary Medicine in the world, thanks to the historical support of traditional complementary medicine in China. In recent history, this was called an 'alternative' approach in the United States, but the word alternative has unfortunately created an unhealthy animosity towards TCM in the medical community. Today, many M.D.'s are taking up the practices of TCM, or Integrative Complementary Medicine, because it is a proven science and an effective low-cost complement to standard care. It is no coincidence that health care spending increases are slowing in the United States and Europe. In the European Union, where Complementary Medicine is mandated for coverage, this practice is quickly expanding, and a number of countries supporting Complementary Medicine, such as Australia and Brazil, cite study that this branch of medicine has indeed brought down health care costs. Although many medical doctors are now taking up the practice of TCM, performing acupuncture and prescribing herbal and nutrient medicines, the Licensed Acupuncturist, or TCM physician, receives comprehensive education in these medical practices, including complex herbal prescription, manual physiotherapies, nutritional supplementation, needle stimulation, and patient counseling. The education of the Licensed Acupuncturist involves a four year standard of medical school that combines knowledge of modern medicine with traditional theory and practice. There is still virtually no training in Complementary Medicine in standard medical schools in the United States, although this is changing.

TCM has always been a complementary branch of medicine, even in ancient historical times in China. China was historically an innovator in medical theory, being the first culture to use vaccines, anesthesia, narcotic pain medications, study of cadavers, and advanced surgical techniques, and the first culture to recognize the complex circulation of blood and the role of the brain in the nervous system, as well as the organ systems and their connections. China was also the first country to recognize diseases associated with nutritional deficiencies and institute treatment. The famed historian Joseph Needham has confirmed that the first organized government health care with preventative medicine, and the first organized holistic approach to public health, originated in China. Widespread adoption of holistic medicine, public health initiative with dietary recommendations, support for the daily practice of therapeutic health maintenance with both physical and mental (meditation) regimens, and preventive health care are hallmarks of Chinese civilization and government, and as they are being adopted in our modern civilizations, both public health is improved and government budget deficits decreased. The support for Big Pharm and corporate healthcare and insurance should be matched by support for simple and inexpensive public health regimens. Such experts as Dr. Dean Ornish and Dr. Andrew Weil agree with, and promote, this mandate. Dr. Weill received his medical degree from the Harvard University School of Medicine, and founded the Arizona Center for Integrative Medicine, while Dr. Ornish was a clinical fellow at Harvard and resident of the esteemed Massachusetts General Hospital, and now teaches at the University of California San Francisco (UCSF) and founded the Preventive Medicine Research Institute.

Integrating the specialty of acupuncture, or Traditional Chinese Medicine (TCM), into your healthcare, provides a proven, safe and pro-active addition to standard medical care that will prevent future health problems and injuries, reduce overall healthcare costs in the long run, and contribute to decreased insurance costs and government health spending in the future. It is obvious that integration of the safest and lowest cost healthcare into our system, whose only side effects are overall improved health, will help alleviate the cost of healthcare in the United States, which has become unaffordable to most families. By supporting the continuing improvement in this medical specialty, future patients will reap enormous benefits, both with improved health and better prevention of disease and injury, but also with less of their earnings going to maintaining health, and a reduction in government spending. TCM is not an added cost in the system, but a cost reducer.

Integration of TCM into standard care, and fully into the systems of insurance and government healthcare, will reap many future benefits. Today, the TCM physician, or 'acupuncturist', works with medical doctors, chiropractors, naturopaths and other medical practitioners in an integrative and complementary fashion to provide a safer and more well rounded approach to medical care. This complementary approach has given the patients more options in health care and often reduces costs by making some of the standard expensive procedures and pharmaceuticals unnecessary. As the United States shifts to outcome measures rather than multiplication of procedures and products to determine health payment, the practice of Complementary Medicine and TCM is becoming more important in the achieving of better outcomes for less expenditure. While most medical doctors are afraid of these changes in their profession, eventually they will embrace the payment for outcome measures rather than excess line item charges, and integration of TCM will provide medical doctors with a new way to efficiently achieve healthcare outcomes with less expense. TCM theory is also finally having a big impact on standard medical approaches, too, as evidenced by the focus on 'Biologicals' in the pharmaceutical industry, as well as treatment focus on hormonal balance, Mind-Body approaches, and holistic approaches to more systemic diseases, such as Metabolic Syndrome, formerly seen as a pre-diabetic state only. Chronic diseases are now often seen as homeostatic imbalances, such as the anabolic dominance of early secondary osteoarthritis, and Complementary Medicine addresses the need to restore a healthy homeostasis. The concepts of Yin and Yang balance, or homeostatic health, are pervading modern medical theory, providing patients and doctors with a healthier approach to treatment.

Recent surveys show that 70-80 percent of the population has utilized Complementary Medicine in the United States, although this branch of medicine continues to consume only about 6 percent of the health dollar, while the practice of acupuncture itself consumes a fraction of one percent of health expenditure in the United States, mostly because of lack of effective coverage in insurance and government health services. The minute costs of acupuncture practice can be compared to the amazing benefits to demonstrate that this type of medicine is very cost effective at a time when health care costs are bankrupting the country, and a number of comprehensive studies around that world have proven this fact. The long term benefits with preventive medicine may also translate into considerable savings in the future, and TCM may be the most effective professional preventive medicine in world history. Public awareness of this medical practice and its reputation as the safest medical practice in world history, with virtually no injury committed with standard practice, has allayed the fears of acupuncture needles and herbal prescription that persisted for many years after the legal introduction of this medicine in the United States in the 1970s by Chinese medical doctors. Today, almost all TCM physicians are graduates of approved specialized medical colleges in the United States who pass a rigorous licensing examination after receiving a masters or doctoral degree. Standard medical colleges in U.S. Universities still do not provide much education related to acupuncture, herbal or nutrient medicine, and the practice by Medical Doctors (M.D.) is often based on almost no professional training. The TCM physician (L.Ac.), on the other hand, brings a wealth of knowledge and expertise to your care, far exceeding the practice of needle stimulation alone. Don't let the title Licensed Acupuncturist fool you, for the actual medical care that you receive is comprehensive and multifaceted.

Public recognition of the importance of acupuncture and Complementary Medicine is very important as the administration of President Barack Obama seeks to offer the option of the federal health care insurance policies to all Americans, and expand preventive medicine in health care reform implementation. As the insurance exchanges in the health care reform are created, the public needs to demand access to, and coverage of, acupuncture and Complementary Medicine. With the enormous power of the medical industry lobbying, only the voice of the public will insure that TCM and acupuncture will be included in public health insurance exchanges. Many aging Americans are also dismayed that acupuncture is still not covered under Medicare. This is not because of the lack of proof of efficacy, but purely due to politics of obstruction and lobbying by the big pharmaceutical and insurance companies, which prevents supportive votes on simple pieces of legislation that are needed to go forward with legal incorporation of the acupuncture mandate in Medicare. Support of the Hinchey Federal Acupuncture Coverage Act, which has been stuck in committee since 1991 due to lobbying efforts, is very important at this time to allow the option of insurance coverage for those Americans that desire it. Acknowledging the practice of acupuncture as a profession in the federal government is also needed. This freedom of choice of the public in choosing Complementary Medicine and acupuncture, or TCM, will not cost the federal government one cent, and may instead reduce total health care spending in the future. The voice of the public must become louder than the monetary incentives of lobbying for this to be achieved, though. Currently, there is almost no lobbying efforts by the professions involved in acupuncture and Complementary Medicine, who have either lacked the money or the will for political lobbying. For further information on this issue go to the sections of this website intitled approach or appointments.

Utilization of Complementary Medicine is proving to be very effective both in public health and in reduction of total medical expenditures for a number of countries. A 2012 report by Gerard Bodeker of the Oxford University Medical School in England, and Fredi Kronenberg of the Columbia University College of Physicians in New York, U.S.A. shows how nearly half the populations in most industrialized countries now utilize Complementary Medicine, or traditional medicine, yearly, and in Australia the money spent on Complementary Medicine now is larger than that spent on pharmaceuticals, even though the bulk of this spending is out-of-pocket. Insurance and government health coverage continues to be difficult in most countries, with only about 12 percent of policies in the United States offering some minimal coverage for acupuncture, and no coverage for professionally prescribed herbal medicine. Acupuncture was introduced into government health care in Australia in 1984, and continues to be popular and effective, growing in use every year in Medicare claims. A study in Canada showed that patients who adopted meditation practices showed a 1 percent drop in health insurance payments compared to a similar group not adopting meditation practices, whose health care costs rose 12 percent annually. This reflects something broader than the efficacy of meditation, though, as individuals that adopt meditation practices almost surely adopt holistic health practices in general. Adoption of a comprehensive holistic health regimen in life could mean that degenerative diseases are reduced and many of the common health problems with aging are prevented. The side effects of Complementary Medicine and healthy lifestyle choices are increased vitality, improved overall health, and the improved ability to function and achieve your goals in life with aging. To see this comprehensive report from the American Public Health Association, the oldest and most diverse organization of public health professionals in the world, click here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3221447/.