The State of 21st Century Acupuncture in the U.S. (Pt. 1)

Clasina (Sina) Leslie Smith, MS, MA, LAc, MD, Dipl. Ac., FAAMA;

Charis M. Wolf, MSc, MSTCM, DTCM, Dipl. Ac.

The Backstory

The impetus for creating a professional journal article defining the profession, education, scope, and utility of acupuncture dates back to a conversation between David Miller, MD, LAc (founding chair of the American Society of Acupuncturists – ASA) and I ( “Sina” Smith) in 2019. He and I share similar backgrounds as dually licensed MDs and LAcs with a passion for educating medical professionals about the value and role of acupuncture medicine.

Series Outline
This six-part series presents key conversations we had in the process of creating the paper. While much of that conversation was not ultimately appropriate for scientific journal publication, we feel it is important to be transparent about the process and open the conversation to a wider audience. We will therefore bring these conversations to you each month, beginning this month with how we define ourselves and what we call ourselves. In subsequent months, we will discuss clinical utilization of acupuncture, questions of insurance and payment structure, the latest scientific mechanisms explicating how acupuncture works physiologically and anatomically, current and future acupuncture education, and marketing the profession. We welcome your feedback, insights, and discussion. We also hope you find our five-year project worthy of a place in your waiting room and a support to you in your professional goals.

Knowing the importance of the primary literature in conventional medicine – and noticing the void of a well-researched paper that medical professionals, patients, legislators and the healthcare system at large could reference, the need for a white paper-style journal article about acupuncture and Acupuncture Medicine was clear to both of us. The idea for such a paper was proposed at the first ASA national conference and was met with much enthusiasm, confirming our sentiments.

I (Sina) volunteered to take on the role of head author, reaching out to the ASA and the Society for Acupuncture Research (SAR) to begin assembling an author team (Bill Reddy, Charis Wolf, Korina St. John, Rosa Schnyer, and a bit later Lisa Conboy, Lixing Lao, and Jen Stone). The team of authors and paper that we will describe to you was born.

We wanted it to be a collaborative effort with the support and input of a broad swath of clinicians and researchers, and it became, as is the nature of collaboration and waiting for input, a five-plus-year project.

Our team of authors offer this paper¹ (and this descriptive AT series) as a support for you as a professional, practitioner and member of the acupuncture community at large. We hope that it will serve to further the needs of acupuncturists everywhere and also act as a guide for those wishing to learn about Acupuncture Medicine – patients, healthcare decision makers, policymakers, and other stakeholders.

We acknowledge that with collaboration comes compromise, and with a finished product comes revision. We know both are necessary as a part of the evolution of the medicine and the way that we talk about it among ourselves, our patients and the larger healthcare system. We also know it is easier to edit and revise than to start from scratch, and offer this as a place to begin editing as we strive for understanding of ourselves and our medicine.

Naming Origins

Around 1690, Dr. Willhelm Ten Rhijne translated the Chinese term zhēn jiû (针灸; the first character referring to needle/injection and the second to moxa) to acupuncture using “acus” from the Latin for “needle” and “puncture” for piercing the skin. Acupuncture Medicine (and all the modalities therein) was thereby reduced to “piercing the skin with a needle.”

This translation is somewhat accurate when considering the main physical action of the medicine in English, but when the term applies to theory and system of medicine that guides this physical act, we come up a bit short. For those of us who truly study the medicine, we can all see what has been lost in translation, which places some responsibility to fill in the gaps. This is where we began.

Acupuncture vs. Acupuncture Medicine

Though it commonly does, acupuncture as a technique does not always involve placing needles into the skin – as exemplified by the use of a teshin or a laser to stimulate acupoints. Further, the medicine overall does not only involve stimulation of acupoints.

The monikers of “traditional medicine” (Chinese, Japanese, Korean, and other cultural origins) are insufficient to describe the medicine as it is practiced today in the United States. It does not, for example, acknowledge the influence of French energetics.

Speaking broadly, we are not exclusively practicing an isolated form of traditional Chinese medicine (TCM) in the U.S. Because the medicine has been developing internationally – and now also biomedically – with a history covering thousands of years, the legacy geographical names fell short. We had to modernize our discussion to be as inclusive and medically relatable as possible.

Based on an examination of school curriculum, continuing-education offerings and other objective measures, we acupuncturists are practicing a blend of different forms of these medicines, filtered through Europe and amalgamated into a hybrid form. Hence, calling ourselves “TCM practitioners” is inaccurate and does a disservice to the U.S. acupuncture profession.

In discussing this with various Chinese-speaking, acupuncture-related organizations and individuals, it became clear that terms such as “traditional East Asian medicine” and “traditional Asian medicine” were also fraught, inaccurate, exclusionary, and misleading. For example, “traditional Asian medicine” could also include indigenous practices from other countries in Asia (that may or may not include practices associated with TCM or acupuncture) such as ayurvedic medicine.

While aiming for inclusion of our historical and theoretical basis, we also didn’t want to exclude ourselves from our more recent medical developments within our curriculum, as well as biomedically based acupuncture research with “traditional” in the name. The goal is to strongly position our profession, honoring the medicine while also allowing growth and recognition within the U.S. healthcare system.

As a profession in the U.S., the Bureau of Labor Statistics has assigned a designation of “acupuncturist.” This made us an official profession in the eyes of the government, which is the language legislators, insurance companies and healthcare system institutions all recognize. Importantly, the public knows us as “acupuncturists,” and the primary understanding of what we do is the stereotype of placing needles into the skin to affect the body’s natural healing mechanisms.

Finally, it is of primary political and strategic importance that we maintain our authority as acupuncturists, e.g., the authorities on acupuncture.

These discussions were happening throughout the profession (including CCAHM, ACAHM and NCCOM), all echoing the broad and most acknowledged term of “Acupuncture and Herbal Medicine” (note the capitalization) be used to refer to the whole-body system of medicine upon which the technique of acupuncture and related therapies is based and the way it is practiced in the U.S. and other non-Asian countries. We propose that the term “acupuncturist” be used to describe the practitioners performing such therapies, and the term “acupuncture” (lowercase) refer to the technique of needle placement.

This titling offers us inclusive unity that doesn’t limit the medicine while establishing authority and notoriety, situating our profession as the most qualified within the healthcare system as such; and ideally also avoiding scope creep by establishing proper educational standards for safety and competency.

Next Segment

In the next segment of this series, we will dive into clinical utilization of acupuncture and how to work with conventional practitioners without subsuming Acupuncture Medicine into conventional care models.

Reference