When performed by a properly trained clinician, acupuncture is a safe, effective, and holistic form of care. Your experience with acupuncture may vary depending on the provider you choose. Finding a licensed acupuncturist (L.Ac) will ensure your needs are met with the highest level of training and educational standards. Licensed Acupuncturists may be generalists or have areas of specialty. It is reasonable to ask about each provider’s training and if they have a particular area of focus in their practice. Licensed Acupuncturists are the only professionals who have completed nationally accredited training and have shown competency via nationally certified board examinations specific to acupuncture. ACAOM Accredited School The first step toward becoming a trained and licensed acupuncturist is graduation from an accredited school. Sanctioned by the United States Department of Education (USDE), the Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM) ensures that qualifying programs meet the educational standards established by Congress.1 The degree program of choice often includes options for master’s level and doctorate level degrees. The foundation of the curriculum is centered on traditional and modern (biomedical) applications of acupuncture diagnostic theory. Master’s Degree Within the United States, there are rigorous training standards to become a licensed acupuncturist. Most states require a three to five-year master’s degree from an accredited acupuncture school 1 and passage of standardized board exams 2 before licensure. A master’s may be attained in acupuncture a or Oriental medicine. b A master’s degree in Oriental medicine highlights practitioners who have completed additional training and course work in Chinese herbal medicine, above and beyond the standard acupuncture course curriculum. After passage of board examinations, acupuncturists are entitled to identify themselves as a Dipl. Ac. (Diplomate of Acupuncture) 3 or Dipl. O.M. (Diplomate of Oriental Medicine) 4 by the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM). NCCAOM Diplomate Standing The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) provides national board certification for Acupuncture and Herbal Medicine practitioners. To be eligible to take the NCCAOM exams, an applicant must have successfully completed a formal education in acupuncture or Oriental medicine through an accredited school. 1 Earning certification from the NCCAOM represents a significant professional achievement. NCCAOM certification makes an important statement about professional competence that is recognized by regulatory bodies, third-party payers, the profession, and the public. Types of NCCAOM Certifications Acupuncture 3 Three-year master’s program 1,905 hours/105 credits of didactic and clinical education. Acupuncture and Oriental Medicine 4 Four-year master’s program in Oriental medicine. 2,625 hours/146 credits of didactic and clinic coursework in both acupuncture and Chinese herbal medicine Certification in Chinese Herbology 5 Four-year master’s program in Oriental medicine OR a master’s in acupuncture and a post-graduate Chinese Herbal Certificate recognized by ACAOM 450 hours of didactic instruction in herbs 210 hours of herbal clinical training Licensing Each state has its own licensing and educational requirements to practice as an acupuncturist. Currently, 46 states plus the District of Columbia, require NCCAOM certification 6 as a prerequisite for licensure. 6 Successful completion of the Clean Needle Technique course and examination administered by the Council of Colleges of Acupuncture and Oriental Medicine is also needed. 7 Maintenance of an active license requires ongoing professional development activities (PDAs) or continuing education units (CEUs) towards renewal. Continuing Education and Specialties In addition to maintaining licensing requirements, many practitioners utilize continuing education to advance their studies in a specialized area. This may be through weekend seminars or full certificate programs. These programs include pediatrics, fertility, dermatology, sports medicine, and more. When seeking out a licensed acupuncturist with expertise in a particular field, inquire about their credentials, training, and experience in the area. Often, you will find practitioners with a history of patient testimonials and a track record of successful outcomes. Advanced Studies: Doctorate Degrees The Doctorate of Acupuncture and Oriental Medicine (DAOM) is a postgraduate degree and provides acupuncturists specialization within a particular field. c The DAOM entails advanced classes, clinical training, and research. It also prepares graduates for practice in integrative settings, such as hospitals, as well as academia. It is the highest level of training offered and the terminal degree in the field. 8 Currently, there are eleven accredited schools nationwide offering this level of training. 9 Following other allied health professions, such as physical therapy and pharmacy, several institutions have begun to offer an entry level or first professional doctoral degree: the Doctorate of Acupuncture and Chinese Medicine (DACM). 10-11 In addition to the aforementioned master’s degree curriculum, this program entails coursework that provides supplementary skills for practice in multidisciplinary settings and referral networks that support collaborative approaches to health care. 12

Acupuncture is a holistic treatment which incorporates the use of acupuncture, herbs, moxibustion, physical therapies, dietary and lifestyle guidance to restore balance to the body. It is not uncommon to incorporate acupuncture in conjunction with other forms of care. This may help to speed healing and rehabilitation after a health crisis, pain syndrome, or emotional trauma. Acupuncture is a safe, effective and relaxing treatment for a variety of health conditions. The number of treatments you will need depends on your condition and treatment plan. While working to decrease your symptoms, acupuncture also frequently produces a feeling of well-being and deep relaxation.

Your care is based on a medical diagnosis and a treatment plan developed during your initial clinical consultation. The assessment is based on medical history, presentation and onset of symptoms, as well as pulse and tongue diagnostics. After a diagnosis is made, the most appropriate and effective treatment plan will be chosen based on the diagnosis of a pattern or set of patterns. For example, five people might see an acupuncture practitioner all complaining of migraine headaches, however, each patient may be diagnosed with a completely different Chinese medical pattern. This pattern will be based on their main complaint and unique symptomatology.

Acupuncture enjoys a high level of evidence for a variety of conditions. 13 Research into acupuncture as a medical treatment has grown exponentially in the past 20 years, increasing at twice the rate of research over other methods of care in biomedicine. 14 Over this period, there have been over 13,000 studies conducted in 60 countries, including hundreds of meta-analyses summarizing the results of thousands of human and animal studies. Acupuncture is recognized by medical experts as a viable intervention for a spectrum of conditions and is one of the most widely recommended treatments in the current landscape of medicine. 15

Acupuncture is a recognized form of therapy that has its origins in ancient Chinese medicine. Current application of acupuncture clinically is performed using both historic understandings of its mechanisms and indications, and from modern, biomedical perspectives. From the biomedical viewpoint, acupuncture has been shown to have numerous mechanisms of action. Research into further mechanisms is on-going, but the neural pathways from the periphery, through the spinal cord, and to pain perception centers have been mapped and are thought to play a foundational role in acupuncture’s pain modulating effects. 16 Acupuncture is also well known to cause the release of numerous chemical mediators of pain such as endogenous opioids, ATP and adenosine, GABA, and substance P, and to affect the brain’s sensitivity to opioids. 17-18 When viewed from the Traditional Chinese Medicine (TCM) paradigm, acupuncture is the insertion of fine needles into acupoints to manipulate the functions of the body. It has been observed over the millennia that certain points on the body have identified functions, and different combinations of points can affect the body in specific ways. Classical Chinese medicine is based in the observation of nature, and how humans interact with and are affected by natural forces. 19 The early Chinese scholars studied how the body moved and functioned under numerous sets of conditions. They learned to apply acupuncture to help the body return to balance when, through natural influences or problematic dietary or lifestyle choices, individuals developed “disharmonies” or illnesses. Practitioners trained to apply acupuncture from the classical perspective utilize this ancient knowledge in the modern setting. They identify patterns of imbalance and are trained in the application of acupuncture as one tool in restoring health and harmony. It is important to recognize that the system of medicine in which acupuncture developed is highly structured and complex. It is also elegant, and its genius is often missed in mainstream criticisms; those criticisms generally put forth by individuals who have not taken the time to study the profound body of material that has evolved over time. Chinese medicine looks at the body from the viewpoint of physiologic systems rather than individual parts, and so its treatments aim to balance complex sets of functions and restore health at the root of illness, rather than by fixing a single, broken piece. Licensed Acupuncturists are trained in this way of organizing human physiology, and have learned full treatment plans for restoring health.

Traditional Herbal Medicine utilizes ingredients from the animal, plant and mineral kingdoms to treat many different health conditions. All ingredients are collectively referred to as “herbs”. Each herb offers a variety of chemical constituents that have specific biological functions. Different parts of the plant (i.e. roots, stems, leaves, flowers, fruit, seed and bark) can often perform different functions. When multiple ingredients are combined to make a formula, the sum of the chemical constituents is often more powerful and efficacious than the individual parts. 20

When we ingest herbal medicines, the same way as food, we breakdown the herb and assimilate the chemistry in the herb. But instead of assimilating the nutrients, we assimilate the medicinal chemicals. In some ways, herbs work similarly to many pharmaceutical preparations. In fact, some pharmaceutical medicines are based upon extractions from plants. For example, the malaria medicine quinine is extracted from the bark of the cinchona tree, and the pain medicine morphine is produced from the opium poppy. However, herbal medicine differs from pharmaceuticals because it uses the complete form of the herb to ensure the balance of constituents within it, instead of just using a specific extraction or single chemical from the plant.

Traditional herbal medicine formulas address the root cause of a health condition, not just a symptom. They treat the body as a holistic system and facilitate the body’s own healing mechanisms. As such, they can be used to treat a variety of conditions including: Allergies Anxiety and Depression Arthritis Cold and Flu Chronic Fatigue Headaches and Migraines High Blood Pressure Infertility Menstrual Irregularities Pain Sexual Dysfunction Skin Issues Sports Related Injuries Side Effects of Herbal Medicine Herbal medicine typically does not incur the unwanted side effects that are often seen in conventional pharmaceutical treatments. However, herbal medicine can be very potent and, if used incorrectly, can rarely cause serious adverse effects. Additionally, some herbs can affect how your body responds to prescription and over-the-counter medicines, either decreasing or increasing the effects of these medicines. In this way, it is very important to let your herbalist know what other drugs and supplements you are taking so they can advise or modify your formula to best avoid complications. Properly trained and certified herbalists are able to adapt herbal use to be safest for each patient. Herbal Medicine Formulas Herbal medicines formulas are sold as tablets, capsules, powders, teas, extracts, syrups, poultices, lotions, compresses, and fresh or dried plants. The form of your herbal medicine will depend upon your practitioner’s preferences, medical condition and sometimes, patient preferences. Herbalists are trained to dispense remedies for specific conditions and symptoms and to determine how much should be taken and for how long. Herbs can be selected to address each person’s unique constitution and sensitivities in addition to their disease or symptoms. For this reason, many herbalists, especially those that utilize raw herbs, will meet with their patients every few weeks to adjust the formula ingredients to meet the changing needs of their patients, as they heal, or to address different symptoms if they appear. This makes herbal medicine extremely flexible and customizable during every step of the treatment time process.

In addition to acupuncture, licensed acupuncturists also use moxibustion, cupping, gua sha, and/or tuina. These adjunctive therapies have been used for over 2000 years. They can be used alongside an acupuncture treatment or alone. Moxibustion Moxibustion involves heat therapy using the mugwort plant (Artemisia vulgaris or Artemisia argyi), also known as “moxa,” to stimulate acupoints. Moxibustion is used for treating many conditions. In a quantitative study of 50 years of bibliometric material, up to 364 types of diseases have been shown to be treated with moxibustion. Moxa is used for digestive, urinary, gynecological/obstetric and orthopedic issues. It has been shown to aid in pain reduction. Moxibustion can be done in a variety of methods – each with different thermal effects. When moxa is lit, it emits visible and infrared electromagnetic waves. This energy is absorbed by the body to promote blood circulation. 21-22 Cupping Cupping therapy involves the use of a cup or a jar. The World Health Organization (Code 5.3.2) defines the cupping method as a “therapeutic method involving the application of suction by placing a vacuumed cup or jar onto the affected or any part of the body surface.” Cupping is used for many conditions from musculoskeletal pain to cardiovascular issues to early colds and flus. 23-24 Gua Sha Gua sha is an instrument assisted manual therapy whereby the body surface is compressed with a smooth-edged tool. 25 This therapeutic process intentionally creates petechiae (tiny red or purple dots on the skin) and increases blood flow into the fascia. The “sha” or redness that is created can last up from one day to one week. 26 This technique increases blood flow to local tissues, helps the body activate a local healing response, and assists in the removal of toxins from the tissue (such as by-products of metabolism in areas with myofascial dysfunction). Gua sha has also been shown to reduce internal organ inflammation by upregulating heme-oxygenase-1. It has been shown to produce a four-fold increase in the surface tissue microcirculation, reduce inflammation and stimulate the immune system. Gua sha is used for many conditions ranging from asthma to musculoskeletal pain and spasms. 27 Tuina Tuina is a school of Chinese manual bodywork therapy. Literally translated as “push” and “grasp,” it is used to promote blood flow, improve function, and enhance resistance to disease. Tuina involves different manipulation techniques for different conditions. 28 Similar to the other therapies described, tuina can be used to treat many types of conditions ranging from musculoskeletal pain to digestive disorders. 29 The use of herbal liniments and oils may be used by the practitioner, depending on the condition presented.

“Dry needling” has created a great deal of confusion in recent years, both among patients and healthcare providers. It is one of many names d that refer to a form of acupuncture utilized by Western medicine clinicians. The term was coined by Janet Travell, MD, and came into prominence during the early 1980s when discussed in her seminal text Myofascial Pain and Dysfunction: The Trigger Point Manual. 30 It was used to distinguish from the implied “wet needling,” which is the injection of a fluid with a hypodermic needle. While a “dry needle” initially referred to an empty syringe, it has evolved to include monofilament/filiform 31 needles routinely used by acupuncturists. The latter of which is utilized in the modern application of “dry needling.” Acupuncture, by default, encompasses “dry needling,” and any suggested distinction, in actuality, exists largely in name. The current interpretation of “dry needling” largely refers to an aggressive form of acupuncture entailing a piston-like motion of deep needling into tender areas in muscles known as trigger points. Many “dry needling” adherents, whether due to being genuinely misinformed or otherwise, suggest that it never occurred to ancient Chinese physicians to manipulate a needle in a piston-like motion or treat trigger points, utilizing the equivalent language of their time. In an attempt to distinguish it from “dry needling,” they unfortunately misrepresent acupuncture as being relegated to superficial or “energetic” needling based on a mystical paradigm. Neither the needling method, nor the concept of trigger points, is new or innovative. This is recognized by numerous clinicians and researchers, acknowledging the historical precedent set by acupuncture. 32-38 For instance, “The Yellow Emperor’s Inner Classic of Medicine” (Huang Di Nei Jing), dating back to between the 2nd century BC and 2nd century CE (Han Dynasty), describes this. The technique, hegu ci, is still used to treat musculoskeletal conditions. It is characterized by deep needling into muscles accompanied by partial retraction and reinsertion at varying angles, which is currently described as “fanning” or “coning.” 39 With regards to trigger points, in his 7th century CE work, “Prescriptions Worth a Thousand Gold” (Qian Jing Yao Fang), the famous physician, Sun Simiao, described ashi points. Ashi, which translates to “Ah, yes!” or “That’s it!” refers to points that are tender or painful upon local pressure and can produce radiating pain – hallmarks of trigger points. 40 These are just a couple of innumerable examples demonstrating acupuncture’s historicity and development over the course of more than 2000 years. Numerous styles and techniques of needling factor in several variables: depth, angle, intensity, frequency, proximity to the diseased/injured area, etc. 39 Acupuncturists are trained in both traditional and biomedical paradigms, evidenced by their educational requirements. In addition, numerous continuing education courses and certificate programs in orthopedic/sports medicine/trigger point acupuncture have been well established prior the recent emergence of “dry needling.” 41-42 For further information on this subject, please read Andy McIntyre’s article “Dry Needling is Acupuncture; but Acupuncture is not Dry Needling.”