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"Do Chiropractors have the right to practice Acupuncture?"
John A. Amaro DC, FIAMA, Dipl.Ac. (NCCAOM)

"….those spots indicate where the needle can be inserted in treatment by acupuncture" When a Chinese is ill the doctor generally concludes that the only way to cure him is to stick a long needle into him and let out the pain or set up counter irritation. The (acupuncture) chart has been made up from millions of experiments during the past 2000 or 3000 years….." The foregoing words appear and sound as a contemporary description of acupuncture, which has become the fastest growing healing art in the nation. This statement was actually written by the founder of the Chiropractic profession, D.D. Palmer in 1906. These words found on page 858 of "The Text-Book of the Science, Art and Philosophy of Chiropractic" were written in 1906 and published in 1910.

Even though Daniel David Palmer refers to "acupuncture" by name in his 1910 book, it would not be until February 1972 when James Reston the famed journalist, escorting President Richard Nixons delegation to China, would mention the word acupuncture in his legendary article "Now about my Operation". In that article Mr. Reston described his personal encounter with acupuncture as a means of anesthesia for an emergency appendectomy. History can trace the popularity and interest of acupuncture in North America directly to this article and the follow up stories it spawned. The fact of the matter is D.D. Palmer, the founder of the Chiropractic profession, recognized acupuncture and made mention of it in his publication a full 65 years before Reston would write of it.

Palmer practiced what may be referred to today as Qi Gong and Reiki from 1887, when he established the Palmer Cure and Infirmary in Davenport Iowa eight years before his "discovery" of chiropractic. Qi Gong, an Asian healing art, which uses the bodies subtle energies, commonly referred to in those days as magnetic healing, has gained enormous popularity worldwide within the last few years. Even though magnetic healing (Qi Gong) had been extremely popular in the 1880's and 1890's, it gradually lost favor with the populace, as allopathic medicine became more and more mainstream. By the end of the first decade of the 1900's, magnetic healing was virtually non-existent.

Chiropractic like allopathy, was likewise beginning to thrive by 1902, as Palmer opened several schools of Chiropractic. One school directed by Alva Gregory MD in Oklahoma City who served as Vice President of the Palmer-Gregory College of Chiropractic. These schools taught the basic sciences and techniques clearly recognizable as chiropractic today but also discussed a myriad of topics, which would most definitely be considered acupuncture. Even though a number of procedures and techniques of meridian acupuncture were common place in early chiropractic, the procedures were generally delivered through finger pressure and stimulation of specific skin areas as opposed to needle stimulation.

In 1972 acupuncture had piqued the interest of North America not to mention a new awakening in Europe, practitioners of this intriguing healing art were very rare and were from The Republic of China (Taiwan) and Japan. At this same time under Mao Tse Tung's communist regime, travel outside of The People's Republic of China was expressly forbidden and in fact tourism by Americans would not even open until 1979. The first practitioners from the People's Republic of China would not make their way to America until the mid 1980's.

As more and more articles expressed the seemingly miraculous results of acupuncture in a variety of disabling conditions and painful afflictions, the American public began to seek qualified, competent practitioners. Interest likewise ran very high in open minded, progressive doctors who wanted to learn more of this new and different healing art. To answer the demand of hundreds of doctors of all disciplines across the nation to learn acupuncture, the first formal postgraduate program in the United States was begun and conducted by Columbia Institute of Chiropractic now known as New York Chiropractic College in the fall of 1972.

I am personally proud to have been in that very first acupuncture certification program which was taught by masters of acupuncture who were physicians from the United States, Great Britain, The Republic of China and Japan. As few early Asian educators of acupuncture spoke English the lectures and demonstrations were translated. Chinese acupuncture practitioners from Communist People's Republic of China would not begin the introduction of Traditional Chinese Medicine (TCM) in the United States for as much as an entire decade later when communication was established. Virtually all acupuncture in North America from 1972 to 1982 was performed through Japanese or Taiwanese "Meridian Style" influences. Likewise, virtually all acupuncture in North America was performed by chiropractic and medical physicians as "acupuncturists" as a profession would not become a reality until the National Commission for the Certification of Acupuncture was established in 1985.

The Chiropractic profession had always taken the lead in acupuncture education and certification. Even though the National Commission for the Certification of Acupuncture would not become established until 1985, the State of Arizona established Board Certification in Acupuncture through the Arizona State Board of Chiropractic Examiners as early as 1983. Certification in Acupuncture in Arizona is through both successful completion of a course of study and passing a State Board conducted acupuncture examination. My personal Certification is dated 1984.

The first acupuncture program in North America was 100 didactic hours and literally hundreds of additional hours in home assignments and clinical applications. It prepared the doctor with a full and complete knowledge of the academics, philosophies, procedures and techniques of acupuncture. The doctors who graduated from that program which was made up of 90% Doctors of Chiropractic the rest being Medical Physicians, became the first certified practitioners of Acupuncture in the United States which followed a comprehensive written examination. The first certificate was dated September 24, 1973. I have certificate number A000003.

Since that first acupuncture certification program in 1972-73 from Columbia Institute of Chiropractic (New York Chiropractic College), programs have been established at National College of Chiropractic, Logan College of Chiropractic, Texas Chiropractic College, Canadian Memorial Chiropractic College, Northwestern College of Chiropractic, University of Bridgeport Chiropractic, Parker Chiropractic College, Cleveland Chiropractic College and even Life Chiropractic College has a significant presence in Beijing at the Academy of Traditional Chinese Medicine.

It has been estimated that over the last 28 years more than 35,000 Doctors of Chiropractic have been trained and certified in acupuncture through the above referenced nationally accredited Chiropractic Colleges. This clearly is the largest single group of practitioners in North America. The majority of the States have regulated through the State Legislature the practice of acupuncture by doctors of chiropractic through 100 didactic hours and clinical application. Even though the concepts of Traditional Chinese Medicine are discussed within these programs, many of the philosophies and theories of TCM are based solely on myth and folklore and have little place within a professional institute of higher education. Significant discussions of modern research into scientific discoveries of endorphins, enkephalins, neural theories and laser and electronic stimulation's are a major focus of the professional program of acupuncture.

The vast majority of medical and chiropractic physicians who have adopted acupuncture principles into their practices have adopted "Meridian Style Acupuncture" as taught and practiced in Japan, Okinawa, Korea and Taiwan as opposed to "Traditional Chinese Medicine" (TCM) as taught in The People's Republic of China. Bear in mind, acupuncture had been practiced in North America for more than 12 years before TCM concepts became introduced. Just as the nations of Japan, Korea, Taiwan, The People's Republic of China. Malaysia, etc. have different cultures, language, appearance and histories, they likewise have different approaches to acupuncture. Just as all automobiles are not Fords, all acupuncture is not "Traditional Chinese Medicine" (TCM)

Unfortunately, there has been a dedicated effort by those practitioners who are non-physician acupuncturists to discredit those doctors who practice acupuncture following 100 hour or 200 hour educational program. The 200 hour program is what is recommended by the World Health Organization as a standard of education for those who are licensed health care practitioners. The acupuncturists' criticism and attack is they go to school for 1,350 hours and in some cases 1,850 hours to give them their background and to learn acupuncture. However what they are not considering, is that the doctor practicing acupuncture, has spent considerable more time in school than 1,850 hours. Doctors have been both nationally and State Board examined in the subjects which make up acupuncture school but is taught in acupuncture school as a fragment of what would be covered in a professional college of chiropractic or medicine.

In addition, Acupuncture Colleges based upon Traditional Chinese Medicine (TCM) teach highly questionable theories based on ancient folklore. Dampness in the Spleen, Liver Yang Turning to Wind, Phlegm Misting the Heart, Damp Heat in the Gallbladder and Invasion of Spleen by Cold Damp are ways to describe medical conditions by acupuncturists practicing TCM. These descriptions still used to this day, are based on myth which predates the Dutch coming to Japan in the 1700's who described and explained anatomy and physiology, which had been described in the West but was unknown in the East.

The doctor practicing acupuncture today is highly skeptical of the acupuncture practitioner of pulse diagnosis, which is one of the standard methods of diagnosing in Traditional Chinese Medicine. The practitioner must ascertain one or more of 28 specific characteristics, which occur on the six pulses of each wrist. According to ancient texts, this procedure is paramount for the practice of acupuncture. In the late1980's and early 1990's, Acupuncture College specifically stressed that in order to properly practice Traditional Chinese Medicine, a very busy practitioner could not physically see more than eight patients a day and many colleges suggested only six. However, I find it so amazing the colleges no longer stress this rule as most practitioners have discovered they have great difficulty in supporting themselves financially on just eight patients a day. As a result, TCM practitioners now shortcut the time necessary to properly employ a pulse diagnosis in order to see more patients. This is in blatant disregard to proper protocol. A pulse practitioner must be able to ascertain what a leathery, minute, knotty, thready pulse may indicate or miss the diagnosis. Tongue diagnosis plays a key role as well. A physician practitioner of Meridian Style Acupuncture may utilize high technologically advanced, Electronic Meridian Imaging which measures the amount of electrical conductivity to determine the electromagnetic nature of the acupuncture meridian. This procedure was developed and perfected in Japan in the mid 1950's.

In essence, Doctors of Chiropractic as well as Doctors of Medicine who are trained within the academic parameters of "Meridian Style Acupuncture" as practiced in Japan, Taiwan etc. have a very full education in clinical/medical acupuncture as opposed to Traditional Chinese Medicine (TCM). Acupuncture was practiced in this country for a full 12-15 years in the Meridian Style prior to the introduction of TCM and hundreds of thousands of patients have benefited from its application. It is disheartening to have fighting occurring as TCM practitioners, colleges and organizations are aligning themselves to become the standard of care in this country with virtually no regard for other styles of acupuncture.

With insurance coverage being a major reason why a patient would seek one practitioner over another, a situation has developed and is being reported in a variety of States. Landmark Healthcare Inc. who's Clinical Management Director is a DC and acupuncturists has thus far eliminated Doctors of Chiropractic from being paid for acupuncture services even though they are licensed to practice acupuncture in their State. His reason is that the basis for a standard of care for an acupuncturist is 1,850 hours. His letter to Colorado doctors states "You were correctly informed that your Colorado acupuncture certificate does not meet Landmark's requirements for credentialing as a participating acupuncturist in our network. Landmark's credentialing criteria for each profession is the standard of care within that profession, not the standard for certification of a particular procedure as an adjunctive modality".

According to this directive, it makes little difference if you are a competent qualified practitioner of the Japanese and Taiwanese style of Meridian Acupuncture which does not focus on learning, a myriad of ancient diagnosis, folklore and questionable practices. It only matters that you attended an acupuncture school for 1,850 hours re-taking class after class which a physician has already been examined in. It's very much like saying "Sorry, you cannot join this club because you're different"! Acupuncture is not restricted to TCM!

Recently I assisted the State of Maine with the successful passage of their acupuncture law for Doctors of Chiropractic. The argument given by the Maine Acupuncture Association of Oriental Medicine a small splinter group of practitioners who are opposed to Doctors of Chiropractic utilizing acupuncture was "We support any health professional doing acupuncture when they can demonstrate adequate training, education and technical competency". Of course they specifically state that Chiropractors are not qualified to perform acupuncture stating that their professional program consists of 100 didactic hours. The other argument was "Chiropractors are not Level 1 practitioners" meaning DC's have no professional relationship to MD's or DO's. Please bear in mind these are acupuncturists saying this. It was stated to the State Legislators of Maine, that "This legislation does not represent a turf war between two professions, but we will persuade legislators of our grave concern over public health and safety and the lack of training presented in this bill". The Maine State legislature didn't buy it. It was obvious, this was a vocal, militant unprofessional group who wanted nothing more than to own the right to practice acupuncture alone. Maine DC's have just received the right to practice acupuncture as part of their scope of practice.

Want to hear what the American Academy of Medical Acupuncture said about acupuncturist in the State of Idaho when acupuncturist were trying to get their law passed. The AAMA is a group that only represents MD's and DO's.who likewise would like to keep acupuncture for themselves. In speaking of acupuncturist, "many have not even graduated from college. This lack of standard, Western medical training as undertaken by every physician acupuncturist who has been graduated from college and an American medical school and who has satisfied internship and/or residency requirements, could leave their patients vulnerable to misdiagnosis resulting form ignorance. Or, absent misdiagnosis could encourage unwitting patients suffering from serious medical problems to use unconventional therapies when Western medicine would be the preferred and more appropriate treatment. Supervision of non-physician acupuncturists by Western physicians is essential to the health and well being of Idaho citizen."

So here we are the chiropractic profession who within the past 28 years have certified over 35,000 practitioners who are licensed or regulated in over 35 States to practice acupuncture as part of our scope of practice with the additional background of 100-200 hours of education. Doctors of Chiropractic are the original pioneers of acupuncture in this country however, with chiropractic as our primary profession, most DC's have incorporated acupuncture as an adjunct into their practice as opposed to a primary modality.

The medical and chiropractic professions have embraced the Japanese and Taiwanese style of Meridian Acupuncture as opposed to the controversial Traditional Chinese Medicine (TCM). Acupuncture is being offered in the majority of Council on Chiropractic Education recognized colleges in North America. We have the background, the dedication and the intelligence to effectively learn and deliver high quality acupuncture within our scope of practice. We are licensed health care practitioners who have six to eight years of college in addition to certification in acupuncture. We are professionals.

The acupuncture programs for chiropractic and medical doctors are inclusive, academic, accelerated, and focus on the aspects of acupuncture which are vital to a practice. Learning the Chinese name for each point is interesting, but unless the practitioner plans on practicing in China, there is little reason to spend the hours in class learning Chinese. To take an X-ray you don't have to know German. There are obviously scores of academic approaches and class hours, which could be trimmed considerably in the TCM schools of 1,850 hours. Since Acupuncture Colleges exist as a business, there is an obvious need to create a certain number of hours as what it takes to graduate. Don't think for a second, just because one put in the 1,850 hours that that is the magic number one must have to suddenly gain competence.

I would love to see doctors practicing acupuncture as well as acupuncturist practicing TCM be able to practice with respect for each other. Oh well, having dealt with the "straight" "mixer" problem for all of my career, it is hardly likely this will be the case.

Doctors, if you are a graduate of a 100 or 200 didactic program in acupuncture you have the tools to be incredibly effective in helping sick people regain their health. It is not necessary to inventory 50-75 raw herbs in your office, it is a matter of using the patent Chinese Herbs which are becoming more popular amongst even the most die hard of practitioners.

Case studies come across my desk weekly from those doctors who are obtaining 'Fellowship" status with the International Academy of Medical Acupuncture. When I see what these doctors are seeing in clinical practice and what they are helping there is no question----

John A. Amaro D.C.,FIAMA, Dipl.Ac.(NCCAOM)
Carefree, Arizona