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"The World Health Organization (WHO)"
Guidelines on acupuncture education. A must read report!

John A. Amaro D.C., L.Ac., FIAMA, Dipl.Ac.

In 1966 when I cheerfully entered the profession of chiropractic by beginning my formal education, little did I know I would be engaged in a fight for my very professional, social and virtual existence for what has now been close to 40 years. Little did I know there would be numerous associations, companies, government agencies, professions and individuals who would prefer to eliminate me and my kind. I had no idea the great healing profession, chiropractic, I had entered would have so many enemies. In 1971 when I began my practice, acupuncture was not accepted by anyone except a handful of radical medical and chiropractic doctors and millions of hopeful patients nationally. There was no such thing as an acupuncturist. Thanks to the wonderful early education in acupuncture offered by a few of the colleges of chiropractic, my personal practice thrived. Interestingly enough the very profession of acupuncture which I helped pioneer in this country is now on the attack against D.C.s, who practice acupuncture. The acupuncturists’ criticism and completely unfounded basis is that D.C.’s and M.D.’s are untrained in acupuncture and a danger to society due to their education being considerably less than the typical acupuncture school. As I write for “Dynamic Chiropractic” concerning issues relating to the politics of chiropractic and acupuncture (see Amaro) the e-mail, phone calls, and letters with hate responses and name-calling, from people outside of the chiropractic profession cannot be overlooked.

It seems I am consistently consulting with a State Chiropractic Association or State Board whose acupuncture credentialing or usage is being challenged by acupuncturist organizations. Some States are in the process of expanding their chiropractic scope of practice to include acupuncture, I have been involved in that fight as well. I constantly hear the same worn out argument that “we’re trained (acupuncturists) and you’re not”! We are continually being whittled on and attacked and this time it is from the acupuncturists that want us eliminated at all costs.

The following published report on the World Health Organization guidelines for acupuncture education is extremely significant. I highly suggest every State Association and Board review this material and use it constructively for the establishment of acupuncture within their state scope of practice. I also refer you to my article “The Bottom Line” and “Do Chiropractic and Medical physicians have the right to practice acupuncture?”. These two articles are very strong resources.

We in the chiropractic profession are extremely well trained in acupuncture and all of the programs being offered today thru chiropractic colleges specifically meet the WHO guidelines for Level three specific to the training of “qualified physicians and certain other medical graduates”. The National Board of Chiropractic Examiners now tests specifically for acupuncture and The American Chiropractic Association has just established the “College of Chiropractic Acupuncture”. Diplomate status (DACCA) will be available soon. Contact me for further information.

The Core Syllabus for education in acupuncture as recommended by WHO is specific to both Level one and Level three of the WHO guidelines for all chiropractic colleges offering acupuncture as a postgraduate program. The word physician when used implies “doctor” and medical/medicine refers to the healing arts. Therefore the practice of chiropractic, podiatry, osteopathy and dentistry are included in the WHO descriptions.

The majority of this article is taken directly from the WHO guidelines.

The World Health Organization (WHO) is without question one of the most internationally respected assembly of educators, scientists, researchers and administrators to ever be formed and is accepted as the undisputed voice of health and welfare worldwide. Universities and governments accept its recommendations globally.

“WHO” has taken a keen interest in the development of acupuncture and having seen the need for an international common language to facilitate communication in teaching, research, clinical practice and exchange of information convened a scientific group in 1989, which approved a “Standard International Acupuncture Nomenclature”. WHO has encouraged and supported countries to identify safe and effective practices of acupuncture through research and proper application. In 1991, the Forty fourth-World-Health Assembly urged nations to introduce measures for its regulation.

In 1995, a scientific group assembled by WHO of more than 50 international experts developed a series of statements and guidelines on acupuncture relating to basic training, safety in clinical practice, indications and contraindications. These guidelines are intended to assist national health authorities in setting standards and establishing official examinations and also medical schools and institutions wishing to arrange training programs. The guidelines cover basic requirements for training non-physician acupuncturists and physicians wishing to use acupuncture in their clinical work. The guidelines also include a core syllabus for education.

Regarding “basic training” in acupuncture, the guidelines of the World Health Organization (WHO) document clearly state “The increasing popularity in recent years of acupuncture as a form of therapy and the interest of some countries in introducing it into primary health care mean that national health authorities must ensure safety and competence in its use”. The WHO guidelines go on to say “Making use of acupuncture in modern medical care means taking it out of its traditional context and applying it as a therapeutic technique for a limited number of conditions for which it has been shown to be effective, without having to reconcile the underlying theories of modern and traditional medicine. In this type of situation, lengthy periods of instruction in traditional medicine as a background to acupuncture are neither feasible nor necessary and shorter training must suffice”. Continuing, the WHO guidelines state “It seems provide guidelines for relatively short periods of theoretical and practical training in acupuncture which with well designed curricula and skilled instructors would be sufficient to ensure the safety and competence of those so trained”.

The WHO guidelines for the use of acupuncture in national health systems specifically recommend in item 2.2 under Examination and licensing, “A system of examination and licensing would be needed to ensure the competence of those trained and to prevent unauthorized practice of acupuncture”. With the establishment of the Acupuncture examination of the National Board of Chiropractic Examiners, the chiropractic profession meets that guideline. The State of Florida has specifically conducted a State administered acupuncture examination for Doctors of Chiropractic since 1988 and the State of Arizona has conducted one since 1983. Other States use the final examination of the college offering the training program as its examination for clinical competence.

Perhaps the most significant portion of the WHO guidelines for the general requirements for the practice of acupuncture, concern the four levels of training with educational requirements and core curriculum for each level.
The four levels are: 1.” Full training for those with little or no prior medical education or experience who wish to qualify as recognized acupuncture practitioners licensed to practice independently subject to the limitations imposed by the Ministry of Health. 2. Full training of qualified physicians (modern Western medicine) in acupuncture. 3. Training of qualified physicians (and certain other medical graduates) from schools of modern Western medicine who wish to include acupuncture as a technique in their clinical work. 4. Limited training of other health personnel (modern Western medicine) working in the primary health care system of their country”.

Level number one: which identifies those “with little or no formal training or experience in modern Western health care”.
The entrance requirement for this level is “completion of secondary schooling, university entrance or equivalent and appropriate training in the basic biosciences”. In the US this level would include those individuals seeking education in “acupuncture and Traditional Chinese Medicine school who graduate to become “acupuncturists”. This level specifically calls for “two years full time (2500 hours) or the part time equivalent, with not less than 1000 hours of practical and clinical work”. The “core syllabus in acupuncture” specifically written and recommended by the WHO guidelines, includes every one of the individual items common to each of the specific syllabus of the nine Council on Chiropractic Education (CCE) recognized chiropractic colleges currently offering postgraduate training in acupuncture.

Level number two: lays out the guidelines for “full training in acupuncture for qualified physicians” This guideline specifically states “Qualified physicians who already have adequate knowledge and skills in modern Western medicine, would only need to follow the Core Syllabus for acupuncture. The theoretical course could be shortened, as qualified physicians can learn traditional medicine more easily than those with no prior medical education”. The guidelines for level two full training of physicians are 500 hours of theory 500 hours of clinical and 500 hours of supervised practice.

Level number three: Is specifically categorized in the WHO guidelines as “Limited training in acupuncture for qualified physicians”. This category is specific to those medical, osteopathic, chiropractic, podiatric, dental and other professionals having attained the degree of “doctor” in the healing arts. This category would include the practice of acupuncture within the scope of their licensed profession and utilized as an adjunct to their usual practice. The guidelines specifically states: “Shorter training courses would be suitable for qualified physicians (and certain other graduates) who wish to become competent in acupuncture as a form of therapy in modern Western clinical practice (or as a subject for scientific research). For them a brief introduction to traditional acupuncture (derived from the Core Syllabus) would probably suffice and the training would then be largely orientated to the use of acupuncture in modern Western medicine. The course should comprise at least 200 hours of formal training and should include the following components:

1. Introduction to Traditional Chinese Acupuncture
2. Acupuncture points
  • Location of the 361 classical points on the 14 meridians and the 48 extraordinary points.
  • Alphanumeric codes and names, classifications of points, direction and depth of insertion of needles, actions and indications of the commonly used points selected for basic training.
3. Applications of acupuncture in modern Western medicine
  • Principal clinical conditions in which acupuncture has been shown to be beneficial.
  • Selection of patients and evaluation of progress/benefit.
  • Planning of treatment, selection of points and methods of needle manipulation and use of medication or other forms of therapy concurrently with acupuncture.
4. Guidelines on safety in acupuncture.
5. Treatment techniques
  • General principles.
  • Specific clinical conditions.

On completion of the course and after passing an official examination, participants should be able to integrate acupuncture into their clinical work or specialty.

Every item within the Core Syllabus as suggested by the WHO guidelines are specific and already established to each of the nine chiropractic colleges offering postgraduate education in acupuncture. This syllabus and the one for Level one has been in general application for over 30 years in chiropractic.

7.2 Special Courses
Some physicians or dental surgeons might wish to acquire proficiency in certain specific applications of acupuncture (for example, pain relief or dental or obstetric analgesia) and for them flexibility would be needed in designing special courses adapted to their particular areas of interest”.

Level number four: Relating to the training of primary health care personnel which consists of allied practitioners such as physical therapist, dental and medical assistants, nurses, inhalation therapists, and those having direct patient contact that are not “doctors/physicians”. The WHO guideline states, “It would seem wiser ….to train such personnel in acupressure (zhi ya) rather than in acupuncture itself. Training in acupressure would make no great demands, could be incorporated into the general training of primary health care personnel and would carry no risk to the patient. The use of acupressure in primary health care would have to be evaluated after a suitable trial period. Some personnel who show particular aptitude might be chosen for basic training in acupuncture, a training programme being arranged according to the applications envisaged”.

Acupuncture as practiced by qualified chiropractic/medical physicians is extremely easy to learn and to establish into a clinical practice. It may be practiced with simple electronic stimulation completely eliminating the use for needle penetration. It is a reimbursable therapy which when used electronically is often referred to as trans cutaneous electronic nerve stimulation (TENS). It may also be used with needle penetration and referred to as acupuncture. Remember, just like chiropractic, “Acupuncture is a principle not a technique”. It may be utilized by a variety of stimulation modalities.

Recently a study from the Harvard Medical School revealed that complimentary and alternative medicine (CAM) had increased 33% among those 60 and over, 50% by baby boomers, and 70% by post baby boomers. Many of these treatments are in the area of acupuncture. It is definitely time for every holistically minded D.C. to add this important healing therapy to your practice.

It is way past time, for every State to include acupuncture as part of its scope of practice.

John A. Amaro D.C., FIAMA, Dipl.Ac., L.Ac.
Carefree, Arizona