What is an Acupuncture Physician?

In the State of Florida, an Acupuncture Physician is a Physician who is licensed by the Florida Department of Health to practice Acupuncture. In case you’re wondering, all physicians are typically referred to as Doctor, as in, “Hi, I’m Dr. Shark.”

Medical licensing is regulated by the states, so the specific requirements for medical licenses vary from state to state.  Several states, such as Alabama, still do not have a licensure process to practice Acupuncture.

This definition brings up two questions:

  1. What is Acupuncture as defined by Florida law?
  2. What is required to receive this license?

First off, “Acupuncture” as defined by Florida includes a lot more than the practice of Acupuncture itself, which is essentially the insertion of very fine needles at specific locations in order to produce a physiological response which results in pain relief or the activation of healing.  In the state of Florida, Acupuncture means the entire system of Chinese Medicine. This includes diagnosis, nutrition, physical/orthopedic exam, herbal medicine, supplement prescription, rehabilitative exercise, intramuscular injection of non-drug substances (such as vitamins or saline), and the ordering and interpretation of lab tests and images (such as blood work or x-rays).  The primary difference between what a Medical Doctor (MD) and an Acupuncture Physician (AP) can do is that the MD can prescribe pharmaceutical drugs and an AP cannot.

What is responsible for this difference? It’s the focus of the medical training of each respective physician. Both MD’s and AP’s spend 4 years in medical school, with similar prerequisites for science education in undergrad. Both physicians study important subjects such as Anatomy, Physiology, Pathology, Pharmacology, Internal Medicine, Orthopedics, Dermatology, and External Medicine. But there is a major difference in the way these subjects are approached.

The driving force behind the difference in approach is the difference in treatment. Medical Doctors’ primary treatments are pharmaceutical drugs and surgery. Their diagnosis primarily directly restates the symptom (e.g. high blood pressure, high cholesterol, high blood sugar, migraines) and seeks to find supporting markers on specific tests which indicate the need for medical interventions—because drugs and surgeries are designed to treat these single symptoms individually.  Acupuncture Physicians’ primary treatments are natural interventions that stimulate the healing process in the body either through activating a specific neurological response (Acupuncture) or by providing particular nutrients or substances (Herbal Medicine, Nutrition, Supplementation). As a result, MDs’ diagnostic processes tend to be more specific (focused on one abnormality at a time), and APs’ more holistic (focusing on the entire body or entire functional system).

There are advantages and disadvantages to both approaches. In general, MD’s are unparalleled in their treatment of emergency conditions. Because of their specificity, they can quickly treat and control life-threatening occurrences like heart attack, inability to breath and major traumas. If the threat of death is imminent, the Emergency Room is probably the best place for you. But because of this focus on health problems as single, isolated events, conventional Medical Doctors are often unable to produce satisfactory results when it comes to conditions that are not immediately life threatening: chronic conditions such as heart disease, diabetes, chronic pain, auto-immune disease and mood disorders. Some Medical Doctors are recognizing this failure and seeking additional training after medical school in a relatively new field called Functional Medicine (FM). An MD who practices Functional Medicine is striving to be far more holistic, though there is a lot of variance between practitioners since this holistic training is not required for their medical license. Though many FM doctors still tend toward their original training of single-problem focus, if you have a chronic condition and the option of choosing an MD trained in Functional Medicine over one trained only in the conventional system, definitely pick the FM doctor. They will be much more likely to consider effective non-drug approaches.

 

Acupuncture Physicians, on the other hand, are trained from the get-go to look at the body through a holistic lens, that is to say that they are analyzing how various systems fit together in order to determine the root of the malfunction.  Rather than zeroing in on a single symptom, such as nasal allergies or an abnormal lab result, AP’s are trained to look at really big picture indicators like digestive function, inflammation and constriction of tissues and blood vessels, detailed health history and the relationship between “physical” and “mental” disorders. This holistic approach gives AP’s the advantage when it comes to pain and chronic disorders. The reason is that chronic disorders are never isolated, single body-part events. They always involve multiple systems and evolve through complex mechanisms. If they didn’t, they would never become chronic; they would simply heal themselves or be quickly eradicated by a short-term problem-focused approach like those typically offered by an MD. And there is no drug on the market that corrects the neurological pain impulse the way that Acupuncture does. Pain medications merely dull or mask the pain in the hope that the body will get better on its own in the meantime. My friend Bob Doane puts it best, MD’s treat the symptom and hope the problem goes away; AP’s treat the problem and hope the symptom goes away.

I would be remiss if I didn’t address the frightening new practice of MD’s and Chiropractors (DC’s) performing Acupuncture in Florida. These practitioners are required to have little to no training in order to perform needling on their patients. I say needling, because they are really not practicing Acupuncture, which as we discussed is a specific holistic therapy; they are merely memorizing some symptom-focused protocols and applying them across the board.

Well, you say, I just have one problem. Why not just let my DC or MD do my Acupuncture? Their appalling lack of training, that’s why! An AP has about 3,000 hours of training and over 1,000 hours internship in the specific diagnostic system and needling technique which allows them to get results. MD’s are not required to be trained at all in order to perform needling, because their license already covers sticking needles in you! If they elect for membership in the American Academy of Medical Acupuncture, they are required to have a whopping 220 hours of training, less than 1/10th of what an AP has. Chiropractors (DC’s) are only required to have 100 hours training to stick needles in you in Florida! This is crazy, folks. I would never let someone with so little training treat me. I certainly would never attempt to adjust your neck or perform an appendectomy when you come in for Acupuncture, and DC’s and MD’s shouldn’t be sticking needles in people and calling it Acupuncture.

The one disclaimer I will add to this article is that all of my explanations here are broad generalizations. I did this to simplify the explanation of different types of medical license. However, all doctors are people, and people are individuals with their own unique strengths and weaknesses. In every field there are excellent, qualified individuals who really do get the big picture and know what they’re doing. I have been educated and inspired by many Medical Doctors and Chiropractors through the years. While I’ve studied with a few really outstanding Acupuncture Physicians, I actually get most of my medical information from work done by exceptional MD’s and DC’s. Some of these doctors do have extensive training beyond those required by law or by certification boards. If you’re wondering about a doctor’s training and background—just make sure to ask; don’t assume they’re knowledgeable about a field that may be out of their area of expertise.

I hope I’ve given you a pretty good overview of what it means to be an Acupuncture Physician. I’m happy to answer questions left in the comments section. We’ll be starting up a video blog soon, so please leave your questions in the comments section. Once we get rolling, we’ll answer a question every week. Be well!


What is Shiatsu?

What is Shiatsu?

Shiatsu is an Asian style of body work focused on balancing the whole system through dynamic pressures, compressions, and stretches that work with the meridian channels.  Shiatsu is done with clothes on so the brain does not get distracted by skin sensations and absorbs the pressure on a much deeper level.   Rather than just focusing on symptoms, Shiatsu focuses on the person’s overall emotional and functional state to get to the root cause of those symptoms.

Communication is an important part of the massage session.  Before beginning any of the hands on techniques, the practitioner should discuss current symptoms, past injuries, and lifestyle to paint a clearer picture of the source of imbalance. The massage then begins with finger pressure applied to Back Shu Points along the outside of the spine to help determine what channels are in an excess (jitsu) state or in a deficient (kyo) state.  From there the session is designed for the individual to bring the body back to balance, by strengthening the weaker channels and dispersing the channels in excess, stimulating the person’s own body to heal itself.

The garden analogy

Both the garden and the human body are microcosms of nature.  The processes, cycles, and conditions that exist in a garden can also be observed in the life of a human being. If we use this analogy the practitioner becomes the gardener.  The gardener does not make the garden grow. Nature does.  The gardener protects the integrity of the garden by promoting growth in some areas and restricting it in others, always observing the interaction between the garden and the outside environment.

 


What Are Acupuncture Meridians?

In my practice, I commonly get asked the question, “How do you pick the points?” or “Are there specific spots where you put the needles?” In order to answer these questions, you have to understand the meridian system. In Acupuncture, the term Meridian comes from the French translation rather than from the original Chinese writings. The Chinese term more correctly translates into Channel or Vessel; it is the same term used for blood vessel. For the purposes of this article, I will use the term meridian—because as you’ll see in a moment it helps me explain what these things really are.

First let’s start with the usual definition. If you look this up elsewhere on the internet, you’ll find several versions of basically the same definition. The meridians are invisible pathways inside the body where the mystical, magical qi (pronounced chee) flows.

These invisible tubes can become blocked by stress or other invisible forces. You may or may not know this is happening. Acupuncture can remove these blockages, but you probably won’t know if it’s working or not. It will take a Licensed Acupuncturist to decode your pulse for you to know if your qi is now flowing smoothly.

Some other practitioners will probably be highly offended at the last paragraph, because this is exactly what they have been telling their patients for years. I know you hate me! But I must de-mystify this meridian business, so that we can all move into the 21st Century together!

Now let’s talk about some other things that have meridians. Have you ever seen a map? A globe? A nautical chart? All of these devices use the markers of latitude and longitude to show the relationships between locations. Another word for longitude is meridian—as in the Prime Meridian.

Now have you ever been in a plane and looked out the window? Have you ever seen one of these meridians drawn across the Earth? That’s right, NO.

So what does this mean? Does it mean Meridians aren’t real or useful or important? NO!

It means that Meridians are man-made devices, drawn by humans, to help us navigate. They are not an inherent part of the natural world. They are our interpretation of the natural world. And so it is with the Acupuncture Meridians.

The Acupuncture Meridians are lines drawn by humans to explain the relationship between different areas of the body. Different parts on the same Meridian are connected. But it goes further than that, each Meridian has a balancing relationship with specific other Meridians. This balancing relationship determines where to put the needles in order to heal the sick area.

So as an Acupuncturist, I only have to determine three things. First, the diagnosis, in other words which channel is sick and where? Second I need to know which channels will balance that sick channel. And third I choose the channel and area that I’m going to needle to balance the sick channel.

See! It’s not mystical at all! It’s actually quite systematic! So far I haven’t needed to use psychic healing on any one of my patients. The science of Acupuncture works just great!

 

 

Acknowledgements:

Thank you so much to Dr. Tan for teaching me this way of seeing our medicine! It has transformed my practice.

See more about his system here in this video:


Acupuncture Helps Arthritis

Many people in San Francisco are looking for a natural, drug-free way to treat their arthritis pain. We boast an incredibly active population in the Bay Area, and people don’t want to give up on being involved in life just because they now have arthritis. However, the desire to stay active can lead to a daily regimen of anti-inflammatory drugs. These drugs are primarily over the counter, so other than being bad for your stomach, most people assume they are safe.

If you were watching the news in 2004, you probably remember Vioxx being pulled off the market due to its connection with heart attacks. The FDA then recommended all similar medications be labeled as possibly dangerous to heart health. What most people don’t know is that medications like Advil (Ibuprofen) fall in this category as well. In fact multiple studies have shown that ibuprofen increases risk of death from heart disease in healthy people. It also interferes with the effectiveness of aspirin therapy in those with cardiac risk. Other studies have shown that NSAIDS (non-steroidal anti-inflammatory drugs) make arthritis worse! That’s right, they have been shown to impede tendon, cartilage and bone repair. “Wait!” you say, “I thought I was supposed to take these drugs for these problems, and now you’re telling me that I am making the problem worse?” Sadly, yes.

So now you want to remain active, even with your arthritis, but you don’t want to risk your stomach, heart and the cartilage you are trying to protect. What now?

Acupuncture has been shown to be wildly effective in the treatment of Arthritis pain. And the reason, in this author’s opinion, comes down to circulation. Arthritis basically consists of two problems: inflammation and low blood flow. The major types of arthritis, Osteoarthritis, Rheumatoid arthritis and Psoriatic arthritis have varying degrees of the two issues with Rheumatoid and Psoriatic being more inflammatory and Osteo being more related to poor circulation.

In Chinese Medicine, the terminology was determined before we had all of these medical explanations. Therefore we often use simple words to explain these conditions. A more inflammatory condition would be called “heat,” and a problem with lack of circulation would be called “cold.” In fact, if you take a thermal scan of a joint, you can, in fact, see that inflammatory conditions are hot (red) and low circulation conditions are cold (blue). We treat these problems with opposite methodology, therefore it is very important to properly evaluate the condition.

Once your arthritis has been properly diagnosed as hot, cold or some combination of the two, treatment can commence. That treatment will focus on correcting the issue. The answer to both problems is in the circulation.

Blood performs two basic roles:

1. To bring nutrients and oxygen to an area

2. To take debris or waste away and eliminate it

Let’s call #1 the milk man and # 2 the garbage collector.

Now the problem with the cold condition (low circulation) is that the milk man can’t get in to deliver the milk. Now the joint is starving. It doesn’t have the proper nutrient flow it needs to stay healthy. This results in a degradation of the tissue. Just like a lack of food would cause you to waste away over time.

With the inflammatory condition (heat), we have too much stuff stuck in one place (usually fluid), and we need the garbage collector to come and take it away. If the garbage collector is not removing the garbage, it will build up and rot. Believe me, your joints are not good place to store the garbage of your body, and your body will revolt if you leave it there.

While this is a vast oversimplification, it is a good illustration of the importance of blood circulation. So what does Acupuncture have to do with this?

Acupuncture’s entire job is to manipulate the circulation of the body. We (Acupuncturists) choose points that are designed to increase or reduce fluid, blood or oxygen in a certain area. That’s all we do. Through thousands of years of experimentation, protocols for affecting the circulation in specific areas (whether that be a joint or an organ) have been developed. As long as the condition is correctly analyzed and the practitioner is trained in the proper treatment approach, the chosen points will work to correct the circulation problem.

So what will this mean in the case of arthritis? How will you know your circulation has been brought back to normal? We could take a thermal scan, and these scans have been used to show the immediate effects Acupuncture has on circulation. But the most important issues to most people with arthritis are pain level and mobility. It turns out that these indicators are quite effective in determining the success of treatment. In other words, if you feel better and can move better we can assume that the Acupuncture is working to correct the circulation problem in your joints.

Link: what to expect at your first visit

For more on how to know when you’re better: link to Acupuncture Done Correctly Gets Results

Vioxx recall: http://www.fda.gov/drugs/drugsafety/postmarketdrugsafetyinformationforpatientsandproviders/ucm103420.htm

Articles on Acupuncture and Arthritis:

http://www.webmd.com/rheumatoid-arthritis/guide/arthritis-acupuncture

Beware of herb suggestions in this one, they’re not entirely accurate: https://www.acufinder.com/Acupuncture+Information/Detail/Acupuncture+for+Arthritis

 

I’d ignore the insurance coverage advice here. Often insurance coverage of Acupuncture is not what it appears to be: http://www.arthritistoday.org/treatments/alternative-therapies/complementary-therapies/acupuncture-gets-respect.php

http://www.livescience.com/8236-acupuncture-arthritis.html

http://health.usnews.com/usnews/health/briefs/arthritis/hb050103c.htm

We really don’t put all these needles in your face. They just love these pictures, because they are so dramatic: http://www.washingtonpost.com/wp-dyn/articles/A14316-2004Dec20.html

More on the heart and stroke dangers of ibuprofen:

http://www.drugs.com/ibuprofen.html

http://www.usatoday.com/news/health/2010-06-11-nsaids-heart_N.htm

Ibufprofen interferes w/ aspirin effectiveness: http://www.mayoclinic.com/health/heart-attack/DS00094/DSECTION=prevention

Ibuprofen causes cartilage damage:

http://www.chiroweb.com/archives/15/22/06.html

http://www.orthosupersite.com/view.aspx?rid=18588

You can find thousands more references on the internet if these are insufficient!

Acknowledgements:

Thanks to Bob Doane, LAc and his office manager Kim for changing my understanding of Acupuncture and circulation. http://www.acupuncturewellness.net/robert-doane/