I once stumbled upon an ancient Chinese curse: “I wish you to live at the times of great changes”. Right now, we definitely live in times of rapidly changing acupuncture world terrain. Is it a curse or a blessing? It seems that new requirements, advancements, or regulations for our profession surface every time I turn around. That can be a blessing, to gain greater acceptance by mainstream medicine. Or it can be a curse, if we do not adapt to necessary changes and are left in the “acupuncture parlor”.

A few major steps were made nationally and internationally to bring us to the blessed future. Some of them are in the area of legislation, others are in the arena of standardization. The biggest terra incognita remaining to unravel is – the DOSAGE OF ACUPUNCTURE.

More and more insurance companies are extrapolating on payment for acupuncture services. It is no longer a question whether acupuncture is effective or not. The questions that are being asked now are things like: how many sessions are needed? how frequently? what are the expectations?

There are not many research papers evaluating real clinical practice which include the diversity of acupuncture styles and pattern presentations. One of the most prominent, which used realistic dosage of acupuncture, and served as a ground for the VA (Veterans Administration) to start employment for acupuncturists, was “The Effectiveness of Individualized Acupuncture Protocols in the Treatment of Gulf War Illness: A Pragmatic Randomized Clinical Trial”. It was published by Lisa Conboy, Travis Gerke, Kai-Yin Hsu, Meredith St John, Marc Goldstein, and Rosa Schnyer, and can be found here: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0149161

So, this is YOUR chance to share what you’ve experienced, is an appropriate dose for acupuncture. Please look at the studies below, and share your expertise based on your style of acupuncture – be it 5 elements, Japanese, one of the famous masters, etc.

To start, lets understand the standard language of Traditional Medicine that I used for TCM diagnosis pattern and treatment principle. You can find the exact definition in the WHO (World Health Organization) manual entitled “WHO International Standard Terminologies on Traditional Medicine in the Western Pacific Region”. This manual can be downloaded here: http://www.wpro.who.int/publications/who_istrm_file.pdf

This manual provided terminology for the future ICD-11, Chapter 26 (Traditional Medicine1) diagnostic codes to be active in 2023. The beta version can be found here: https://icd.who.int/en/.

Case studies below use current billable ICD-10 diagnostic codes of western medicine, with the addition of non-billable ICD-11 (TM1) codes. This is how our billing will be in the future.

Please recall your clinical experience and email your comments and thoughts, being as specific as possible, to suzy@fsoma.org

1. Do you agree with the goal’s time frames? If no, why not?

2. If you practice a different style (Five Element, Japanese, Korean, etc.), would your goals differ because of the differences? If yes, how so? If no, please let us know that too.

3. Would you request different frequency of visits?

4. Do different medications (please specify) used in the past or present change the goal’s time frames, frequency and length of the treatment?

5. Comment on anything else you think is relevant.

Case Study #1:

30 years old male presenting with a chief complaint of “pulling” constant low back pain radiating to right buttock that started after camping trip 4 months ago to the lake and is worse with rainy weather. Severity of pain is 4/10. As well has frequent dull frontal headache and sensation of heaviness in the body. Has a frequent loose stool.

Objectively: No pathology was found on X-Ray

TCM Tongue: pink, with thicker white coat

TCM Pulse: soggy

Western medicine billable diagnosis: M54.5 Low back pain with right side sciatica

Non-billable ICD-11 (TM1) Diagnosis: SC61Lumbago disorder (TM1) due to SE82 Dampness factor pattern (TM1)

TCM treatment principle: relieve pain, expel wind-damp

Acupuncture Tx: position prone

TCM points – GB20, UB12, SP9, K7. UB23,25, Yaoyan, Right buttock Ashi.

Adjacent techniques: TDP lamp on lumbar region

Recommended acupuncture tx frequency:

• 2-3 times a week for 3 weeks,

• after that 1-2 times a week for 2-3 more weeks

Treatment Goal:

in 3 weeks pain reduction by ~ 50%

in 6 weeks pain reduction by ~ 75%

Take home recommendations:

TCM Herbal Rx: Qian Huo Sheng Shi Tang

Topical: Zheng Gu Shui Spray 3-6 times a day

Treatment Goal with addition of herbs:

• in 3 weeks pain reduction by ~ 75%

• in 6 weeks pain reduction by ~ 90-100%

Case Study #2

32 years old female presenting with chief complaint of dull low back pain with occasional sharp electric sensation radiating down to the knee on the lateral side of her right leg that started after lifting her 2 years old child 6 months ago. Severity of pain is 3-5/10. As well she has mild dysmenorrhea, PMS and alternating bowels. She is prone to depression.

Objectively: No pathology was found on X-Ray

TCM Tongue: pink, with thin white coat

TCM Pulse: string-like (wiry)

Western medicine billable diagnosis: M54.5 Low back pain with right side sciatica

Non-billable ICD-11 (TM1) Diagnosis: SC61Lumbago disorder (TM1) due to SE91 Qi stagnation pattern (TM1), SG2A Gallbladder meridian pattern (TM1).

TCM treatment principle: relieve pain, promote smooth movement of Qi, open Gall Bladder Meridian

Acupuncture Tx: prone

Points Auricular – LV, Shenmen

Points TCM: LI4, LV3, UB19,24,25, Yaoyan, R-GB29,30,31,34,41, R-SJ5

Adjacent techniques: Tuina on lumbar region

Recommended acupuncture tx frequency:

• 2 times a week for 4 weeks,

• after that 1 times a week for 4 more weeks

Treatment Goal:

in 4 weeks pain reduction by ~ 40%

in 8 weeks pain reduction by ~ 75%

Take home recommendations:

TCM Herbal Tx: Chai Hu Shu Gan San modified – (herbs expected to be taken for 3-6 months at therapeutic dose for low back pain, after that are tempered to maintenance dose for management of dysmenorrhea, PMS and mood)

Topical: Po Sum On Oil 3-6 times a day

Treatment Goal with addition of herbs:

• in 4 weeks pain reduction by ~ 75%

• in 8 weeks pain reduction by ~ 90-100%

Case Study #3

Example: 55 years old male presenting with chief complaint of “stiff “ low back pain with occasional “cramping” pain radiating down on the back of right leg all the way to the lateral side of the foot that started gradually 3 years ago and is worse with cold weather. Severity of pain is 5-7/10.

As well he has cold pale extremities, high triglycerides and decrease in libido

Objectively: MRI showed L5 bulging disk

TCM Tongue: pale, with moderate white coat

TCM Pulse: slow, deficient on right chi position

Western medicine billable diagnosis: M54.5 Low back pain with right side sciatica

Non-billable ICD-11 (TM1) Diagnosis added in comments window current EMR systems: SC61Lumbago disorder (TM1) due to SF97 Kidney yang deficiency pattern (TM1), SG26 Bladder meridian pattern (TM1)

TCM treatment principle: relieve pain, move Qi, warm Kidney Yang, open Bladder Meridian

Acupuncture Rx: prone

Points TCM: LI4, LV3, UB23, 25, K3, Yaoyan, R-GB30, R-UB36,37,39,40,56,62, R-SI3; Points Auricular: K

Adjacent techniques: TDP lamp on lumbar region, Moxa

Recommended acupuncture tx frequency:

• 2 times a week for 6 weeks,

• after that 1 times a week for 6 more weeks

• give one month of break and repeat if necessary.

• every year in the summer repeat course of acupuncture treatment for 6 weeks 1 time a week preventatively

Treatment Goal:

in 6 weeks pain reduction by ~ 25%

in 12 weeks pain reduction by ~ 50%

Take home recommendations:

TCM Herbal Tx: Du Huo Ji Sheng Tang – expected to be taken for 6 – 12 months. Possibly may need to be taken at maintenance dose long term.

Topical: Capsaicin cram 3 times a day or patch at skin tolerance

Treatment Goal with addition of herbs:

• in 4 weeks pain reduction by ~ 50%

• in 8 weeks pain reduction by ~ 75%

Case Study #4

75 years old female presenting with chief complaint of constant “burning, aching” low back pain, accompanied with “stabbing” pain extends to right glut. Pain started 15 years ago and becomes progressively severe and is worse on standing and walking. She cannot walk or stand longer than 15 minutes. Severity of pain is 6-8/10

As well has insomnia with difficulty to stay a sleep, reduction in memory, tinnitus, thinning hair, dry mouth, stiff aching knees, varicose veins and cyanotic feet.

Objectively: MRI showed degeneration of L3,4,5 discs, Spinal stenosis

TCM Tongue: red, moist, no coat

TCM Pulse: string-like and deficient on both chi positions

Western medicine billable diagnosis: M54.5 Low back pain with right side sciatica

Non-billable ICD-11 (TM1) Diagnosis added in comments window of current EMR systems: SC61Lumbago disorder (TM1) due to SF01Blood stasis pattern (TM1),

SF94 Kidney yin and yang deficiency pattern (TM1)

TCM treatment principle: relieve pain, break Qi, activate Blood, warm Kidney Yang, nourish Kidney Yin

Acupuncture Rx: prone

Points TCM: Li4, Liv3, HuaTuoJiaJi-L4,5, UB23, Yaoyan, K3, R-GB29,30, UB60, R-SI3, L-UB62, R-GB41, L-SJ5

Points Auricular: K

Adjacent techniques: TDP lamp on lumbar region, Gua Sha, Cupping, E-steam

Recommended acupuncture tx frequency:

• 2 times a week for 6 weeks,

• after that 1 times a week for 6 more weeks

• after that every second to every fourth week dependent on severity of pain

Treatment Goal:

• in 6 weeks pain reduction by ~ 10-15%

• in 12 weeks pain reduction by ~ 30%

Take home recommendations:

TCM Herbal Tx: Shen Tong Zhu Yu Tang + Liu Wei Di Huang Tang modified – indefinitely

Topical: Tiger balm 3-6 times a day + Wu Yang Plaster – at skin tolerance

Treatment Goal with addition of herbs:

• in 6 weeks pain reduction by ~ 30%

• in 12 weeks pain reduction by ~ 50%

Comment: These are just four possible scenarios. There are a many more combinations of TM1 patterns for WM billable diagnostic code of low back pain.

We look forward to hearing from you!

To prevent a Flu or Common cold:

·         Guna-Flu Homeopathic remedy

·         Acupuncture

·         Chinese Herbs To Treat:

Guna-Flu Homeopathic remedy Acupuncture Chinese Herbal Formulas that have antiviral and antibacterial properties, and relieve symptoms (fever, cough or headache)To restore immune system after a disease:

Acupuncture Herbal tonics Proper dietary recommendations Nutritional supplements

How homeopathic Guna-Flu works?

The principle of homeopathy is that like shall be cured by like. In other words, a substance produces symptoms of illness in a well person when administered in large doses; if we administer the same substance in minute quantities, it will cure the disease in a sick person. The dose is small so that there is no danger of any long term side effects. Homeopathic remedies never have an issue with resistance.  This is because the remedies do not have any direct effect on the virus.  They just modify our body’s response to it by enabling our defense mechanism to a better recognition of what needs to be fought off.

Guna-Flu is a new generation remedy combining classic homeopathy with discoveries of modern medicine. It addresses not only symptoms of a disease but also introduces a proper immunologic response of the body.

According to Clinical research on 291 children between 3 and 6 years old on prevention of Flu, compare Guna-Flu versus standard Western Drugs: only 38% of the children included in the Guna-Flu (Omeogriphi®) Group fell ill with URI compared with 50% of those included in the Control Group. These percentages certainly illustrate that Guna-Flu has better preventive efficacy than Bacterial Lysates (conventional reference medicines).

Guna-Flu is effective for prevention and treatment.  How Acupuncture and Chinese herbs work?

Chinese medicine has successfully treated the cold and flu for thousands of years with Chinese herbs and acupuncture treatment. Acupuncture and Herbs helps to prevent the flu by simply strengthening the body’s immune system. Traditionally to decrease a susceptibility to a common cold or flu patients are seen four times a year, at the change of seasons, to increase immunity to the ever changing environment.

Prevention is the key to everything and Oriental Medicine is no different. You will benefit much more from being treated prior to the onset of flu symptoms. However, if symptoms due being to arise, then immediate treatment is imperative. The sooner treatment is received for flu-like symptoms the faster and more effective treatment is. Our treatment either stops the cold and flu within one to two days or significantly reduces symptoms and duration. Chinese medicine also helps resolve sinus congestion, sore throat and coughs. Studies have shown that certain blood counts and immune enhancing chemicals stay elevated for at least 3 days following an acupuncture treatment.

What Western Allopathic Medicine has to offer? 

To prevent a Flu or Common cold:

Hand WashFlu Vaccine- shot or oralTo Treat:

No medicine to kill a virusChemical drugs effects to suppress symptoms (fever, cough or headache)Antibiotics to treat bacterial complications such as Bronchitis, Pneumonia or Pleurisy.To restore immune system after a disease:

·         None

Is a Flu vaccine safe and effective?

Common thought: “Flu shots are like a religion. Questioning the efficacy of flu shots to ‘believers’ is seen as unreasonable and foolish.”

It takes about 9 months to make a vaccine!

Each winter scientists and researchers from the World Health Organization try to predict which strains of flu will circulate the following year. After officials select the three strains of flu virus that they think are most likely to be circulating during the next winter season (they picked the wrong ones last year), vaccine makers grow the viruses in fertilized chicken eggs, with 500,000 eggs per day (each examined by hand) for up to eight months.

Formaldehyde is used to inactivate the virus. It is a known cancer-causing agent. Aluminum is added to promote an antibody response. It is a neurotoxin that may play a role in Alzheimer’s disease. Other additives and adjuvants in the flu vaccine include Triton X-100 (a detergent), Polysorbate 80, carbolic acid, ethylene glycol (antifreeze), gelatin, and various antibiotics – neomycin, streptomycin, and gentamicin – that can cause allergic reactions in some people.

Two-thirds of the vaccines made for the 2008–09 flu season, 100 million of them, contain full-dose thimerosal, an organomercury compound, which is 49% mercury by weight. It is used to disinfect the vaccine. Each one of these 100 million flu shots contain 25 micrograms of mercury, 250 times more than the Environmental Protection Agency’s safety limit. Mercury is a neurotoxin, which has a toxicity level 1,000 times that of lead.

Mercury in vaccines has also been implicated as a cause of autism. Vaccine makers have now removed thimerosal from all childhood vaccines, except flu shots.

Three serious, acknowledged adverse reactions to the flu vaccine are joint inflammation and arthritis, anaphylactic shock (and other life-threatening allergic reactions), and Guillain-Barré syndrome. Guillain-Barré syndrome (GBS) is a paralytic autoimmune disease that fells people several weeks after their flu shot.

Last year was not a good year. A good rate of protection would be 70 percent. A CDC report says the efficacy rate of the 2009 vaccine was 44 percent.

The report found that over a 12-month period, headache patients who received regular acupuncture sessions reported fewer headaches, had a higher quality of life, missed fewer days from work, used less medication, and made fewer visits to a general practitioner than patients given standard treatment for headaches. The research was conducted at a series of single acupuncture practices and general practices in Wales and Great Britain. In the study, the authors recruited 401 patients who suffered from chronic headaches, predominantly migraine headaches. The patients were randomized to receive either acupuncture or “usual care” from a general practitioner. In the acupuncture group, subjects standard care for headaches, and were also treated with acupuncture up to 12 times over a three-month period. Treatment patterns were individualized to each patient, and different points were used based on the discretion of the acupuncturist providing care. In the usual care group, patients received standard headache care from their general practitioner, but were not referred out for acupuncture.

At various times throughout the study, patients used a daily diary to track the frequency and severity of headache pain, and any related medication use. Headache severity was measured four times a day on a six-point scale, with the total summed to give a headache score. In addition, the patients completed the SF 36 Health Status Questionnaire at the start of the study, and at three months and 12 months after treatment. Patients also completed a series of questionnaires every three months that monitored use of different headache treatments, days missed from work due to illness, and other usual activities.

Initially, there was not much difference between patients in either group. By the 12-month interval, however, striking differences were noted in terms of frequency of headache, doctor visits and medication use:

Patients given acupuncture had an average of 1.8 less days with headaches over the first four weeks of the study compared to the control group. When projected over 52 weeks, the authors estimated that acupuncture would result in an average 22 fewer days of headaches per year.

The effects of acupuncture appeared to be long-lasting. At the start of treatment, the average weekly headache score among acupuncture patients was 24.6. Three months after the start of the study, the average score had dropped to 18.0; at 12 months, it had dropped by more than 34 percent, to 16.2. In the standard care patients, weekly headaches scores dropped only 16 percent over the course of the year.

Results from the SF-36 questionnaire showed significant benefits for acupuncture patients in terms of physical role functioning, energy levels and changes in health. Over the course of a year, physical role functioning, energy and health change scores increased an average of 9.6, 7.4 and 10.3 points, respectively, for those in the acupuncture group. These scores also increased in usual care patients, but at much lower levels.

Acupuncture patients used an average of 15 percent less medication to treat headaches than patients receiving only usual care. They also made 26 percent fewer visits to a general practitioner, and missed fewer days from work due to sickness.

“Acupuncture in addition to standard care results in persisting, clinically relevant benefits for primary care patients with chronic headache, particularly migraine, compared with controls,” the researchers commented. “We also found improvements in quality of life, decreases in use of medication and visits to general practitioners, and reductions in days off sick.”

In their conclusion, the researchers admitted they could not rule out the occurrence of a placebo effect, as the study did not include a sham acupuncture group. In addition, since the patients knew which treatment group they were assigned to, there remained the possibility that patients could give somewhat biased assessments of their treatments. However, the authors noted that the results of their study were similar to results seen in blinded, placebo-controlled trials, which “provides further evidence that bias does not completely explain the apparent effects of acupuncture.”

The authors recommended that their findings should be taken into account by policymakers when assessing the most cost-effective ways of treating patients. They also called for an expansion of acupuncture services for the treatment of chronic headaches in the National Health Service, which provides health care to millions of Britons each year.

In an interview with the BBC, Dr. Mike Cummings, the medical director for the British Medical Acupuncture Society, called the study “innovative” and agreed with the authors’ assertions.2

“It is very positive for us,” he said of the research. “This should help to lift acupuncture out of what is seen to be alternative to mainstream medicine … It should be made available in primary care to treat pain and to prevent costly referrals to hospitals.”

By Michael Devitt.