Abstract
Purpose:
To address the role of acupuncture in mainstream health care for symptom relief, condition outcome, pain management, and shared therapy in resolving chronic diseases. This article explores how acupuncture education can adapt to meet the standards required for inclusion in conventional health care.
Objectives:
To discuss the future of acupuncture education and its part in training providers for inclusion in a comprehensive health care system that involves physician acupuncturists and licensed acupuncturists for treating and managing specific chronic diseases. To strategize the future of acupuncture education at an advanced clinical level that fosters incorporating acupuncture therapy into selected allopathic settings. To encourage the recognition of translational research for promoting the acceptance of acupuncture by providers and insurers.
Conclusion:
Translational research employs clinical evidence to support acupuncture therapy when incorporated into selected areas of allopathic practices, including pain management, palliative care for patients with end-stage cancer, sleep disorders, anxiety disorders, post-traumatic stress, female hormonal conditions such as premenstrual syndrome and menopausal syndrome, as well as chronic fatigue syndromes including Myalgic encephalomyeltitis/chronic fatigue syndrome (ME/CFS) and Long COVID. Advanced clinical training in acupuncture schools and postgraduate certification courses are required to prepare acupuncturists to safely and effectively provide the specialized integrative acupuncture services needed in these clinical areas.
INTRODUCTION
The profession of acupuncture in the United States is becoming more collaborative and, for some conditions, shoulder to shoulder with features of mainstream medicine. Acupuncture education is adapting to meet the professional standards of a health care model embracing integrative therapies in selected clinical settings.
This article addresses acupuncture’s academic and clinical needs for increased integration and attempts to answer the following questions: (1) Are current acupuncture graduate programs comprehensive and specific enough to prepare acupuncturists to deliver care in integrative clinical practices and hospital settings? (2) How can acupuncture programs update training to meet these challenges? (3) Can the profession evolve rapidly enough to graduate highly competent acupuncture providers? (4) Can acupuncture schools provide advanced training for physicians?
ACUPUNCTURE ADDRESSES THE EPIDEMIC OF CHRONIC DISEASE
According to a 2024 paper, about 129 million people in the United States have at least one major chronic disease, including heart disease, cancer, diabetes, obesity, and hypertension. 1 Forty-two percent have two or more chronic diseases. The cost of treating chronic diseases is staggering, with over $1 trillion spent every year in the United States. 2 Unlike in the past, when infectious disease was the leading cause of death, chronic noncommunicable diseases are now the leading cause of death, even in developing nations. 3 It’s not only time to take chronic diseases seriously but acknowledge modern pharmaceutical medicine’s failure to solve this crisis and look for safe and effective alternative treatments.
This article’s premise is that acupuncture can play a central role in specific areas, particularly in alleviating chronic pain, but it is not limited to pain treatments. In the past, acupuncture has been excluded from the U.S. government-funded health care system. According to Patterson 4 and the experience of practicing acupuncturists, many patients with chronic diseases seek acupuncture treatment even if they must pay “out of pocket.”
As more patients receive acupuncture, most are paying out of pocket, but some receive partial coverage from medical insurance for a limited number of sessions for specific conditions. For example, in the United States, Medicare Part B (Medical Insurance) covers up to 12 acupuncture treatments within 90 days for chronic low back pain (Medicare.gov, n.d.) (Medicare.gov/coverage/acupuncture, n.d.). Medicare will cover an additional eight sessions if the practitioner provides documentation of improvement. If the patient isn’t improving based on objective evidence, Medicare won’t cover more treatments, and the patient must pay 100% of the costs if continuing to get them. A maximum of 20 acupuncture treatments is allowed in a 12-month period. However positive this is, Candon and coauthors found that medical insurance coverage for acupuncture is inconsistent. 5
Effective pain and chronic disease management requires patient availability to acupuncture and fair reimbursement by medical insurers for at least part of their expenses. Unfortunately, physician awareness remains low about the effectiveness of acupuncture and what diseases it can treat. Therefore, physician referrals for acupuncture fall short of patient needs. One reason for this low referral rate is that acupuncture was considered fringe treatment and not part of legitimate modern medical care.
ACUPUNCTURE EDUCATION IN THE UNITED STATES
The direction for U.S. acupuncture training is for an evidence-based practice of acupuncture and traditional Chinese medicine. It may also integrate functional therapies such as nutritional supplementation, homeopathy, homotoxicology, and biopuncture, a type of injection therapy. Six states already offer an expanded scope of practice that includes biopuncture for licensees with 60 hours or more of advanced clinical training. States with expanded practice include Florida, New Mexico, Washington, Arizona, Colorado, and Maryland.
Traditional acupuncture training rests on the classical theory of Yin and Yang and meridian dynamics. However, advanced clinical acupuncture in collaborative care requires an enriched academic environment and thorough clinical training, including the implementation of exacting scientific standards, high-quality clinical trials, and cooperation with Western medicine schools, clinics, and hospitals.
ACUPUNCTURE EDUCATION INTEGRATED WITH BIOMEDICAL TRAINING
Academic and clinical acupuncture training requires collaboration and a structure to pivot to an integrated care model to achieve this transition. For example, it could incorporate medical and acupuncture students at training sites, such as the collaboration between Bastyr University and Harborview Medical Center, which incorporated acupuncture students into a trauma center hospital setting. Another example is Emperor’s College, providing acupuncture in the post-traumatic stress disorder (PTSD) clinic at the Greater Los Angeles Veterans Hospital, where Department of Veterans Affairs (VA) physicians refer veterans for treatments.
Several acupuncture colleges have repositioned their academic programs; some have added nursing degrees. These colleges are well on their way to training a new generation of acupuncture physicians prepared to work in traditional health care settings and shoulder to shoulder in clinical research.
REPOSITIONED ACUPUNCTURE COLLEGES AS INTEGRATIVE HEALTH SCHOOLS
Pacific College of Health and Science
https://www.pacificcollege.edu/
Virginia University of Integrative Medicine
Massachusetts College of Pharmacy and Health Solutions
Northwestern Health Sciences University
Doctoral Level Education
A Doctor of Acupuncture and Herbal Medicine requires an intensive 2-year program beyond a 4-year undergraduate college degree and a 2-year acupuncture master’s degree program. Postgraduate specialty training involves an additional 2 years of education. For example, it prepares acupuncturists to collaborate with health care colleagues and to work in integrative medical settings and hospitals. Required courses include advanced diagnostic studies and imaging, intermediate and advanced acupuncture pain management, and courses in the detailed clinical physiology of acupuncture. In addition, the curriculum should address system-based and functional medicine and introduce the principles of collaborative care.
Acupuncture Requirements for Medical and Osteopathic Doctors
Medical doctors (MDs) and osteopathic doctors (Dos) can reposition their practices as evidence-based functional medicine specialists and acupuncture providers. However, most recognize that advanced training is necessary to practice acupuncture effectively and safely. The American Board of Medical Acupuncture (Board Certification Process, n.d.) defines medical acupuncture as “a medical discipline having a central core of knowledge embracing the integration of acupuncture from various traditions into contemporary biomedical practice.” A physician acupuncturist is an MD or DO who has acquired specialized knowledge and experience integrating acupuncture within a biomedicine practice.
Requirements vary, but most states allow licensed MDs and DOs to perform acupuncture within the scope of their medical practice if they are adequately trained and educated in the field. Some states, including Florida and North Carolina, allow chiropractors (DCs) to practice acupuncture. The Helms Medical Institute is one of the first and most comprehensive CME acupuncture courses for physicians (Helms Medical Institute, n.d.). It sets the standard for entry-level medical acupuncture consisting of 300 hours of AMA Category 1 credits. Other programs include Contemporary Medical Acupuncture for Health Professionals at McMaster University in Canada (Trinh, n.d.).
COOPERATIVE CARE MODELS
In the era of cooperative medicine, sometimes called shared care (Doull, 2012), therapeutic models are evolving to include acupuncture for pain management, poststroke care, selected functional disorders, and palliative care. One model that health insurance covers is already in practice in California, allowing treatments by licensed acupuncturists performing neuromuscular treatments under an MD or DO referral within the patient’s Blue Shield benefits (PRV-Acupuncture, 2021).
Pain Management
Research finds several areas of care where acupuncture is superior to pharmaceutical drugs, including pain management for breast cancer survivors. 6 An example of upper-level students treating patients in a hospital setting is Bastyr University’s program, which integrates DAOM students into anesthesiology and acute pain service, providing acupuncture to postoperative inpatients. Results found that 323 consecutive patients who received acupuncture for pain during their hospital admission had clinically significant benefits. No serious complications or safety concerns were reported. A 2023 study of 465 patients found reduced pain intensity after a single acupuncture session. 7 Though more research is needed, these and other studies favor the value of acupuncture and electroacupuncture for pain management to ease patient suffering.
Poststroke Care
Several studies, including a 2022 randomized controlled trial of 497 patients with ischemic stroke, found those who received acupuncture recovered better than rehabilitation alone. 8 Though acupuncture is commonly used in China for stroke patients, and anecdotal evidence is favorable, study results are often inconclusive. However, evidence for the effectiveness of acupuncture continues to emerge, supporting acupuncture as part of a holistic recovery program for stroke patients.
Functional Disorders
An organic disease is one in which measurable biological changes in tissues and organs lead to symptoms required for diagnosis. Examples include chronic infections, autoimmune and immunodeficiency diseases, gastrointestinal disorders, and cancer. A functional disorder is one in which there are symptoms but no measurable changes in tissues or lab markers. These “gray” conditions don’t fit neatly into the traditional Western disease model, so they have been overlooked and undertreated. However, acupuncture is uniquely suited for the treatment of functional conditions.
Functional disorders occur when an organ doesn’t work as it should or when there is biological miscommunication between systems, such as the gut-brain axis. For example, irritable bowel syndrome (IBS) is considered a gut–brain axis disorder (Kennedy 2014). Symptoms of functional disease tend to become chronic and ebb and wane, but they can cause significant impairment and disability. While the symptoms may be disruptive, they are generally not life-threatening.
Examples of Functional Disorders
Adrenal fatigue
Chronic fatigue syndromes (ME/CFS, Long COVID) and functional mitochondrial diseases
Chronic musculoskeletal pain like persistent lower back pain
Fibromyalgia
Hormone imbalances
Interstitial cystitis
IBS
Metabolic syndrome and obesity
Migraines
Sleep disorders
Temporal mandibular joint syndrome
Tension headaches
Functional medicine is a systems-biology-based approach that focuses on identifying and addressing the root cause of chronic disease. It addresses systems, not just symptoms. It helps restore organ function and systemwide biological integrity. Functional disorders are well-suited for acupuncture therapy. For example, acupuncture regulates vagal tone, 9 promoting self-regulation of the autonomic nervous system. The vagus nerve oversees various crucial bodily functions, including mood control, immune response, digestion, and heart rate. 10 Autonomic nervous system disruption can occur alone or co-exist with other diseases, such as Parkinson’s, cancer, autoimmune diseases, neuropathies, diabetes type II, and multiple sclerosis. 11
Cooperative Clinical Models for Palliative Care
Another area for acupuncture is in palliative care for end-stage cancer. The Memorial Sloan Kettering Cancer Center’s Fundamentals of Oncology Acupuncture is an evidence-based model offering an online continuing education course to introduce, review, and reinforce the detection and treatment of certain cancers to prepare acupuncturists for work within the hospital setting. A portion of patients living with cancer or managing postoperative or chemotherapy-induced nausea and vomiting use acupuncture (Abrams 2018).
NEW RESEARCH MODELS
Key to this paradigm shift in acupuncture education is translational research. The scientific method, once the gold standard for all clinical research, was created to facilitate drug development into an approved and profitable pharmaceutical prescription treatment. However, functional diseases are challenging to categorize and often have no biological marker associated with a diagnosis that improves with a specific drug. Conventionally trained physicians find this a difficult hurdle to overcome because pharmaceutical drugs are notoriously ineffective for functional conditions. To effectively address this epidemic, not only are newer treatment strategies necessary, but new research models are also needed. The latest research models include outcomes research, translational medicine, and implementation science.
Outcomes Research
“Outcomes research” is an umbrella term without a consistent definition. It describes research that is concerned with the effectiveness of health interventions. Clinical attention focuses on the individual patient and measures outcomes, such as quality of life, compared with medical treatments or other interventions such as acupuncture. Outcomes research also refers to the effectiveness of health care delivery, with measures such as cost-effectiveness, health status, lifestyle, and the emotional effects of disease burden. This type of research is well-suited for assessing acupuncture efficacy.
The primary goal of acupuncture outcome research is to define the effectiveness of a specific condition, the cost compared with other ways of achieving the same outcome, and the reduction of disease burden if a cure is impossible. Like other research areas, acupuncture outcome research measures, monitors, evaluates, and finds what improves patient experiences, health outcomes, and quality of care across the disease continuum to optimize patient health and well-being. Decisions necessary to implement strategies that achieve positive clinical and public health goals must be based on credible, relevant outcomes research.
For example, a German outcome study of 1162 patients with low back pain found that they improved for at least 6 months after acupuncture treatment. The effectiveness of acupuncture was almost twice that of conventional therapy. 12 Most patients were not cured of their condition but modified to a degree that resulted in less pain and improved quality of life.
According to Marcia Testa of the Harvard T.H. Chan School of Public Health, patient-centered outcomes provide high-quality care while helping clinicians make better decisions. Individual treatment plans, long a hallmark of traditional acupuncture therapy, are now recognized as the “true voice” of individual patients more involved in their care. *
Translational Medicine
Translating theoretical knowledge and experimental breakthroughs in the laboratory into the clinical practice of medicine is challenging. Acupuncture is no exception. Clinically, acupuncture has proven helpful for a wide range of conditions. However, because acupuncture requires a different research model, it has only recently received more attention in the West.
Translational research designs are suited for evaluating the effectiveness of acupuncture in specific conditions such as low back pain, migraine headaches, sleep disorders, the unremitting pain of terminal cancer, and cardiovascular conditions. They seek to produce more meaningful, applicable results that directly benefit human health. Their goal is to move (translate) fundamental scientific discoveries or treatments with historical evidence, such as acupuncture, more quickly and efficiently into clinical practice.
A 2023 article states, “The main purpose of translational medicine is to promote basic research to solve practical clinical problems and improve the level of clinical treatment.” 13 According to the National Center for Advancing Translational Sciences, translational research aims to produce more meaningful, applicable results that benefit human health.
For example, the authors reviewed selected translational studies on cardiovascular regulation in Translational Acupuncture Research. 14 One area of investigation found 10 favorable studies of acupuncture treatment for arrhythmia out of 571 randomized controlled trials. Several of these studies demonstrated conversion from atrial fibrillation to normal rhythm. Another study conducted at the College of Health Sciences of the University of California, Irvine, found electroacupuncture for hypertension was slow to influence blood pressure but produced long-lasting results. Atrial fibrillation and hypertension are common cardiovascular problems that require safe and effective management. Translational research aims to turn medical discoveries into clinical practices, providing health solutions that improve function and foster wellness.
The Clinical Value of Implementation Science
Implementation science is another new way to study methods that promote evidence-based therapies in modern health care systems. In a 2021 paper, Miller and Rosen 15 state that acupuncture in the United States has a fragmented history but, paradoxically, has been rigorously tested for many common conditions and found clinically helpful and cost-effective.
Acupuncture is an evidence-based practice with a research foundation conducive to implementation in specific health care areas. For acupuncture to be implemented in traditional health care settings as the Los Angeles VA does for PTSD, there must be a consistent need for specific conditions, and it must be administered safely and effectively.
To become clinically meaningful, study designs should follow translational goals of moving results and discoveries toward implementation in clinical practice. Once in practice, accurate and detailed patient records, including pain scales and other ways to consistently record medical data, are required. The practice itself must be administered safely and consistently with evidence-based research.
DISCUSSION
None of the challenges presented in this article, well known among practicing physicians and acupuncturists, are insurmountable. Acupuncture is a well-defined system of meridians and points for understanding health and treating disease with centuries of history and now a wealth of modern biomedical research. Understanding disease and successfully treating patients is complicated. There is no scientific reason not to include acupuncture in Western clinical care. However, acupuncture education requires advanced technical and integrated communication courses to train providers in the professional clinical delivery of acupuncture services.
CONCLUSIONS
Acupuncture, guided by ancient beliefs translated into contemporary theory, is finding greater acceptance among patients and physicians. Modern medicine provides significant health advantages for acute trauma care but is lacking for chronic diseases. Highly trained, skilled medical acupuncturists are needed to complement medical practitioners in health care areas inadequately served by modern medical practice. A TIME article noted that as the evidence base for acupuncture grows, it will become more popular, increasing its mainstream use in the United States. 16
This article emphasizes the necessity for focused clinical training in the last year of acupuncture study to specifically address chronic diseases. It encourages postgraduate certification courses in pain management and palliative care to prepare acupuncturists for inclusion in an expanding health care system based on translational outcome studies and implementation science.
Footnotes
AUTHORS’ CONTRIBUTIONS
J.E.W.: Lectures on internal medicine/immunology, lead and corresponding author. Y.K.: President of Emperor’s College advised on current acupuncture policies and educational challenges. J.M.: Academic Dean of Emperor’s College, advisor, and content reviewer.
AUTHOR DISCLOSURE STATEMENT
The authors have no conflict of interest to declare.
FUNDING INFORMATION
No funding was received for this article.
ABOUT THE AUTHORS
J.E.W. has more than 40 years of clinical and teaching experience. He was a founding faculty member of California Acupuncture College and Pacific College in San Diego, the academic dean of the East West College of Natural Medicine in Sarasota, FL, and taught integrative medicine courses at the University of Miami Miller School of Medicine and NOVA Southeastern University. Y.K. comes from a family of traditional Korean doctors. She is a licensed acupuncturist and holds a doctorate in education from USC. She is the president of Emperor’s College, the oldest acupuncture school in California. J.M. has 50 years of experience in the acupuncture profession. He studied auricular acupuncture in France with Dr. Nogier. He served as the academic dean of the California Acupuncture College in Los Angeles and San Diego. He is currently the Academic Dean of Emperor’s College.
