A Discussion of Integrative Dry Needling and Acupuncture
This has long been on my to-do list of things to write
about, and given it can be a sensitive topic for acupuncturists and other
allied health professionals, I have mostly ignored the discussion to this point.
However, the intent behind my company’s mission is “to educate and empower
people to take an active role in their personal, family and community wellness”.
So I wanted to discuss the topic of “Trigger Point Dry Needling” or “integrative
Dry Needling”, which ais now marketed in other allied health professions –
Medical Doctors, Physical Therapy, Chiropractic an in some areas Massage
Therapy – from the perspective of “education”. The point of this article, pun
intended, is not to argue for or against the use of acupuncture by other
professions, but to educate my patients, family and community.
To begin, what is acupuncture? Acupuncture is a treatment
procedure which uses thin, sterile, filiform needles to penetrate the skin at
strategic anatomical locations on the body to stimulate healing effects locally
and systemically. More broadly, acupuncture and Oriental medicine (AOM), is a
system of holistic medicine involving acupuncture, Chinese herbal medicine,
manual bodywork, cupping and other heat therapies – including moxabustion and
laser therapy. While the mechanisms of acupuncture are not entirely known, it
is a highly researched area of study. It is now understood that when a needle
penetrates the skin, and is manipulated, it creates a local micro-trauma which
triggers a cascade of local biochemical reactions. These effects were reported
in 2012 in a paper released by Evidence Based Complimentary and Alternative
Medicine (1):
1. Tissue injury leads to impulse resulting local vasodilation
and release of vascular and neuroactive mediators from immune cells leaking
from vessels.
2. Mast cells, platelets and other immune cells migrate to
the place of injury. Together with damaged cells they release neuroactive
mediators, like histamine, serotonin, substance P, acetylcholine,
y-aminobutyric acid, somatostatin, nitric oxide, adenosine, bradykinin,
prostaglandins, cytokines and many others. Those substances infiltrate the
tissues and act at corresponding receptors on the surface of afferent nerves.
Some of the effects of acupuncture on the body can be
attributed to the stimulation of the central nervous system (CNS) – the brain
and spinal cord. Signals received by sensory, or afferent nerves carry
information to the higher centers of the CNS, including the hypothalamus,
medulla oblongata, midbrain, and prefrontal cortex. In 2013, there was a
wonderful article published in Evidence Based Complementary and Alternative
Medicine that attempts to explain the effects of acupuncture on the brain (2).
The description of the potential mechanisms of acupuncture
are related to direct mechanical stimulation of local sensory receptors, local
and systemic biochemical releases stimulating neuro-endocrine effects, and
microcirculatory changes in local blood flow. So, it is evident that the effect
of acupuncture is layered and may effect many of the bodies systems including
circulatory, sensory, and humoral (or immune responses).
The history of acupuncture and Chinese medicine is long and
deep. Many of the texts were written over two thousand years ago. While this is
impressive, what is equally impressive is the accuracy in which the authors
identified the anatomy and physiology for the human body so long ago. The
relationships of the acupuncture points are quite evident. The points have
direct relationships with the internal and sensory organs (e.g. Heart, Stomach,
Liver, Eyes, Ears, Nose, etc.), and also, with the cardiovascular,
musculoskeletal, and nervous systems. Many of the points are found near blood
vessels, or over specific muscle motor points, (the terms “trigger point”, “innervation
zone” and “motor points” are used synonymously here). From my perspective, the
intent behind the points are to treat the anatomy and physiology of the body.
I believe the translation of Chinese medicine has led to
some confusion within the Western or “Biomedical” fields. I feel this
complicates the understanding of the intent of this rich medicine. I believe it
to be a physical science, a physical medicine. I believe modern acupuncture
views the body through this lens. With that said, this does not diminish or
distill the other deep and complex factors in the universe that affect our
environment and nature. What I find so amazing and beautiful about Chinese
medicine, is that it may account for these unknowns in its approach without thoroughly
understanding it. Chinese medicine can use very simple concepts to make
understanding of very complex issues.
It is for these reasons I continue to be enamored by Chinese
medicine. While its approach is holistic and effective, it does not attempt to
explain the inner working of every disease. I simply observes and considers all
the influences that impact the whole body. It then effectively distills these
observations into a pattern of diagnosis that the practitioner can approach with
a deep toolbox of skills and techniques. I believe the distinct attributes of
Western biomedicine and Chinese medicine allow them to integrate extremely
well. I am proud and honored to share this knowledge and experience with my
patients.
The following is a description of the educational
requirement for acupuncture and Oriental medicine (AOM). It is simply meant to
educate patients on the scope and diversity of acupuncture studies. It is not
meant to compare this training with that of other allied health professionals.
I respect the rigors of these other areas of study and appreciate their scope
of practice. In fact, I am honored to work alongside many extremely talented
and brilliant professionals in these fields. I feel as though, in my experience
interacting with the general public – and on occasion other healthcare
practitioners – that many do not recognize the depth and scope of education,
training and experience an acupuncturist endures along the path to becoming a licensed
practitioner.
With full disclosure in mind, I feel it is worth noting at
the time of writing this article, programs that train other allied health
practitioners in Dry Needling complete a substantially different level of
practical skills training. For example, Harvard Medical School offers physician
(MDs) 300+ hours of continuing education in acupuncture over a “9-month period
with 6 hours per week of web-based didactic sessions and video demonstrations,
and 5 live intensive weekend workshops with hands on sessions” (3). This
program trains physicians in acupuncture theories and techniques. They expound
upon this education discussing, “current theories of the neuromodulatory and
humeral effect of acupuncture…and the clinical literature presented” (4). The “Integrative
Dry Needling” program offered to other allied health professionals (Physical
Therapists, Chiropractors, etc.) complete a “27-hour applied-learning course
that combines interactive lectures and practical hands-on labs” to become
certified to practice (5). I mention these programs to punctuate the depth of
information and level of practical training involved in these different
continuing education programs. Again, it is not meant to minimize or diminish
the level of training these professions encounter during their careers.
Training requirements for a Licensed Acupuncturist (L. Ac.)
3-4 year Masters of Acupuncture and Oriental Medicine
(Massachusetts College of Pharmacy and Health Sciences) – 151 Credit hours
required for graduation, and include didactic, practical training and clinical
internships.
Graduate Entrance requirements:
Bachelors degree, including required Science prerequisites:
General
Psychology (3 credits)
General
Biology (3 credits)
Microbiology
with lab (3 credits)
Human
Anatomy and Physiology 1
Human
Anatomy and Physiology 2
Clinical requirements:
350+ total clinical treatments
120+ new patient
visits
650+ clinical hours
65+ Chinese herbal formula prescriptions (MAOM only)
Pass 3- or 4- National Board Exam requirements:
Biomedicine Exam
Acupuncture with Point Location Exam
Foundations of Chinese medicine Exam
Chinese Herbal Medicine Exam (MAOM only)
Visit
https:/www.mcphs.edu/academics/school-of-acupuncture/acupuncture-and-oriental-medicine-maom
for more details.
Acknowledgements:
Much of the information contained within this document is
presented by Dr. B. Chmielnicki from the organization, Evidence Based
Acupuncture (6). This organization is dedicated to showing the current state of
knowledge about acupuncture. Visit https://www.efidencebasedacupuncture.org/mechanisms/signal-transmission
for more information and access to current research. I wish to acknowledge
their work and thank them for the contribution to the Acupuncture and Oriental
Medicine profession.
References:
1.
Mechanical signaling through connective tissue:
a mechanism for the therapeutic effect of acupuncture. Langevin HM, Churchill
DL, Cipolla MJ, FASEB J, 201 Oct; 15(12):2275-82.
2.
Acupuncture effect and central autonomic
regulation. Li QQ, Shi GX, Xu Q, Wang J, Liu CZ, Wang LP. Evidence Based
Complement Alternat Med. 2013; 2013:26795. Doi: 10. 115/2013/267959. Epub 2013
May 26.
4.
Website. https://integrativedryneedling.com/events/category/dry-needling-courses/foundation-courses
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