The Past, Present, and Future of Acupuncture in Chiropractic
ACUPUNCTURE
John A. Amaro
DC, FIAMA, Dipl.Med.Ac.
The chiropractic profession has the honor and distinction of being the first healing arts profession to embrace acupuncture in North America, in addition to hosting the first educational program at the college level to be offered in clinical/medical acupuncture.
As early as 1967, chiropractic practitioners in the US began utilizing the general principles of acupuncture through applied kinesiology (AK). Diagnosing through “muscle testing,” as formulated by Dr. George Goodheart, specific acupuncture points on the affected meridian channels were located and stimulated through noninvasive means in an effort to restore homeostasis to the meridian system. The clinical effects were noteworthy, and literally scores of DCs nationally began using this approach with outstanding success. Even though it was not acupuncture per se, it utilized many of the general principles and specific points of acupuncture to bring about balance. The technique was quite effective and popular among the DC profession. It was the first time that the word “acupuncture” would be used within the professions.
Obviously, it came under intense scrutiny by not only the DC profession but also by all medical professions. However, despite the criticisms, the procedure grew among the practitioners, and it was the odd DC who was not utilizing a form of this procedure in clinical practice. Even though I personally was a casual observer of this technique and quite fascinated with the response observed both diagnostically and clinically, in 1967,1 was a student and would not graduate from Cleveland Chiropractic College Kansas City until 1969. Therefore, I was not one of the early practitioners of this method of meridian balancing being unlicensed and still had two full years ahead of me in my education. Upon my graduation in 1969, the war in Vietnam was raging, and I entered the US Army. On my return to civilian life in 1971,1 entered clinical practice with the hopes, aspirations, and dreams of establishing a successful life.
Bear in mind, the term “acupuncture” would not be known or used in America nationally until 1971 following The New York Times journalist James Reston’s famous article entitled, “Now About My Operation,” in which he recounts his experience with acupuncture analgesia following an emergency appendectomy while traveling with President Richard Nixon in the People’s Republic of China during the first official diplomatic trip there.
In April of 1972, the very first acupuncture certification program was established in America, sponsored by Columbia Institute of Chiropractic (now known as New York Chiropractic College), and it was taught by Dr. Richard Yennie.
This program was held in Kansas City, Missouri, home to both Dr. Yennie and myself. Dr. Yennie was my neighbor from when I was a small child until my late teen years. My mother would frequently say, “Why don’t you become a doctor like Dr. Yennie?” He was a DC and became quite successful very early in his career with chiropractic. My entire family were his patients, and this experience solidified my desire to become a DC.
Dr. Yennie was of Scots-Irish descent and grew up in Kansas City. Even though his last name may sound as if it may be Asian, he was American but fluent in the Japanese language having been taught by a high school friend who was Japanese.
During the end of World War II, Dr. Yennie was too young to be drafted, but because of his unique position with the Japanese language and culture, he was assigned the job of being a war crimes interpreter by the US government since few Americans were fluent in Japanese and could be trusted with national security. I obviously was fascinated with Dr. Yennie.
When “acupuncture” became a household word in 1971 and the American interest in this topic was at fever pitch, Dr. Yennie traveled to Japan and renewed old acquaintances in the medical and acupuncture field whom he had known when he was younger and involved in Japanese martial arts.
When the first acupuncture program in the US was launched in April 1972, the entire focus was on the Japanese style of acupuncture. Even all eyes were on China with President Nixon’s visit, the Japanese approach to acupuncture was introduced to America. Chinese traditional medicine would not be introduced to America for close to a decade. China was off-limits to Americans traveling and would not open until well after Mao Tse Tung’s death in 1975. Therefore, the Chinese style of acupuncture was unknown to Americans except for Taiwanese and Hong Kong styles, which was open to international travelers and was much closer in style to Japanese acupuncture.
Acupuncture and its particular styles and delivery is totally unique to the country from which it originates from. In my personal development, I have had the very good fortune to have studied acupuncture in 14 different nations, including China (eight different times), countries in Southeast Asia, and every country in Europe, all of which are unique and different from one another. So when someone asks if you do the procedure this way or that way, the answer is generally “yes,” because it depends on the country of origin of the acupuncture application
The 1972 US acupuncture program was the first of its kind and grew over the next several years with multiple symposiums to educate more than 1,000 practitioners of all medical disciplines in North America, South America, Europe, and Australia. I can only imagine the number of patients this education positively influenced over the next years—very humbling, to say the least. In 1973, Dr. Yennie invited me to present the acupuncture academia of Chinese hand acupuncture to the doctors and students of the Acupuncture Society of America, which I had learned in Taiwan and utilized in my own practice with stunning success.
One of the most accepted and popular forms of acupuncture from virtually every country of origin utilizes a technique known as “Surround the Dragon.” In this approach, which has ancient origins, a practitioner palpates the area of pain and recognizes very specific nodules of muscle contractility and increased discomfort on pressure. These areas of involvement correspond to what have been termed “trigger points” and precisely with what had been practiced for a thousand or more years as “Surround the Dragon” in acupuncture internationally. This concept of trigger point therapy was formally introduced to the world in 1983 by Dr. Janet Travell and Dr. David Simons in their book Myofascial Pain and Dysfunction: The Trigger Point Manual. This publication gave “Surround the Dragon” legitimacy and, even though it had been practiced for centuries, now had medical and scientific backing.
In the early days of acupuncture in America and Europe following the first US 1972 acupuncture program, very few DC practitioners utilized needles for stimulation because they were under intense scrutiny by state boards nationally and had been considered a surgical procedure. Therefore, most chiropractic practitioners utilized noninvasive procedures such as the “teishein,” a non-penetrating instrument that simply stimulated superficial skin points corresponding directly to acupuncture points and “Surround the Dragon” trigger points. The clinical effects were exactly the same as the needle and quick to apply with predictable outcomes. As a result of utilizing noninvasive procedures, many practices in the nation grew to unheard of dimensions, seeing more than 100 patients daily because of the extreme interest in acupuncture the press had created. This approach to treatment was the polar opposite of those utilizing needles who could see, on a very busy day, on average 10 to 20 patients. Besides the teishein, simple electronic stimulation was utilized to the acupoint and carried an impressive clinical response equaling needle stimulation in most cases (laser was not an option until the mid-1980s).
The chiropractic profession was undeniably the leader in acupuncture in the US due to its popularity, ease of access, clinical results, and speed of delivery. The acupuncture profession, which trains and licenses “acupuncturists,” has its own specific schools as well as state boards. I personally have the distinction of having served on the Arizona Board of Acupuncture, having been appointed by the governor for three full years in its initial development of the board of examiners.
As acupuncture grew in popularity among the professions, especially the chiropractic profession, the National Board of Chiropractic Examiners established a specific acupuncture certification within the DC profession as well as multiple individual states that license DCs in acupuncture. I have the honor of having served on the development of the NBCE Acupuncture Certification Examination.
Acupuncture falls within the scope of practice of the majority of the states for the utilization of needles within the DC profession for the administration of acupuncture. It is imperative that prior to utilizing needles that the state board be contacted to confirm acceptability. However, bear in mind that electronic and laser stimulation of acupuncture points are accepted internationally and produce the same or better response than most procedures used in acupoint stimulation. Needles are still utilized in the practice of acupuncture but primarily by “acupuncturists,” as opposed to the myriad of noninvasive techniques available in acupuncture and popular within the DC profession.
When Drs. Travell and Simons introduced their work on trigger point therapy in 1983, these hyperirritable points were classically treated by direct digital pressure or, in many cases, needle injection of a variety of substances, including simple saline solution. Anesthetic agents were also popular for injection into the trigger point. After many applications of needle injection into the trigger point, the suggestion was made of what would happen if nothing were injected into the point, and only the needle itself would be introduced to the areas? Thus the term “dry needling” was first introduced. Shockingly, to most observers, the clinical response was seemingly the same as the previous “wet” needling of injection into the point.
The term “wet” needling was never officially used, but “dry needling” has become one of the most popular forms of therapy in the world today. It is virtually the same identical therapy that has been used in acupuncture for more than a thousand years and known as “Surround the Dragon.” The procedure obviously works clinically, is easy to deliver, and the results are predictable. It is nothing more than locating the tight “trigger point” in the general area of pain or dysfunction known to the Asians as an “ah shi” point, in Japan as an “ah so” point, or in English “oh yes” point.
Treatment may be administered in many forms to include needle stimulation to the point, electronic stimulation, laser application, or direct digital stimulation to relieve tightness and irritation.
In contemporary society, “dry needling” has become one of the most popular and discussed therapies for a variety of pain conditions. Again, it is nothing more than what has been described for centuries and utilized by the acupuncture practitioner as “Surround the Dragon.” Many different approaches have been developed in recent days, but it is all the same general procedure with a predictable response. It is the way acupuncture has been practiced for millennia.
It is nothing more than locating the tight "trigger point" known to the Asians as an "ah shi" point, in Japan as an "ah so" point, or in English "oh yes
The acupuncture profession is currently very involved in this seemingly “new” procedure, and it appears as the profession of acupuncture is changing in front of our eyes from “traditional Chinese medicine” to one of the most elementary but significant approaches in clinical acupuncture.
Having been involved with acupuncture in North America from its inception, I see a disturbing trend happening within the general acupuncture profession since many of the practitioners have only adopted a simple “Surround the Dragon,” or “dry needling,” approach to the treatment of hyperirritable trigger points. The treatment is valid, extremely good, and has stood the test of time.
I feel the chiropractic profession, having been the innovator of acupuncture in North America, is in the unique position to develop the direction and techniques that will propel acupuncture and chiropractic into the future with the same or better response as in the past. This is the ideal time in history to add acupuncture to an existing practice because it is only going to become better and more popular with time.
You may contact Dr. John Amaro. International Academy of Medical Acupuncture Inc.
John A. Amaro, DC, L.Ac., FIAMA, Dipl. Med. Ac. PO Box 1003, Carefree, Arizona 85377 800-327-1113, [email protected]
