One common misconception about acupuncture is that it is unified under a single system. Patients generally expect healthcare practitioners in the same field to practice similarly. For example, if a patient had knee pain, they would expect similar treatment strategies and exercises if they went to different physical therapy offices. However, if they were treated with acupuncture, they may encounter three different practitioners and all three use different points! One can see how this can generate confusion in the patient, even more so when all three of them were effective in treating the knee! This is also a barrier in acupuncture research, where it is rather difficult to find “standardized protocols” that everyone will agree with for specific conditions. This makes it especially hard to make comparative studies to show that acupuncture “works”.
Why is it that acupuncturists can be so different? There are general concepts that are the core of acupuncture theory and would rarely be different between styles, such as the concept of the energy “Qi” and how it travels through the meridian pathways in the body. However, there are also many subtle differences in each style of acupuncture that emphasizes different diagnostic methods which would ultimately lead to a different selection of points. The name acupuncturist itself is rather misleading, as acupuncturists learn an entire medical system with its own diagnosis, treatment and underlying theory. Acupuncture is just a modality within the medical system. Acupuncturists have access to a variety of treatment options in addition to acupuncture such as herbal medicine, cupping, gua sha, and moxibustion. This can be compared to how modern physicians have access to pharmaceuticals and various surgical procedures as treatment options.
TCM as the “Textbook” Style
Traditional Chinese Medicine, shortened as TCM, is the basic “textbook” style that is most commonly taught in acupuncture schools throughout the country. This style teaches the necessary medical theories in order to be proficient in acupuncture and herbal medicine. As a result, the national board exams are based on the TCM system. Because of this, the TCM style is often practiced by newly graduated acupuncturists. Typically, their treatments use only traditional acupuncture points and their indications. Despite being the basic style, it contains all the foundational knowledge and theory for the medicine. A deep understanding of TCM theory is often required even before exploring other styles of acupuncture. However, just because an acupuncturist practices a basic TCM style does not necessarily indicate they are new to the field. There are many seasoned acupuncturists that can treat very complex diseases with this basic foundational knowledge.
This style’s history is mostly traced back to the early 20th century, when China sought to unify and standardize its medical tradition. Under Mao Ze Dong in the early 1950’s, the Chinese healthcare system underwent many changes (Hinrichs & Barnes, 2013). One change was the attempt to create a singular integrated medicine that combined Chinese medicine with modern Western medicine. Western medical physicians in China began to be trained in Chinese medicine with full government support. New textbooks and teaching materials were created by the Chinese Communist Party (CCP). The primary goals were to simplify, regulate and systematize Chinese medicine and provide all students equal access to traditional resources and texts. One major landmark was the founding of four Chinese medicine colleges in 1956 in Chengdu, Beijing, Guangzhou, and Shanghai (Hinrichs & Barnes, 2013). Textbooks from these colleges have been translated into English and are the core textbooks for many acupuncture programs in the United States to this day.
Historically, Chinese medicine was mostly being transmitted through apprenticeships and family lineages. Furthermore, modernization of medical licensure displaced older practitioners as the new tests also required extensive biomedical knowledge. An institutionalized education meant detachment from interpretations, experience and habits of individual teachers that would traditionally occur under apprenticeships (Hinrichs & Barnes, 2013). Critics believe the creation of Traditional Chinese Medicine under the CCP represented a major shift from the scholarly medicine of old into a more diluted simplistic system (Hinrichs & Barnes, 2013).
“Classical” and Other Divergent Styles Commonly Seen in the United States
As discussed before, even though the TCM style itself is very capable, acupuncture students for some reason or another often choose to study and incorporate other styles of acupuncture into their practice. Perhaps some view that just practicing the style taught in school is narrow-minded. Sometimes faculty and mentors in acupuncture schools that practice different styles inspire students to follow in their footsteps as they see how effective other styles are in treating patients. There is also some aspect of romanticization of learning the “real” Chinese medicine that survived the standardization by the CCP and represent continuity to the old traditions.
An example where acupuncture was relatively unaffected by the CCP is where acupuncture was transmitted to other countries earlier in history and continued to develop independently. Japanese style acupuncture has a presence in the United States, largely through teachers such as Kiiko Matsumoto who first taught in the New England School of Acupuncture that was founded in 1975 and continues to teach in the United States (Hinrichs & Barnes, 2013). Japanese style acupuncture is characterized by its unique diagnostic system and style of needle insertion and retention. Hara diagnosis refers to the palpation of the abdominal area that has its own theory and application that is not seen in TCM (Matsumoto & Birch, 1988). Japanese style acupuncturists also tend to very shallowly insert needles into the patient's skin. Furthermore, the effectiveness of the needle insertions is constantly being evaluated by the practitioner through abdominal palpation, pulse, or reports of pain and pressure before further insertions are made. This contrasts with TCM, where after a point prescription is made after a diagnosis, the needles are inserted to a certain depth and retained for some time.
“Classical” styles often emphasize the aspect of unbroken lineage to the medicine prior to the creation of TCM. One such style is known as Five Element Acupuncture or Worsley Acupuncture, named after its founder Jack Reginald Worsley. After learning East Asian medicine in Asia, with Japanese practitioners being his main influences, Worsley taught extensively (Hicks et al, 2004). He is credited with bringing acupuncture to the western world, especially to England and later the United States. There are many acupuncture schools in the United States that teach Five Element Acupuncture as the main style, one of the earliest being the Worsley Institute of Classical Acupuncture in 1988 in Miami, Florida (Worsley Institute, 2015). Five Element Acupuncture primarily diverges from TCM by emphasizing the Five Elements in diagnosis and treatment of disease. In line with the CCP goal of eventually unifying modern and Chinese medicine, TCM diagnosis has an emphasis on the various organ systems in the body. Any imbalances of the organs are often treated with its corresponding channel. Five Element theory is taught as a broad concept in TCM, however it is further refined and applied clinically by Five Element acupuncturists. Five Element theory has an emphasis on overall balance, categorizing symptoms, colors, and smells into the Wood, Fire, Earth, Metal, and Water Elements. While still using the same traditional acupuncture points used in TCM, points and channels have also been categorized into the Five Elements. Points are chosen based on the Element diagnosis of the patient and the points are selected to assist in balancing the Elements.
Another influential style in the United States was largely introduced by Miriam Lee, who was the first licensed acupuncturist in California. She is famous for being arrested for practicing medicine without a license and subsequently in court many patients came to testify that her acupuncture was the only effective treatment for their conditions (Hinrichs & Barnes, 2013). This led to California regulating acupuncture and establishing licensure requirements. Miriam Lee learned from Master Tung in Taiwan, who was known for breaking tradition by teaching others about the medical system used by his family lineage. Master Tung acupuncture was famous for being extremely effective despite using a few number of needles. This aspect allowed Master Tung to treat a large volume of patients (Lee, 1992). Master Tung acupuncture is unique because it uses its own system of acupuncture points. There is some overlap with traditional acupuncture points seen in TCM, but sometimes the indications for their use are completely different. Master Tung acupuncture also has an emphasis on what is known as distal or mirror treatment. In TCM, orthopedic cases are typically treated with both local points, acupuncture points near the area of pain, and distal points, acupuncture points that are on the same channel but are near the ends of the channel. Master Tung acupuncture rarely puts needles in the local area where the pain is, and furthermore often has the needle inserted on the opposite side of the affected area. Some TCM practitioners may emphasize using distal treatments even if they do not use the unique Master Tung acupuncture points, which reflects its influence in the acupuncture field.
Even though acupuncturists get similar training as required by national accreditation and board exams, they can end up choosing completely different styles to practice in clinic which would be reflected in different point prescriptions. There are many more systems and styles of acupuncture beyond what is discussed here, but this short introduction should be enough to allow one to appreciate the complexity and diversity that exists within the Chinese/East Asian Medicine field!
Hicks, A., Hicks, J. & Mole, P. (2004). Five Element constitutional acupuncture. Churchill Livingstone.
Hinrichs, T.J. & Barnes, L.L. (2013). Chinese medicine and healing: An illustrated history. The Belknap Press of Harvard University Press.
Lee, M. (1992). Master Tong’s acupuncture: An ancient alternative style in modern clinical practice. Blue Poppy Press.
Matsumoto, K. & Birch, S. (1988). Hara diagnosis: Reflections on the sea. Paradigm Publications.
Worsley Institute. (2015). JR Worsley. https://worselyinstitue.com/jr-worsley/