Reflection Nine: Acupuncture,
BodyMind & MindBody
Medicinea Cultural Shift
THE PROBLEM:
During the past 23 years since I wrote
Bodymind Energetics, the Complementary and
Alternative Medicine professions as a
collective phenomenon have evolved greatly,
much in the direction I had anticipated. The
only problem is that the AOM profession,
intently focused as it was on establishing its
own professional identity, tended to ignore
the fact that to the average CAM
practitioner, and to conventional medical
providers and patients, AOM, unfortunately
referred to in error as TCM, is in fact seen as
one part of this larger and more national
CAM/IM/CAIHC movement. Luckily the
CCAOM has become involved in the most
active CAM organizations and AOM is
having a voice in how CAM as a whole, and
AOM in particular, is being viewed by the
larger public. In my first decade and a half of
practice as an acupuncturist, I was actively
involved, as were several of my colleagues,
with key proponents of alternative medicine,
holistic medicine and what came to be
known as mindbody medicine. Students were
exposed through what I termed
Acupuncture Human Service Skills to
classes with practitioners of Feldenkrais and
Somatics, Body-Centered Psychotherapy,
Rolfing, Visualization, Neurolinguistic
Programming, and Ericksonian
Hypnotherapy, and these mindbody practices
were seen as the western complement to
acupuncture as a bodymind therapy. And
then. Rather suddenly, many many students
and a good number of faculty resisted the
intrusion of these courses into the training of
AOM practitioners, and they gave way to
courses that were closer to AOM I origin,
like Tai Qi, Qi Gong, Sotai, with the
mindbody realm recast into our counseling
courses where Focusing was the only
approach students no longer balked at. In the
summer if 2007, recognizing the need to
bring the mindbody practices back into the
core curriculum of the college, a group of 16
faculty studied the Mindfulness Based Stress
Reduction approach developed by Jon KabatZinn for a 24 hour, three day intensive. The
faculty group vetted, and endorsed the
course, which now serves as the first intensive
seminar students in the MS/Ac program
engage in within the first few weeks of their
education with us. What will this return to
mindbody practices as a compliment to
AOM education bring with it, one might
wonder? And more interestingly, why are
current students embracing wholeheartedly
such practices as MBSR, when these were
met with such disdain not even a decade ago?
What has changed during this time period?
Contextualizing Acupuncture in North
America
In Bodymind Energetics, written in 1986, I
sought to situate Acupuncture in North
America within the larger arena of mindbody
medicine that was developing at that time.
Meditation, relaxation response training,
Ericksonian hypnotherapy and other
mindbody approaches continued the
psychosomatic medicine work of the 40-60s,
aimed at regulating the body and its process
of manifesting physical symptoms
(somatizing) through mental training and
psychotherapy. Acupuncture, it seemed to
me, represented a bodymind approach that
complemented the other, where
psychosomatic, problems and manifestations
are understood, identified and treated at the
level of bodily/somatic dysfunctions that
acupuncture can prod toward normalcy.
As it turns out, acupuncture and Oriental
medicine has become a well established field
in its own right over the past 25 years, with
the development of accreditation standards
for AOM colleges, recognized by the US
Department of Education, and national
board certification examinations based on
those standards. In this 25 year long struggle
for its own identity, the AOM profession
now recognizes that it has been focused on
training private independent acupuncture
and Oriental medical practitioners with little
interest in, or training for working in more
mainstream or integrated care settings.
mainstream or integrative care settings must
possess these core competencies as well. Thus
those draft FPD standards call for
competencies in communication with other
healthcare providers, awareness of the role of
AOM care in the larger context of a patients
entire plan of care, and the ability to translate
AOM plans and treatments for conventional
and CIM providers for best care of the
patient.
During the same time, the field first known
as Complementary and Alternative Medicine,
and then Complementary and Integrative
Medicine, which some now prefer to refer to
as Integrative Medicine, has also developed
and achieved some amount of recognition at
the federal level, and the Institute of
Medicine has called for recognition of CAM
(or CIM) but also for challenging CAM/CIM
professions to integrate in the five core
competencies in which the Institute of
Medicine believes all 21st century healthcare
providers need to be trained. These five core
competencies, inpatient-centered care;
communication/ cooperation/collaboration
in teams; informatics; evidence-based
practice; quality improvement, would train
all conventional and complementary and
integrative care professionals in a way that
they will be able to communicate and
collaborate across their different practices
with this core set of competencies to guide
this communication.
What has occurred over the past 25 years is
that the AOM field, while building its own
identity and gaining recognition, has become
a part of Complementary and Integrative
Medicine, and is now reaching a mature
place where it can recognize its coexistence
with other CIM professions, and that from
the government and the publics point of
view, it is a part of this bigger CIM
movement.
MindBody and BodyMind Approaches
That being the case, it would seem even more
critical for those training in acupuncture &
oriental medicine to be aware of the other
main CIM fields, and where AOM care fits
best within that larger context, for any given
patient. It would also seem essential for
AOM professionals to be familiar with the
main mindbody concepts and practices that
have insinuated themselves into many CIM
fields.
Recognizing the importance of these core
competencies, the Council of Colleges of
Acupuncture & Oriental Medicine and
ultimately the ACAOM doctoral task force,
developed draft standards for an eventual
first professional doctorate in the field that
does incorporate these competencies to a
large degree. This was done based on the
realization that while current entry level
masters standards do in fact train a person
narrowly for private practice, the doctoral
standards are different in that they recognize
the changing nature of AOM and CIM, and
that AOM providers who wish to work in
In the biopsychosocial model that developed
during this same period, the person and her
illness are seen as part of a larger social
context where that illness is defined,
according to biomedical standards of care,
along with psychological ramifications of any
given illness on a patient. Mindbody
approaches aim to look at the whole person,
and to help the person cope better with
stress, make better choices that effect quality
of life, and focus on health, wellness and
prevention: a salutogenic perspective that
replaces a pathogenic one.
based stress reduction a mindbody medical
practice-- to start off Year I of the MA/Ac
program, to complement training in
QiGong, a bodymind practice, both aimed at
bodymind/mindbody integration.
While the AOM field has its own lifestyle
practices, including dietary practices,
meditation, Qi Gong, Tai Qi, Dao Yin, these
stem from a Chinese view of body and mind
different in many ways from that of North
Americans, who might take more readily to
some of the mindbody practices that have
developed in this country, albeit often from
East Asian inspiration (eg: Relaxation
Response training, developed by Benson,
based on his research of practices of Indian
yogis; Mindfulness Based Stress Reduction
training developed by Jon Kabat-Zinn, based
on east Asian mindfulness practices).
This is also why students in the MS/Ac
program are encouraged to keep practicing a
mindbody, and a bodymind discipline, like
MBSR and Qi Gong, as part of their training
in AOM, and so that they might be able to
instill an interest among the appropriate
patients in such practices as part of the
patients own self-care, once they become
acupuncture interns in the community clinic.
This is also why students go through the selfstudy manuals by Borysenko and Caudill in
Year II, to continue to challenge them to
become familiar with Western mindbody
concepts and practices, and to attempt some
of the practices themselves, to be able to
encourage and support patients who might
wish to undertake such a self-care process as
part of their acupuncture clinic care.
Chinese medicine in fact recognizes the need
for mindbody as well as bodymind
interventions, referred to as tongshenming.
Ted Kaptchuk refers to this concept which he
translates as penetrating divine
illumination. Others translate shenming
as spirit clarity, meaning the ability to
understand the entire existential situation of
the patient and her illness, on all levels,
similar to the biopsychosocial model. When
exhibiting a major moment of clarity or
insight, which penetrates through the
patients situation or dilemma in such a way
that what the Chinese doctor says is already
therapeutic, Chinese medicine recognizes the
same power of language and of verbal rapport
which is rarely talked about in Chinese
medical textbooks from the Peoples
Republic of China or Japan, in more than a
passing reference.
Students have also been trained for quite
some time in Year II at the college in
Gendlins focusing, which is a powerful
approach any patient can be taught for
becoming more aware of where and how they
are stuck emotionally, in a way that makes
change possible.
The final part of this training in mindbody
medicine will occur early in the Fall of Year
III, when students will now be trained in the
neurolinguistic programming (NLP) practices
of reframing that stem from Milton
Ericksons work in hypnotherapy. After a
summer and 50 hours of treating patients in
the community acupuncture clinic, and 200
hours of acupuncture clinical practice on perpatients in Years I and II ACP, senior interns
have gathered enough experience with
acupuncture to be able to use mindbody
medicine techniques like content and
context reframing as a powerful form of
verbal rapport to reinforce the
If AOM students were trained in basic
mindbody practices, they may be able to
achieve moments of shenming with their
patients that would empower the
acupuncture & Oriental medical practices.
This was the premise that lead to
development of an intensive in mindfulness
acupuncture/bodymind medicine they are
practicing.
CAM/CAHC Use in North America
Acupuncture & Reframing
On July 31, 2008, in the House of
Representatives, a senator submitted House
Resolution 406 (H. Con. Res. 406), which
was referred to the Committee on Energy
and Commerce, expressing the sense of
Congress that any effort to reengineer the
health care system in the United States
should incorporate sustainable wellness
programs that address the underlying causal
factors associated with chronic disease.
What I mean by acupuncture reframing or
imaging is that whether we are aware of it or
not, we are reframing a patients condition,
often already defined/diagnosed in
biomedical terms familiar to the patient, in
East Asian acupuncture terms (meridian
blockages, yinyang regulation, patterns of
disharmony) just to make sense of it from
our own acupuncture medical point of view.
This partially unconscious reframing must be
recognized, and then it can be utilized to
provide a powerful and different way for a
patient to view her condition. An example
might best illustrate this:
Five months later, on December 10, 2008,
the U.S. Department of Health and Human
Services, Centers for Disease Control and
Prevention and the National Center for
Health Statistics, issued a National Health
Statistics Reports Number 12, on
Complementary and Alternative Medicine
Use Among Adults and Children: United
States, 2007, comparing statistics from a
2002 report to this 2007 report.
While palpating a patients right shoulder, in
a situation where the patient suffering from
chronic nagging pain has already had an MRI
that shows minor supraspinatus tendon tears,
an acupuncturist might remark: you seem to
have several really tight muscles here, along
pathways we call meridians (reframing the
diagnosis of supraspinatus tendonitis into
tight muscles along a meridian pathway
that the practitioner seems to be totally
familiar with, and that match and validate
where the patients pain is), and this point I
am pressing here, called a trigger point,
might be partially responsible for your pain
(reframing the potential cause of some of the
pain). If that is the case, a few treatments
should be enough (reframing a chronic
condition into something that might change
for the better fast) to release the constriction
in the tight muscles significantly, and relieve
the strain on the tendon while it heals,
leaving you with far less pain (reframing
chronic pain into pain that can change) than
you have experienced (reframing the context
of the pain from being perpetual, chronic,
into something of the past by the use of the
past tense).
Most significantly for the discussion here is
that acupuncture use went from 2,136,000
adult users in 2002 to 3,141,000 in 2007.
Massage therapy, which of course included
tui na, shiatsu and anma, went from
10,052,000 to 18,740,000 adult users. Adults
who engaged in Qi Gong went from 527,000
in 2002 to 625,000 in 2007.
The fact that the bodymind component at
the college in the upgraded program starting
with the class of 2010 now includes tui na
and Qi Gong training would seem to make
our graduates of this upgraded program more
marketable due to the increased therapies or
services they can provide. And plans to
develop a medical Qi Gong post-graduate
program, which might well be folded into the
eventual 4th Year of a potential First
Professional Doctoral Program in
Acupuncture, would increase that
marketability.
any of these, from Zheng Gu Tui Na to
Medical Qi Gong to advanced acupuncture
training, to NLP, Ericksonian hypnotherapy,
MBSR, meditation, yoga etcetera, so as to be
able to provide more comprehensive
Acupuncture & Oriental Integrative
Medicine services for their patients.
On the mindbody side, 15,336,000 adults
used meditation in 2002, which increased to
20,541,000 in 2007. Likewise, adult users of
progressive relaxation increased from
6,185,000 in 2002 to 6,454,000 in 2007, and
adults who used deep breathing as a
mindbody therapy grew from 23,457,000 in
2002 to 27,794,000 in 2007. Finally, adult
users of hypnosis grew from 505,000 in 2002
to 561,000 in 2007.
And graduates of the MS/OM program of
course can offer natural remedies as well.
While these reports do not contain much
data on various Chinese herbal remedies,
3,345,000 adults used ginseng in 2007,
1,528,000 used green tea pills, and 3,446,000
used combination herb pills.
What is also very interesting is the reverse
trend among children using CAM therapies.
While 150,000 children 18 years of age or
under used acupuncture in 2002, only
27,000 used it in 2007. Childrens use of
homeopathy, naturopathy, chiropractic or
osteopathic manipulation dropped three-fold,
and use of massage dropped from 743,000 in
2002 to 297,000 in 2007. Childrens use of
meditation similarly dropped from 725,000
to 400,000, progressive relaxation, from
329,000 to 164,000, and deep breathing,
from 1,558,000 to 704,000. Finally, for
comparison to adult users, 50,000 children
used Qi Gong, compared to only 4,000 in
2007.
Concerning the issue of whether our
students gain sufficient exposure to those
types of conditions which send adult and
children users for CAM care in general, here
are the statistics from this report, which show
that our students are in fact receiving
excellent exposure in their clinical training,
to the array of disorders that CAM users in
2007 presented with:
Back and neck pain/dysfunction:
19,356,000 (23%)
Joint pain or stiffness or other joint
condition: 4,537,000 ( 5.2%)
Arthritis: 3,057,000 ( 3.5%)
Other musculoskeletal: 1,498,000 (
1.8 %)
Severe headache or migraine:
1,359,000 (1.6%)
Regular headaches: 813,000 (1.0%)
Fibromyalgia: 755,000 (0.8%)
Sprain or Strain: 605,000 (0.7%)
Given the strong increase among adults over
18 years of ageclearly our biggest market,
over that 5 year time-span, it would seem that
the inclusion of training in Mindfulness
Based Stress Reduction, the relaxation
response, progressive relaxation and deep
breathing exercises in MBSR and Borysenko
and Caudills self-care programs, and the
hypnosis related NLP and Ericksonian
therapy skills in the Lifestyle Counseling III
in the Fall of Year III, will also provide our
graduates with marketable skills in integrated
bodymind and mindbody therapies that
speak directly to the adult populations
search for such alternatives as they cope with
chronic disorders in growing numbers. While
all third year interns will be able to begin to
use all of these therapies in clinic, for the first
time in the colleges history, they will also be
well primed for taking advanced training in
Pain is clearly the biggest category of
condition that adult users of CAM care seek
such care for. In contrast only about 11% of
children users seek CAM care for pain
conditions.
Finally, adult users of CAM care also
presented with the following conditions:
Anxiety: 2,293,000 (2.8%)
Cholesterol: 1,827,000 ( 2.1%)
Head or chest cold: 1,693,000
(2.0%)
Insomnia or trouble sleeping:
1,191,000 (1.4%)
Stress: 1,124,000 (1.3%)
Stomach or Intestinal Illness:
974,000 (1.2%)
Depression: 962,000 (1.2%)
Hypertension: 842,000 (0.9%)
Diabetes: 650,000 (0.7%)
Coronary heart disease: 586,000
(0.7%)
recommended by another CAM provider),
and MS/OM students have another 2 day
course with him to understand the
implications of herb-drug interactions as this
pertains to Chinese herbal medicine.
A Case for Humility
As the Tri-State College of Acupuncture
embraces a training of faculty in Classical
Chinese Medicine approaches and practices
that will be passed along to its graduate
students, as well as a training in NeoConfucian Ways of Learning and SelfCultivation, one must take pause.
To put this all in a bit more perspective,
38,183,000 adult users used nonvitamin,
nonmineral, natural products in 2002, and
38,797,000 in 2007 (fish oil, glucosamine,
echinacea, flaxseed oil, ginseng, combination
herb pills, chondroitin, garlic supplements,
COQ-10, Fiber/psyllium, green tea pills,
cranberry pills, saw palmetto, soy
supplements, melatonin, grape seed extract,
MSM, milk thistle, lutein). I suspect that
these supplements are what many sufferers of
high cholesterol, diabetes and coronary heart
disease sued as their CAM therapy. Any
many probably also used diet-based therapies,
which accounted for 7,099,000 adult users in
2002, and 7,893,000 adult users in 2007.
And from what I see from my patients, many
of these users are probably using these
supplements self-recommended, from on-line
and magazine and television advertising and
information.
The Complementary and Alternative Health
Care approaches above are making a
significant impact on the efforts of ordinary
citizens to engage in self-care and even selfcultivation as they struggle against an overly
medicalized health care system.
People suffering from chronic stress, chronic
and debilitating pain and normal aging
disorders find little help in the mainstream
medical system and are seeking alternatives.
The next generation of elderly is from a time
when New Age medicine and an East-West
fusion seemed a possibility for the future,
and they embrace all sorts of nonconventional approaches to health and selfcultivation.
As a member of that generation I have lived
my 62 years seeking very little treatment,
Eastern or Western, for the stresses, strains
and pains of daily living and stress. I grew up
poor working class, and the fathers in the
neighborhood and especially in the small
western Pennsylvania town of 2000 people
where my mother was born and where I
spent my summers, who worked hard for a
living, served as a reminder that life was hard,
that as one got older one would have aches,
pains, disabilities, and suffering, and that this
was part of the human condition. They knew
If I were also trained in Chinese herbal
medicine especially, I would probably feel the
need for formal training after graduation in
the use of nutriceuticals, so as to be able to
better direct my patients who want to
combine those supplements with herbal
remedies. And of course the college does
expose MS/Ac students to a day long class
with John Chen, pharmacist, on potential
herb-drug and herb-supplement issues and
how to access reliable information to better
understand that aspect of a patients care
plan (whether self-prescribed or
that death was inevitable, they had little
money and little if any insurance and they
were hell-bent on leaving this earth owing
nothing, and not leaving their families with
having to bear the costs of their passing. The
ads one sees on the television late at night for
cheap insurance to cover these rights of
passage are aimed at just these people.
thought was due to the anesthesia. The next
day we spent with her, where she tried her
utmost to break out of the bed, pull off the
oxygen (she was on oxygen due to
emphysema and lung cancer for years
already). At midway through the day, her
surgeon came in to visit, and lamented to her
that she seemed far more confused than the
day before, and seemed not to recognize her.
When he asked hoe she knew who he was
the day before, she pointed to his nametag!
She did not know who he was, or what he
was saying, he now realized, but was just able
to state he was her surgeon and give his
name, and that she would do as he said. This
amazing surgeon sat down with me, and
apologized, stating that he should have taken
her DNR which had an additional note from
her from the week before (!) saying she
refused any surgeries or any interventions
more seriously and refused to operate. Her
family doctor came in next, and he too
apologized, and stated it was clear what she
was trying to communicate through her
efforts to break loose that she wanted out of
the hospital. Within an hour we had her at
home under hospice care, and she died that
night peacefully in her sleep, as she wished.
Ending Ones Days
While I had many problems with my mother,
her way of choosing when to die were
something to behold and were inspired by
her own mother, a woman I also had serious
issues with.
One day I received a call from the nurse at
the assisted living facility where my mother
lived stating the cleaning woman noticed my
mother had not gotten out of bed, which was
not typical for her and she left a note for the
nurse. The nurse checked on my mother, still
in bed the next day, and noticed a mass on
her lower abdomen and rushed her to the
hospital nearby and called me. I got into the
car and made my way the 365 miles with my
wife at the time in record speed. We called
my cousins significant other, who had gone
to visit my mother in the hospital, and then
spoke with her surgeon whom she had used
for a few other surgeries.
When I examined her checkbook to settle
her accounts I learned that she had not
prepaid her funeral expenses as I had
thought and as was typical in her family, of a
few thousand dollars for cremation services.
Excellent at math, she made an error in her
favor of exactly that amount, so that she died
confident she owed nothing.
He reported that this was simple hernia that
he could repair it and she would be out of
the hospital in 1-2 days. I explained that I
knew she had a DNR in her chart at the
hospital, and he reassured me that she
understood how simple this surgery was and
consented to it and passed the phone to her:
when I asked if she understood what the
surgeon was suggesting, she said he is my
surgeon and I will do as he says.
So while those of us who strive to be solidly
middle or upper middle class pay small
fortunes to life insurance for our heirs, the
poor take care of their final days in a much
simpler way.
Does this make them less wise, more selfish,
more self-centered, or just the contrary?
When we arrived in her town she was just
coming out of a successful surgery but
seemed to barely recognize me, which I
This way of dying was poor working class,
informed by a lifestyle with no frills and no
promises.
Would these people have been better off if
they received CAHC and AOM care? Would
they have fared better if they had engaged in
self-cultivation practices and watched their
diets? I do not know. My mother dies the
youngest in her family so far, at 87 having
beaten breast cancer for 8 years and having
been a 3 pack-a-day smoker for over 60 years.
Her mother died at 94, and her sister at 88.
Go figure.
