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"All About Acupuncture"
The Daily News
October 26, 1998

When acupuncture first came to the United States in the mid. 19th century, it was, largely the province of Chinese immigrants.  Today, more than a million Americans rely on this ancient discipline to treat ailments as varied as poor vision, bronchitis, infertility, addiction - even arthritis in their pet dogs.  

In fact, it has been so successful in treating substance addictions that hundreds of prison, jail and court-ordered outpatient-treatment programs now recommend or even require it.  And, spurred by Mayor Giuliani's threats to abolish methadone programs, more New York-area health-care providers are becoming interested in the concept.

"Acupuncture works as part of a puzzle, not by itself", says Dr. Michael Smith, director of the recovery center at Lincoln Hospital in the Bronx, who ha& been using the treatment for substance abuse for the last 24 years.  "In the addiction field, almost nothing works by itself. The idea is that acupuncture prepares a person to participate in counseling and group meetings."

Throughout New York, more than 100 substance-abuse programs, Including all city hospitals except Bellevue, use the Lincoln Hospital model of "ear acupuncture," with the same points, all on the outer ear, used for each person.  The ear, like the foot Is thought to contain acupoints that correspond to all Parts Of the body - thus, using those points ensures overall treatment.

People are cared for in an outpatient group setting so one therapist can administer the treatment - which takes about 45 minutes - to several people at a time.  At the beginning, patients go every weekday, then decrease to once or twice a week, then once a month, then taper off.  "As a person gets more stable, the emphasis is much more on 12-step meetings," says Smith.  Lincoln Hospital's recovery center sees well over 100 people a day.

Acupuncture is probably the most studied and most accepted of "alternative" medical practices.  Last Year, the National Institutes of Health (NIH) issued a consensus Statement concluding that acupuncture, either alone or in combination with Western medical Practices, was a clearly effective treatment for a variety of complaints.

It la based on the concept of qi (pronounced "chee"), most often translated as "energy."  To adherents of the discipline, all diseases and disorders are believed to result from interruptions to the flow of qi.  To restore balance, needles (or sometimes heal pressure, friction or lasers) are inserted at points along the bills 12 primary medians - the pathways along which qi travels.

Each acupoint is associated with a particular internal organ and with a specific bodily function.  "Qi is a very real idea, but we're not attached to its validity as a scientific concept," says Kevin Ergit, dean of the Pacific Institute of Oriental Medicine.  "Qi is probably many processes.  We donÍt expect to isolate it.  It's an elegant way to generalize about complex processes."

On the surface, acupuncture procedures are quite simple. During an initial visit which can last up to an hour and a half, the practitioner takes an extensive medical history, asking "standard" questions about a patient's energy level, sleep pattern and medications, in addition to questions about the patient's "constitutionî (seasonal, taste - even color - preferences). "We're making a diagnosis based on a pattern," says Marnae Ergil, a Manhattan acupuncturist who is married to Kevin Ergil. "Where on the head is the headache? What other things are going on with the individual? We make a differential diagnosis based on a full complex of signs and symptoms."

Followup visits are generally shorter: about 40 minutes. Again, the acupuncturist asks questions relating to the patient's general quality of life as well as to specific symptoms. Then, he or she takes the patient's pulse in 12 places (six on each wrist) and touches different areas of the body, inquiring as to whether they are sore or tender. In China says Dr, Naomi Rabinowitz, an M.D. who has been practical acupuncture for 17 years, the acupuncturist also examines the tongue, but because Americans brush and gargle so much there's not much to be seen there.

Needles and Pains
Acupuncture needles are really more like pins: They are thin (about as wide as a strand of heir), solid and extremely flexible. They have tapered Ups and range from 1/4 or 1/2 inch to 5 inches long. Though the needles penetrate the skin, there is rarely any bleeding or bruising.

Patients seldom experience pain, though they may feel tingling or heaviness. Some patients actually fall asleep during treatments.

By contrast "Western" needles are heavier and thicker, hollow and sometimes serrated. Ten to 12 acupuncture needles can fit into the standard hypodermic needle used to draw blood.

Common Treatments
Though acupuncture treatments tend to be highly individual, some points seem to have the same or a similar effect for many people:

Inner Gate - a point about 2 Inches above the wrist on the inner side of the arm - is useful for motion sickness, morning sickness or any sort of nausea.

Large Intestine 4 - a point in the web of the hand between the thumb and Index finger. Massaging this point for a couple of minutes will often relieve a headache.

Stomach 36 - a point about 3 inches below the knee on the outside of the leg - is a general wellness point. Massaging, needling or pressure on that point daily Is said to prevent disease.

Based on all this information, the practitioner determines where the needles are to be placed. The most powerful points, says Frank Butler of Soho Herbs and Acupuncture, are from the elbow to the end of the hand and from the knee to the end of the foot.

Sometimes patients see results right away, but most practitioners suggest giving the treatment eight to 12 weeks, adding that if there's no change in three or four mouths, maybe it's time to try something different. Chronic conditions    may require seeing the acupuncturist indefinitely, perhaps for years. "I see the treatments as part of an integrative approach to medicine, one in which no method is practiced to the exclusion of another and one that emphasizes prevention and whole-body health," says acupuncture patient Celia Baruchin, who also sees Western medical doctors when she needs to.

Occasionally there is a "miracle" cure, such as the woman who went to see Rabinowitz after having been unable to talk for several months. She began peaking again after two treatments.

The situation is complicated by the fact ht patients in the United States try acupuncture as a last resort "We usually see complex cases because people come to us later," says Kevin ETMI. "In China, itÍs a routine point of call [there are even roadside stands set up to administer the treatment]. They go to the acupuncturist first for a cold." Ideally, say practitioners, patients would go to an acupuncturist regularly to keep healthy rather than to stop being sick. This is about keeping you healthy," says Rabinowitz. "We canÍt prevent a virus, but we could affect the vulnerability to viral infections."

Though no one knows exactly how acupuncture works, some of its effects have been documented. Research conducted by Western scientists has shown that it results in the secretion of various neurotransmitters and neurohormones, specifically stimulating the release of endorphins (painkilling hormones produced by the body) as well as the anti-inflammatory hormone cortisol.

As Smith, who uses the treatments for substance abuse, puts it: "The fact that [abusers in acupuncture programs] have less cravings, are more receptive, thoughtful, flexible - presumably all those relate to physiology one way or another, but it has not been earmarked as to how that's done."

Yet even with the burgeoning scientific literature relating to acupuncture    a body of critics still refers to it " "quackupuncture". Perhaps in an effort to co-habitate comfortably, acupuncturists are quick to point out that they are not out to replace conventional Western medicine, only to complement it "I will only treat someone who's got cancer if they actually are going to a Western counterpart," says Butler. On the other hand, even medical doctors will admit that Western medicine is often ineffective for any number of chronic ailments ranging from Crohn's disease to sinusitis to irritable bowel syndrome. And it's here that acupuncturists seem to be having the most impact The trick is knowing whom to see when.

Acupuncture & Rehab
Ten years ago, a New York City court ordered Melinda (not, her real name) to enter a substance-abuse recovery program. She was then 24 and had been using cocaine for 1.5 years. She had lost her job and custody of her children, Including the youngest, who tested positive for drugs when he was born.

The rehab program   Melinda entered at Lincoln Hospital combined acupuncture with Individual and group counseling and a 12-step Support Program. "We used to call each other pinheads," says Melinda, who admits the she was Initially leery of the treatment.

But, she says, "after a while, it relaxes the body and reduces the cravings and urgings to use. You're able to focus an things you need to CIO. I was able to keep appointments. I was able to do the things I had to do for my family instead of thinking where the next drug was coming from."

Melinda, free of drugs for 10 years now, has regained custody of her children, and for the last eight years has been a counselor administering acupuncture to new patients.

Costs & Insurance
What you should expect to pay for acupuncture in the New York City area

FIRST VISIT - $75 to $150

FOLLOW VISITS - $40 to $100

Many acupuncture schools offer reduced-fee treatment by advanced students under the supervision of an experienced practitioner. Insurance policies vary, but many insurance companies (probably between 70% and 80%) will now cover acupuncture treatments.

Licensing
Of the approximately 12,000 practicing acupuncturists in the United States, 3,000 are medical doctors. Licensing requirements vary from state to state, but In New York, M.D.s who practice acupuncture are required to have 300 hours of acupuncture training, making him or her a certified acupuncturist. Licensed acupuncturists (L-Ac.) must have completed a minimum of three years' training as well as 60 semester hours of undergraduate work. In addition, anyone practicing acupuncture must pass the National Certificate Examination In Acupuncture.