While it is exciting to witness the stages of integration, the dominance of the Western medicine model over the Chinese or Asian Medicine model is apparent in the world of diagnosis and pattern discrimination. Even in private practice, licensed acupuncturists must often placate to Western diagnoses because patients frequently seek the Asian medical paradigm after a series of Western diagnoses and treatment failures. The design flaw of using a snapshot of lab values with signs and symptoms to dictate a Western diagnosis, to be controlled or managed by a pharmaceutical, includes the illusion that favorable changes to lab values indicates an improvement of health. The drug itself is often toxic and generates disease while not addressing the underlying cause of the original health complaint. Often, there is not a complaint but a finding after a routine checkup or screening that renders a person suddenly a sick patient. A major flaw is the isolation and focus on one area or system of the body. Health, illness, and disease are neither static nor isolated.
The genius behind the Chinese/Asian medical model is pattern discernment and differential diagnosis aimed at treating the chief complaint and the underlying cause. This is thought of as treating the branch and the root. This results in a combination of patterns and differential diagnoses that generates treatment principles. For example, Asthma is Western diagnosis. The Chinese counterpart is Xiao Chuan.
According to Dr. Google, who has collected a snap shot of biomedical understandings, Asthma is a very common condition resulting in about 3 million cases each year in which one’s airways become inflamed, narrow, swell, and produces extra mucus rendering in difficult breathing. Dr. Google gathered information from credible sources such as Mayo Clinic, John Hopkins, and the Centers for Disease Control that dictates this condition requires a medical diagnosis often supported by labs or images and that the condition is chronic, lasting for years or forever. It can interfere with daily life or be life threatening, thus managed by a range of medications such as steroids, formoterol, salmeterol, and tiotropium. Most common side effects include acne, glaucoma, high blood pressure, weight gain, diabetes, tachycardia, tremor, excessive sweating, anxiety, insomnia, agitation, dizziness, sinus infection, migraine headaches, dry mouth, throat irritation, and an increased risk of heart attacks, stroke, and cardiovascular death.
According to Chinese medicine, Xiao Chuan is also a common condition. Xiao patterns include short rapid breathing and wheezing while Chuan patterns include significantly labored breathing. While often seen together, these patterns are differentiated by very unlike presentations save the root of development. The basic concept of Xiao is phlegm lodged in the lung. While this is similar to mucous, phlegm involves a very different pathogeneses. There is also an understanding that other external factors that do not have a biomedical equivalent, and internal factors of emotion, diet, and stress on a weak system. One of the key differences in Chinese differentiation is the involvement of other organs than just lung; specifically, kidney and possibly liver/spleen. Combined with the factors above, there could be phlegm and cold in the lung, or phlegm and heat in the lung. There could also be deficiency in the kidney and or lung. Treatment is aimed at reducing acute factors and boosting organs during remission. Treatments mainly include herbs and acupuncture that do not render adverse side-effects, are cost effective, and strategically geared towards resolution versus management.
In typical integrated situations, the biomedical phenomenon of protocol treating a targeted area dominates the individualized whole person approach. While the success of treating veterans has opened the door to treating other than pain, the authorizations to treat a specific area with a specific diagnosis illustrates this challenge. Many licensed acupuncture providers want to embed logic by adding diagnoses and treating other areas of the body. However, adjudicators of the claims simply want the authorized treatment area to match what was treated in the medical note. Administrators and many medical providers cannot be expected to understand that sometimes to treat knee pain, licensed acupuncturists may pragmatically insert acupuncture needles on the sides of the spine at L4. Although we can explain this in a logical biomedical manner, there is a growing demand to have licensed acupuncturists add body area modifiers to acupuncture and other modality treatment codes.
This has been frustrating for all parties involved. The ownness to craft this change may be in the licensed acupuncturists’ court. Plowing through and complaining with disregard for the Western medical administrators, has not been a winning strategy. In fact, it has recently been postulated that practitioners use modifiers after acupuncture and other modality service billing codes. Some direct provider agreement regional VAs now require a GP modifier if billing for a body part that could be serviced by a physical therapist; a GO modifier if billing for an area from the elbow to the finger tips (occupational health); and a GN modifier for areas of the face and jawline (speech pathologist). For more information, please visit https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM10176.pdf.
In any urgent situation, such as a respiratory or asthmatic event, life-saving medicine is critical. Outside of emergencies, pharmaceutical treatments often complicate many chronic and complex diseases. Conversely, acupuncture / Chinese medicine offers less harmful approaches that do not require Western diagnoses to treat or reverse complicated conditions. Integrated approaches require an understanding that pathologies can be interconnected to organs, tissue, rheum, musculoskeletal, emotional, genetic, and lifestyle factors. That level of elucidation must come from acupuncture medicine providers with a savvy for Chinese medical diagnosis, biomedical knowledge, and consummate communication skills.
Jennifer M. Williams, PhD, DACM, L.Ac
Dr. Jennifer M. Williams is a licensed acupuncturist who focuses on complicated presentations. As a former Army Soldier, Federal Program Manager, Civil Service Army Acupuncturist, and Veteran Affairs Fee Basis acupuncture provider, she is working towards higher acupuncture standards of care and expanded scope of Chinese medical services for veterans, Soldiers, and in integrated medical settings. Dr. Williams completed her Ph.D. in Counseling Studies at Capella University and completed her doctorate in Acupuncture Chinese Medicine at Pacific College of Oriental Medicine. She completed her M.S in Traditional Chinese Medicine at the Academy of Chinese Culture and Health Sciences in the California Bay area, and her B.S. in Information Technology in Pleasanton, California.
Dr. Jennifer M. Williams teaches for the Pacific College of Oriental Medicine Doctoral program; serves as the Doctorial Research Methodology and Capstone Lead at the Academy of Chinese Culture and Health Sciences; and is on faculty at Walter Reed National Military Medical Center. Dr. Williams has published articles, contributed to books, and participated in research. As a national and international National Certification Commission for Acupuncture and Oriental Medicine professional development activity partner, she is committed to providing quality continuing education. Dr. Williams has a small Chinese Medical Practice north of Asheville, North Carolina where she specializes in complex presentations and difficult diseases. In her North Carolina and Tennessee mountain properties, she raises chickens, and grows herbs, mushrooms, and tea.