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First published 2006
ISBN 0 443 10088 8
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NOTICE
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Running a Safe and Successful Acupuncture Clinic
“Running a Safe and Successful Acupuncture Clinic represents a distinct step
forward for the practice of acupuncture as a clinical discipline . . . Zhu’s orig-
inal contribution will enhance the professional practice of acupuncture and
Oriental medicine”.
William R Morris, OMD, MSEd, LAc
President, American Association of Oriental Medicine
“It is amazing that Dr Hong Zhen Zhu has taken the trouble to review acupunc-
ture mishaps in such detail and to advise about the ways to avoid them. This is
a remarkable book. Dr Zhu has created a masterpiece that should become the
standard text for all students and practitioners of acupuncture and TCM. From
potential complications, and techniques to avoid them, to the nuances of relat-
ing to patients and the ethics of practice, he has left no stone unturned.”
Linda M Rapson,MD, CAFCI,Chair, Complementary Medicine Section, Ontario
Medical Association, Canada. President, Ontario Society of Physicians for
Complementary Medicine,
Executive President, Acupuncture Foundation of Canada Institute and Medical
Director, Rapson Pain and Acupuncture Clinic.
“What a wonderful book! The text is what has been missing in acupunc-
ture/TCM education for the student and neophyte practitioner – and is also a
good read for the experienced practitioner to refresh and reflect. The book is
testament to Dr Zhu’s rich experience in the dual role of practitioner and edu-
cator. He understands and delivers the information that, until this book, has
not been readily available and easily readable and referenced by students and
new practitioners. This book is very much needed in today’s educational
system – and the sooner it gets out there the better!”
Mary Watterson, Dr TCM, Reg Ac Member of Standards of Education and
Examination Committees, College of TCM Practitioners and Acupuncturists of
BC, Canada. Founding Member, North American Council for Acupuncture and
Oriental Medicine.
“This book is very engaging and holds your interest. That is because it is not
too technical and it is fun to read. Situations one commonly encounters in
clinical practice are presented comprehensively in simple and clear language
so before you know it you have read the whole book . . . It serves as a great
handbook for re-examining my practice. This book is the amalgamation of the
author’s rich clinical experience in the West and his business savvy. It is a long
awaited text indispensable for all practitioners.”
Junji Mizutani, Chief Editor and Director of NAJOM (the North American
Journal of Oriental Medicine).
“The issue of safety will always be one of the highest priorities in the field of
acupuncture and Oriental medicine. Dr. Zhu’s book on safety, patient/practi-
tioner issues, and basic information regarding one’s practice offers superb
information on a variety of topics that affect every practitioner. His case
studies are practical and most informative. This book should be in all college
libraries and practitioners’ offices.”
Elizabeth A Goldblatt, PhD, MPA/HA,Provost/VPAA at the American College of
Traditional Chinese Medicine (ACTCM), former President of the Council of
College of Acupuncture and Oriental Medicine, USA, and the Oregon College
of Oriental Medicine, Portland, USA.
vi
About the author
Hong Zhen Zhu, Dr TCM, RAc (Canada),
MD (China) is a master of the art of
traditional Chinese medicine and a
treasury of expertise and compassion,
based on 30 years of practice and
teaching in China and Canada. He
earned his medical degree at
Chongqing University of Medical
Science, China, where he studied under
professors and doctors who pioneered
the fusion between traditional Chinese
and Western medicine, which guides
his practice to this day.
Dr Zhu’s experience ranges from training barefoot doctors in the Three
Gorges region of the Yangtze River during the Cultural Revolution, to working
as a general physician practising both Western and Eastern medicine at the
famous Ren Ji Hospital in Chongqing, established more than a century ago by
Canadian missionaries.
Dr Zhu, who now has a thriving Traditional Chinese Medicine (TCM) prac-
tice in Victoria, BC, Canada, has published numerous articles and research
papers in medical magazines, journals and newspapers in China, Canada and
the United States. He has also been an instructor, clinical supervisor and pres-
ident of the Canadian College of Acupuncture and Oriental Medicine.
Throughout this book, you will feel his generous spirit and his profound
knowledge.
Dr Zhu is also the author of Building a Jade Screen: Better Health with
Chinese Medicine(Penguin Canada).
vii
Contributors
SUSAN BROWN, DTCM, LicAc (UK) is fied in the acu-detox protocols of the
now retired from private practice in National Acupuncture Detoxification
Victoria, BC, Canada, where she also Association, and has been involved in
taught at the Canadian College of research on drug addiction and multiple
Acupuncture and Oriental Medicine. sclerosis. Dr Demorest is a former presi-
dent of the Acupuncture Association of
HEATHER BURY, Dr TCM, has a private British Columbia and sits on the North
acupuncture and TCM practice in Comox, American Council on Acupuncture and
BC, Canada, and teaches anatomy and Oriental Medicine.
Oriental medical theory at Windsong
School of Healing in Campbell River, BC, DAVID IP, RAc, DTCM, DAc, trained in
Canada. She also spends two months TCM theory and practice in Calgary,
each winter teaching at the Rebalancing Canada. He interned at the Zhejiang
Bodywork residential school in Costa College of Traditional Chinese Medicine,
Rica. the largest TCM school in the world, in
the city of Hangzhou, China, home of the
XIA CHENG, MD (China), PhD, RAc, famous and scenic West Lake. David Ip
earned a PhD in Medicine, specialising now has his own West Lake Clinic in
in acupuncture and chronomedicine Regina, Canada, where his treatment spe-
(Chengdu University of TCM) and has cialties include chronic pain relief and
been a physician, herbalist, acupuncturist adjunct therapy for patients receiving
and researcher for more than 20 years. conventional medical treatment.
She has taught at colleges in Europe,
Canada and China, published several TCM CHRISTOPHER LAM, MD, is a Western-
works, and continues to be involved in trained medical doctor and physician
the process of regulating acupuncture acupuncturist with an integrated gen-
and TCM in the province of Alberta, eral practice in Victoria, BC, Canada. He
Canada. She is the founder and president is also past president, Association of
of the Canadian Institute of Traditional Complementary Physicians of British
Chinese Medicine and the director of the Columbia, and a Clinical Instructor in
BodyMind Synergy Health Centre, both in the Department of Family Practice,
Calgary, Canada. Faculty of Medicine, University of British
Columbia, Vancouver, BC, Canada.
LOUISE DEMOREST, Dr TCM, is an
acupuncturist and herbalist with a pri- XIAOSHU ZHU, BMed (Nanjing, China)
vate practice in Richmond, BC, Canada. MMed (Nanjing, China), PhD candidate
Her advanced studies in China and Japan (Sydney, Australia),is a lecturer and clin-
included acupuncture, Japanese massage, ical coordinator for the Chinese Medicine
Zen Shiatsu and herbology. She is certi- Program, School of Exercise and Health
ix
Contributors
Sciences, and a Researcher, Center for istered Chinese Medicine Practitioner,
Complementary Medicine Research at and over the past 20 years has amassed
the University of Western Sydney, intensive teaching and clinical experi-
Australia. She is also a qualified and reg- ence both in China and Australia.
x
Foreword
The western practice of acupuncture has progressed beyond its early roots
when Harviell introduced The Secrets of Chinese Medicine, Consisting of the
Perfect Knowledge to Europe in 1671 and Benjamin Franklin's great grandson
Dr Franklin Bache wrote the first US medical acupuncture article, entitled
Memoirs on Acupuncture in 1825. Given these initial forays into the arcane
methods of the east, acupuncture literature remained rare until James Reston,
a reporter for The Times, witnessed a surgery using acupuncture anesthesia
while traveling with President Nixon. This sparked interest in acupuncture and
English language translations from the great body of Chinese literature. Then,
subsequent to the increasing popularity, research and growth of accredited
degree programs in acupuncture, the FDA reclassified the acupuncture needles
from experimental devices to Class II medical devices in 1996. In a similar vein,
Running a Safe and Successful Acupuncture Clinic represents a distinct step
forward for the practice of acupuncture as a clinical discipline.
Hong Zhen Zhu is to be lauded for bringing an essential discussion of risk
and ethics in the practice of acupuncture to the foreground. With case his-
tories and evidence he discusses an array of adverse events along with useful
management strategies and referral criteria. There are clear descriptions of
anatomical structure and the symptoms that can occur after inadvertent
puncture of vulnerable structures such as the organs or nerves. The cases dis-
cuss the very real risks of inappropriate needling methods along with graphic
examples of the needling method that caused the complication. Consideration
is given to the anatomy and anatomical changes that occur in various disease
states that can increase the risk of damage to organs. Although serious com-
plications are rare, the authors share cases that highlight the very real prob-
lems that can occur when acupuncture is performed improperly or by under
trained personnel.
This is a clearly referenced and evidence based approach to the manage-
ment and prevention of adverse reactions that can occur in the administra-
tion of acupuncture. The discussion includes needling risks based on normal
anatomy as well as the risks that are of concern for certain body types and
diseases conditions.
The development of ethical concerns has been correlated with the emer-
gence of medical professions within most cultures. While the concern for
ethics in medicine has been present since the earliest records in the Persian
Hammurabi texts circa 2300 BCE and developed further in the Hippocratic
xi
Foreword
Oath as well as the writings of the famous Sung Dynasty physician Sun Simiao,
the translation of medical ethical discussion from an eastern culture to the
west has not received much attention. The author discusses the historic devel-
opment of ethics through the three treasures of Confucianism, Taoism and
Buddhism. He connects it to the practice of acupuncture in the modern clini-
cal settings of the west. It is reasonable to predict that essential materials like
this will provide a basis for the development of public policy and protection in
the future, especially as it concerns the need for professional level training in
acupuncture.
This text will have an impact on the development of standards of practice
for acupuncture in the west. The clear discussion of risk involved with the pro-
cedures will assist legislators to understand the need for training to a full level
of competency. It will assist those practitioners who are forging laws in parts
of the world where there are none to establish for the public that the neces-
sary critical dialogues are occurring within the profession such that autonomy
is granted and the rights to exercise professional judgment are preserved.
Zhu's original contribution will enhance the professional practice of
acupuncture and Oriental Medicine.
William R Morris
xii
Preface
This book will form a valuable addition to the reference library of anyone asso-
ciated with acupuncture and traditional Chinese medicine (TCM). It is among
the first in the English language to amalgamate into one comprehensive work
the issues of ethical considerations and risk management, as well as offering
in-depth, practical answers to the questions of newly graduated practitioners
facing a new set of daunting tasks following their formal education.
Others who will benefit from this book include students, especially in their
internship years, looking ahead to starting their own practice. It will make stu-
dents aware of the serious nature of ethical practice and accident prevention
from the very beginning. It takes far more than a knowledge of point location
and needling technique to make a good acupuncturist; our responsibility to
patients requires taking care at every step. If we cannot always help, at least
we will know enough to do no harm.
This book is also helpful for the practitioners who want to deepen their
knowledge, whether that is in learning more effective and less painful needle
techniques, better clinical management or going to China to study. It goes into
great detail in areas of technique because the quality of our practice and the suc-
cess of our treatments rest on our attention to these small but crucial matters.
Applicants for certification and licensing exams will find the sections on
safe and effective needling, infection control and accident prevention in
acupuncture and other TCM techniques a useful reference. The book is a new
and valuable resource for registration bodies setting licensing and competency
standards, as well as for anyone researching legal issues related to the safe and
ethical practice of acupuncture.
Emergency and trauma departments of hospitals will want to have this ref-
erence on hand for review by their physicians and surgeons, to enhance their
knowledge of what injuries can fairly and accurately be attributed to an
acupuncture treatment, and when they are only coincident and not related to
acupuncture. This will avoid a significant number of misunderstandings that
currently arise between Western and TCM practice.
In addition, medical doctors and other health professionals who are incor-
porating traditional Chinese medicine into their practice will find information
to help them connect their knowledge of human physiology with the theory
and practice of acupuncture.
2005, Victoria, BC, Canada Hong Zhen Zhu
xiii
Acknowledgements
My wife Xiao Feng Li and daughter Judy Zhu have been a constant, daily and
faithful support in body and spirit. In addition to their unwavering encour-
agement, they have also uncomplainingly dealt with many mundane tasks
such as research, typing, proof reading, computer problems and the regular
and crucial contribution of nourishing and comforting meals!
The creation of a book of this scope has required skills that go far beyond
technical writing ability. As editor, Sherry Lepage has been one part writer, one
part psychologist and one part mind reader. Sherry is a writer and filmmaker
who specializes in health education projects, several of which have won awards
in international competition, as well as social issue and cultural documentaries
which have been broadcast across Canada. Over the year that we have worked
together on this book, we have enjoyed many fruitful discussions about com-
plementary medicine philosophies and the interplay of cultures. Her questions
have sometimes sent me scurrying home to do more research and expand my
own thinking. Sherry’s entire family has lent its support, especially her daugh-
ter, Sara Cowan, whose advice on what psychology students like and dislike
about university textbooks helped us with many details. The fact that this is
the second book we have happily collaborated on says a great deal about how
much I value our partnership. I feel very fortunate to be able to call on her
skills and her friendship.
The assistance of Heather Bury, Dr TCM, has been invaluable, especially in the
formative stages of the book. As a skilled practitioner, as well as a former student
of mine, she contributed many excellent ideas about content and structure, and
edited much of the original manuscript. As the book has grown and developed,
Heather’s international teaching experience has widened its scope, and she has
been extremely generous with her knowledge and advice. Her many contribu-
tions are woven throughout the text, but are especially evident in the sections
on following up with herbal prescriptions, the schools, styles and cultural con-
text of Chinese medicine in the West and marketing and publicity.
I am also profoundly grateful for the assistance of Louise Demorest,
Dr TCM, whose background as a leader of professional bodies in the field of
acupuncture has given her a comprehensive understanding of ethics and pro-
fessional practices, which she has contributed to this book. She raised a num-
ber of important issues, from legal questions to technique, which kept us busy
making sure these important matters were properly covered. As an experienced
practitioner, she has also offered so many suggestions that if we were to take
xv
Acknowledgements
them all we would still be writing! As a member of the North American Council
on Acupuncture and Oriental Medicine, Louise has many international con-
nections in the field, which she has been kind enough to share, giving the book
a wider usefulness.
Christopher Lam, MD and physician acupuncturist, embodies in spirit and
practice the reason why the integration of Chinese and Western medicine can
be greater than the sum of its parts! His contribution in Section 2 should
berequired reading for every medical practitioner, Western and Eastern. Ialso
greatly appreciate his help in locating some of the anatomical illustration
references and correcting proofs.
This project has benefited greatly from the assistance of Xia Cheng MD
(China), PhD, RAc, who brings her vast knowledge, many academic qualifica-
tions and international experience as a practitioner and educator. I thank her
for her contributions, which include a historical perspective of the develop-
ment of ethics in TCM, as well as suggestions on clinical management, style
and customs of treatment, the use of herbs, and study in China. I also appre-
ciate her generosity of spirit in introducing me to her colleague David Ip.
I would also like to express my appreciation to David Ip, RAc, DTCM, DAc,
for his excellent and well thought-out contributions to the ethics section, par-
ticularly the articles on dealing with patients who face difficult health issues,
and on professional ethics.
My deep thanks to Mary Watterson, Dr TCM, who as a leader and pioneer
in the registration of acupuncture and development of standards of practice in
Canada has been extremely helpful in providing communication and network-
ing information. She has responded to every request with grace.
I am very grateful to Linda Rapson, MD, chair of the Complementary
Medicine Section of the Ontario Medical Association and president of the
Ontario Society of Physicians for Complementary Medicine, for volunteering to
undertake a detailed technical review of the manuscript, and in the process,
correcting a number of awkward translations of Western medical terms.
Across the Pacific Ocean, I extend my thanks to Xiaoshu Zhu, Dr TCM, RAc
and an educator at the University of Western Sydney. Despite her extensive
travels between Australia and China, she somehow managed to squeeze in the
time to update the section on study in China.
And thanks also to Susan Brown, DTCM, LicAc (UK), for allowing me to use
her article on sexual ethics.
Finally, for their assistance in many ways, from lending research materials
and sharing information about issues in their practice, to modelling for illus-
trations to taking photographs, I thank the following people for their kindness
xvi
