Did you hear the huge sigh of relief on February 28th? If you have super-human ears and you did but you don’t know where it came from, well…you can stop wondering now. That was me, and it was the exhale of the century because I passed my last board exam. Which one? Chinese Herbology, which is one of the more daunting of the four exams an aspiring licensed acupuncturist must take and pass if they want to practice in many states across the country, including Texas.
But why would this matter to you?
~~~An acupuncturist’s education and exams~~~
Even people who are familiar with acupuncture do not realize the amount of education that goes into preparing for a career as a licensed acupuncturist (much less a licensed acupuncturist AND herbalist). Those who really aren’t familiar with traditional Chinese medicine at all have no idea what we go through. When I told my dentist about my program, for example, he marveled and said, “It sounds like you have about the same amount of biomedical background that I do!” All total, an acupuncturist will have spent at least three years (the accelerated program) or four and a half years (the regular route, which I took) in school. This will include all the basics of Western medicine plus coursework in traditional Chinese medicine and herbal study. In addition to the coursework, there is, of course, quite a bit of supervised clinical internship. Over the course of a program, a student has practical and benchmark and competency and exit exams. Some are written, some are (these would be the practical exams) performed on live models.
An acupuncture student does not spend a mellow year or so hugging trees, crunching granola, and getting in touch with energy and aura in order to become credentialed. An acupuncture student studies and practices in clinic and takes one test after the next. And that’s just the academic program. Before becoming licensed and able to practice, an acupuncturist must undergo stringent board exams in three, and in some states four, subjects. The first three (biomedicine; foundations; and acupuncture) are common to all students. Some states, including Texas, require an herbology board too.
This is important because it is important for you, the patient, to know that your licensed acupuncturist is highly trained and has been stringently vetted before being able to place a needle or prescribe an herbal formula. Acupuncture and traditional Chinese medicine (TCM) came to the United States in the 1970s and remained somewhat of a fringe practice for decades. As acupuncture’s benefits became more widely acknowledged in varying venues, Western biomedicine took interest (more on that in future blog posts) and TCM started to appear more and more as an accepted complementary modality (hence the term “complementary alternative medicine”). At present, TCM is growing in the public consciousness and if you stick around, you will read more and more blog posts from me on the subject of cultural and historical construction of notions surrounding TCM in the United States. Meantime, you can read a nice and short article about the history of TCM in the US here.
But what, you ask, of the board exams? And why is this important for you, dear reader?
My first board exam was what I called my Evil Western Biomedicine exam. Anyone following my blog or social media knows that I crack a lot of jokes and make funny nicknames for just about everything. The biomedicine exam content varies because the tests are computer generated and not standard for all applicants. In essence, though, the expectation is that a test taker has the ability to demonstrate a certain level of skill in Western biomedicine. This includes being able to perform physical assessment and read lab reports. It means knowing when to refer and at what speed to refer. (Does the patient need to go to an emergency ward? Can the issue wait until tomorrow? A couple days from now? A week?). We need to be able to educate on subjects like diet and nutrition and we are expected to be able to work with patients’ pharmaceutical drug lists. From a broad perspective, what it looks for is this: can the applicant provide the safest care for a patient and can the applicant interact with Western physicians in an integrative manner?
I wrote about my Evil Western Biomedicine exam here, and it’s a post worth reading. If you want to learn a little more about how this test fits into the big picture, do check it out. You can also find out more about how TCM fits into patients’ options of health care that range from TCM only to integrative medicine to Western biomedicine only. It’s valuable information, and I hope that you will enjoy my delivery of it.
Too long; didn’t read? Long story short: we do get quite a bit of biomedical training and they do test us on it.
~~~Foundations of Traditional Chinese Medicine~~~
This one is actually “Foundations of Virtuous and Benevolent Chinese Medicine” but I guess whoever named it was being modest. Whatever you call it, this test is a beast. Did you know that TCM has many different schools of thought regarding diagnosis? Well, if an applicant wants to pass, they had better be versatile in their methods of assessing a case. Traditional Chinese medicine has a long and storied history. We need to show that we are well-versed in the theories that underpin this medicine. To pass this one, a person needs to be really, really good at diagnosis. We also need to be familiar with the seminal literature of the field and be able to parse it from many angles. Anyone who thinks that acupuncture is “woo woo” and lacking in theory, history, and sophisticated clinical thought is just plain wrong.
Most important, though? We need to demonstrate that we are able to view and treat the body the way a Chinese physician would. TCM is a holistic practice. Western medicine tends to go for the symptom in order to get rid of it. Chinese medicine looks at the whole picture and tries to alter patterns so that the body heals itself. Mind and body are not separate. We don’t just look at the one thing and try to eradicate it. Chinese medicine is subtle and requires a good sense of relational objects and meaning. The board exam tests for this skill and it is a challenge to pass it. The applicant who does has studied for years, not just in the classroom but also in the supervised environment that is student clinic.
Too long; didn’t read? Long story short: traditional Chinese medicine is a system that is constructed via sophisticated thought process and rich history. The Foundations board exam will test for knowledge of the cornerstones and building blocks of this medicine. Passing this exam reflects ability to think critically about the philosophy and practice of Chinese medicine.
~~~Acupuncture and Point Locations~~~
This was the third test that I passed. What this test does is demonstrate that the applicant knows some very basic must-know material and it is designed to show ability to construct point prescriptions.
The very basic? That would be safety and skill. There are some points that require care because you can injure internal organs if you needle incorrectly. Other points need to be avoided during pregnancy. Still others are right near nerves or large veins and must be approached with attention, knowledge, and care. The test, one way or another, makes sure the applicant is well-versed in safety, clean needle technique, risk management, and sanitation. In addition, it’s not just safety alone that makes for a great treatment. Your practitioner will have spent many hours of supervised clinical work learning the different methods of needling and other modalities, including cupping, gua sha, and moxibustion. The test will also check to see if an applicant knows the principles of needle technique and skill. Topics like scalp acupuncture and ear treatments (auriculotherapy) also feature on the test because these are important regions for needle work. An applicant needs to know many different needle techniques and locations and theoretical underpinnings so that the treatment plan is well thought and safely and properly delivered.
Point prescriptions (and locations, for that matter) relate to whether or not an applicant can do things like read a case study, figure out the issue, and then select just the right combination of points for the situation at hand. This is complicated. Some schools of thought prefer many needles; others, less. Some treatments are better if the needles are in the location of the issue. Other ways to effect healing require a distal treatment with needles far from whatever is causing trouble. There is no one point prescription to memorize but, instead, many. Just like when a student is dealing with a patient in clinic, the applicant will need to be able to assess the situation from potentially more than one diagnostic school of thought. This will in turn have an effect on the actual point prescription. A board exam will make sure that the applicant is versatile and able to perform this duty with competence and care.
Too long; didn’t read? Long story short: a licensed acupuncturist does not simply pop in needles at random. We are required to be certified in clean needle technique, we spend quite a bit of time under the watchful eyes of our supervisors, and we demonstrate, when we pass this board exam, that we know how to plan a treatment and deliver it safely.
This last one is a beast. In Texas, herbalists aren’t regulated…unless you want to practice acupuncture. Then you are required to undertake two solid years of herbal study, complete internship hours, and pass all sorts of tests, including the board exam. I know people who have failed this exam multiple times and I know people who have left Texas because they can’t pass the herb board. Most people are scared of the herb board. I know I was!
I will not be able to top my sweet post about Harry Potter and why the series made me love herbal study so much; go here and enjoy if you want the full story of the magic of herbs according to yours truly.
Chinese herbs are marvelous though, whether or not you love Harry Potter. If you’re like me, you have a nasty reaction to just about every pharmaceutical drug you’ve ever been prescribed so herbal formulas are the way to go. The nice thing about herbal formulas? We can custom make them for you. There are ways to take care of everything from the common cold to much more serious disorders by virtue of either classic formulas that have lasted for thousands of years because they work or by special modifications and tweaks to herbal collections so that your issue is dealt with in a way that is specific to you. This takes a lot of studying and practice in student clinic. Trust me, if your practitioner has taken the herb board and passed it, it means that they have worked very, very hard to learn this venerable healing modality.
Too long; didn’t read? Long story short: An applicant who passes this exam has demonstrated that they know the history and richness and strength of herbal medicine. We demonstrate that we know how to build on existing formulas in order to customize them. We show that we know how to provide safe, effective herbal treatment so that our patients receive the maximum benefit of traditional medicine in the safest way possible.
As you probably already know, I’ve been practicing traditional Chinese bodywork therapy as an AOBTA-CP (a certified practitioner) for almost three years now. (I’m super blogger on that subject; for more, go here). Even after I’m licensed, I will continue to offer this modality to patients and I will also remain current with my health coaching certifications. Between now and the license, though, is the Texas Medical Board. Like any other healthcare provider, a licensed acupuncturist will need to file all the requisite paperwork and (at least in Texas; other states probably vary) we take a jurisprudence exam that screens for knowledge of Texas law and medical ethics. That one isn’t as scary as the boards because we all have access to the test material beforehand. Once that’s done, all my varying credentials, test results, and paperwork will be gathered and the TMB will issue my license. This process will take about six to eight weeks. And then I’ll be able to practice acupuncture and herbalism along with the bodywork and health coaching that I already offer.
(By the way: if you’re wondering whether tui na is better for you or if acupuncture is your best bet, take a look at my blog post on the subject, here.)
Long story short? Your licensed acupuncturist has spent four years or more in a rigorous program that is followed by a series of challenging board exams. Your practitioner is vetted and credentialed by the state in question’s medical board. He or she is practicing a traditional medicine that has stood the test of time over the course of thousands of years.
Different practitioners will have varying specialty areas. We are all, generally speaking, going to be highly competent in the bread and butter of acupuncture practice: chronic pain, anxiety/stress, digestive problems, insomnia, common illness (colds, allergies, headaches), and other like. And then there are specialty areas. For me, these include anything related to orthopedics; dermatology; facial rejuvenation/aesthetics; Ehlers-Danlos syndrome; men’s health; weight loss; and nutrition-based health nurturing. When you look for an acupuncturist, ask about their specialty if you don’t see your issue on their web site. If they can’t help you, a good acupuncturist will refer out to someone who can. There is someone for everyone, though, so look around and see what’s near you and don’t settle until you feel happy with your practitioner. Truly, there is someone for everyone.
I’m writing this less essay than a week after I finished my last board exam. Honestly, it hasn’t quite sunken in yet that boards are over. Tomorrow I will spend the afternoon quizzing a dear friend who is undergoing her board exam process; the day after, I will be in my North office treating patients with bodywork modalities. People are waiting for my acupuncture license to be issued but nobody’s giving up on tui na with me even so. I’m happy to be done with this process and marveling at how it feels to be able to join the profession as an acupuncturist and herbalist after the years of study and dedication.
If you’ve never tried acupuncture because you aren’t convinced it works or because you think that it is not real medicine, do reconsider. As I discuss in my essay about my first board exam, it is true that acupuncture works better for some people and others do better with biomedicine. But, as I explain, most people will do best with a judicious use of both. You miss out if you don’t try it even at least once. And if you’ve tried acupuncture and love it, I hope that this article will inspire you to speak to your practitioner about herbs and all the possible modalities that may enhance your health nurturance plans. We have so much for you in traditional Chinese medicine.
Are you ready to try traditional Chinese medicine? Your highly trained and genuinely dedicated practitioner is here for you. Or maybe you are already a TCM aficionado and you are now that much more enthused about your healthcare choices. Either way, TCM is should be part of your life. Trust me when I say: your health and your wellbeing will thank you for it.
Have you ever though to try traditional Chinese bodywork? At present, I offer tui na (similar to massage) and other ancient Chinese therapies, including cupping, gua sha, moxa, and more. If you are looking for a holistic wellness consultant and coach, my services can entail short or longer term programs. You are your own best investment, and when you take charge of your wellbeing you invest in yourself now and for the benefit of your future.
Two Hearts Wellness is a local holistic health and wellness outfit with a passion for all things nourishing, including but not limited to: joyful living, great food, art, and literature, and–of course–traditional Chinese medicine. If you want to learn more about me, click here and do feel free to follow my blog and/or my Instagram, connect with me on Facebook, or contact me here to set up an appointment for personal training or health coaching services. If you are interested in Asian bodywork therapy, click here to book an appointment online.