因為民眾對中醫針灸治療的需求增加，所以參與這項工作的專業人員也不斷增加。雖然我們沒有 確實統計資料顯示在美國有多少西醫從事針灸的研究和治療，但我們知道參與者越來越多。例如在美 里蘭州，西醫針灸協會會員從兩年前一兩百人增加到今年約一千兩百多人，而加州則從幾年前數十人 增加到現有的一千多人，即可知其發展趨勢了。此外還有專業的執照針灸醫師（即執照中醫師），全 美大約有一萬多人，其中在加州就有將近五千人。

　　雖然中醫針灸治療廣被接受，需求日增，各州不斷立法承認而納入正規醫療體系，但仍有不少法 律問題尚待解決。

　　美國食品與藥物管理局（FDA）最近已經免除了針灸針的實驗要求，本來針灸針被列入一種實驗材 料而有很多使用上的限制，二十多年的時間，比一般實驗醫療器材為長。為了取消此實驗限制，曾受 到美國醫界和藥商反對的巨大壓力。其阻擋的理由是：

　　1.在美國沒有足夠的科學研究以支持針灸醫療之有效性和安全性。
　　2.雖然新畢而取得執照的針灸醫師之知識已漸漸達到很好的水平，針灸醫學之標準規範及訓練仍 然不夠有待改進。很多現在執業的針灸醫師的西醫知識，不夠附合美國醫界標準。
　　3.融合中醫針灸和傳統西醫的問題也仍有困難，我認為，其原因在於缺乏了解和溝通。

　　美國食品與藥物管理局（FDA）對於中藥的測定規條也不完備，其原因是堅持測驗方劑中之各個 單一中藥之效能和毒副作用，以為該方劑之效能和毒副作用及其使用核准依據，不接受中藥學中使某 些毒性中藥可通過炮製變成無毒或低毒的方法。中醫本草和醫典中有很多記載通過特殊炮製和配方之 後，可在臨床上安全使用。這使我相信，在美國應該有更多這類的研究。拒絕採用外國對中醫針灸的 研究也是美國對科學研究的標準設定之差異問題。例如臨床實驗之研究，要求科學性之選樣、雙盲或 單盲之使用，在中醫針灸的研究上就相當不容易。

　　在美國的針灸團體內，政治的和派別的爭論也防礙著中醫的發展。由於行業公會、中醫院校及資 格審核委員會之間的觀念不同，很難建立一個真正的國家標準。

　　1.行業公會方面（以擁有最多針灸醫師人數之加州為例），因為針灸醫師（即中醫師）擔負如一 般西醫師同樣的基本保健工作，傾向於推廣提高中醫教育水準以應付較高的法律責任。希望盡快達到 如西醫一般地位（畢業時能被授於博士學位）。
　　2.學校方面因為財政考量，只要民眾不致受害，不希望改變而提高教育水平。
　　3.資格審核委員會則考慮到各州情形不同，各地有不同需求，較高水準會對一些小州不利，也不 希望改變太快。

　　最近美國衛生機構（NIH）提出報告肯定針灸對痛症治療、炎症病變、某些過敏及藥物成癮等問題 的療效。這個報告對針灸醫學在美國的發展有很大助易，致使很多醫療保險公司開始對針灸治療費的給 付。有些醫院開始雇用專業針灸醫師以提供針灸治療之服務。某些西醫院校也為學生開設針灸課程。

　　近來在美國也陸續成立了一些中醫專科，如骨傷科、婦科、皮膚科和眼科等。成立專科學會試圖制 定審核標準。

　　Acupuncture and TCM therapy are gradually becoming more popular in the United States. Acupuncture therapy is increasingly assuming the role of an associate in primary health care and is treating many difficult cases that have not had satisfactory results with Modern (Traditional western) medicine. Aside from the treatment of Acute and Chronic Pain Disorders, Chemical Dependency problems, and other allergic disturbances, Acupuncture and TCM therapy are becoming known more and more to control some infectious disorders including viral infections. Institutes are already starting to use TCM and Acupuncture to treat HIV, hepatitis for example.

　　Due to the increase in the number of patients asking for acupuncture treatment, there has also been an increase in practitioners' participation in the acupuncture field. Although we do not have records showing how many MD physicians practiced acupuncture in United States, we know that there are more physicians practicing in different states. For example, there are about 1,200 medical acupuncturist members in Maryland, 1,000 members in California. There are professional licensed acupuncturists in many states. There are also more than 10,000 licensed acupuncturists practicing in the United States, about half of them are practicing in California.

　　Even though, on the one hand, Acupuncture and TCM have been increasingly accepted by the population and is legally sanctioned in many states, there are some political problems remain within the profession:

　　The FDA has recently released from experimental status the use of acupuncture needles, which was kept in this legal restriction for more than twenty years, longer than any medical device in the history of the FDA. There was great pressure from the medical establishment and biomedical industry against the release of this experimental status. The arguments they have raised were

　　1. There is not enough scientific research in the United States to support the effectiveness and safety of Acupuncture and TCM therapy in certain diseases.
　　2. Standardization in Acupuncture training still needs improvement. Even though the level of knowledge of the new graduate acupuncturists in the United States has been gradually reaching a good standard, there are still practitioners who do not have enough Western Medical training and knowledge to fulfill the standards of the medical society.
　　3. Integration in the use of Acupuncture and TCM therapy with traditional Western medicine would also be difficult. One of the reasons, I believe, is due to lack of understanding and communication between health professionals.

　　There are also inadequate testing protocols for herbs by the FDA, the reason are: Insistence on testing herbal formulas one herb at a time for a complete chemical breakdown; and then, testing each substance of each herb is both financially unfeasible and medically unnecessary. Testing of complete formulas and whole herbs in situ without alteration is the only way to test the efficacy of Chinese Herbology. Traditional texts have numerous details explaining the preparation of certain toxic Herbs, to either make them less toxic or even non-toxic. After special preparation, the single herb is combined with other herb or herbs into a special formula, thereby becoming clinically safe. It seems to me that we need more of such kinds of research in the United States. The automatic rejection of foreign research of Acupuncture and TCM Therapy may be due to the different scientific criteria standards.

　　Within the national acupuncture community, political and factional disputes hinder our progress as well. There has been some difficulty in establishing a true national standard because of the different views of the states, professional associations, schools and accreditation boards:

　　1. The professional associations (with the largest acupuncturists' population in California) tend to push for higher educational standards because of their primary care status, which implies an increased legal liability. They feel compelled to go mainstream as soon as possible (resulting in a one-tier doctorate program standard for the profession).
　　2. The schools, which feel constrained by financial restraints, want a slower change of standard and tend to reflect the notion that as long as the public is protected from harm, they don't need to move as fast.
　　3. The school accreditation boards take the position of the states and feel that because we have so many different needs at the local level, a higher standard will harm smaller states with different needs.

　　Lately, the NIH (National Institute of Health) issued a report assuring the effectiveness of Acupuncture therapy in treating pain, inflammatory disorders, some allergic and drug addiction problems, etc. The report has changed the situation of Acupuncture therapy in the United States.

　　There are more and insurance companies establishing policies to cover acupuncture treatment.

　　Many hospitals are starting to hire acupuncturists in order to provide qualified acupuncture service for their patients. Some medical colleges have established acupuncture courses for students.

　　Many sub-specialization's of Acupuncture and TCM are being developed in the United States, such as orthotraumatology, gynecology, dermatology and ophthalmology. There are some specialty board established, and they are trying to do the standardization work.