Acupuncture

The American Journal of Chinese Medicine, Vol. 46, No.
7, 1–33
© 2018 World Scientific Publishing Company
Institute for Advanced Research in Asian Science and Medicine
DOI: 10.1142/S0192415X18500738
by UNIVERSITY OF NEW ENGLAND on 10/10/18. Re-use and distribution is strictly not permitted, except for Open Access articles.
The Most Commonly Treated

Acupuncture Indications in the United States:
A Cross-Sectional Study
Haiyi Wang,*,|| Guanhu Yang,† Shaobai Wang,‡,|| Xin Zheng,§,|| Wei Zhang¶ and Yongming Li||
Am. J. Chin. Med. Downloaded from www.worldscientific.com
*School of Medicine, Shanghai Jiaotong University

Shanghai, P. R. China
†
Department of Specialty Medicine, Ohio University
Athens, Ohio, USA
‡New York Acupuncture & Chinese Herbs Clinic
New York City, New York, USA
§Pacific College of Oriental Medicine, New York City, New York, USA
¶
Center for Pain Medicine, Massachusetts General Hospital
Boston, Massachusetts, USA
||American TCM Society, New York City, New York, USA
Published 5 October 2018
Abstract: Acupuncture has been a popular alternative medicine in the United States for
several decades. Its therapeutic effects on pain have been validated by both basic and clinical
researches, and it is currently emerging as a unique non-pharmaceutical choice for pain
against opioid crisis. However, the full spectrum of acupuncture indications remains unex-
plored. In this study, we conducted a cross-sectional survey among 419 acupuncturists
nation-wide to investigate the top 10 and top 99 acupuncture indications in private clinics in
the United States. We found the top 10 indications to be: lower back pain, depression,
anxiety, headache, arthritis, allergies, general pain, female infertility, insomnia, neck pain
and frozen shoulder. Among the top 99 indications, pain represents the largest category; and
mental health management, especially for mood disorders, is in greatest demand. The fol-
lowing popular groups are: immune system dysfunctions, gastrointestinal diseases, gyne-
cology and neurology. In addition, specialty index, commonality index, and the potential to
become medical specialties were estimated for each indication. Demographic analysis sug-
gests that China trained acupuncturists tend to have broader indication spectrums, but the top
conditions treated are primarily decided by local needs. Also, gender, resident states, age and
Corresponding to: Prof. Yongming Li and Prof. Guanhu Yang, Licensed Acupuncturist, 676 US Highway 202/206
N, Bldg #2, Bridgewater 08807, New Jersey, USA. Tel: (þ1) 908-619-0691, Fax: (þ1) 908-203-0471, E-mail:
[email protected] (Y. Li); Licensed Acupuncturist, 204 Grosvenor Hall, Athens 45701, Ohio, USA. Tel: (þ1) 513-
652-5688, Fax: (þ1) 888-847-1235, E-mail: [email protected] (G. Yang)
1
2 H. WANG et al.
clinical experience all affect indication distributions. Our data for the first time outlines the
profile of acupuncture treatable conditions in the US and is valuable for strategic planning in
acupuncture training, healthcare administration and public education.
Keywords: Common Acupuncture Indication; Survey; Pain; Mental Health; Immune

Disorders; Gyneocology; Chinese Medicine; Review.
Introduction
Since James Reston’s 1971 New York Times report about his acupuncture experience in
Beijing (Li, 2014; Prensky, 1995 Dec 14; Reston, 1971 Jul 26), this ancient medical
modality has become popular in the United States in the past 46 years (NCCAOM, 2003;
Samadi, 2012 May 15). During this time period, a number of acupuncture trials have been
launched following principles of evidence based medicine (EBM). Despite methodological

challenges, some conclusions have been reached about its effectiveness, especially on pain
management (Berman et al., 2004; Lao et al., 1999; Manheimer et al., 2007; Ning and Lao,
2015; Vickers et al., 2012, 2018; Vickers and Linde, 2014). Further, basic researches on
the neurobiology of pain has helped to explain how acupuncture anesthesia works,
uncovering one important aspect of the physiological mechanisms involved in acupuncture
(Han, 2011, 2004; Zhang et al., 2012).
In 1997, the NIH (National Institutes of Health) consensus conference accredited
acupuncture to be effective in treating post-operative pain, dental pain, nausea and
vomiting (chemo or pregnancy induced), and promising at alleviating menstrual cramps,
tennis elbow and fibromyalgia based on available clinical evidences (Acupuncture, 1998;
Morey, 1998; Wootton, 1997). In 2016, the NIH-NCCIH (National Center for Comple-
mentary and Integrative Health) updated the clinical application of acupuncture according
to the research data, affirming its effectiveness in pain management, including back and
neck pain, osteoarthritis and knee pain, and headaches. Acupuncture may also help with the
side effects of cancer treatments, but the results are uncertain for depression (NIH-NCCIH,
2016).
The leaps in acupuncture research, though small, have profound impact on public
health. In 2016, the US Surgeon General’s report for the first time in history recognized the
epidemic of drug addiction as a serious public health concern (Murthy, 2016). In 2017, the
testimonies from the NIH, the CDC (Centers for Disease Control and Prevention) and
the FDA (Food and Drug Administration) together called for public attention to this
“opioid crisis,” and promoted acupuncture as an alternative treatment to prevent patients
from being addicted to drugs (Collins, 2017; NIH, 2017). The 2017 ACP (American
College of Physicians) guideline also placed acupuncture as a first line therapy for both
acute and chronic low back pain, while opioid pain medications were considered to be the
last resort (ACP, 2017; Qaseem et al., 2017).
Pain only represents one category of indications that acupuncture specializes in treating.
In 1979, the WHO (World Health Organization) collected experts’ opinions and
COMMON ACUPUNCTURE INDICATIONS IN THE US 3
recommended acupuncture for 43 diseases (Bannerman, 1979; Li and Zhang, 1992). In

2002, the WHO Consultation on Acupuncture summarized 255 clinical reports and con-
cluded acupuncture to be effective for 28 indications and promising for 63 other indications
(Chmielnicki, 2014). The AAMA (American Academy of Medical Acupuncture) also
announced an open list of recommended indications from the “medical acupuncture”

perspective (AAMA). In China, clinical researchers of Traditional Chinese Medicine
(TCM) analyzed historical and modern literatures, and proposed that acupuncture could be
effective for more than four hundred medical conditions (Du et al., 2007, 2009). For these
medical conditions other than pain, rigorous medical research is needed to validate the
empirical observations and understand the biological mechanisms. Therefore, what medical
conditions acupuncture can effectively treat still remain to be investigated.
As an alternative therapy in the US, acupuncture is being used in 46 states and
Washington DC with legitimacy (Fan et al., 2017). In a few decades, 56 schools were
founded, and 38 thousand acupuncturists passed board exams (Fan et al., 2017). The
growing capacity of acupuncture medicine provides an opportunity to answer the above
question on a market-based, country-specific context.
In the United States, the practice of acupuncture is predominantly operated in individual
clinics, while some hospitals maintain outpatient clinics or provide inpatient services
(Wang, 2013). Often times, acupuncture clinics are privately owned and run by one or a
few acupuncturists. Most acupuncturists treat a variety of medical conditions, while some
of them specialize. The conditions commonly treated in acupuncture clinics are determined
by patient needs, acupuncture efficacy, insurance coverage, government regulation,
alternative or competing treatment options and demographic characteristics of the acu-
puncturist.
Therefore, we designed a questionnaire-based, cross-sectional survey among acu-
puncturists nationwide, to investigate the most commonly treated acupuncture indications
in private clinics in the United States and analyzed the acupuncturist characteristics that
determine the indication distributions.
Materials and Methods
Questionnaire Design
A questionnaire of nine questions in both English and Chinese was designed for
acupuncturists who run or practice in private clinics in the United States (Supplementary
Table S6). Three questions cover demographic information, including: age, gender, and
ethnicity. Three questions are about acupuncture training and practice, including: country
obtaining acupuncture education, years of acupuncture practice, and resident state where
acupuncturists practice. Two questions are investigating the most frequently treated indi-
cations in acupuncture clinics, aiming for the top 99 indications and the top 10 indications,
respectively. One last question is optional: email contact for receiving ICD-10 table as a
gift reward.
4 H. WANG et al.
Generate a Pool of Indications for Selection
A list of 189 candidate acupuncture indications was drafted by three acupuncturists,

Guanhu Yang, Shaobai Wang (Tang Acupuncture) and Yongming Li, according to pub-
lished studies (Du et al., 2007, 2009), WHO documents (Chmielnicki, 2014), TCM text-
books (Cheng, 2009), as well as their own clinical experiences. The three all have
comprehensive training in both Chinese and Western medicine and have been practicing
acupuncture for 28 years or more in China, Japan or the US. This initial indication list was
circulated among acupuncture experts for further revision, ensuring that the commonly
seen acupuncture indications were fully covered.
Survey Distribution and Collection

A Sogo Survey website for this study was launched online on September 2015. Licensed
acupuncturists with more than three years of clinical practices were invited via mobile app
Wechat (Tencent Inc.), local acupuncture societies and TCM school websites. This survey
is anonymous, and acupuncturists participate on a volunteer basis. Informed consent was
obtained, and participants who completed the first eight questions and submitted the results
online by May 2016 were automatically enrolled in this study.
Data Extraction and Analysis
The original data were downloaded from SogoSurvey website. Excel was used to perform
the general statistical analysis and generate charts and tables.
Commonality Index and Specialty Index
To evaluate the potential of developing a medical specialty for each acupuncture indica-
tion, two indices were generated. “Commonality index” (CI) was used to describe how
broad an indication distributes among the surveyed clinicians, and “Specialty Index” (SI)
was used to assess the chance of being a top indication in any acupuncture practice. The
calculations were as below:
Top 99 Top 10
Total Vote (all participants, all indications) 28349 4223

Total Indication 189 189
Ave. Vote/Indication 150 22
Total Participants 419 419
Ave. Vote/Participant 68 10
For each indication,

Commonality Index ðCIÞ* ¼ vote # in top 99/150
Specialty Index ðSIÞ** ¼ vote # in top 10/22

Acupuncture Specialty Potential ðASPÞ*** ¼ SI/CI (cut off: SI > 1, CI > 1)
*: Any indication with a commonality index (CI) above 1 is considered “common” in
relative to those with CI below 1. The average vote per participant equals 68, only two
thirds of 99, indicating that “top 99” as a cutoff is able to fully cover the commonly seen
indications in acupuncture clinics. Denominator “150” indicates that if every participant
picks 68 indications at random, each indication will have 150 votes on average.
**: Any indication with a specialty index (SI) above 1 is considered as an acupuncture
indication in relative to those with SI below 1. Denominator “22” indicates that if every
participant picks 10 indications at random, each indication will have 22 votes on average.
***: Any indication with ASP value above 1 is considered as a potential indication for
developing an acupuncture medical specialty.
Normalization of Sub-Population for Between-Group Comparison
For the comparison among residential states, China educated Asian acupuncturists were
selected. The total participant number per state was normalized to 60, and the vote number
for each indication in that group was scaled in proportion to the total participant number.
After normalization, the vote number of each indication will be comparable among
different state groups. Normalization for other between-group comparisons (gender,
education) in this study was carried out following the same principle.
Calculation of Bias Rate
After normalization, if indication A has votes number X, Y, Z in NY, CA, FL states; Bias
of indication A in NY ¼ (X - (XþYþZ)/3) – 1.
Bias rate will be a number between 0% and 100%. A bias rate of 0 means that the vote
for indication A in NY state is the same as the mean, therefore on average indication A is
neither favored nor excluded by NY acupuncturists. An increasing rate suggests more bias
exists.
Bias rate for each indication in other between-group comparisons (gender, education) in
this study was carried out following the same principle.
Results
In the time window between September 23rd, 2015 and May 18th, 2016, 430 acu-
puncturists returned the survey. Among them, 9 acupuncturists practice in countries or
areas other than the United States, and 2 acupuncturists did not complete the first eight
questions. In total, 11 surveys were filtered out, and 419 valid responses were included in
this analysis.
Demographic Information: Demographic Characteristics and Distribution
The demographic characteristic and distribution was summarized in Figure 1 and Sup-
plementary Table S1. Among all 419 acupuncturists, more than half of them (66%) were
6 H. WANG et al.
(A) (B) (C)

(D) (E)
(F) (G)
(H) (I)
Figure 1. The demographic characteristic and distribution. (A–C) Pie charts were used to describe the percentage
composition of each item for gender, primary education and ethnicity in our surveyed population. (D, E) Bar charts
were used to describe the distribution of each age or year group among surveyed population. (F, G) The number of
China or US educated acupuncturists was presented in orange or blue bar, for each age group or clinical experience
group. The corresponding percentage of these two education backgrounds per group was also shown. (H) The
ethnicity distribution among China or US educated acupuncturists. (I) The ethnicity distribution among acu-
puncturists in Florida, New York or California.
women (Fig. 1A). Considering the age, about half of the participants (222, 53%) were
between 50 to 60 year-old, and one fourth (102, 24%) were between 40 to 50 year-old
(Fig. 1D). The above 60-year-old group and 30–40-years-old group accounted for 12%
(49) and 9% (37) respectively, and only 2% (9) of the participants were younger than 30
(Figure 1D). As to ethnicity, the majority (342, 82%) of the participants in the survey were
Asian or Pacific Islander, and the rest included white (64, 15%), Hispanic or Latino
(8, 2%), and mixed race (5, 1%) (Fig. 1C).
Of the 419 respondents, 249 (59%) received primary acupuncture education in China,
and 170 (41%) were primarily trained in the United States (Fig. 1B). Despite a missing of
acupuncturists trained in other countries, such as Korea and Japan, US- and China-trained
acupuncturists are known to represent the vast majority of acupuncture practitioners in the
United States (Fabrey et al., 2003).
A further analysis on years of clinical practices was summarized in Fig. 1E. The largest
group (119, 28%) was the least experienced, with 3–10 years of practice, followed by three
groups of 104 (25%), 103 (25%) and 86 (21%) acupuncturists, each with 10–20, 20–30 and
30–40 years of practice, respectively. Only 7 (2%) acupuncturists had over 40 years of
clinical experience. In general, the distribution patterns reflect the growing history of
acupuncture in America, while junior groups are slightly expanding in comparison to their
immediately senior groups. Forty-year seems like the threshold of maximum practicing
years, probably due to retirement, a late start of second career, or the relatively short history
of acupuncture in the US. Overall, our data suggest a stable and sustainable acupuncturist
community with varying levels of clinical experience, indicating this profession is grad-
ually integrating into the healthcare system in the United States.
The Relationship among Different Demographic Factors
The relationships among different demographic factors were summarized in Supplementary

Table S1 and Fig. 1. Between-gender differences were little among groups of different age,
ethnicity, primary education or years of practices (Supplementary Table S1). However, an
interesting relationship between primary education and other parameters were shown
(Fig. 1). Ethnicity wise, 99% of the participants primarily trained in China were Asian/
Pacific Islander, and this percentage dropped to 56% among graduates from US acu-
puncture schools (Fig. 1H). Age was another factor to consider. Mid-age acupuncturists
were more likely to be trained in China, while younger practitioners more often attended
TCM schools in the United States (Fig. 1F). This trend was even more distinct when it
came to years of practice (Fig. 1G). The more experienced acupuncturists with 20–40 years
of clinical practice were predominantly educated in China (69%), while acupuncturists
early in their career (3–10 years of experience) were mostly educated in the US (59%)
(Fig. 1G). Collectively, the relationship between primary education and other demographic
factors marks an older generation of acupuncturists from the East, as well as an increasing
body of locally trained junior acupuncturists in the West.
In terms of the relationship between ethnicity and age or years of experience (Sup-
plementary Table S1), a quartile (88, 26%) and a half (191, 56%) of Asian/Pacific Islanders
8 H. WANG et al.
were between 40–50 and 50–60-years-old, respectively, with longer practice years; in
contrast to White, half (36, 56%) and one third (19, 30%) of whom had 3–10 and 10–20
years of practice, respectively, representing a younger generation of locally produced
acupuncturists. Consistent with other observations, these statistics illustrate a historical
immigration wave of Chinese TCM doctors to the US around 1980s to 1990s and reca-
pitulate the growth of acupuncture education and industry in the United States in the past
40 years (Fan et al., 2017; Li, 2011, 2014).
Considering resident status, male acupuncturists (29%) favored New York more than
female acupuncturists (19%), while less gender difference was observed in California (28%
female, 22% male) (Supplementary Table S1). A total of half Asian/Pacific Islander acu-
puncturists practiced in California (30%) and New York (24%), and about one third of
White acupuncturists resided in Florida (33%) (Fig. 1I), consistent with ethnicity com-
position of local populations. Probably owing to cultural diversity and cosmopolitan na-
ture, California and New York also maintain the population of the oldest and the most
experienced acupuncturists (Supplementary Table S1), many of whom pioneered in de-
veloping and renovating the acupuncture industry in the United State (Li, 2011).
Common Indications Treatable by Acupuncture: Top 10 Indications
The top 10 frequently treated indications among US acupuncture clinics in our study are
ranked in Figure 2. Among them, lower back pain (209, 50%), depression (194, 46%) and
anxiety (190, 45%) were the most common, each checked by almost half of the acu-
puncturists. The next group included headache (171, 41%), arthritis (170, 41%), allergies
(167, 40%) and general pain (167, 40%), each receiving around 40% votes. The third tier
consisted of female infertility (153, 37%), insomnia (151, 36%), neck pain (150, 36%) and
frozen shoulder (144, 34%).
Among these ten most typical acupuncture indications in the US clinics, pain was the
top concern, representing half of the clinical complains acupuncturists encountered. The
next categories were mood related disorders, including depression, anxiety and insomnia.
Allergies accounted for the third major group of common indications; and female infertility
was another popular reason for patients to visit an acupuncture clinic.
Top 99 Indications and Six Major Categories
To extend our understanding to a broader spectrum of acupuncture indications in the

United States, the top 99 frequently treated conditions were surveyed and summarized in
Fig. 3. Interestingly and slightly different from the top-10 list, depression (384, 92%) and
insomnia (378, 90%) ranked as the top two commonly treated indications among the 419
surveys, suggesting large demands for and acupuncture’s potential in alleviating mental
stress (Fig. 3). Several types of pain and neuromuscular disorders, including low back pain,
arthritis, hip pain, headache, neck pain, frozen shoulder, tennis elbow, leg pain and heel
pain, were checked by more than or close to 80% of the acupuncturists, again, rendering
Figure 2. The top 10 indications. Bar chart was used to describe the top 20 indications based on vote number. The
top 10 indications were colored in orange.
pain as the largest category of acupuncture indications (Fig. 3). Allergies (335, 80%) and
female infertility (331, 79%) fell into the top-20 list, together with other typical acu-
puncture indications such as Bell’s palsy (322, 77%), carpal tunnel syndrome (312, 74%)
and chronic fatigue syndrome (304, 73%) (Fig. 3).
The 99 indications were further grouped into 13 major categories according to Western
medicine (Supplementary Table S2). Figure 4A ranked the categories based on total
number of indications in that category. Consistent with current literatures (Kligler et al.,
2015; MacPherson et al., 2016; Manheimer et al., 2005; Vickers and Linde, 2014), pain
management was the most comprehensive category, targeting various types of pain (25 in
total) on different parts of our body. Next categories were gastrointestinal disorders,
neurology, gynecology and internal medicine; each contained a 10–12 indications treatable
by acupuncture. Mental health and immune disorders took the 6th and the 7th. Figure 4B
ranked these categories using average vote number per indication in that category. Im-
pressively, mental health rise to the top, indicating a large demand for managing psy-
chological or psychiatric problems in modern society, and acupuncture may be helpful in
alleviating many of them, including: depression, insomnia, anxiety, chronic fatigue syn-
drome, drug addiction, smoking cessation and nervousness (Fig. 4B, Supplementary Table
S2). Psychiatry in Western medicine is a highly specialized field covering a variety of
serious mental illness, while acupuncture seems to help with mood-related disorders in
particular. Another major category in our analysis was immune disorders, especially
chronic inflammation and autoimmune reactions, including: allergies, asthma, fibromyal-
gia, allergic rhinitis and multiple sclerosis (Fig. 4B, Supplementary Table S2). In addition,
10 H. WANG et al.
Figure 3. The top 99 indications. Bar chart was used to describe the top 99 indications based on vote number. The
first 10 indications were colored in blue.
(A) (B) (C)
Figure 4. The categorization of top 99 acupuncture indications. The top 99 acupuncture indications were cate-
gorized into 13 categories (Table S3). The 13 categories were sorted by indication counts (A) or average vote per
indication (B). The evaluation of prioritized categories was summarized in (C).
arthritis received high vote (355 votes, 4th of top 99) and was categorized to pain, but its
rheumatoid subtype often derives from immune dysfunction (Supplementary Table S2).
In summary, acupuncture has a broad application in pain management; and is sought
after for treatment for mental health and immune disorders. It may also have a sound
foundation in treating gastrointestinal, gynecology, neurology and internal medicine con-

ditions (Fig. 4C). These seven categories should be prioritized in developing medical
specialties for acupuncture.
CI (Commonality Index), SI (Specialty Index) and the Potential to Develop

Acupuncture Specialties (ASP)
Commonality index (CI) and specialty index (SI) were generated from the top-99 list and
top-10 list, respectively, to quantitatively evaluate each indication for 1) how broad it
distributes in the market, and 2) how much specialty may it require (Fig. 5). The SI/CI ratio
was used to assess the potential of a particular indication treatable by acupuncture to be
developed into a acupuncture medical specialty (ASP, acupuncture specialty potential)
Figure 5. Commonality index (CI), specialty index (SI) and acupuncture specialty potential (ASP). Bar charts
were used to describe the commonality index (CI, in blue) and specialty index (SI, in orange), and the acupuncture
specialty potential (ASP) was calculated and shown in gray curve below. Indications were sorted by ASP value.
12 H. WANG et al.
(Fig. 5). Consistent with prioritized categories, low back pain and other types of pain;
anxiety, depression and insomnia; allergies; as well as female infertility; hold the highest
potential to become leading indications in developing acupuncture sub-specialty (Fig. 5).
Further, the ranking differences between the top-10 and the top-99 lists indicate intrinsic
feature of specialty or commonality for each indication. One example is female infertility,
which ranked 15th on the top-99 list and rose to 8th on the top-10 list (Figs. 2 and 3),
suggesting that female infertility is a specialized field in acupuncturists’ mind. On the other
hand, insomnia topped at 2nd on the top-99 list but only ranked 9th on the top-10 list
(Figs. 2 and 3), suggesting that insomnia is a common indication that shows up in most
clinics, however it may require less specificity on treatment paradigm. Therefore, the top-
99 list helps to predict the commonality of an indication, while the top-10 list suggests
more about its specialty demands.
Demographic Factors Affecting Acupuncture Indication Profiles: Gender
In general, the between-gender difference was little among acupuncturists of different

primary educations, ethnicity, age groups and years of practice, except that more males
resided in Florida and more females lived in California (Supplementary Table S1). A direct
comparison of gender-biased indications after normalization revealed more female-biased
indications than male-biased ones (Tables 1 and 2). Female acupuncturists had more
patients with gynecological, mood and functional disorders, while male acupuncturists saw
more patients for man’s health issues, organ disease and traumatology issues (Table 1).
Moreover, gynecological disorders were common among female-biased indications; while
male-specific conditions were mostly categorized to be rare (Tables 1 and 2).
Education Background
Primary education helps shape the spectrum of an acupuncturist’s practice. In our study,
China-trained acupuncturists selected a much longer list of indications with a broad variety,
while acupuncturists who have graduated from TCM schools in the United States prefer-
entially treat various conditions of pain and emphasize well-being maintenance (Table 3).
To minimize the effects superimposed by skewed ethnicity and geographic locations,
we further examine the China- or US-education biased indications in the sub-population of
California Asian (Supplementary Table S3). Interestingly, the selections of top 99 indi-
cations were pretty similar between the China and US educated California Asians (except
“car accident”, Supplementary Figure S1), suggesting a similar spectrum of clinical
practice regardless of their education origin. In particular, the vote numbers for the most
frequently treated indications (i.e., top 30) were fairly comparable (Supplementary Figure
S2), indicating that the most common indications were primarily determined by local
medical demands for acupuncture rather than practitioners’ education background. How-
ever, the less common indications (i.e.: top 91–189) usually received more votes from
China-educated participants than US-trained acupuncturist (Supplementary Fig. S1). On
average, Chinese graduates picked 64.6 indications, 15% more than US graduates (56.4).
Table 1. Gender Biased Common Indications.
Female (Bias > 5%, Ave. Vote > 71) Bias (%) Female Male Female Male Bias (%) Male (Bias > 5%, Ave. Vote > 71)
Endometriosis 22 95.0 61.0 64.0 79.4 11 Dry Eye

Hip Bursitis 16 83.5 61.0 70.5 85.1 9 Urinary Frequency/Urgency Urination
Colitis, General 13 81.3 62.4 82.7 96.5 8 Edema
Morning Sickness/Nausea Vomiting 12 114.4 89.4 112.2 129.1 7 Obesity/Overweight
Hormonal Imbalance 12 102.2 80.9 96.4 110.6 7 Stroke Rehabilitation
Fibromyalgia 11 148.2 119.1 121.6 139.0 7 Hypertension
Cold/Flu 10 145.3 117.7 89.2 100.7 6 Trigger Finger
Menopausal Syndrome 9 152.5 126.2 71.9 80.9 6 Intercostal Nerve Pain/Neuropathy
Premenstrual Syndrome (PMS) 9 92.1 76.6 74.1 82.3 5 Peripheral Neuropathy
Carpal Tunnel Syndrome (CTS) 8 156.8 133.3 80.6 89.4 5 Trigeminal Neuralgia (TN)
Irritable Bowel Syndrome (IBS) 7 128.8 112.1 70.5 78.0 5 Cosmetic Acupuncture/Facial Beauty
Nervousness 7 94.2 82.3 95.7 105.0 5 Nausea and Vomiting
Chronic Fatigue Syndrome 6 151.1 133.3
Inflammatory Bowel Disease 6 97.8 86.5
Dysmenorrhea 6 103.6 92.2
Arthritis/Joint Pain, Rheumatoid Arthritis 5 175.5 157.4
Dermatitis/Eczema/Atopic Dermatitis 5 89.9 80.9
Dizziness 5 164.0 147.5
Infertility (Female) 5 163.3 147.5
Menorrhalgia/Menalgia/Dysmenorrhea 5 79.9 72.3
COMMON ACUPUNCTURE INDICATIONS IN THE US
Notes: Participants after normalization: China 200, US 200.

Ave. votes/indications after normalization: 71.5.
Cut-off: Ave. vote > 71.5, Bias > 5%.
13
14
Table 2. Highly Gender Biased Rare Indications.
Highly Female-Biased, Rare Indications Bias (%) Female Male Female Male Bias (%) Highly Male-Biased, Rare Indications
18.7 38.3 34 Premature Ejaculation

28.1 48.2 26 Concussion
54.0 87.9 24 Sexual Dysfunc./Low Desire/Intercourse Pain
45.3 73.8 24 Erectile Disorder (ED)
Miscarriage Prevention/Tocolysis 24 55.4 34.0 35.3 55.3 22 Benign Prostatic Hyperplasia (BPH)
Labor Induction/Post Term Pregnancy 22 61.9 39.7 31.7 49.6 22 Prostatitis, Acute and Chronic
Breeched Baby 21 56.8 36.9 36.7 56.7 21 Head Injury
Uterus Fibroids 17 57.6 41.1 48.2 69.5 18 Deafness, Hearing Loss
H. WANG et al.
Amenorrhea (Primary or Secondary) 16 82.0 59.6 48.9 63.8 13 Hypotension

Ovarian Cyst/Benign Ovarian Tumor 14 59.7 45.4 42.4 55.3 13 Palpitation/Tachycardia/Bradycardia
PCOS 12 66.2 52.5 38.1 46.8 10 Genital Itch/Pain/Pruritus
Notes: Participants after normalization: China 200, US 200. Ave. votes/indication after normalization: 71.5. Cut-off: 30 < Ave. Vote < 71.5, Bias > 10%, Biased Vote > 45.
Table 3. Education Biased Indications.
Bias Bias
Primary TCM Education in China Rate (%) CHINA US US CHINA Rate (%) Primary TCM Education in US
Acne 25 110.8 65.9 88.2 61.8 18 Tail Bone Pain/Sacrococcygeal Pain

Stroke Rehabilitation 14 112.4 84.7 112.9 83.5 15 Plantar Fasciitis
Meniere’s Disease 13 81.1 62.4 141.2 109.2 13 Well-being, Acupuncture Maintenance
Bone Spurs 13 98.8 76.5 123.5 98.8 11 Herniated Disc (Thoracic and Lambarosaccral)
Dermatitis/Eczema/Atopic Dermatitis 10 94.0 76.5 97.6 80.3 10 Edema
Cancer Supporting Treatment 9 116.5 96.5 92.9 77.1 9 GERD
Diarrhea 9 140.6 116.5 83.5 69.9 9 Urinary Frequency/Urgency Urination
Allergic Rhinitis 9 141.4 117.6 112.9 94.8 9 Herniated Disc in Neck/Cervical Region
Diabetes Mellitus/Metabolic Syndrome 9 87.6 72.9 77.6 65.9 8 Restless Leg Syndromes
Gasy/Abdominal Distention/Flatulence 8 100.4 84.7 176.5 151.0 8 Pain, General
Infertility (Female) 8 167.9 143.5 122.4 108.4 6 Osteoarthritis (knee, hip, and others)
Fibromyalgia 8 147.0 125.9 134.1 118.9 6 Sinusitis
Trigger Finger 8 98.8 84.7 82.4 73.1 6 Peripheral Neuropathy
Morning Sickness/Nausea Vomiting 8 112.4 96.5 96.5 85.9 6 Nervousness
Colitis, General 8 79.5 68.2 148.2 132.5 6 Sciatica/Piriformis Muscle Syndrome
Gastritis 7 117.3 101.2
Asthma 7 137.3 118.8
Endometriosis 7 88.4 76.5
Amenorrhea (Primary or Secondary) 7 78.7 68.2
Bell’s Palsy 7 162.2 141.2
Cervical Vertebra Disorder 7 148.6 129.4
Car Accident Related Disorders and Issues 6 139.8 123.5

Dizziness 5 165.5 148.2
Golf Elbow 5 145.4 130.6
Inflammatory Bowel Disease 5 98.0 88.2
Notes: Participants after normalization: China 200, US 200. Ave. Vote/Indication after normalization: 71.4. Cut-off: Ave.Vote > 71.4, Bias > 5%.
15
16 H. WANG et al.
Table 4. Resident State Biased Indications (Asian, China educated).
%* Votes
California
Car Accident related Disorders and Issues 17 50.00

Trigger Finger 16 34.00
Gout 15 38.00
Cold/Flu 12 47.00
Herpes Zoster/Shingles 12 35.00
Golf Elbow 10 47.00
New York
Smoking Cessation (quit smoking) 33 39.27
Stroke Rehabilitation 20 39.27
Obesity/Overweight 19 41.45
Nausea and Vomiting 16 33.82

Allergy (seasonal, pollen, food etc.) 14 55.64
Sinusitis 13 36.00
Gasy/Stomach or Abdominal Distention 11 36.00
Sciatica/Piriformis Muscle Syndrome 11 41.45
Irritable Bowel Syndrome (IBS) 11 38.18
Well-being, Acupuncture Maintenance 11 33.82
Florida
Peripheral Neuropathy 55 32.73
Infertility (male)/Sperm Disorders 47 38.18
Endometriosis 40 34.55
Amenorrhea (primary or secondary) 39 32.73
Herniated Disc in Neck/Cervical Region 34 38.18
Premenstrual Syndrome (PMS) 32 34.55
Nervousness 27 36.36
Edema 26 30.91
Meniere’s Disease 23 30.91
Gastritis **(25) 22 45.45
Dysmenorrhea 22 40.00
Fibromyalgia **(11) 22 50.91
Herpes Zoster/Shingles 22 38.18
Hormonal Imbalance 21 32.73
Indigestion **(24) 21 45.45
Anxiety/Panic Attack **(3) 19 58.18
Morning Sickness 18 40.00
Cancer Supporting Treatment 17 41.82
Inflammatory Bowel Disease 17 30.91
Dermatitis/Eczema/Atopic Dermatitis 17 34.55
Constipation **(21) 16 47.27
Allergic Rhinitis **(10) 15 50.91
Herniated Disc (thoracic/lambarosaccral) 13 36.36
Bell’s Palsy **(5) 13 56.36
Infertility (female) ** (4) 13 56.36
Cold/Flu ** (20) 13 47.27
Nausea and Vomiting 12 32.73
Table 4. (Continued)
%* Votes
Acne 11 36.36
Tinnitus 11 40.00
Diarrhea **(23) 11 45.45
Notes: Each population was normalized to 60 participants. *Cut-off: nor-
malized votes > 30; bias rate > 10.
These patterns among California Asian acupuncturists are consistent with the trend ob-
served in total population (Table 3), making the difference in primary TCM education that
China-educated acupuncturists have a wider disease spectrum than their US-educated
peers.
Resident State
To determine if resident state of acupuncturists has influence on their practice, we analyzed

the data from China-educated Asian acupuncturists, a sub-population with the same eth-
nicity and education background in California, New York and Florida for comparison
(Supplementary Table S4). Gender, age and years of practice do not vary much among the
three sub-populations (Supplementary Table S4). After normalization, the bias rate of each
indication was calculated, and the biased spectrums of top 99 and top 40 indications were
plotted in Supplementary Figure S3. Interestingly, California had a pattern distinct from
Florida but shared more similarity with New York. State-biased indications listed in
Table 4 validated this observation: a long list containing many indications among the
elders described Florida, whereas California had the shortest list. A similar pattern was also
observed among top 10 indication lists (Supplementary Table S5). In short, Florida features
senile diseases or symptoms; New York leads in work and stress related symptoms, and
California is popular with conditions due to living styles.
Age and Years of Practice
Age and number of years in practice may also affect a patient’s decision. The survey data
suggested that patients with conditions like herniated disc, constipation, numbness, chronic
fatigue, lower back pain, hip pain and insomnia tend to see younger acupuncturists (data
not shown). On the other hand, patients with complicated conditions may prefer practi-
tioners with multiple years of clinical practice, such as dizziness, cancer support, acne and
infertility (data not shown).
Discussion
Our survey was disseminated by a mobile app WeChat, a popular Chinese social media
application, via web post and emails to members of local acupuncture societies, and alumni
18 H. WANG et al.
of several acupuncture schools in the US. The final responders were mostly Chinese due to
the WeChat channel as expected, which is a clear limitation. But the issue was addressed in
data analysis via normalization or analysis within defined sub-populations. The skewed
data, however, provided a good resource for comparison of acupuncturists with different
education backgrounds.
Although the majority of registered acupuncturists in the current market have received
TCM training in the United States of America (Wang, 2013). 41% and 59% of the par-
ticipants in our survey are primarily educated in China and US, respectively. A direct
comparison between these two populations led to an intriguing observation that acu-
puncturists trained in China tend to treat a broader variety of medical conditions, while the
US educated acupuncturists have a more focused disease spectrum. This contrast probably
reflects the rich repertoire of clinical skillsets that acupuncture medicine developed
throughout history in the East, although it might also be attributed to longer years of
clinical practice among these Chinese TCM immigrants. Additionally, acupuncturists with
an Asian background or who were educated in China are predominantly middle-aged and
experienced groups, while the White group or locally trained acupuncturists are younger
and less experienced on average and represent the emerging generation of this profession in
the US. In other words, the main resource of practicing acupuncturists is gradually tran-
sitioning from being dependent on internationally imported TCM trainees to becoming
self-sufficient within American educated graduates.
In past decades, acupuncture succeeded in pain management, documented by bedside
practices, clinical trials and neurobiology studies of pain (Han, 2004; Lao et al., 1999; Li
and Zhang, 1992; MacPherson et al., 2016; Ning and Lao, 2015; Vickers et al., 2012,
2014). Consistent with this, pain represented the largest category of common acupuncture
indications in our top-99 indication analysis. As a complex syndrome, pain could arise due
to or be associated with neural-muscle injury, chronic inflammation and affective status
(Hummel et al., 2008; Johansen et al., 2001; Zhang et al., 2012). Chronic lower back pain
caused by a combination of these factors, for example, could be effectively alleviated by
acupuncture and other non-pharmacological therapies and ranked the top among the 10
most frequently treated conditions in our survey, further supporting acupuncture’s effec-
tiveness on treating pain.
Besides pain, the top-10 list includes three mental health conditions: depression, anxiety
and insomnia, among which depression and anxiety also ranked as the top two indications
in the top-99 list. In addition, depression and insomnia were chief complaints among
acupuncturists from different residential states. Moreover, as an indication category, mental
health received the highest votes per indication, suggesting large medical demands on this
issue. Taken together, the real-world statistics imply increasing patient needs for main-
taining mental wellness, and acupuncture has so far established a positive impression in
alleviating mental stress and psychotic or psychosomatic syndromes. These data support
acupuncture to be a truly integrative therapy, extending the modality of practice from
“musculoskeletal pain” to “mind-body harmony,” the core mentality in traditional Chinese
medicine. The “mind” aspect of acupuncture deserves more clinical and lab-based
investigations and will require interdisciplinary collaboration between acupuncturists and

experts from psychology, psychiatry, neuroscience and biomedical engineering.
The top 10 and top 99 lists, from a practitioner’s perspective, illustrated an epidemi-
ological landscape of acupuncture indications in the US market. Analysis of demographic
factors, including gender, age, ethnicity, education and clinical experiences, further
revealed a unique pattern for each indication. The intrinsic feature of commonality and
specialty was estimated for each indication and encourages a strategic renovation in TCM
education: (i) to consolidate the foundation, both theories and skills, for common indica-
tions; and (ii) to develop medical specialties in particular indications through training and
licensing for practices. More specific surveys are required to investigate the experience-
based distribution of indications within each acupuncture specialty. Other factors, like
clinical setting, insurance coverage, patient composition, working hours per week, annual
income, etc. are also interesting to consider in future studies.
Results from our survey collectively outline current status of acupuncture profession
and these data would guide acupuncturists in daily practice, patients seeking for medical
care, other medical practitioners for referrals, as well as TCM students for career devel-
opment. The protocol and analysis methods we developed could serve as templates for
future studies on different scales, with specifically designed sampling and clearly defined
questions. The shortage of scientific or epidemiological data supporting the effectiveness
and efficacy of acupuncture in treating many conditions beyond pain urges the medical
community to invest more in basic and clinical research, public education and physician-
patient communication of acupuncture.
Acknowledgments
We acknowledge Dr. Yin Fan and Dr. Ling Zhen for critical discussions on understanding
the real world data. We appreciate Dr. Jun He for professional revisions on methods and
formats of epidemiological analysis. We also thank Lisa Lam for proof reading this
manuscript.
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22 H. WANG et al.
Supplementary Figure
Figure S1. The profile of top 99 indications between US or China educated acupuncturists (California, Asian). Bar
charts were used to describe the top 99 indications for US and China educated acupuncturists (California, Asian),
sorted by normalized vote numbers (US in blue, China in gray).
Figure S2. Indication profile comparison between US and China educated acupuncturists (California, Asian).
California Asian population was selected for this comparison. Top 99 indications among US- or China-educated
acupuncturists were shown in bar chart (US in blue, China in gray).
Figure S3. Indication profile comparison among acupuncturists in California, New York and Florida (Asian,
China educated). China educated Asian acupuncturists in each state was selected for this comparison. The bias
rates of top 99 or top 40 indications were sorted and shown in different colors (California, green; New York, red;
Florida, blue).
Supplementary Table
24
Table S1. Demographic Characteristics and Distributions for All Participants in this Survey.
Gender Primary Education Ethnicity
Total % Female % Male % China US Asian/PI Hispanic/Latino Mixed Race White
Questions Groups 419 100 278 100 141 100 249 100% 170 100% 342 100% 8 100% 5 100% 64 100%
Gender Female 278 66
Male 141 34
Primary Education China 249 59 166 60 83 59
US 170 41 112 40 58 41
Ethnicity Asian/PI 342 82 226 81 116 82 246 99% 96 56%
Hispanic/Latino 8 2 3 1 5 4 0 0% 8 5%
Mixed Race 5 1 4 1 1 1 2 1% 3 2%
White 64 15 45 16 19 13 1 0% 63 37%
Age < 30 9 2 5 2 4 3 2 1% 7 4% 4 1% 1 13% 0 0% 4 6%
30–40 37 9 27 10 10 7 14 6% 23 14% 24 7% 4 50% 1 20% 8 13%
40–50 102 24 66 24 36 26 62 25% 40 24% 88 26% 1 13% 2 40% 11 17%
50–60 222 53 153 55 69 49 150 60% 72 42% 191 56% 2 25% 2 40% 27 42%
H. WANG et al.
> 60 49 12 27 10 22 16 21 8% 28 16% 35 10% 0 0% 0 0% 14 22%

Years of Practice 3–10 yrs 119 28 82 29 37 26 18 7% 101 59% 73 21% 7 88% 3 60% 36 56%
10–20 yrs 104 25 68 24 36 26 54 22% 50 29% 84 25% 1 13% 0 0% 19 30%
20–30 yrs 103 25 68 24 35 25 89 36% 14 8% 96 28% 0 0% 1 20% 6 9%
30–40 yrs 86 21 55 20 31 22 81 33% 5 3% 82 24% 0 0% 1 20% 3 5%
> 40 yrs 7 2 5 2 2 1 7 3% 0 0% 7 2% 0 0% 0 0% 0 0%
Practice States California 109 26 78 28 31 22 60 24% 49 29% 104 30% 1 13% 1 20% 3 5%
New York 94 22 53 19 41 29 57 23% 37 22% 83 24% 0 0% 0 0% 11 17%
Florida 67 16 42 15 25 18 34 14% 33 19% 37 11% 7 88% 1 20% 22 34%
New Jersey 26 6 19 7 7 5 14 6% 12 7% 22 6% 0 0% 0 0% 4 6%
Ohio 25 6 20 7 5 4 7 3% 18 11% 9 3% 0 0% 1 20% 15 23%
Texas 18 4 11 4 7 5 15 6% 3 2% 18 5% 0 0% 0 0% 0 0%
Pennsylvania 14 3 11 4 3 2 8 3% 6 4% 12 4% 0 0% 0 0% 2 3%
Georgia 13 3 8 3 5 4 11 4% 2 1% 13 4% 0 0% 0 0% 0 0%
Table S1. (Continued)

Age Years of Practice
<30 30–40 40–50 50–60 > 60 3–10 yrs 10–20 yrs 20–30 yrs 30–40 yrs > 40 yrs Total % Question Groups
9 100% 37 100% 102 100% 222 100% 49 100% 119 100% 104 100% 103 100% 86 100% 7 100% 419 100
278 66 Gender Female
141 34 Male
249 59 Primary Education China
170 41 US
342 82 Ethnicity Asian/PI
8 2 Hispanic/Latino
5 1 Mixed Race
64 15 White
9 2 Age < 30
37 9 30–40
102 24 40–50
222 53 50–60
49 12 > 60
9 100% 32 86% 35 34% 35 16% 8 16% 119 28 Years of Practice 3–10 yrs
0 0% 4 11% 34 33% 53 24% 13 27% 104 25 10–20 yrs
0 0% 1 3% 33 32% 63 28% 6 12% 103 25 20–30 yrs
0 0% 0 0% 0 0% 71 32% 15 31% 86 21 30–40 yrs
0 0% 0 0% 0 0% 0 0% 7 14% 7 2 > 40 yrs
0 0% 9 24% 22 22% 62 28% 16 33% 35 29% 26 25% 24 23% 20 23% 4 57% 109 26 Practice States California
3 33% 7 19% 22 22% 49 22% 13 27% 23 19% 24 23% 22 21% 25 29% 0 0% 94 22 New York
3 33% 8 22% 14 14% 34 15% 8 16% 20 17% 16 15% 17 17% 14 16% 0 0% 67 16 Florida
1 11% 1 3% 8 8% 14 6% 2 4% 8 7% 12 12% 2 2% 4 5% 0 0% 26 6 New Jersey
2 22% 4 11% 7 7% 10 5% 2 4% 16 13% 4 4% 5 5% 0 0% 0 0% 25 6 Ohio
0 0% 2 5% 2 2% 9 4% 5 10% 3 3% 2 2% 4 4% 6 7% 3 43% 18 4 Texas

0 0% 1 3% 4 4% 9 4% 0 0% 4 3% 3 3% 6 6% 1 1% 0 0% 14 3 Pennsylvania
0 0% 0 0% 10 10% 1 0% 2 4% 0 0% 7 7% 5 5% 1 1% 0 0% 13 3 Georgia
25
Table S2. Thirteen Categories of the Top 99 Indications.

26
# Categorization Indications (Vote Numbers)
25 Pain Low back pain/Lumbago/Lumbar vertebrae disorders (358); Arthritis/Joint pain/Rheumatoid arthritis(355); Hip pain(353); Frozen shoulder
(349); Headache/Migraine/Tension headache(345); Neck pain/Cervical vertibrae disorders(342); Tennis elbow(342); Pain, general(338);
Leg pain(332); Heel pain/Plantar fasciitis(322); Cervical vertebra disorder(295); Golf elbow(292); Sciatica/Piriformis muscle syndrome
(291); Osteoarthritis (knee, hip and others)(239); Herniated disc in thoracic and lambarosaccral region(228); Temporomandibular oint pain
(TMJ)(220); Herniated disc in neck/cervical region(214); Gout(200); Plantar fasciitis(200); Trigger finger(195); Bone spurs(188); Pelvic
pain/Low abdominal pain(180); Hip Bursitis(159); Dental pain/Toothache(157); Tail bone pain/Sacrococcygeal pain(152)
12 Gastrointestinal Constipation (302); Diarrhea(274); Heart burn(266); Irritable bowel syndrome (IBS)(258); Indigestion(258); Obesity/Overweight(247); Gas-
tritis(232); Nausea and vomiting, general (post chemo, operation etc.)(207); Gasy/Stomach or abdominal distention/Flatulence(197);
Inflammatory bowel disease(Ulcerative colitis/Crohn’s disease)(197); GERD(175); Colitis, general(157)
11 Neurology Dizziness (332); Bell’s plasy(322); Xarpal tunnel syndrome (CTS)(312); Numbness(267); Vertigo(248); Stroke rehabilitation(212); Trigeminal
neuralgia(TN)(175); Peripheral neuropathy(161); Intercostal nerve pain/Neuropathy(157); Loss of memory/Poor memory(151); Restless
leg syndromes(148)
11 Gynecology Infertility (female)(331); Menopausal syndrome(301); Irregular menstruation(284); Morning sickness/Nausea vomiting (related to pregnancy)
(222); Dysmenorrhea(209); Premenstrual syndrome(PMS)(182); Endometriosis(175); Menorrhalgia/Menalgia/Dysmenorrhea(162);
Amenorrhea (primary or secondary)(156); Pain or symptoms related pregnancy(136); PCOS(129)
10 Internal Medicine Cough (293); Cold/flu(285); Hypertension(267); Hormonal imbalance(199); Acne(194); Edema(183); Diabetes mellitus/Metabolic syndrome
(171); Hypothyroidism(146); Hyperthyroid(138); Irregular heartbeat/Arrhythmia(119)
H. WANG et al.
7 Mental health Depression (384); Insomnia(378); Anxiety/Panic attack(347); Chronic fatigue syndrome (304); Smoking cessation/Quit smoking(219);
Nervousness(189); Drug addiction and withdraw syndrome(134)
5 (6*) Immune Disorder Allergy (seasonal, pollen, food etc.)(335); Fibromyalgia(290); Allergic Rhinitis(276); Asthma(272); Multiple sclerosis(129); (Arthritis/Joint
pain/Rheumatoid arthritis(355)*)
5 Eye Ear Nose Throat Sinusitis (262); Tinnitus(261); Menieres disease(154); Dry eye(145); Post nasal drip(129)
5 Dermatology Herpes zoster/Shingles (217); Dermatitis/Eczema/Atopic dermatitis(182); Cosmetic acupuncture/Facial beauty(153); Hives/Urticaria(148);
Itching/Pruritus(137)
4 Reproductive/Urology Urinary frequency/Urgency urination (158); Infertility (male)/sperm disorders(154); Sexual dysfunction/Low desire/Intercourse pain(137);
Urinary incontinence(120)
2 Oncology Cancer supporting treatment (227); Breast cancer care (all stages)/Cancer supporting treatment(132)
1 Injury Car accident related disorders and issues (279)
1 Wellbeing Wellbeing, acupuncture maintenance (256)
Note: *Arthritis was categorized into “pain”, however its rheumatoid subtype also belongs to “immune disorder”.
Table S3. Demographic Characteristics of US and China Educated Acupuncturists (California Asian).
Years of Practice Age

Ethin. Resident State Primary Edu. # of Survey Female Male 3–10 10–20 20–30 30–40 > 40 < 30 30–40 40–50 50–60 > 60
Asian California US 44 35** 9 27 13 3 1 0 0 4 10 23 7

80% 20% 61% 30% 7% 2% 0% 0% 9% 23% 52% 16%
Asian California China 60 41 19 4 12 21 19 4 0 3 11 37 9
68% 32% 7% 20% 35% 32% 7% 0% 5% 18% 62% 15%
Table S4. Demographic Characteristics of Acupuncturists in California, New York and Florida (Asian, China Educated).
Years of Practice Age

Ethin. Primary Edu. State # of Survey Female Male 3–10 10–20 20–30 30–40 > 40 < 30 30–40 40–50 50–60 > 60
Asian China California 60 41 19 4 12 21 19 4 0 3 11 37 9

68% 32% 7% 20% 35% 32% 7% 0% 5% 18% 62% 15%
Asian China New York 55 34 21 5 10 19 21 0 1 3 11 35 5
62% 38% 9% 18% 35% 38% 0% 2% 5% 20% 64% 9%
Asian China Florida 34 21 13 2 6 12 14 0 1 3 10 19 1

62% 38% 6% 18% 35% 41% 0% 3% 9% 29% 56% 3%
27
28 H. WANG et al.
Table S5. The Top 10 Indications in Florida, New York and California (China Educated, Asian).
Florida New York California
1 Insomnia** 60.0 1 Depression** 60.0 1 Depression** 52.0

2 Depression** 58.2 2 Insomnia** 56.7 1 Arthritis/Joint 52.0

Pain/RA**
2 Anxiety/Panic Attack 58.2 3 Low Back Pain* 55.6 3 Hip Pain* 51.0
4 Infertility (female)* 56.4 3 Allergy (seasonal/food) 55.6 4 Car Accident Related 50.0
4 Bell’s Palsy 56.4 5 Frozen Shoulder** 53.5 4 Tennis Elbow* 50.0
6 Arthritis/Joint Pain/RA** 54.5 5 Headache/Migraine 53.5 4 Neck Pain* 50.0
7 Frozen Shoulder** 52.7 7 Infertility (female)* 52.4 4 Frozen Shoulder** 50.0
7 Dizziness 52.7 8 Arthritis/Joint Pain/RA** 50.2 4 Low Back Pain* 50.0
9 Cervical Vertebra Disorder 50.9 8 Hip Pain* 50.2 9 Leg Pain 48.0
10 Fibromyogia 50.9 10 Neck Pain* 49.1 9 Insomnia** 48.0
10 Allergic Rhinitis 50.9 10 Tennis Elbow* 49.1
Note: *Top 10 in two of the three states.

**Top 10 in all three states.
Table S6. The Questionnaire used in this Study.


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The American Journal of Chinese Medicine, Vol. 46, No.

The Most Commonly Treated

*School of Medicine, Shanghai Jiaotong University

Published 5 October 2018

Keywords: Common Acupuncture Indication; Survey; Pain; Mental Health; Immune

launched following principles of evidence based medicine (EBM). Despite methodological

recommended acupuncture for 43 diseases (Bannerman, 1979; Li and Zhang, 1992). In

announced an open list of recommended indications from the “medical acupuncture”

Materials and Methods

Generate a Pool of Indications for Selection

A list of 189 candidate acupuncture indications was drafted by three acupuncturists,

Survey Distribution and Collection

Data Extraction and Analysis

Commonality Index and Specialty Index

Total Vote (all participants, all indications) 28349 4223

For each indication,

Specialty Index ðSIÞ** ¼ vote # in top 10/22

Normalization of Sub-Population for Between-Group Comparison

Calculation of Bias Rate

Demographic Information: Demographic Characteristics and Distribution

(A) (B) (C)

The Relationship among Different Demographic Factors

The relationships among different demographic factors were summarized in Supplementary

Common Indications Treatable by Acupuncture: Top 10 Indications

Top 99 Indications and Six Major Categories

To extend our understanding to a broader spectrum of acupuncture indications in the

(A) (B) (C)

foundation in treating gastrointestinal, gynecology, neurology and internal medicine con-

CI (Commonality Index), SI (Specialty Index) and the Potential to Develop

Demographic Factors Affecting Acupuncture Indication Proﬁles: Gender

In general, the between-gender difference was little among acupuncturists of different

Table 1. Gender Biased Common Indications.

Endometriosis 22 95.0 61.0 64.0 79.4 11 Dry Eye

Notes: Participants after normalization: China 200, US 200.

Table 2. Highly Gender Biased Rare Indications.

18.7 38.3 34 Premature Ejaculation

Amenorrhea (Primary or Secondary) 16 82.0 59.6 48.9 63.8 13 Hypotension

Table 3. Education Biased Indications.

Acne 25 110.8 65.9 88.2 61.8 18 Tail Bone Pain/Sacrococcygeal Pain

Car Accident Related Disorders and Issues 6 139.8 123.5

Table 4. Resident State Biased Indications (Asian, China educated).

Car Accident related Disorders and Issues 17 50.00

Nausea and Vomiting 16 33.82

To determine if resident state of acupuncturists has inﬂuence on their practice, we analyzed

Age and Years of Practice

investigations and will require interdisciplinary collaboration between acupuncturists and

AAMA. American Association of Medical Acupuncture. http://www.medicalacupuncture.org/For-

Wootton, J. National Institutes of Health consensus development statement on acupuncture. J. Altern.

acupuncturists were shown in bar chart (US in blue, China in gray).

> 60 49 12 27 10 22 16 21 8% 28 16% 35 10% 0 0% 0 0% 14 22%

Table S1. (Continued)

0 0% 2 5% 2 2% 9 4% 5 10% 3 3% 2 2% 4 4% 6 7% 3 43% 18 4 Texas

Table S2. Thirteen Categories of the Top 99 Indications.

Years of Practice Age

Asian California US 44 35** 9 27 13 3 1 0 0 4 10 23 7

Years of Practice Age

Asian China California 60 41 19 4 12 21 19 4 0 3 11 37 9

Asian China Florida 34 21 13 2 6 12 14 0 1 3 10 19 1

Florida New York California

1 Insomnia 60.0 1 Depression 60.0 1 Depression** 52.0

2 Depression 58.2 2 Insomnia 56.7 1 Arthritis/Joint 52.0