Dr. Karen Rosario

Not every needle comes with the same preparation

When a patient hears the word “acupuncture”, they may assume that everyone who uses needles received similar preparation.

That is not the case.

There is an enormous difference between adding acupuncture through a supplementary course and spending years of professional education studying Traditional Chinese Medicine as a complete medical system.

At Yerbal Health we believe the patient has the right to know that difference.

Because you are not paying for a needle.

You are paying for the knowledge behind it.

More than 5,000 hours of formal professional education

Our professional training comprises a master's and a doctorate in Traditional Chinese Medicine, adding up to more than 5,000 hours of formal professional education.

But saying “5,000 hours” does not explain what is inside that preparation. We are talking about years of education in:

• Acupuncture
• Needling techniques
• Channel and point theory
• Diagnosis and pattern differentiation
• Internal medicine
• Chinese herbal medicine
• Materia medica
• Herbal formulas
• Gynecology
• Obstetrics and pregnancy
• Fertility
• Pediatrics
• Tuina
• Pain management
• Anatomy
• Physiology
• Pathology
• Pharmacology
• Biomedical sciences
• Supervised clinical practice
• Patient safety
• Electroacupuncture
• Moxibustion
• Cupping
• Gua sha
• Chinese dietary therapy
• Auriculotherapy

And since then we have kept adding advanced education and international training.

Acupuncture and needling: years, not weeks

Our formal training included roughly two years or more of progressive education directly related to acupuncture, point location, channel theory and needling techniques, plus their continuous application during clinical practice.

It is not just memorizing where a point is. We learn:

• anatomical location
• functions
• indications
• contraindications
• point combinations
• diagnosis-based selection
• depth
• angle
• direction
• manipulation
• anatomical precautions
• local and distal strategies
• tonification
• dispersion
• building individualized protocols

We did not just learn where to insert a needle.

We learned why, when, how, and when not to.

Diagnosis: it is not one class

Our preparation in diagnosis and pattern differentiation comprises roughly 8 to 10 or more courses and academic components, plus their integration into other subjects and clinical practice. It includes:

• observation
• questioning
• tongue
• pulse
• Zang-Fu
• Qi
• Blood
• Body Fluids
• channels
• Eight Principles
• pathogenic factors
• other diagnostic systems of Traditional Chinese Medicine

Then all of that has to be integrated with real patients. Because memorizing a theory and recognizing it in a patient are two different things.

Internal medicine

Our education comprises several courses in Traditional Chinese Medicine internal medicine, roughly three core courses plus their ongoing integration with diagnosis, acupuncture, herbal medicine and clinic.

Here we learn something essential: a patient rarely walks in as just “a diagnosis”. They may bring:

• pain
• insomnia
• migraines
• constipation
• anxiety
• hormonal changes
• fatigue
• digestive symptoms
• menstrual changes, all at the same time

Our job is to connect the pieces.

It is detective work.

Chinese herbal medicine: roughly three years

Our training comprises roughly three years of progressive study of Chinese herbal medicine, including:

• materia medica
• herb categories
• properties
• actions
• indications
• contraindications
• combinations
• classical formulas
• formula modification
• clinical application

First you learn the components. Then how they interact. Then the formulas. Then how to modify them. And finally how to apply them to the individual patient.

Women's health: a large part of our training

One of the especially important areas of our preparation is women's health.

When we add up our academic, clinical and supplementary education related to gynecology, pregnancy, fertility, herbal medicine, acupuncture, pediatrics and manual modalities, we estimate roughly 700 to 800 hours of exposure and training related to women's health, pregnancy and pediatrics.

That figure is approximate: it adds up training in subjects that overlap, and it is not an official curricular number.

But the point matters:

Women's health was not a single isolated course.

It was studied from several perspectives and with different therapeutic tools.

Gynecology in Traditional Chinese Medicine

Our education in gynecology comprises several courses and components related to:

• the menstrual cycle
• dysmenorrhea
• amenorrhea
• irregular bleeding
• fertility
• PCOS
• endometriosis
• symptoms tied to hormonal change
• perimenopause
• menopause
• pregnancy
• postpartum
• other gynecological conditions

And we also studied how these presentations can be approached through the different branches of Traditional Chinese Medicine. Not only with needles.

Women's health does not mean acupuncture alone

Our preparation in women's health draws on tools from:

• acupuncture
• Chinese herbal medicine
• dietary therapy
• tuina
• moxibustion
• other Traditional Chinese Medicine modalities

That is why we can look at the same problem from different angles within the system. A patient does not necessarily need the exact same tool at every stage of her treatment.

Pregnancy requires specific training

Treating a pregnant patient takes far more than knowing “which point helps with nausea”. There are points, regions, intensities and techniques that call for particular precautions.

You also have to recognize when a symptom can be part of a normal pregnancy and when it is an obstetric red flag that needs immediate medical evaluation.

Our pregnancy-related training sits inside a broader education in gynecology, internal medicine, diagnosis, acupuncture, herbal medicine, biomedical sciences and clinical safety.

Pediatrics

Our education also includes pediatrics within Traditional Chinese Medicine, starting with the recognition that a child is not evaluated as a “small adult”. Physiology, pattern presentation and technique selection can all differ.

Besides acupuncture when it is appropriate, Traditional Chinese Medicine has other tools, including pediatric tuina, manual techniques and other approaches adapted to the patient's age and condition.

Tuina: another full branch of Chinese medicine

Our training is not limited to needles. Tuina is one of the traditional manual modalities of Chinese medicine, and it can be brought in depending on the patient, their age, their presentation and the goal of treatment.

Our education includes exposure and training in tuina, including its use with different populations and clinical presentations.

Women's health: why does this difference matter?

When a woman is looking for help with:

• fertility
• menstrual pain
• irregular cycles
• PCOS
• endometriosis
• symptoms during pregnancy
• preparing for labor
• postpartum
• perimenopause
• menopause
• other gynecological problems

it is reasonable to ask the practitioner:

“How much specific training do you have in women's health?”

Not just: “Can you do acupuncture?”. Those are completely different questions.

How does this compare with supplementary training like Webster?

Here the comparison has to be made correctly.

Within chiropractic there is specialized training such as the Webster Technique, used particularly in chiropractic care during pregnancy. That training is usually obtained through additional postgraduate education, and it should not be confused with a full education in gynecology, obstetrics or Traditional Chinese Medicine.

So the relevant comparison is not “who can see a pregnant woman?”. The question is:

“How much specific training, and what kind, does each practitioner have for the service they are offering?”

Our preparation in women's health runs through gynecology, diagnosis, internal medicine, acupuncture, herbal medicine, tuina, dietary therapy, pregnancy, postpartum and clinical practice. They are different training models, and the patient deserves to know that difference.

Facial acupuncture: additional training

We also have extensive education, inside and beyond our academic training, in facial acupuncture and techniques for the face.

On top of what our professional education covered, we have completed roughly 50 or more hours of continuing education and additional training in facial acupuncture and related techniques, including advanced postgraduate training.

That lets us work on the face from a perspective that brings together anatomy, musculature, circulation, point selection, needling techniques and the principles of Traditional Chinese Medicine.

Pain management: a dedicated semester

Pain management was not just a lecture either.

During our training at ACAOM in Texas we completed roughly one academic semester (about five months) devoted specifically to pain management, in addition to the pain-related training inside other subjects and later during clinical practice.

That means studying the different kinds of pain, their mechanisms, evaluation, point strategies and clinical approaches. And after that we added years of experience treating patients in pain.

Biomedical sciences and Western medicine

Our education also comprises roughly three years or more of ongoing academic exposure to the biomedical sciences, depending on how the subjects are grouped. It includes areas such as:

• anatomy
• physiology
• pathology
• pharmacology
• medical terminology
• clinical evaluation
• biomedical diagnosis
• red flags
• safety

These subjects matter because a practitioner needs to recognize when something can be handled complementarily and when it calls for tests, medical evaluation, emergency care or follow-up with another specialist.

Supervised clinical practice

A substantial part of our education happened in supervised clinic. First observing. Then taking part. Then evaluating and treating patients under supervision.

That is where diagnosis, anatomy, physiology, pharmacology, acupuncture, herbal medicine and safety stop being separate subjects.

And become clinical reasoning.

Clean Needle Technique and safety

Our preparation includes training and certification in Clean Needle Technique, plus safety woven through our education.

Acupuncture is generally safe when practiced properly, but it is not risk-free. That is why we study:

• anatomy
• depths
• directions
• precautions
• aseptic technique
• contraindications
• proper recognition of adverse events

Although uncommon, there are documented complications, including injury to anatomical structures and pneumothorax.

Safety begins before the first needle goes in.

Electroacupuncture, moxibustion, cupping and other modalities

Our preparation does not end with the manual needle either. It includes training in:

• electroacupuncture
• moxibustion
• cupping
• gua sha
• tuina
• auriculotherapy
• dietary therapy
• other modalities

Each tool has its own indications, contraindications and considerations. That is why mastering a complete medicine is different from learning a single modality.

5,000+ hours is only the formal education

The 5,000+ hours are our formal professional education. They do not include all the independent study it takes to master the subjects, prepare for the boards, read the literature, complete continuing education and keep growing after graduation.

We estimate more than 15,000 additional hours of study, preparation, practice and professional development over our career. That number is a personal estimate of accumulated time, not additional accredited curricular hours.

Four national boards + Clean Needle Technique

Our preparation also includes passing four national board exams, along with training and certification in Clean Needle Technique. Preparing for those exams means integrating years of knowledge across several disciplines.

Before TCM: three years of chiropractic education

Our academic training did not begin with Traditional Chinese Medicine either. Before studying TCM we completed roughly three years of education at a chiropractic school.

Although we did not complete the Doctor of Chiropractic degree, those years gave us extensive exposure to:

• human anatomy
• physiology
• biomechanics
• the spine
• the musculoskeletal system
• neurology
• physical evaluation
• radiology and X-rays
• Western biomedical sciences

That built an additional foundation we were later able to integrate with Traditional Chinese Medicine.

Biology + Anthropology

Our university education also includes Biology and Anthropology. Biology added fundamentals in the natural sciences. Sociocultural Anthropology added another dimension: understanding that a patient does not exist outside their culture, family, beliefs, behavior, environment and social circumstances.

The patient-practitioner relationship also happens inside that context. It helps us see the human being beyond the name of a disease.

Seven years as a medical interpreter

There is another essential part of our path:

Roughly seven years as a medical interpreter.

A medical interpreter makes precise clinical communication possible between patients and health professionals who speak different languages, preserving the medical meaning of the conversation.

During those years we were there in real time while physicians evaluated patients, explained tests, discussed diagnoses and treatments, obtained consent and made clinical decisions.

More than 30 hospitals and clinical centers

As a medical interpreter we worked in more than 30 hospitals and clinical centers in the United States, mainly in Houston, Texas. Our experience included:

• inpatient care
• pre-operative care
• post-operative care
• outpatient clinics
• oncology
• cardiology
• neurology
• rehabilitation
• spinal cord injury
• diabetes
• psychiatry
• many other specialties

We were not practicing Western medicine as physicians. We were inside the clinical encounter, interpreting specialized medical communication between professionals and patients. That gave us extraordinary exposure to how Western medicine works day to day.

Five years of exposure to psychiatry

Within that experience we spent roughly five years in more than ten psychiatric hospitals and settings as medical interpreters. That meant direct exposure to patients, psychiatrists and other members of mental-health teams, and to the clinical language, medications, crises and complexity of psychiatric conditions.

Cardiology, diabetes, cancer and complex medicine

Our interpreting experience also included educational and clinical settings tied to the American Heart Association, diabetes, oncology and cancer at MD Anderson, cardiovascular centers, rehabilitation and spinal cord injury.

We have also interpreted at conferences and in settings where specialists explained complex diseases and treatments.

Teaching hospitals: Western medicine in real time

Working inside teaching hospitals offered something no book can fully reproduce. We were in the room while medical teams and patients discussed cases, tests, procedures, risks, medications and treatment plans.

It is Western medicine happening in front of you.

All of that accumulated exposure later met our training in Traditional Chinese Medicine.

And that is where our integrative perspective comes from

The way we think clinically does not come from a single discipline. It is shaped by:

• biology
• sociocultural anthropology
• three years of chiropractic education
• extensive exposure to Western medicine
• more than 5,000 hours of Traditional Chinese Medicine
• herbal medicine
• clinical experience
• international training

Each system lets you see different pieces. Our job is to work out how the pieces of the puzzle fit together.

International training: five countries

Our training continued through clinical and educational experiences in the United States, China, Taiwan, Vietnam and Australia.

Tianjin, China

We have documented training at the First Teaching Hospital of Tianjin University of Traditional Chinese Medicine. Inside an integrative hospital model, we saw Traditional Chinese Medicine working within a modern hospital setting, including neurology, rehabilitation, stroke and complex clinical cases.

Chengdu, China

We also have documented training at Sichuan Orthopedic Hospital, with an integrative focus on orthopedics, rehabilitation, sports medicine and musculoskeletal care.

Sanya, China

We also have documented training in a Traditional Chinese Medicine hospital and university setting in Sanya, again within an integrative clinical model.

Nanning, China

Our experience in China also included training and clinical exposure in Nanning, in Traditional Chinese Medicine and clinical-integration settings.

China reinforced one fundamental idea

In those hospitals we learned that Traditional Chinese Medicine and modern medicine do not have to exist as enemies. They can coexist.

It is not East vs. West. The question should be: “What does this patient need?”

Taiwan

Our international training also included clinical experience in Taiwan associated with China Medical University Hospital, where we observed another hospital model integrating Chinese medicine and modern medicine.

Vietnam

We also had clinical exposure inside traditional-medicine hospitals in Vietnam, including experience in Ho Chi Minh City, observing the clinical use of acupuncture, rehabilitation and other traditional modalities.

Australia

At Sustain Health Academy in Australia we continued our advanced education, including training in scalp acupuncture and techniques for neurological patients and complex cases.

Houston: Chinese medicine inside the hospital system

Our preparation also included rotations and clinical training in Traditional Chinese Medicine at Houston hospital institutions, including MD Anderson Cancer Center and Houston Methodist Hospital. Those experiences took place in integrative-medicine settings, where we saw how different modalities can coexist with specialized medicine in complex patients.

Now put it all together

• Biology
• Sociocultural anthropology
• Three years of chiropractic education
• Biomedical sciences
• Seven years of medical interpreting
• More than 30 hospitals and clinical centers
• Five years of exposure to psychiatry
• Pre-operative and post-operative care
• Outpatient medicine
• Cardiology
• Oncology
• Neurology
• Rehabilitation
• Spinal cord injury
• Teaching hospitals
• 5,000+ hours of Traditional Chinese Medicine
• A master's degree
• A doctorate
• Four national boards
• Clean Needle Technique
• Herbal medicine
• Acupuncture
• Gynecology
• Pregnancy
• Fertility
• Pediatrics
• Tuina
• Pain management
• Facial acupuncture
• Thousands of additional hours of study
• International clinical training in five countries

That is part of what stands behind a visit at Yerbal Health.

A needle costs pennies. Knowing what to do with it takes years.

The patient is not simply paying to have needles inserted. They are paying for the knowledge that determines:

• what to treat
• how to treat it
• which points to use
• which points to avoid
• what depth
• what direction
• what technique
• what modality
• which information in the record matters
• which medication can change our decisions
• which symptom is a red flag
• which seemingly separate symptoms may be connected
• what needs medical follow-up
• when we must refer immediately

Why is our price different?

Because the service is not simply “a needle session”. It is the accumulated knowledge behind that session. And we believe that difference should be transparent to the patient when comparing prices.

And what do health plans have to do with it?

Plans can decide, administratively, which services they cover, which diagnoses they recognize, how many visits they authorize, which codes they allow, what they require for credentialing and how much they reimburse.

But the fact that two practitioners are administratively allowed to bill “acupuncture” does not mean they have the same specific training in acupuncture and Traditional Chinese Medicine.

The right comparison

A physician may have thousands of hours of medicine. A chiropractor may have thousands of hours of chiropractic. A naturopathic doctor may have thousands of hours of naturopathy. Those are serious professional educations. But those hours are not automatically hours of Traditional Chinese Medicine.

When we compare specific competence in acupuncture, we should ask:

How many hours of specific training does each person have in acupuncture and Traditional Chinese Medicine?

That comparison can reveal differences of thousands of hours.

Why does this matter?

Because a patient can get a few sessions of something called “acupuncture”, not get the result they hoped for, and conclude: “acupuncture doesn't work”.

But one question is missing: “what level of specific training did the person who gave the treatment have?”

One experience with one provider does not represent a whole profession. And not knowing those differences can lead a patient to give up on a therapeutic option they may never have received with the same level of evaluation or training.

That is why we do not want a policy designing our medicine

A patient can come in for lower back pain and also have migraines, insomnia, constipation, neuropathy, digestive problems, menstrual changes, anxiety or fatigue.

We do not want to build the treatment by asking “what does the plan cover?”. We want to ask:

“What does this patient need?”

Our experience with complex cases

Our practice has worked with patients with neurological, autoimmune, gastrointestinal, gynecological and musculoskeletal conditions, chronic pain and other complex cases.

We have many testimonials from patients reporting major improvement, and cases of patients with autoimmune disease who later went into clinical remission. Some patients have had extraordinary recoveries.

That guarantees no one's result. But our experience has taught us:

Training matters. Diagnosis matters. Strategy matters. Experience matters.

Before you get acupuncture, ask

• How many hours did they specifically study acupuncture and Traditional Chinese Medicine?
• Was it a full professional degree or supplementary education?
• Where did they study?
• How much supervised clinical practice did they complete?
• Did they pass the profession's national boards?
• Are they trained in Clean Needle Technique?
• Do they have specific training in your condition?

If you are pregnant: how much training do they have specifically in pregnancy? If you are trying to conceive: how much training specifically in gynecology and fertility? If you are seeking treatment for your child: what training specifically in pediatrics? If you have a complex neurological condition: what advanced training do they have treating these patients?

These are not awkward questions. They are questions about your health.

That is why Yerbal Health has decided not to accept health plans

We want to keep our clinical independence. We want to use the full scope of our training. We want the time to connect the different pieces of the puzzle.

And we want to design our care around the patient, not around what fits inside a billing code.

When you compare two places that offer “acupuncture”

Do not only ask “how much does it cost?”. Ask:

“Who is behind the needle?”

Because two people can hold exactly the same needle. That does not mean they have the same training to use it.

A needle costs pennies. Knowing what to do with it takes years.