POINT / COUNTERPOINT
John A. Amaro D.C.,
Before you read this article, It must be borne in mind, I am an acupuncturist. Yes, I have a degree as a Doctor of Chiropractic (D.C.) but I am also an acupuncturist. I graduated from Cleveland Chiropractic College in 1969 and began my practice in 1971. I have practiced continually the last 30 years with the exception of extended studies at the Chinese Medical Institute in Kowloon China in 1975-76. In addition, I have made 12 study trips to the People's Republic of China and have observed and studied in a total of eight Asian nations. My studies and lectures have taken me to Australia five different times and throughout my career, have been a frequent student in both France and England having been to both seven times. Yes, I am generally considered a very well trained acupuncturist. I am well versed in Traditional Chinese Medicine as well as a variety of other forms of acupuncture to include Vietnamese and Cambodian. My personal acupuncture background is multi-national.
I serve on the Arizona Acupuncture Board of Examiners having been appointed by the Governor to serve in that capacity and am duty bound to be fair and equitable to the growing body of fine acupuncturist who come to this state to be licensed. Arizona law states two members of the Board of Examiners must be licensed physicians in the state. I serve in that capacity as well as a medical physician in addition to seven additional members of the Board.
I did not attend TCM acupuncture school in the United States because frankly there weren't any available and would not be for over a full decade after I began my practice of acupuncture. I was familiar with the Academy for Traditional Chinese Medicine in Columbia Maryland under the foundation of the renowned J.R. Worsley having studied with him personally in the mid 1970's and visiting his college in 1983. However, this wonderful Institute even though named Traditional Chinese Medicine, bore very little resemblance to the TCM that would come out of the People's Republic of China.
When President Richard Nixon and his entourage visited Chairman Mao Tse Tung and the People's Republic of China in 1972, historic and significant diplomatic relations were created. The people of America also first heard the word "acupuncture" thanks to James Reston the famed journalist who penned an article entitled "Now About My Operation". In this historic article Mr. Reston reported of his experience with acupuncture as an analgesia for an emergency appendectomy while in China. America was enthralled.
Not only were many of our worst political fears calmed during these diplomatic sessions, but we as a nation had learned of a unique system of healing which would grab the attention of the American public. As more stories, reports, and articles were written about acupuncture and its seemingly miraculous clinical response, multitudes of patients began to inquire about its possible use on them and on family members and friends. Acupuncture in the spring of 1972 became a household word.
Perhaps it was because the Doctor of Chiropractic who in 1972 had yet to establish a scientific explanations for its own profession that it felt compelled to adopt this child called acupuncture and to bring it into its domain. Since acupuncture's acceptance was so related to blind faith and chiropractic at that time was likewise, it appeared to be a compatible union. Even though the medical scientist and general medical practitioner was skeptical of the positive reports of acupuncture, its only logical explanation was simply that it was actually nothing more than hypnosis.
In 1972 the National Institutes of Health (NIH) gave its first grant to study acupuncture. The study reported that acupuncture was not hypnosis and that while needles alone could slightly decrease experimental pain, electrical stimulation added to needles produced statistically significant greater relief.
To answer the demand of the general public to experience acupuncture first hand, hundreds of doctors of all disciplines across the nation began to learn of the working mechanisms of acupuncture. The first formal postgraduate program in the United States was begun in the fall of 1972. This program was conducted through Columbia Institute of Chiropractic now New York Chiropractic College under the tutelage of Asian physicians from Japan, Taiwan, Hong Kong and America with strong educational ties to both China and Japan. That same year, The National College of Chiropractic now National University of Health Sciences completed a study of clinical response in several conditions primarily Bell's Palsy, and intercostal neuralgia. Later that year, The National College in Lombard Illinois, would be the only health care institute in Illinois allowed to provide programs in acupuncture to allopathic, chiropractic, or osteopathic physicians.
Both of these educational programs conducted by respected chiropractic colleges and those that would follow, would focus on "clinical acupuncture" and not what is generally described today as Traditional Chinese Medicine (TCM). TCM would not be introduced into this country until the first doctors trained in Mao's Communist China would begin to immigrate to America. This would not happen until the early and mid 1980's.
After the death of Chairman Mao Tse Tung in 1976 it would be three years (1979) before the first Americans would be allowed to visit the People's Republic of China. I was fortunate to have been one of those first Americans to visit the PRC. It would be several more years before those in the PRC would be given special permission to travel outside of their country. Chairman Mao held a tight unforgiving reign on his people. This was most clearly demonstrated in a recent movie entitled the "Red Violin" which traces the origin and situations of a specific violin and its owners as it moves from person to person and country to country. In a scene which is historically accurate, the violin ends up in the People's Republic of China during the regime of Mao Tse Tung in 1965 who has issued an edict that no music will be played in the PRC other than "Traditional Chinese Music" (TCM). To do so would be punishable by harsh imprisonment or death. Mao only wanted to surround himself and his people with Chinese art, music, and thought processes. The parallel to Traditional Chinese Medicine (TCM) is also of historical significance since it was Chairman Mao who reestablished it.
The concepts and practice of Traditional Chinese Medicine was literally resurrected by Chairman Mao in 1940 as he repelled anything Western and embraced everything both Traditional and Chinese. He was further faced with a massive population and few Western trained physicians since most had followed Chiang Kai Shek to Formosa now Taiwan. The "Barefoot Doctors Manual" became the bible by which thousands of practitioners were trained to take Traditional Chinese Medicine into the countryside. The ban on acupuncture and Traditional Chinese Medicine in effect since 1882 by the Chinese Royal Medical Academy was now lifted.
The introduction of acupuncture into the United States in 1972 was introduced by those practitioners and teachers who were from Japan, Hong Kong and Taiwan. TCM as a theoretical foundation for the diagnosis and practice of acupuncture literally did not make it's way into North America for 10-12 years. Virtually all acupuncture was Meridian based with its main focus being Five Elements with strong overtones from England and France. Japanese Meridian Acupuncture played a major role in the early development of acupuncture in North America.
The first practitioners and students of acupuncture in the United States were Doctors of Chiropractic and very progressive thinking medical (allopathic) physicians. Some would refer to them as radical in their thinking to investigate acupuncture. This was at a time when most of our medical colleagues viewed acupuncture as quackery. The early acupuncture programs were 100 hours of didactic education with over 200 hundred hours of home assignments and clinical applications. These programs prepared the doctor with a full and complete basic knowledge of the academics, philosophies, procedures and techniques of meridian based acupuncture. The first certificate of clinical competence in acupuncture was awarded following the didactic, clinical and written examination was issued September 24, 1973. I have certificate #A000003.
Since that time Post Graduate programs in acupuncture / meridian therapy have been and are routinely conducted by the Department of Post Graduate and Continuing Education at Logan College of Chiropractic, Parker College of Chiropractic, Texas College of Chiropractic, Canadian Memorial Chiropractic College, Northwestern College of Chiropractic, Cleveland Chiropractic College and UCLA School of Medicine in addition to New York Chiropractic College and National University of Health Sciences.
Since the first acupuncture certification program in 1972-73, it has been estimated 9,000 Medical physicians and more than 30,000 Doctors of Chiropractic alone have been trained and certified through the above referenced nationally accredited Chiropractic and Medical Colleges.
It is estimated that currently the combined total of Medical, Chiropractic, Dental, Podiatric, Osteopathic and Naturopathic physicians who practice acupuncture on a day to day basis within the scope of their practice outnumbers the approximate 10,500 acupuncturist by as much as three to one. This is the obvious reason this "point / counterpoint" article is being written. This article has little to do with standards of education it has everything to do with "turf".
When I was told this article was to focus on the right of chiropractic and medical doctors to practice acupuncture due to what has been considered an inadequate number of hours of education, I knew immediately exactly what the problem was and that was, "who owns acupuncture" and "who should practice it"?
I couldn't help to make exception to Mark Seem's article in the September, 2000 issue of "Acupuncture Today" entitled Message from the Front Lines. I found it so interesting when he states "for so many of us who were instrumental in making this profession happen in the United States ." Ask him if he were there in 1972, 1973, 1974, 1975, when acupuncture was being attacked by the medical establishment and general practitioner as voodoo, fraud and quackery. The National Council Against Health Fraud was very instrumental in convincing the vast majority of physicians that acupuncture had no merit, as a result, most physicians shunned the mere mention of the word. I am sure acupuncture would not have survived the first tumultuous several years had it not been for the dedicated chiropractic and medical practitioners who embraced acupuncture and put it into clinical practice. It was practiced by practitioners who with their non-Traditional style, achieved outstanding results. Where referrals for this work were overwhelming. Due to the outstanding clinical response which acupuncture is famous for and the amount of favorable press acupuncture received chiropractic/medical acupuncture practices grew to incredible proportions.
My own personal clinic as early as 1977-78-79 would see on average between 75 and 125 patients per day five days a week from literally all parts of North America. This was with the help of 12 clinical assistants. In those early days of acupuncture, practitioners who were serious about this work numbered approximately 1,500 across the nation. Obviously to see this volume of patients, the focus was on Meridian based acupuncture and not Traditional Chinese Medicine where the 28 pulse characteristics would be analyzed between 20 and 30 minutes per wrist. Please bear in mind, the clinical results for "Meridian" based acupuncture and Traditional Chinese Medicine are compatible.
Doctors of Chiropractic have always been the original "alternative care practitioners" prescribing herbs, vitamins and minerals and being referred to as "health nuts" because of it. D.C.'s have always been on the unconventional side of medicine however, what used to be questionable practices of chiropractic are now being shown to be mainstream procedures in the general practice of medicine.
As more and more medical physicians are exploring "alternative" therapies, medical practices are changing drastically across America. Since acupuncture has been practiced in this country for over 25 years, the contemporary medical and chiropractic doctor just graduating has literally grown up with acupuncture as part of their life. It is not shocking, it is not mysterious, it has scientific explanations for pain control, patients inquire about it and it is easy to learn and incorporate into a clinical practice. It has been shown to be effective in pain control and condition response, the critics are few and far between, the science has recognition from the National Institute of Health as well as the World Health Organization. Acupuncture may be practiced with electronic and laser therapy as opposed to needles. In essence more and more medical, osteopathic and chiropractic physicians have developed an interest and are incorporating the concepts and procedures of acupuncture into their daily practices.
I think Mark Seem in his previously mentioned article perhaps said it best when he shouted in his article with bold letters, "acupuncture is about to be lost and scattered to the four winds of the health care world". We must keep in mind, acupuncture has for 28 years been within the health care world. It is only recently the acupuncture profession has developed to the point where it is now jealously guarding its treasure. However, as stated earlier, many professions have established acupuncture as a part of their scope of practice over the last two decades. The Arizona Chiropractic Board of Examiners had established guidelines and "Board Certification" in Acupuncture as early as 1983. The National Commission for the Certification of Acupuncture (NCCA) was not established until 1985.
Acupuncture has taken on a different character with the advent the last 15 years of the new profession known as "acupuncturists". However, as Mark Seem points out, "the new thrust is for Oriental Medicine"
That is what has apparently been created in the acupuncture profession, it no longer appears to be just "Acupuncture" it is now "Acupuncture and Oriental Medicine". We see the "Accreditation Commission for Acupuncture And Oriental Medicine" (ACAOM) which was established in 1982. We see the "Council on Colleges of Acupuncture and Oriental Medicine" (CCAOM). We see the "National Acupuncture and Oriental Medicine Alliance". Look what happened to the NCCA after several years of operation, they became the NCCAOM. "The National Commission for the Certification of Acupuncture and Oriental Medicine". In fact in a November 1998 report of the ACAOM showing the names of the accredited and candidate colleges, 24 of the 40 colleges listed had as part of their name either "Oriental Medicine" or "Chinese Medicine".
What Mark Seem has obviously forgotten in his scathing remarks concerning "the far inferior medical acupuncture" (acupuncture practiced by medical doctors with merely 200-300 hours of training)" is that on the rear of his book "A New American Acupuncture", he quotes Joseph M. Helms M.D. Founding President of the American Academy of Medical Acupuncture for his complimentary comments of his book. In addition he states emphatically on page 63, "The excellent acupuncture training program for physicians developed by Dr. Joseph Helms for the office of Continuing Medical Education of the UCLA school of medicine is also based on the French meridian acupuncture, and his graduates fare quite well with this approach in a wide range of health care problems."
So what is it? Is it a far inferior medical acupuncture program or is it worthy of praise? I guess it depends on whom you are speaking to or trying to sell books to.
At the same time,
hear what The American Academy of Medical Acupuncture whose membership
is limited to M.D. and D.O. only, addressed to "All Members of the
Idaho House of Representatives" on March 5, 1999at a time when acupuncturists
were struggling to have a licensing law passed in Idaho. "Fourth,
to allow clinical technicians to treat patients without the supervision
of a licensed physician indicates a frightening lack of understanding
and appreciation of potential medical risks and could further jeopardize
the health and welfare of the public. Non-physician acupuncturists and
clinical technicians must have a physician supervising their practice.
This protects both the public and the non-physician acupuncturists from
potentially deadly errors.
This entire issue
is not about standards of education it is totally and unequivocally about
turf! Who owns it?
When Mark Seem states in the September 2000 issue of "Acupuncture Today" "if the acupuncture and Oriental medicine profession does not begin to develop variable training programs for physicians and chiropractors in excess of the 100-300 hour courses now available, patients will suffer. Oddly acupuncture schools recently opted to refrain from teaching abbreviated courses to physicians or chiropractors, thereby leaving these professionals with no choice but to find other options-usually enterprising individuals with relatively limited resources. It is my belief that acupuncture schools have a responsibility to the public to actively seek out and attract serious minded physicians and chiropractors by developing training programs that satisfy our profession's standards."
I suppose the professions
standards Mark Seem President and CEO of Tri-State College of Acupuncture
was referring to was the fact that in multiple issues of the International
publication "DYNAMIC CHIROPRACTIC" he placed a large display
ad for his "Video Mastery Series" a course for licensed acupuncturists
and chiropractors and physicians certified to use acupuncture in their
scope of practice. This program in "Acupuncture Physical Medicine"
allows one to "treat chronic pain and stress disorders effectively".
Yes, there is no question, it's all about "turf", it's all about money!!!!
Mark Seem sums it up nicely when he states " this signals the inherent value of acupuncture as a treatment in its own right is in serious jeopardy. Unless our profession reclaims acupuncture for itself, acupuncture may be diminished by our Western counterparts to a mere part of treatment-one more billable modality to hike the overall price of a visit". Unfortunately, the public remains ill equipped to distinguish between practitioners with abridged versus comprehensive acupuncture education's. (Emphasis added)"
Again, it's totally a turf war. Nothing else.
The abridged versus comprehensive acupuncture education's issue is and will be at the heart of the matter concerning any legislative activities which now affects the medical or chiropractic profession. However, I do not know of any acupuncture program in the medical or chiropractic educational graduate school program, which professes to teach "Oriental Medicine". All of the programs I am personally acquainted with are programs in "Medical (Clinical) Acupuncture" which has little focus on Mao's Traditional Chinese Medicine (TCM). The programs which are taught in the medical /chiropractic schools are being taught by the Graduate School of United States Department of Education recognized schools certified by the State Education program of its respective state. The Chiropractic programs are all taught through accredited colleges certified to award higher education degrees.
Just as one may wish to have an Asian dinner tonight, we could go for Japanese, Korean, Malaysian, Szechwan, Mandarin, Cantonese, Taiwanese, Singapore, Vietnamese, or Thai. Just as each of these have different flavors, styles, presentations, ingredients, spices, and each country or region has different cultures, the same is true of acupuncture. One may not assume all acupuncture being practiced or taught is Traditional Chinese Medicine (TCM). Therefore, each of the philosophy, techniques, procedures even though compatible are totally different. Each style is academically and clinically different, some are very difficult and shrouded in myth and folklore whereas other styles are relatively easy to learn and to put into clinical practice.
Having the extensive background which I have in the areas of both Acupuncture and Oriental Medicine over 30 years, I am frankly astounded by the fact the Acupuncture and Oriental Medicine Colleges in America feel they can teach the extensive knowledge of TCM in as little as three years attending part time. I am personally appalled by the fact that numerous acupuncture colleges throughout the nation are only focusing on 7-8 most common pulses as opposed to the 28 pulse characteristics that are historically significant in Traditional Chinese Medicine. Medical/Clinical Acupuncture as taught and practiced by physicians often relies on Japanese style Electro-Meridian Imaging (EMI) (Ryodoraku) diagnosis. Japanese pulse interpretation, abdominal palpation and energetic therapy localization are various forms of diagnosis used by the physician. This differs dramatically from the 28-pulse concept. Tongue diagnosis is common to both schools of thought.
Oriental Medicine has been in America long enough now to begin seeing some of the veteran practitioners that only time and experience can produce. I am proud to have them as colleagues.
In the early days of acupuncture school in this country, when they were still pure and living their mission statement of helping people get well, it was commonplace to advise students that if you are going to practice Traditional Chinese Medicine you can only see a maximum of 6-8 patients a day. That concept has gone by the wayside, as economics have taken over and practitioners find out they cannot make a living on 6-8 patients a day with office overheads. Suddenly it's ok to see more patients, just don't spend as much time in the four shins of diagnosis. Amazing how our philosophies change when money and or survival is the heart of motivation.
I have heard criticism of the chiropractic profession using acupuncture that "clean needle" is not taught nor is it a part of the general chiropractic curriculum. This is a total absurdity. Doctors of Medicine and Chiropractic have within their core curriculum programs dealing with blood borne pathogens and OSHA requirements, to include safety and sterile fields.
Sterile needle application is a given. It obviously should be and would be expected to be an integral part of the core curriculum of every acupuncture Institute in the country. Utilizing a hypodermic needle for blood withdrawal or injection or if it is an acupuncture needle is no different regarding sterility. Sterility procedure for these applications are an inherent part of the curriculum of both medical and chiropractic colleges.
When the acupuncturist in Maine tried to eliminate the chiropractic professions acupuncture inclusion by lobbying the legislature with the false information they were not trained in "clean needle" , they were literally laughed atas being involved in a "turf war".
What about the education of the Chiropractic Physician? The September 1998 issue of "Alternative Therapies" carried a research paper titled A comparative study of chiropractic and medical education. In this official research paper some very significant statistics were brought to the attention of the American public and for legislatures for impending law inclusion for chiropractic. When comparing three chiropractic with three medical schools in California, Texas and Iowa the total contact hours of Chiropractic was 4826 compared to Medical at 4667 hours. Basic Sciences showed 1420 for Chiropractic and 1200 for Medical. Clinical Sciences was 3406 for Chiropractic and 3467 for Medical.
In selected topics of the basic sciences, Anatomy 570 Chiropractic, 368 Medical. Biochemistry 150 Chiropractic, 120 Medical. Microbiology 120 Chiropractic, 120 Medical. Physiology 305 Chiropractic 142 Medical. Pathology 205 Chiropractic 162 Medical.
The real issue at hand here is who owns acupuncture and who is going to be able to practice it. Apparently the acupuncture profession is attacking the chiropractic profession vehemently in an effort to thwart any legislation the D.C.'s may be garnering in an attempt to stop their inclusion of acupuncture as more states are looking to add acupuncture to its scope if it is not already included. Currently, there are 29 states that allow for acupuncture by D.C.'s with a number of states showing great interest in adding it to their scope of practice.
All 50 States now allow Medical Doctors to practice acupuncture with only eight states requiring any hours of training. The M.D. degree is an all-inclusive license. Several states such as New York, New Jersey, Virginia, Pennsylvania, Maryland, District of Columbia require between 200 and 300 hours. The remaining states allow M.D.'s to practice acupuncture regardless of training.
I recall so well in 1974 while practicing in Kansas, the Medical profession lobbied to the Attorney General and the State legislature that acupuncture was the practice of surgery and only those licensed to practice surgery were allowed to perform acupuncture. This enacted ruling eliminated D.C.'s. practicing acupuncture as D.C.'s do not perform surgery as part of it's scope of practice. The medical profession wanted acupuncture totally for itself, even at a time when it only superficially endorsed its remote possibilities.
As president of the Kansas Acupuncture Society, we filed a lawsuit to reverse the Attorney General's decision that acupuncture was surgery. Having lost two times in the lower courts, the case was appealed to the Kansas Supreme Court where the decision was reversed and acupuncture clearly came into the domain of the Doctor of Chiropractic. To this date, I still have hanging on my wall, the certificate from the State of Kansas allowing me to practice acupuncture which expires February 1975. This is of historical significance because had this court case been lost, it would have set precedent throughout the country that "acupuncture is the practice of surgery". This would allow only physicians licensed to perform surgery to use acupuncture.
Writing in the "Newsletter of the National Acupuncture and Oriental Medicine Alliance" the Executive Director stated "The practice of acupuncture and Oriental medicine by other health care providers is one of the major issues facing our profession today. It is one that we must discuss and come to grips with. Increasingly, it appears from viewing the legislative arena, that the issue is not whether other health care providers should practice acupuncture. The issue is how we choose to relate to the fact that they do".
Currently the acupuncture profession has risen to be a significant group. Even though the profession is in its infancy, they have come along a long and tortuous road. Its legislative leaders are to be commended for bringing the profession so far in so short a time. However for a profession to harbor the hatred, the jealousy, the verbal and printed attacks from one profession to another, is not only non-productive, it is pathologic in the strictest sense.
I fully understand why the acupuncture profession has taken the stance that medical and chiropractic doctors should not practice acupuncture. It has nothing to do with standards of education because the education the doctors are receiving in "Meridian based Acupuncture" is exceptional. It only has to do with greed and ownership.
I fear the acupuncture profession will eventually eliminate themselves if they continue to make enemies in the medical professional ranks with their weak accusations and pointed attacks as to "We're trained and you're not"!.
Look at the handwriting on the wall, currently there are in excess of 30,000 medical, chiropractic, osteopathic, dental, podiatric and naturopathic physicians in the country who are practicing "Acupuncture" on a daily basis. These ranks are growing yearly. They are generally non-Traditional Chinese Medicine based practitioners and their practices have been rewarded with increased clinical results, increased referrals and increased income. They have no intention of eliminating this work from their practice because some acupuncturists who have been organized less than two decades have deemed they are not worthy to practice.
I see yellow page ads around the country advertising "Medical Acupuncture practiced by physicians, achieving better results and less chance of missing a diagnosis". No wonder the acupuncturists want to eliminate the medical professions from performing acupuncture. Of 500 potential patients who would seek acupuncture services from a practitioner, in reality, what do you think the odds are of John Q. Public seeking the doctor who is practicing acupuncture as opposed to the acupuncturists?
The acupuncturists screams and stamps their feet and says, "Yea, but they're not trained" . In the meantime, John Q. Public continues to see his doctor for acupuncture because like it or not, the physician using acupuncture as an adjunct to their practice is by and large seeing tremendous clinical response, their patients are referring and with HMOs being what they are, have added a new dimension to their practice. Doctors find acupuncture a natural to their practice as more and more patients inquire of its use.
Remember that I am an acupuncturist in addition to being a chiropractic physician. I love acupuncture. I want to see it thrive not merely survive. Having been a chiropractor for so long, it saddens me, angers me and stirs incredible emotion when I think how far further the chiropractic profession would be right now had it not been for the senseless fighting this profession is noted for. If it is a death wish the acupuncture profession has for the other professions practicing acupuncture, I am afraid it will only turn to suicide.
As I write this, I have no idea who the author is who is taking the opposing stance to this article. I do not know what has been said. However, having been around this profession as long as I have, I have a pretty good idea. It saddens me to think that we as healing professionals who should have but one goal in mind and that is the relief of pain, the elimination of pathology and the general welfare of our patient, can become mired in the destructive muck of incrimination and intimidation.
We as acupuncturists speak of balance as being healing. This profession is sorely out of balance within itself.
The Medical and Chiropractic
Physician are going to continue to practice acupuncture regardless of
what is thought by the acupuncturist. Wouldn't it be so much better to
have an ally than an enemy? I continually refer patients to non-physician
acupuncturists around the country. In fact last year alone, the International
Academy of Medical Acupuncture Inc. of which I preside referred 287 patients
to 204 practitioners in North America (note this is not The American Academy
of Medical Acupuncture limited to M.D. and D.O. only).
I would suggest we create a dialogue with each other as colleagues not as enemies. Regardless of what the other author has said in this Point/Counter Point article, it would still be best for all concerned that we collaborate rather than alienate. We exist for the common good of the patient. Acupuncturists view doctors practicing acupuncture as a threat to society and sadly, doctors view acupuncturists the same way. Hopefully, all of us can come away with a mutual respect for each others skills and philosophies and go about the business we entered into and that is for the enhancement of the healing of our patients. There is no room for jealousy and envy in a health practitioner's spiritual make up we must touch our patients with positive energy and purity of heart. Then we can be called "Healer"
It is with positive affirmations that I hope we glean the message here and go forth with Best Wishes for our own healing. For the universe can only distribute what we have in our consciousness. It's either hate or love, degeneration or healing, criticism or praise.
Best Wishes in the Year of the Snake!