187 online questionnaire were sent, out of which 102 valid survey questionnaires were collected,the effective response rate is 54.55%. Respondents are from 18 countries and regions (11 countries in Europe, 3 countries in the Americas, 3 countries/regions in Asia, and 1 country in Oceania). 62 respondents are from the Chinese mainland and 40 outside the Chinese mainland. Their working experience in acupuncture is 21.2±14.3 years.
Legal perspective
Regarding the legality of acupuncture, 97.50% of the experts surveyed outside the Chinese mainland replied that their countries/regions acknowledged the legal status of acupuncture-moxibustion (39/40). One French respondent chose ‘illegality’. However, other French respondents who were surveyed in the same period all chose ‘legality’. Regarding the question of ‘whether there is acupuncture-related legislation’, there were experts from 8 countries/ regions (the United States, Canada, Australia, Switzerland, Romania, Russia, South Korea, and Hong Kong) responded unanimously to ‘yes’. Experts of 3 countries responded ‘no’ (Sweden, Norway, Brazil). Experts from the other 6 countries responded inconsistently (Germany, Italy, Spain, the United Kingdom, France, the Netherlands). 92.50% experts believe that the development of the standard of Technical Specification of Acupuncture-moxibustion: General Rules for drafting will help them to improve the legal status of acupuncture-moxibustion in their countries/regions and promote acupuncture-moxibustion legislation.
Perspective on payment for acupuncture-moxibustion
In the response to the question ‘Does the national public medical insurance cover the cost of acupuncture-moxibustion treatment?’, of the 40 experts, only 15.00% (6/40) chose ‘it is paid’, 17.50% (7 /40) chose ‘partial paid’, and the remaining 67.50 % (27/40) selected ‘it is not paid’. In the response to the question ‘Does private medical insurance cover the cost of acupuncture-moxibustion treatment’, 40.00% (16/40) chose ‘it is paid’, 42.50% (17 /40) chose ‘partial paid’, and 17.50% (7/40) chose ‘it is not paid’. 90.00% (36/40) of experts believe that the publishing of the series of international General Rules will help expand the scope and proportion of acupuncture-moxibustion payments in the medical insurance system of their countries/regions.
International application of common acupuncture-moxibustion techniques
As shown in table 1, the application of 24 acupuncture techniques which are covered by the existing Chinese standards in countries/regions outside the Chinese mainland are investigated. More than 50% of the acupuncture-moxibustion techniques are widely used. Most of them are conventional acupuncture techniques with relatively high international popularity. Prioritization is done on demands for developing international standards for different acupuncture-moxibustion technical specifications. The average comprehensive score is calculated by the sorting integral method. Acupuncture-moxibustion techniques with an average score over 10 points are ‘filiform needling method’ (22.20), ‘moxibustion’ (18.37), ‘electro-acupuncture’ (17.23), ‘cupping therapy’(13.85) and ‘ear acupuncture therapy’(11.36). These 5 acupuncture-moxibustion techniques are widely used internationally and have a high popularity. Thus, it is concluded that developing priorities shall be given to international standards of these acupuncture-moxibustion techniques.
The existing national General Rules for drafting
The awareness rate of the existing General Rules is 71.57% of 102 experts, among which 52.50% are outside the Chinese mainland, 83.87% are inside the Chinese mainland. 64.71% of the total number of the experts have consulted or received relevant training, among which 50.00% are outside the Chinese mainland and 74.19% inside the Chinese mainland. Utilization rate of the General Rules is 72.55%, among which 57.50% are outside the Chinese mainland and 82.26% inside the Chinese mainland. 98.04%(100/102)of the total number of the experts believe that it is necessary to develop the international standard of the General Rules. 79.41% (81/102) considered that the existing General Rules need to be revised. As shown in Figure 1, differences in the proportion of options on ‘what need to be revised’ can be found in experts inside and outside Chinese mainland. The number of experts outside the Chinese mainland are higher than that of the experts inside the Chinese mainland in the option ‘The expression is not clear enough’. While the number of experts inside the Chinese mainland is significantly higher than that outside the Chinese mainland in the option ‘Not practical enough’.
Demands for the scope of the international General Rules for drafting
As shown in Figure 2, demands of experts inside and outside the Chinese mainland are slightly different in term of scope. A greater difference is found in the option of ‘cover common issues in manipulating various kinds of acupuncture-moxibustion’ (52.50% outside the Chinese mainland, 91.94% inside the Chinese mainland). Experts in the Chinese mainland want to highlight commonalities while experts outside the Chinese mainland want to retain more specialties. Some experts also comment that the item of ‘basic requirement’ should be adapted according to the situations in different countries. The work flow for the WFAS standard should be clarified and the text structure and abbreviations should be unified in processing the English version.
Common issues of acupuncture-moxibustion operations
All experts agree that common issues should be emphasized in acupuncture-moxibustion application process. However, in Figure 3, their opinions differ greatly in terms of ‘relevant terminology’, ‘pre-operative preparation’ and ‘adverse reactions and contraindications’. Experts outside the Chinese mainland paid less attention to the above-mentioned issues while experts inside the Chinese mainland considered them to be very important. In addition, some experts inside the Chinese mainland also added issues such as ‘the tolerance definition for acupuncture-moxibustion techniques in different countries’ and ‘compatibility and adaptability in different countries’.