Here in the United States, each state has its own licensing requirements.  In California, standard training involves 2 to 4 years of college plus the completion of a 4-year program at an oriental medical school.  The training includes the different aspects of Oriental Medicine as well as classes in Western Medicine and medical sciences.  Upon graduation most Oriental Medical Schools grant the degree of Master of Science in Oriental Medicine which is currently the highest accredited degree in the field.  The individual must then pass the California State Board Exam before getting a license to practice acupuncture. Currently, there are no regulations concerning the practice of herbal medicine or the other modalities of Oriental Medicine. An acupuncturist is considered a primary health care provider and therefore can be seen without a referral from a M.D.