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The Practice of Chinese Medicine in the US

The following is a talk I gave at the US Consulate General in Chengdu, China on December 12th, 2007. Despite the hassle of getting through security, about sixty English speaking Chinese students and one old man who comes every week to get out of the cold attended. They were a bright group that asked very interesting questions after the talk. The two most interesting concerned the differences between Western and Chinese medicine, and the relation of traditional Chinese culture to Chinese medicine. I may write about these in the future.

I practice Chinese medicine. I went to school in the Pacific Northwest of the United States, graduating in 2004 from the Oregon College of Oriental Medicine in Portland. The weather in Oregon is quite similar to Chengdu’s. It’s often cloudy, and sometime you don’t see the sun for weeks at a time, although I never thought I’d live somewhere where one sees the sun less often than in Oregon. But here we are. Chengdu is also similar to Portland in the way people rely on bicycles as a form of transportation. In Portland we ride bikes, and rarely drive.

I went into Chinese medicine because I’ve always been attracted to Chinese philosophy and culture. I’m drawn to Taoism and Buddhism, martial arts, and Qi Gong. In High School I first started using the I-Ching, or The Book of Changes. I wanted to learn a craft which I wouldn’t get bored with. I felt that Chinese medicine was something which would keep my interest the rest of my life. Because it’s so vast and varied, I thought that there would always be something new to learn. I wanted that kind of life-long engagement with my work.

The fundamental orientation of Chinese medicine is towards Qi, or vital life force. We all have Qi. It’s what makes us go. According to Chinese medicine, when Qi gets stuck, or doesn’t flow, we experience discomfort and pain. Other times, we may not have enough Qi, and we feel tired. Sometimes we have other internal imbalances, and we can’t sleep, or we develop allergies, or have digestive distress. For all these situations, through the use of needles and herbs, a Chinese doctor can get one’s Qi moving again, or through herbs can give you more Qi to overcome fatigue, or help restore imbalances so you can sleep.

There are twelve major meridians, or pathways for Qi, which correspond to twelve internal organs, which each has its own functions. For instance the Spleen, among other things, is responsible for transforming food into Qi. It’s meridian starts just off the nail of the big toe, travels up the inside of the leg, and ends up in about the middle of the rib cage, on the side of the chest. The Lung does many things, but one of its main functions is to transform the air we breathe into Qi. It’s meridian pathway starts in the pectoral muscle on the upper chest, and travels down the arm out to the thumb.

The basic idea is that the human body, when working correctly, is healthy and disease free. Chinese doctors tune the body so that it works well, thus eliminating problems. In addition to acupuncture and herbs, Chinese medicine also includes things like cupping, moxabustion, gua shua, and electro-stimulation.

Chinese Immigration Although various forms of Chinese medicine have been used in China for thousands of years, it is very recent that these practices have come to the US. It is most likely that Chinese medicine first came to America with the Chinese immigrants of the mid-1800s.

Many of the first wave of immigrants from China were skilled artisans, hotel and restaurant owners, fishermen, and merchants. This was followed by thousands of unskilled workers. At that time some 25,000 Chinese immigrants were working in California, mostly as part of the “Gold Rush.” Another 10,000 worked on building the Central Pacific Railroad.

In 1882 the US Congress passed the Chinese Exclusion Act, the first in American history to place broad controls on immigration. The Act suspended Chinese immigration, and required all Chinese people to carry documents identifying themselves and their line of work. It was not repealed until 1943.

Many Chinese came to the US to support their families back home. They would work for less pay than non-Chinese workers, and this caused tensions. Chinese and non-Chinese laborers were pitted against each other. This resulted in anti-Chinese discrimination and violence. For instance, in 1887, in the Snake River Massacre, 30 Chinese miners were murdered near the Oregon-Idaho border.

It was around this time that a young man named Ing Hay moved to John Day, in Eastern Oregon. Ing Hay was born in China and came from a family of herbalists. Know as Ing ‘Doc’ Hay, or the China Doctor, Ing Hay is probably the most famous early practitioner of Chinese medicine in the US. He and his friend Lung On opened a store called Kam Wah Chung along The Dalles Military Road. They supplied canned foods, tobacco, and bulk goods from China. Kam Wah Chung also functioned as a social center and hiring hall. This is where Doc Hay established his medicine practice. He treated not only other Chinese immigrants, but also local cowboys and miners. Doc Hay had a reputation for curing blood poisoning, a common problem for Oregon ranch hands.

Doc Hay was primarily an herbalist. He practiced in John Day from 1888 until 1948, and died at the age of 89 in 1952 in Portland, Oregon. When the Kam Wah Chung building was reopened in the 1960s, over 500 Chinese herbs were discovered, some of which have yet to be identified.

Doc Hay relied primarily on pulse taking for diagnosis. In Chinese medicine there are three pulses on each wrist at the radial artery, and each of the three corresponds to different internal organs, and in turn has three levels. For instance at the top, near the wrist crease on the left is the Heart, below this is the Liver, and at the bottom is the Kidney Yin. On the right at the top is the Lung, under that is the Spleen, and finally the Kidney Yang. This is one of several schemes. A well-versed pulse reader can diagnosis a great deal about the state of a person’s health simply by reading pulses. Although Doc Hay is the most well-known, there must have been other doctors amongst the wave of Chinese immigrants to the US in the 1800s, although their stories are yet to be told.

Chinese medicine first came to the attention of the Eastern Establishment when acupuncture was mentioned in the medical literature in 1822, and was endorsed by Sir William Osier for the management of lumbago, or low back pain, in his text. The Principles and Practice of Medicine, published in 1892. Unlike France, however, where acupuncture was incorporated into mainstream medical practice in the 19th Century, Chinese medicine didn’t make it into the mainstream in the US until the 1970s.

I think there are three main events which propelled acupuncture and Chinese medicine into the mainstream in the US.

Acupuncture in the Headlines Acupuncture was first brought to the attention of large numbers of Americans by a New York Times reporter named James Reston in 1971. Reston was in China covering the opening up of relations between the US and China, when he suffered an attack of appendicitis, and had to have an operation. In the Chinese hospital he was administered acupuncture to treat his post-operative pain. He was amazed and intrigued by the effectiveness of this approach, and wrote an article on it for the Times. This caused a stir in the US, generating a great deal of interest. For the first time millions of Americans heard about using needles for health.

Miriam Lee’s Civil Disobedience At the same time, a Chinese immigrant named Miriam Lee was living in San Francisco, working in factories. She was a trained acupuncturist. Although acupuncture was not at that time a recognized form of medicine in the US, she was convinced to use her knowledge to address a friend’s illness. Her treatment was so effective that her friend told her friends about it, and before she knew it she was treating lots of people. She found a sympathetic MD, and set up her practice in her office, and soon lines were forming around the block. Ms. Lee was subsequently arrested for practicing medicine without a license. But she did not desist from helping people. Through a kind of one-women campaign of civil disobedience, in which she’d break a law she felt was unjust, the state of California eventually relinquished its punishment, and instead recognized acupuncture as a legitimate form of medicine. This was only thirty years ago, in 1976.

Lincoln Hospital and Acupuncture Detox On the East Coast in 1970, in New York City, a group called The Young Lords Party was agitating about the terrible conditions at Lincoln Hospital in the Bronx. The Young Lords were a group of Puerto Rican activists that came together to work for the rights of Puerto Ricans specifically and poor people generally in New York and Chicago. A coalition emerged, including the Young Lords, the Black Panthers, hospital workers, and community people to bring about improvements in conditions.

Despite recording hundreds of grievances, the hospital administration refused to acknowledge problems and talk to the activists. Lincoln Hospital was in a building that had been condemned and was both understaffed and under-financed. After mass demonstrations were also ignored, the Young Lords occupied the hospital in the middle of the night. The next morning the media publicized the occupation and the issues that led to it.

During the occupation, a preventive medicine community clinic was set up. One result of the occupation was that an historic acupuncture-detoxification program was established, with licensed doctors, acupuncturists, and staff members hired from the community including members of the Young Lords Party and Black Panther Party. Ahead of its time, for years the Lincoln Hospital Detox Program served as an international model of treating heroin and alcohol addiction with acupuncture instead of methadone, before it was eventually closed down by Mayor Koch later in the ’70s. None-the-less, it became the model for acupuncture detox programs around the country.

At Lincoln Hospital a Five Needle Protocol, or 5NP, employing five acupuncture points on the ear was developed to treat addiction and is now the cornerstone of detox programs around the US. Out of the experience at Lincoln Hospital, an organization called NADA (National Association for Acupuncture Detox) developed to promote education and training of chemical dependency clinicians in 5 NP. NADA has trained 10,000 people.

As a student intern, I worked at the Portland Alternative Health Center, or PAHC. PAHC combines acupuncture, herbs, Western medicine, counseling, housing, and other modalities, while serving a homeless addict population. They were successful in 89% of their efforts at getting people off heroine after six months. It was great to be able to work at PAHC. People would come in and sit in chairs. We’d talk to them about what else was bothering them, in addition to battling withdrawal symptoms. We put five needles in each ear, then a few more for various ailments, such as knee pain, or neck problems. The people who came to PAHC were very thankful for this service.

As a result of the efforts around the Lincoln Hospital takeover, NADA, and institutions like PAHC, acupuncture has had a positive effect on thousands of members of an otherwise underserved population. Acupuncture has become a very effective and widespread component of community detox programs around the country.

TCM Schools and Varieties of Chinese Medicine In the late 1970s and 1980s, people began establishing Chinese Medicine schools. One of the first to be established was the New England School of Acupuncture in 1979. My school, OCOM, was established in 1983. It was one of the first Chinese medicine schools to offer a Master’s Degree, and in 2005 began offering a PhD, or Doctoral Degree.

Most schools in the US teach Traditional Chinese Medicine, or TCM. TCM is a system of Chinese medicine put together under Mao, following the Revolution. This is the style of medicine practiced here in China, and is the standard for the national certification exam in the US.

Other forms of Chinese Medicine popular in the US include Five Element and Dr. Richard Tan’s system. Five Element was primarily developed in England, and is more psychological and esoteric in its approach. The people who developed it claim it’s more based in the way Chinese medicine used to be practiced, long before the development of TCM. The five elements – Earth, Metal, Water, Wood, and Fire – each have different characteristics and personalities. For Five Element practitioners, each person has a basic type, either you are Earth, or you are Water, or you are Wood, and so on. Once your type is determined, you can be treated by points related to this element, as each element has two organs associated with it, which in turn has meridian pathways and points. The points can then be needled to bring about a change in consciousness or a physical condition. For instance if you are an Earth element, you would primarily be treated on the Spleen and Stomach meridians.

The third major type of Chinese Medicine practiced in the US is that developed by Dr. Richard Tan. Dr. Tan has developed an interesting system in which the body mirrors itself. For example, if someone is suffering knee pain, Dr. Tan suggests treating their opposite elbow. For hip pain one would treat the opposite shoulder, or vice-a-versa. And this works! Basically one is looking at which meridian is affected, then looking at the paired meridian on the opposite side of the body. This style of acupuncture is very effective for pain management, and is used frequently in walk-ins clinics and in detox centers because people are sitting in chairs and are clothed. Therefore a doctor will want to choose distal points that can be accessed easily, usually from the knees down, or the elbow to the hand. This is the primary system we used at PAHC.

Some acupuncturists choose to specialize. Some of the most popular specializations include gynecology, fertility, allergies; and musculo-skeletal pain. Most of my patients tend toward this last group, perhaps because I am also a massage therapist.

Increased Acceptance and Insurance Coverage In 1996 acupuncture needles were designated an “accepted medical instrument” which both recognized acupuncture as a form of medicine, and laid the basis for insurance companies to start covering acupuncture treatments. In the last several years that’s just what is happening, as an increasing number of insurance companies are paying for acupuncture.

The medical community in the US is also becoming increasingly open to acupuncture. Doctors can do a several week training to learn the basics of acupuncture to incorporate it into their practice. This is good and bad. On the one hand it’s good MDs are learning about the Chinese system of health. On the other, they are learning it at a very basic level. Basically, if the patient has knee pain, use these points. They thus avoid learning all the complex theory which would lead one to choose those points. It is still a positive development to have doctors incorporate acupuncture into their practices.

In addition, hospitals sometimes now have acupuncturists on staff to treat patients. As an intern I worked at a hospital alongside MDs. We were very busy, treating patients that the Doctors believed that Western medicine was inadequate for, mostly patients with chronic pain. It was a great experience, in which doctors actually deferred to me, an acupuncturist, in diagnosing and treating patients. We had a great deal of success working in this hospital, and hopefully there will be more of this in the future.

Community Based Acupuncture An exciting recent development in the US is something called Community Based Acupuncture. The motivation behind Community Based Acupuncture is to make acupuncture accessible to more people. From this perspective, acupuncture in the US is too exclusive because it costs so

much. A typical acupuncture session in the US runs between $60 – $100 dollars. Many people can’t afford that, and the price also makes it difficult to get the type of regular treatment that acupuncture requires. Here in China one typically goes for acupuncture every day, or every other day until the problem begins to resolve, then you can start going less frequently. In the US, frequent treatment is more often once a week, sometimes twice. The price makes getting treatment more often prohibitive. In community based clinics, the cost is usually $15 to $45 per treatment, sliding scale.

There is also a critique of the isolation of the treatment process in the US, in which patients are brought into a room by themselves. In contrast to this, people who come to a community based clinic are treated in one large room, together, the way acupuncture is practiced here. The idea is to create an environment in which people will feel comfortable, and which they can afford. Having the cost cheaper both allows more people without a lot of extra money to come in for treatment, and to come in more often.

There are now several community based acupuncture institutions in Portland and about fifty around the country. There is also an organization of clinics and practitioners called the Community Acupuncture Network.

This development is very important, as a significant percentage of the population in the United States lacks health insurance, and therefore has little to no access to health care, or if they do, the bills haunt them for decades afterwards. By setting up Community Based Acupuncture clinics, affordable health care is being made available, and acupuncture can fill an important need for potentially millions of people. When I return to the US, I plan to work with a Community Based Acupuncture clinic, and eventually open my own clinic.

The emergence of Community Based Acupuncture is very exciting as it points acupuncture in the US in a direction more in line with the way it’s practiced here in China, and also in a way that will make it available as a form of health care to larger numbers of people.

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