Contemporary Chinese Medicine and Acupuncture

437 Pages·2002·11.89 MB·English

by  Claire Monod Cassidy

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JOHNJ. B.ALLEN, PhD SUSAN CUSHING, LAc
AssistantProfessor AsariAcupunctureClinic
DepartmentofPsychology Reedsburg,Wisconsin
UniversityofArizona
Tucson,Arizona DAVID L. DIEHL,MD, FACP
ClinicalAssociate ProfessorofMedicine
W.JUMBE ALLEN, LAc DepartmentofMedicine
Private Practice DivisionofGastroenterology
Oakland,California NYUSchoolofMedicine
NewYork,NewYork
STEPHEN BIRCH, PhD, LAc (USA), FNAAOM
President PETERECKMAN, MD, PhD,MAc (UK), FNAAOM
Stichting(Foundation) forthe Studyof Private Practice
TraditionalAsianMedicine(STEAM) San Francisco,California
Amsterdam,The Netherlands
JEAN EDELEN
JUNE BRAZIL, DiplAc, PDM, LAc, FNAAOM ManagementConsultant
Deceased FreelanceWriter
Alexandria,Virginia
ZOE BRENNER, MAc, LAc, DiplAc, Dipl CH,
FNAAOM MITRA C. EMAD, PhD
Faculty AssistantProfessor
TraditionalAcupunctureInstitute CulturalStudiesProgram,Department
Columbia,Maryland ofSociology/Anthropology
UniversityofMinnesota-Duluth
JAMES C. BUTLER-ARKOW, MA, DiplAc, LAc Duluth,Minnesota
Private Practice
Arlington,Virginia ROBERT L. FELT, BA
Publisher
BRYN CLARK, MAc, LAc, DiplAc, Dipl CH, CMT, ParadigmPublications
FNAAOM Brookline,Massachusetts
Faculty, Herb Program
Academyfor FiveElementAcupuncture JINGYUN GAO, BS, OMD, LAc
Halendale,Florida; Chairperson
Herb Program DepartmentofAcupuncture
TraditionalAcupunctureInstitute MarylandInstituteofTraditionalChineseMedicine
Columbia,Maryland; Bethesda,Maryland;
Secretary,Associationfor ProfessionalAcupuncture Private Practice
Philadelphia,Pennsylvania Washington,DC
v
VI Contributors
ALISON GOULD, MSc PAULETTE McMILLAN, LAc, Dipl Ac, Dipl CH,
NorthernCollegeofAcupuncture RD,LN
York,England Faculty
UnitedKingdom MarylandInstituteofTraditionalChineseMedicine;
CenterforAcupunctureandComplementaryHealing
JANE A. GRISSMER, MAc Bethesda,Maryland
SeniorFaculty
TaiSophiaInstitute BARBARA B.MITCHELL,JD, LAc
Columbia,Maryland; ExecutiveDirector
Director, AcupunctureandOrientalMedicineAlliance;
Crossings: ACenterfor the HealingTraditions Co-Chair,
TakomaPark, Maryland NorthAmericanCouncilofAcupunctureandOriental
Medicine
RICHARD HAMMERSCHLAG, PhD Olalla,Washington
Research Director
OregonCollegeofOrientalMedicine MARGARETA. NAESER, PhD, LAc, DiplAc
Portland,Oregon Neuroimaging/AphasiaResearch
VABostonHealthcareSystem;
MARTHA HARE, PhD Research ProfessorofNeurology
SeniorHealthResearch Scientist BostonUniversitySchoolofMedicine
Centersfor Public HealthResearch andEvaluation Boston,Massachusetts
BattelleMemorialInstitute
Arlington,Virginia MICHAELA. PHILLIPS,MAc, LAc
Faculty
PAULETTE C. HILL, MD, MPH, MAc TraditionalAcupunctureInstitute
PrimaryCarePhysicianandAcupuncturist Columbia,Maryland
Sinai HospitalAddictionandRecoveryProgram
Baltimore,Maryland ROSA N. SCHNYER, DiplAc, LAc
SeniorResearchAssociate
LONNYS.JARRETT, MAc, LAc, FNAAOM DepartmentofPsychology
PrivatePractice UniversityofArizona
Spiritpasspress.com Tucson,Arizona
Stockbridge,Massachusetts
MICHAELO. SMITH, MD, DrAc
KIM A.JOBST, MB, BS, MA, DM, MFHom, MRCP Director
ConsultantPhysicianandMedical Homeopath LincolnHospitalRecoveryCenter
Visiting ProfessorofHealthcareandIntegratedMedicine Bronx,NewYork;
OxfordBrooks University AssistantClinicalProfessor
Oxford, England DepartmentofPsychiatry
UnitedKingdom CornellMedicalCollege
NewYork,NewYork
CAROL KARl, RN, MAc, LAc
TraditionalAcupuncture VALENTINTUREANU, MD
Bethesda,Maryland Obstetrician/Gynecologist
Toronto,Ontario
DAN KENNER, PhD, LAc
BoardofDirectors LUMINITATUREANU, MD
MeijiCollegeofOrientalMedicine Obstetrician/Gynecologist
Berkeley,California Toronto,Ontario
HAIYANG LI, LAc, OMD
Faculty
MarylandInstituteofTraditionalChineseMedicine
Bethesda,Maryland
Contributors Vll
TAO WANG, BM, PhD, LAc GRANT ZHANG
Manager,Clinical Development AssistantProfessor
OtsukaAmericanPharmaceutical,Inc ComplementaryMedicineProgram
Rockville,Maryland; UniversityofMarylandSchoolofMedicine
Clinical Faculty Baltimore,Maryland;
MarylandInstituteofTraditionalChineseMedicine Faculty
Bethesda,Maryland MarylandInstituteofTraditionalChineseMedicine
Bethesda,Maryland
Tothememoryofmyparents
HeleneLucileMonod
FredericGomesCassidy
andtoJohnandJulie
PS Don'tforgettoSMILE:)
"Fromwonderintowonder, existenceopens"
lAoTzu
7: heaimofthis Seriesisto provideclearand ra and Europe. Each topic is presented in ways that are
tional guidesfor healthcare professionalsand understandable and that provide an importantunder
studentssotheyhavecurrentknowledgeabout: standingofthe intellectualfoundationsofeachsystem
• Therapeutic medical systems currentlylabeled as withtranslationbetweenthecomplementaryandcon
complementarymedicine ventional medical systems where possible. These
• Complementary approaches to specific medical explanationsdrawappropriatelyonthesocialandsci
conditions entificfoundations ofeach systemofcare.
• Integrationofcomplementarytherapyintomain Rapidlygrowingcontemporaryresearchresultsare
streammedicalpractice also includedwherepossible.In additionto providing
Each text iswritten specificallywith the needs and evidence indicatingwhere complementarymedicines
questionsofahealthcareaudienceinmind.Where pos may be oftherapeutic benefit, guidance is also pro
sible,basicapplicationsinclinical practiceareexplored. vided about when complementary therapies should
Complementary medicine is being rapidly inte notbe used.
gratedintomainstreamhealthcarelargelyin response This field ofhealth is rapidly movingfrom being
to consumerdemand,aswellasin recognitionofnew considered alternative(implying exclusive use ofone
scientific findings that are expanding our view of medicalsystem oranother) to complementary(usedas
healthandhealing-pushingagainst thelimitsofthe an adjunct to mainstream medical care) to integrative
currentbiomedicalparadigm. medicine(implyingan active,consciouseffortbymain
Healthcare professionalsneedto knowwhattheir streammedicineto incorporatealternativesonthe ba
patients are doing andwhat theybelieve about com sis ofrational clinical andscientificinformation and
plementaryand alternative medicine. In addition, a judgment).
basic working knowledge ofcomplementarymedical Likewise, health care professionals and students
therapiesisarapidlygrowingrequirementfor primary mustmove rapidlyto learnthefundamentalsofcom
care,somebiomedicalspecialties,andthealliedhealth plementary medical systems in order to better serve
professions.Theseapproachesalso expandourviewof theirpatients'needs,protectthepublichealth,andex
the artandscience ofmedicine and make important pand theirscientifichorizons and understandings of
contributions to the intellectual formation ofstu healthandhealing.
dentsin health professions.
ThisSeries providesasurveyofthefundamentals MARC S. MICOZZI
and foundations ofcomplementary medical systems Philadelphia,Pennsylvania
currentlyavailable and practiced in North America 1997
xi
~ raditional medicine ofChinacan be thought ancient Chinese medicine might be consideredquite
ofasanempiricaltraditionofsystematiccor complementary.
respondences that make reference to fivecos In theoreticalterms,wehavemanychoicesin heal
mic elementsandextendbackto approximately3000 ing. In practical terms, the sheer cost, size, scale, and
BCE. Forcomparative purposes, Chinese medicine is complexityofthehealthcare systemled to its regula
oftenviewed asahomogeneousmonolithicstructure; tion by "third parties," such as the governmentand
however, this view neglects the changing interpreta the insurance industry. The introduction of"third
tionsofbasicparadigmsofferedbyChinesemedicine parties" into the traditional doctor-patient relation
through the ages and the synchronic pluralityofdif ship indirectlyordirectly (as in Oregon) leads to ra
feringopinionsandideasoverthousandsofyears. tioningofhealth care. So thesuccess ofbiomedicine
Chinesemedicinepresentsotheroptionsfor heal has ultimatelycontributed to health care rationing.
ing with a wide spectrum ofalternative therapeutic MostAmericansdo notwantto seenecessitiessuchas
modalities.WemightcompareChinesemedicinewith foodandmedicine rationed.
the following characteristics ofcontemporaryWest In China,far fewer resourcesare devotedto health
ernbiomedicine: care.Therehas beenarecentrelianceonthe"barefoot
1. Materialist focus on the body in a mechanical doctor" in anattempt to address the minimal health
modelvsenergeticmodel care needs ofthe people in the Peoples' Republic of
2. Emphasis on the physical body vs nonphysical China.MuchofwhatthetraditionalChinesemedical
realmsofhealing practitionerdoes is thought to influence the flow or
3. Focus onthe disease (or diseaseagent) vsthe per balance ofthe body's energycalled "Qi." In myview,
son("Ieterrain"orhost) the Chinese concept ofQi, which is translatedas en
4. Taxonomyondisease typesvstypesofhealing ergy,bioenergy,orvitalenergy, has ametabolicquality
S. Perception of high technology as having more becausetheChinesecharacterfor Qi maybedescribed
healingpower as vapororsteam risingover rice.The term rice has a
6. Representsthemostinvasive therapiesontheheal specific qualitythatweassociate withaspecificfood,
ingspectrum butit also has thegenericmeaningof"food"orfood
7. Emphasisonacute,trauma,andend-of-lifecarevs stuff. Forexample, thecharacter"rice hall"isused to
wellnessandprevention describearestaurantin Chinese.Theelusive meaning
8. Highcost ofQi may thereforebelikenedmoreto livingmetabo
The sheer powerofmodern biomedicine can be lism (the "vital energy" ofthe 19th century) than to
overwhelming.Althoughwetendto linkthispowerto the energy that we associate todaywith electricityor
theabilityto deliver"comprehensive"care, abalanced electromagneticradiation.
comparison ofsimilarities and differences with Chi Energy or Qi also has the dynamic qualities of
nese medicine reveals that each system maybe more "flow"and"balance."Because flowandbalancearedy
comprehensive than the other, depending on which namic,theymightbedescribedinchangingtermsfrom
domain ofhealingis chosen for comparison. In fact, onepatientto thenextorin thesamepatientfromone
taken as a whole, modern Western biomedicine and day to the next (not using static, fixed pathological
Xill
XIV Series Editor's Preface
diagnostic categories). Such concepts present great work, and how they heal. Formularyapproaches (to
challenges in translationto the biomedicalmodel. acupuncture,herbalism,andhomeopathyforexample)
Acupunctureisamajormodalityforthe manipula may work because theyappear to affect the bodyin
tionofQi.Clinicalobservationsofefficacyareincreas someofthe same waysbothwithinandwithouttheir
ing, and some biomedical explanations focuson the culturalcontents.These formularyapproachesprovide
physiological effectsofskin punctureand/ormodula evidencethatempiricalculturalhealingtraditionsmay
tionofneurotransmittersubstances.Someexperiments have discovered truths about human physiologyand
indicate thattheacupunctureneedlemayhavethesame encodedthemintoculturalbeliefsystems.Chinese civ
effect when it ismerely held in place over the appro ilization, which has made so manydiscoveries in sci
priatepoint (withoutpuncturingthe skin), leadingto ence and technologyover the centuries, surelyholds
bioenergetic explanationsformechanismofaction. promiseforuncoveringsomeofthe stillheld secretsof
Aswelookacrossthe historyandheritageofhealth the artandscienceofmedicine.
andhealing,throughthisbookseries,MedicalGuidesto
Complementary& AlternativeMedicine, it is clear that MARC S. MICOZZI, MD, PhD
healthisnotsolelyaboutagivenmedical systemor tra Philadelphia,Pennsylvania
dition.Itisaboutthe mindandthe body,andhowthey March2001
9 njust30shortyearsChinese, orOriental,med factors such as the lack ofa bioscience theoretical
icine has moved from a rare curiosityin the foundation that could subsume the energetic argu
West to a well-known and widely available ments ofChinese medicine, ofphysiological under
medicine ready for integrationwithbiomedicine,chi standingsofwhatwas"happening" duringacupunc
ropractic, massage therapy, naturopathy, and other ture treatments, and ofresearch designs thatcould
medical practices.This remarkable transformation of accuratelymeasure the effects ofacupuncture,herbs,
attentionandviewpointoriginallyowedmuch to poli tuinamassage, orQigong.The USNationalInstitutes
ticsandeconomicdemand,butafter30yearsit isemi ofHealth(NIH) NationalCenterfor Complementary
nentlyclear thattraditionalChinesemedicalpractices andAlternativeMedicine (previouslythe NIH Office
are clinicallyeffective.This pointissupportedbythe ofAlternativeMedicine formed in 1992), supported
rapidgrowthofthe profession-foraprofessioncannot clinical research onOM from the outset. In the early
grow unless patients demandits services,studentsat 1990saseriesofworkshopssponsoredbythe USFood
tenditsschools, andlegalentitiesmandateitsuse.And andDrugAdministration(FDA)andthe NIHfocused
though scientific research has been running to catch on developingappropriateresearch methodologiesfor
up-researchwasnotoriginallypartofthe tradition-its alternative medicine. Based on data concerning its
results are increasingly providingnotonlystatistical safety and utility, the acupuncture needle was re
supportforclinicaleffectiveness,butbyusingtheener classifiedfrom"experimental"to "medicaldevicesfor
geticinsightsofthe medicine, alsoopeningnewdoors general use" by trained professionals by the FDAin
to understandingthe physiologyofthe humanbody. 1996. In 1997 the NIH hosted'an Acupuncture Con
Consideringhowlittlewaspubliclyknownofthis sensus Conference during which the newest clinical
medicineoutsideofAsiaeven in theearly 1970s, this trials research data was presented. The consensus
growthhas been nothingless thanspectacular.James panel concluded thatacupuncture was effective and
Restonreportedusingacupunctureforanalgesiaafter listedaseriesofconditionsforwhich the best research
surgeryin 1971, sparkingfascination as people real dataexisted. Thesedataandmuch moreare reviewed
ized Chinese medicine offeredat least one avenue of in thistext.
release from the economic pressures associated with Despite this growth, public and medical practi
practicing the highly technological biomedicine. tionerknowledgeofthefieldremains limited.Although
Hungerfor this medicine was acute; by 1975 several manynew textbooksand popularintroductionsexist,
pioneering schools were already training Oriental todate there hasbeen no introductionaimedat health
medicine practitioners in the United States, using careproviders,researchers,andlayreaderswhowantan
teachers trainedmostlyinAsiaorEurope.Today,there in-depth yet nontechnical presentation. Contemporary
are over40accreditedschools,well-developedprofes ChineseMedicineandAcupuncturefillsthis gapandreme
sional and legal support systems, thousands ofpro dies this situation.This bookisscholarly yetreadable,
fessional practitioners, and thousands ofstudents offeringenough detailedinformation to help readers
who spendat least3yearslearningacupuncture,plus appreciate both the complexityand clinical power of
oneor twomoreto learnherbology. Researchinterest Orientalmedicineascurrentlypracticedin theWestby
was high from the outset, butsuccess was slowed by professionalacupuncturistsandherbalists.
xv
Preface
XVl
PartI begins with a review ofOriental medicine nese medicineandthatsome peoplelaboredundera
theoryand interventive modalities. In PartII, actual numberofprejudices. Ihope this bookwill improve
practice is placed in context through discussions of both knowledge and communication among pa
the differingphilosophiesofcare in biomedicineand tients, students, professional health care providers,
Chinese medicine, and practitioners speak through andresearchers.
casehistoriesandbriefautobiographies.Thenin Part
III,thecurrentstateofresearchonacupunctureisre
viewedin multiplechaptersonphysiology, epidemiol ACKNOWI,EDGMENTS
ogy,andclinical care.Thesechaptersincludeanalyses
thatcan guidebothreferringcliniciansandpotential Many people contributed to this book, both actively
researchers. Finally, PartIVoffers anotherapproach and indirectlybytheir inspiration. First, Iwould like
to contextbyexplaininghow Chinesemedicine prac to thankeach ofthe authorsofthe chaptersandside
titioners are trained and howeach US state licenses bars,who spentmanyhoursnotonlyworkingontheir
professional practitioners (with guidance for finding own contributionsbutalso editingthemlaterso that
the laws thatcontrol practice in other parts ofthe theywouldflowsmoothlywithallthe otherchapters.
world). The bookendswithaspecial chapteronrefer To these Isay:wonderfulwork!
ral aimedat health care providers.This briefchapter To my editors, Marc Micozzi, Inta Ozols, Kellie
discussescircumstances underwhich referralislikely Conklin, and Jennifer Watrous, thanks for your
to be helpful and explains how to meet and assess patience and perception! Thanks also to myteachers,
Chinesemedicineprofessionals. from Lao Tzu whose powerful words have guided
Ichoseto presentthiswide rangeoftopics to of untold livesfor more than 2000 years to those ofto
feracompleteimageofpracticeofthisemerging(in day, my fellow Chinese medicine practitioners, who
the West) healthcare system,to demonstrateits high inspiredme to change mycareer.Youare manyin my
levelofprofessionalism,andtosupportwhatIhope heart.
will bean increasinglyinformed, friendly, andeffec Iofferaspecial bow ofacknowledgmentfor their
tiveintegrationofcare amongmedicalsystems.Ide insight and healing ways to Carol Kari and Richard
cided to include not only theory and interventive Hammerschlag. Finally, I thank my parents for mak
modalities(the topicsofmosttexts) butalso dataon ing me and my husbandand daughterfor succoring
practice,research,andlegal mandatewhenit became medayto day.Toeach andallofyou, metaqiesen.
cleartome thatmanypeople,especiallyotherhealth
care practitioners, lacked useful knowledge ofChi- CLAIRE MONOD CASSIDY