Archive for the ‘History’ Category

A comment paper on dry Needling to Board of Physical Therapy, Virginia, From: http://www.townhall.virginia.gov/L/viewcomments.cfm?commentid=47915

Commenter: Mark Seem, PhD, LAc *                                                     12/28/15

Oppose ‘Dry Needling’ by Physical Therapists

I am a licensed Acupuncturist in the States of New York and Maryland for the past three decades and more. I developed a classical Chinese acupuncture approach to integrating acupuncture needling of myofascial pain and related disorders, where release of tight knotted muscles, often called ‘trigger points’ after the work of Dr. Janet Travell. I shared this classical acupuncture technique with her by treating a complex old whiplash syndrome for her Myotherapy traveling companion and friend who was an expert at acupressure to release such trigger points, when Travell taught with Maryland neurologist Robert Gerwin, MD in 1990, who had never seen acupuncture needling of trigger points before, nor had Dr. Travell. He wondered what he was doing lecturing to a group of half acupuncturists, and I asked contrariwise how he felt comfortable teaching physical therapists, who had no required training in the use of such solid filiform needles in their entry-level programs there. He was not able to make the demonstration I did that night for Dr.Travell and her trigger-point bodywork expert colleague as he had a dinner to go to. Whenever I successfully needled in classical Chinese style muscle channel shallow technique, with a 1 inch needle inserted half way into the soft tissue that I had compressed with my non-needling hand as the Japanese often do, easing up now and again to give the deeper muscle room to react, it would twitch often dramatically that was visible to Dr. Travel and me and very palpably experienced by her colleague who even remarked that it felt just like deep trigger point injections done by Dr. Gerwin who directed the training in the Travell  Seminar Series when elderly Dr. Travell was no longer able. Myotherapists ran the parallel training for physical therapists in the manual therapy technique sections of that course, where physicians taught the trigger point  injection techniques. Physical therapists, according to Travell’s instructions, who are licensed to practice ischemic compression that can be almost as effective as trigger point injections, and much less risky than using thick 3-5 inch long syringes, were very pleased with these powerful manual techniques hey are licensed to practice based on the same manuals. Medicare and Medicaid standards for coding for trigger point injections call for coding for a few, or multiple, trigger point injection sites; as well as coding for what medication filled the syringe – usually lidocaine or even cortisone as the case may be, and sometimes homeopathic solutions that medical doctors and their ‘physician extenders’ use as well.

Travell and Simons’ 2 volume seminal text on this practice always provide manual therapy ‘ischemic compression’ technique options, so there is no reason for any well trained physical therapist who takes such a 50-75 hour program practicing on peers to ever need to learn needling techniques, which Travell did not favor ever being taught to other than medical doctors, dentists and osteopathic physicians given the danger of hitting nerves and also important organs when needling over the torso on the front, back or side.

After Dr. Gerwin heard Dr. Travell and her colleague report on the similarity in efficacy of my one acupuncture session to trigger point injection, and he saw the thin short Japanese Serein needles I gave him to check out, he looked for externs and found an osteopathic resident trained in such acupuncture release of trigger points. Subsequently he met and partnered eventually with a physical therapist who claims to have learned such needling with acupuncture needles in the Netherlands where he is from. I taught that technique to physical therapists in the Netherlands who were the main licensed providers, along with physicians in my classical acupuncture seminars for the Anglo-Dutch Institute comprehensive acupuncture and traditional Chinese medicine program, as well as to physical therapists and physicians in rehabilitative medicine in the UK, and they all concurred no one should do acupuncture treatment of such myofascial conditions without proper acupuncture training. They also agreed that ‘dry needling’, which is to say the use of an empty syringe with no medication was nonsensical, even though Dr. Hong, an acupuncturist who like Dr. Gunn went on to become a physical and rehabilitation medicine physician, dropping any reference to that earlier acupuncture training as Dr. Baldrey in the UK, and Dr. Ma in Colorado have done, to cover up their original comprehensive acupuncture training. Hong’s research study had 3 options – actual trigger point injections of lidocaine into myofascial trigger points; injection of saline solution instead; and dry needling with no fluid injected. While no insurance company would ever provide coverage for such dry-needling, Hong was able to show that all 3 techniques worked equally well, with post-injection soreness the mildest as expected in those who received lidocaine, an anesthetic, and greater for those who were injected with cortisone, and the greatest with those injected with a ‘dry’ syringe.

Travell and Simons had already come to the conclusion that the twitching evoked in acute myofascial trigger point conditions was the actual therapeutic mechanism, as the twitching stretched the tight contracted muscle fibers [trigger points] within the sorest part of such muscles, and so stretching created by the injection, accompanied by some soothing fluid, even saline solution, with lidocaine seeming to make that stretching release last the longest, explained the mechanism for such often dramatic relief.

While a more time consuming technique, ischemic compression release which all entry-level physical therapists have learned, allows them to approximate the release from the more risky trigger point injections, at a fraction of the cost of such surgically coded injections. They can also use electro-stimulation techniques on such trigger points conditions with equally good results, and there are even ultra-sound, and laser devices hey are licensed to use.

The only reason physical therapists could possibly have for wanting to use acupuncture needles, then, since they are not at a loss for their own manual therapy techniques and FDA legal regulated devices, is to be able to tell their patients who ask if what they do is as effective as the ever more popular 2000 year old originally Chinese acupuncture, where no potentially harmful medications are ever ‘injected’, making it a primary nonpharmacological therapy among those physical and occupational therapists are licensed to practice, as appeared for pain management conditions in the accreditation manual update of the Joint Commission that accredits some 20,500 mainstream and integrative medicine hospital and integrative medicine outpatient facilities and programs, where acupuncture was also on that list, where physical therapy does not figure, for behavioral healthcare, mood and mental disorders, including psychosomatic and organ functional problems like IBS or Reflux that physical therapists are not trained to treat.

In short, unless the Board would consider it appropriate for licensed acupuncturists to be able to practice all of the licensed manual therapy techniques a trained physical therapist may practice, since we learn our own East Asian acupressure-related techniques, or the same licensed chiropractic and osteopathic manipulations those providers may practice, if we learn far simpler release techniques within our acupuncture scope of practice, without the same level of osteopathic or chiropractic training in their required entry-level well supervised training treating the public that the short trigger point [acupuncture] dry-needling courses may never provide for legal reasons, I submit that the approval for physical therapists to practice using FDA regulated medical devices known as acupuncture needles, for those licensed in acupuncture to use such needles or for licensed surgeons, is irresponsible in the extreme and opens the Pandora’s box for all licensed therapists to start using other licensed therapist’s FDA regulated techniques and devices.

Finally, the high likelihood that the 20,000 licensed acupuncturists in this country will have had enough, and will file a federal class-action suit with the FDA to penalize these poorly trained self-professed trigger point ‘dry-needlers’ [illegal acupuncturists] is high and poses a serious risk for the Board and for each physical therapist the state licenses, where the implicit final determination of entry-level competence in physical therapy does not include national or state training, standards or assessment of any level of competence in such lucrative CEU short courses that are only good for the course owners themselves.

I suspect that passing such a bill will leave licensed acupuncturists no choice but to mount a powerful full disclosure public relations attack on your Board and on any physical therapists who practice such shoddily learned acupuncture techniques without a license in acupuncture. And the door will be open for them to advertise that they practice physical therapy acupuncture and trigger point needling, beating the physical therapists at their own game while legally billing for what physical therapists must be illegally checking off as a manual [rather than intramuscular] therapy, which is another kind of fraud altogether that your Board would do well to investigate.

I thank you for considering these comments based on 38 years teaching, supervising and practicing licensed acupuncture, after what is now a master’s degree accredited 3 year program of some 1906 hours of training minimum, with 500 hours in the practice of acupuncture.


Mark Seem, PhD, LAc.

Founder and Past President, Tri-State College of Acupuncture

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Dr. Gene Bruno: The beginning of the acupuncture profession in the United States (1969–1979) — acupuncture, medical acupuncture and animal acupuncture | PDF |

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摘自:《档案春秋》200503期 作者:顾留馨

















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一九八四年的SB2179 提案規定健保組織(HMO)或自身保險或殘障保險計畫以外的醫療保險計畫,包括非營利醫院等集體性的醫療保險計畫都必需具備供選購的針灸福利。


特別是一九九九年的SB466 和 2001年的SB341,明文界定並擴大中醫師可以使用的行醫手段。例如:可以使用營養物品、草藥以及膳飲輔助食品等,特別註明中醫師在臨床治療中可以處方使用各種植物、動物及礦物產品。除了過去已經取得合法地位的電針療法、艾灸療法與拔罐療法,以及使用東方式按摩(推拿)、呼吸技術(氣功)、醫療體育(太極拳等)等各治療手段等項外,再增加一項磁療法。


 從中醫專業教育課程和執照考試制度的發展歷史也可以清楚看到名義上的「針灸師」 是如何逐步演變成為事實上的「中醫師」的過程:

美國的正規中醫教育開始於七十年代初,基礎比較薄弱。加州的中醫教育一直走在全國的最前列,隨著加州中醫專業地位的不斷提高,(例如:成為完全獨立的專科醫療職業,成為第一線醫務工作者,後來在工傷補償系統中被列為醫師等項進步。)社會對中醫師的學術要求也自然逐步提高,而加州的中醫院校多年來也一直在逐步提高教育程度。教學總學時的要求從七十年代的不足2,000學時,到八十年代的2,348學時,乃至九十年代的3,000學時左右。目前許多院校開始提供博士學位課程 (總學時在4,000學時以上),其質素已經達到國際上中醫專業高等教育的同等水平。





就中醫界內部而言,雖然韓裔和日裔中醫師也都認識到「針灸」一詞在加州有明顯的局限性和誤導性。但是出於他們的民族主義的理念,至今無法接受「中醫」一詞。好在我們的華裔前輩具有寬大的胸懷,並沒有用中國的民族主義來與之對抗。他們用智慧的妥協解決了這個矛盾。大家都同意使用「東方醫學」(ORIENTAL MEDICINE)一詞來表達我們的專業,從而維護了團結,共同推動立法和教育的進步。

八十年代開始的中醫博士學位教育使用的就是DOCTOR OF ORIENTAL MEDICINE或 OMD。雖然ORIENTAL一詞多少隱含有對東方民族的歧見,不過三十多年來各族中醫業者,包括白人業者,對此並未曾提出過非議,這一名稱或頭銜也得到官方或中醫教育系統的接受。多數中醫團體和院校,包括華裔和非華裔的組織或機構,現在都還在延用這個名詞,例如:CAOMA, CSOMA, AAAOM, OCOM, PCOM, ECTOM, NCCAOM, ACAOM, CCAOM等等。目前,在主流媒體、在民間、在中醫院校、特別是在華裔中醫團體的英文文件中一般都直接用CHINESE MEDICINE來代替「東方醫學」,或與東方醫學互換使用。不過在有關中醫針灸的法律文件中正式使用CHINESE MEDICINE 或TCM一詞目前尚無法被其他亞洲族裔所接受。這個問題看來還有待通過世界衛生組織水平的國際協商才有機會最終解決。


其實,中醫正名還有一個更大的關卡,那就是來自西醫公會的阻力,因為他們基本上壟斷了「MEDICINE」一詞,不准其他醫療專業使用。2002年,加州中醫界曾委託趙美心議員提出的AB1943,只不過規定加州官方有關中醫針灸事務的法律文件一律統稱之為「針灸與東方醫學」ACUPUNCTURE AND ORITENTAL MEDICINE,以反映中醫界的實際現狀,卻立即遭到西醫公會的強力反對。此項要求甚至無法通過衛生委員會的初步審議而被刪除。隨後,於2006年中醫界又委託眾議院教育委員會哈福議員提出「成立亞洲醫學局法案」 AB2821,簡單地要求將目前的『針灸局』改稱「亞洲醫學局」BOARD OF ASIAN MEDICINE。然而西醫公會還是堅持不讓中醫界使用「醫學」一詞,提案很快就被封殺。顯然,一個只有碩士水平的專業要爭取「醫學」的名銜,阻力必然是很大的。


經過業界全體同仁近四十年的辛勤耕耘和各族裔中醫針灸組織的共同奮鬥,加州執照針灸師已經升格成為「第一線醫務工作者」(PRIMARY HEALTH CARE PROFESSIONAL),甚至在工傷系統中正式列為「醫師」(PHYSICIAN),可以獨立診治內、外、婦、兒、骨傷各科病患。毫無疑問,我們已經是事實上的中醫師。今天加州的中醫事業已經建立起一套比較完善和相當嚴謹的規章條例、教育體制和考試制度;還得到其他醫療職業者,如西醫、整脊醫、心理醫師等的初步肯定;也在廣大消費者中培育起一定的專業信譽。加州中醫正在逐步納入主流醫療體系。這個成果來之不易,應當十分珍惜。為了保證加州中醫事業可持續地健康發展,我們認為極有必要堅定地保持尚未正名的「加州針灸局」的高度專業性。

中醫藥在美國是外來文化,這個專業的力量現在還相當弱小。因此,中醫界不容分裂,我們必須團結一致。同時,中醫學是一門完整的浩瀚系 統,中醫學不容分割。中醫業者要納入主流社會,還必須尊重西方文化,效法西方教育體制和醫療體制的傳統:先修取博士學位,再考取行醫 執照,然後進一步提高成為專科證書醫師。中醫界在當前的立法問題上,在各族裔 中醫業者和中醫團體還有很大的意見分歧的情況下,我們認為應該繼續協商和溝通,沒有達成共識之前似乎不宜匆忙地強行立法。中醫入 主流,教育是關鍵。我們的當務之急是趁布朗擔任州長的寶貴時機, 加緊再次策劃一個中醫專業教育法案,修改入門標準,規定所有中醫從業人員必須修取博士學位後方可參加執照考試,實 現中醫教育與美國其他醫療專業的教育體制相匹配。如此方有利於中醫正名的推動,而全體中醫師的基本權益也才能得到較為可靠的保障。


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Toy Avenue

Well-respected Chinese herbalist and landowner Toy Wah Hing was born in Sacramento in 1869.(There also are avenues names Wah and Hing.) The family name, however, was Yee. His father was Yee Fung Cheung, a Chinese herbalist who treated Leland Stanford’s wife, Jane, when she was deathly ill. Stanford called him Dr.Hing, and he came to assume that name, said Melvin Hing, a great-grandson of Yee. Toy Wah Hing also too up the name and herbalist trade, but also invested in large tracts of land, including the land from Auburn in Placer County to areas south of the city of Sacramento. His herbal practice sometime ran afoul of authorities  who accused him of possessing morphine, heroin and opium when he was raided in 1920. Nevertheless, his family, including 16 chilren, was the only Chinese family lived in downtown, and he was the first Chinese man in town to own a car. Grandson Melvin Hing remembers going around to collect rents in the 1930s in an “old jalopy”. Toy Wah Hing’s land holdings included an area now know as Woodbine, where in 1915, he plotted out streets named Toy, Wah and Hing. The streets were plotted on a map. They did not appear on the grounds for years. Song, a street named for his wife, was never built. Three other streets were named Yee, Lock and Sam, the herbalist’s  Chinese names…….(until now, only Lock was built, Fan’notes). Toy Wah Hing’s home was at 725 J street.

Carlos Alcala.Sacramento Street Whys: The Whys Guy’s Wise Guide to Sacramento Street names. Big Tomato Press. Sacramento. 2007 page 71-72.

Yee Fung Chung, Sacramento Pioneer.

Yee Fung Chung came to Sacramento during the gold rush. In 1862,Jane Stanford, the wife of Sacramento businessman and California governorLeland Stanford, became sick…..After moving to Virginia City, Noveda, in 1869, he bagan using his second birth name Wah Hing, a name he utilized until returning to Sacramento. The exact date of his return is unknown, but advertisements for his business at 1209 Third Street, under the name of Yee Wah Hing, appeared in 1901, and he opened an office at 725 J street in 1905. His son, Yee Lok Sam, adopted the name T. Wah Hing in about 1897, continueing his father’s business on third street, but he resumed the name Yee Lok Sam in 1910. Yee Lok Sam’s son Henry grew up in the United States and later continued the family tradition of herbal medicine at another office on J street.

William Burg. Sacramento’s K street, where our City was born. The History Press.Charleston.2012.Page 37-38. (03/25/13 searched)

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Dr. Ralph Coan: a hero in establishing acupuncture as a profession in the United States

Journal of Integrative Medicine: Volume 11, 2013   Issue 1


1.         Arthur Yin Fan (McLeanCenter for Complementary and Alternative Medicine, PLC. Vienna, VA22182, USA )

2.         Ziyi Fan (McLeanCenter for Complementary and Alternative Medicine, PLC. Vienna, VA22182, USA )

DOI: 10.3736/jintegrmed2013007 Fan AY, Fan Z. Dr. Ralph Coan: a hero in establishing acupuncture as a profession in the United States. J Integr Med. 2013; 11(1): 39-44. Received July 23, 2012; accepted August 25, 2012. Open-access article copyright ? 2013 Arthur Yin Fan et al. Correspondence: Arthur Yin Fan, PhD, MD, LAc; Tel: +1-703-499-4428; Fax: +1-703-547-8197; E-mail: ArthurFan@ChineseMedicineDoctor.US

Figure 1  A recent photograph of Dr. Ralph Coan This photograph was taken during the interview. He had recently partially recovered from a stroke while also suffering from heart disease.

1 Introduction

Dr. Ralph Coan is not well known to the general public. Originally, we had wanted to interview him as he was the medical director of the first acupuncture center in the United States that opened in the early 1970s[1]. We wanted to know more about that center’s history. Prior to visiting Dr. Coan, we found an article written by Dr. Sherman Cohn that mentioned Dr. Coan. The article noted that Dr. Coan was the founder of the American Association of Acupuncture and Oriental Medicine, which is the national association of acupuncturists and Chinese medicine practitioners in the United States[2]. While interviewing Dr. Coan on February 18, 2012, it became apparent that he truly is a leading light in establishing acupuncture as a profession in the United States.?Dr. Coan is 75 years old and retired several years ago from his busy medical practice in Kensington, Maryland, USA. As he had recently partially recovered from a stroke while also suffering from heart disease, he could not talk much (Figure 1, Dr. Coan was in the interview). To collect further information about him, we also consulted his former colleagues and relatives, and researched articles written about him.


2 An acupuncture believer

“I put an advertisement in the Washington Post stating Looking for a Physician Position. To my surprise, I immediately got a call in the same day. He said, ‘Are you interested in working in an acupuncture clinic? If so, please come.’ I was not familiar with acupuncture before this. However, I had to get a job to support my family after I left the United States Army. At that time, most of the medical doctors (MDs) and politicians did not believe in acupuncture; some media treated acupuncture as a ‘quack’ profession. I started the work with great suspicions. It was at the beginning of 1973.” Dr. Coan recalled 40 years later.

Dr. Coan graduated from the Georgetown University School of Medicine in Washington, D.C. in 1963 as an honors student, had a one-year internship in the University of Chicago Hospitals, and completed his residency at WalterReedArmyHospital in Washington, D.C. He joined the United States Special Army and served at Fort Bragg, North Carolina, in the Canal Zone, Panama, at Lowry Air Force Base, Colorado, and Walter Reed in Washington, D.C. In 1972, Dr. Coan left the Army after serving for eight years due to the end of the Vietnam War. He was one of the three earliest staff physicians, with six Chinese medicine doctors or acupuncturists, to work for the Acupuncture Center of Washington, the first legal acupuncture center in the United States[1]. At that time, Western-trained MDs performed the diagnoses and decided which patients needed acupuncture, and the Chinese medicine doctors would perform acupuncture treatment under the MDs’ supervision. The first MD director of the Center was Dr. Arnold Benson, a New York internist and one of the three founders. Dr. Coan became the second MD director a year later, since Dr. Benson was busy and could not work full-time. As the staff director and co-founder, Dr. Yao Wu Lee recalled that Dr. Coan worked part-time initially, then became a full-time doctor, and at last, served as the MD director, while Dr. Chingpang Lee, a Chinese medicine doctor, served as the office manager.

“I was not sure whether acupuncture was safe and effective, so I wanted to do a little research by myself before I finally decided to work there. I collected the contact information of the first 50 contiguous patients and examined them — the Center had an official copy; I collected by myself secretly. Over approximately two months, I called all of those patients. The results were very encouraging: more than 80% of the patients told me that they got better without any obvious adverse effects. I became a believer, so I decided to work full-time there. I stayed in that Center for approximately 10 years.” Dr. Coan said.

At that time, there were very few acupuncture clinics, and patients came from throughout the United States as well as from many other countries. The Center was immensely popular and had to split into two separate clinics: the Acupuncture Center of Washington and the WashingtonAcupunctureCenter. At their peak popularity, both clinics saw about one thousand patients per day. Within one year, there were thirteen acupuncture clinics open in Washington, D.C., leading it to become a capital of acupuncture. The acupuncture business was so successful that buses full of patients came from New York, New Jersey, and other cities daily to visit the Center[1]. Such scenes and the effectiveness of acupuncture amazed many open-minded MDs like Dr. Coan[2]. However, the booming acupuncture business aroused anxiety and unease within conservative Western style medical institutions and drug manufacturers. In 1974, the Washington, D.C. Board of Medicine gave the Center orders to close acupuncture offices six times. To save the acupuncture profession, as well as the Center, the directors decided to respond. From mid-1974 to the early 1975, they were involved in two lawsuits in the Superior Court of the District of Columbia. The court conducted a serious hearing on acupuncture. Judge Fred Ugast listened to the testimonies of the Washington, D.C. Board of Medicine, the Acupuncture Center of Washington and WashingtonAcupunctureCenter, as well as the public for three months. Dr. Coan was one of the key MDs who attended the hearing and played an important role[2,3].

Dr. Coan remembered very clearly, “One day I was in court. I testified that in Washington, D.C. there were no MDs or dentists trained in acupuncture. It is impossible to get rid of acupuncturists in an acupuncture practice, because they are the experts. Then, Judge Fred Ugast let the doctor who was in charge of the Washington, D.C. Medical Board in. The judge asked him, ‘Dr. Robinson, your regulation wants to limit the right to practice acupuncture to licensed physicians and dentists in Washington, D.C. Do you know how many Western-trained doctors in Washington, D.C. were trained in acupuncture? How many patients need acupuncture everyday?’ The doctor replied, ‘I don’t know.’ Then the judge said, ‘Oh, you can go now.’”

“I predicted that we would win the case. At last, the judge announced that the new Washington, D.C. regulation which wanted to limit the right to practice acupuncture to licensed MDs and dentists is unconstitutional. The rights of physicians to choose proper treatment based on his best judgment, acupuncturists to perform acupuncture, and patients to get professional acupuncture services have been protected. So, acupuncturists could continue to perform acupuncture as long as it is under a MD’s supervision.”

Dr. Coan was a diligent doctor and held at least six qualifications in subspecialties of internal medicine, such as endocrinology and infectious diseases, which is many more than what doctors today may have. He worked with those acupuncturists in his office from 1972 until late 1990s. He said, “I am a believer of acupuncture, although I did not insert any acupuncture needles into any patient. When my family members were sick, I always suggested them to use acupuncture first. Acupuncture works!”

3 A pioneer in acupuncture research

There was very little acupuncture research reported in the 1970s and 1980s, Dr. Coan was one of the pioneers in conducting acupuncture clinical trials. When I mentioned his name to Dr. Lixing Lao, a well-known researcher in acupuncture and Chinese herbology, and a Chinese medicine doctor at the Center for Integrative Medicine of the University of Maryland, he gave Dr. Coan very high praise, “Dr. Coan was an important acupuncture researcher with historical status. His two papers in acupuncture clinical trials on neck pain and low-back pain have been cited by many researchers today.”

In mid-September, 1973, the National Institutes of Health (NIH) held a special workshop for acupuncture scientific study. Dr. Benson and Dr. Coan reported their clinical observation of acupuncture’s effectiveness in 36 cases of rheumatoid arthritis (RA)[4] which was conducted by Dr. Coan.

The presentation at this NIH meeting showed that during the first six weeks after the center was established in December 1972, there were 64 patients with RA who were treated with acupuncture. The first follow-up was conducted three months later. They were able to contact 55 patients, of whom 36 had been given 5 to 24 acupuncture treatments (average 6.6). Of the 36, 25 patients (69%) reported improvement, including less need for pain medications and in some cases, reduction of the nodules which occur on arthritis sufferer’s joints. Of 19 patients who had fewer than 5 treatments, only 5 cases (16%) reported improvement. The second follow-up was conducted six months later, which showed continued improvement by 16 of 27 patients (59%) from the original group. The average age of patients in this study was 55 years, and they had been suffering from RA for an average of 11.5 years.

Many newspapers in the United States reported this news, which encouraged more patients to try acupuncture.

An article entitled The acupuncture treatment of low back pain, a randomized controlled study[5] was reported by Dr. Coan and his colleagues in 1980. The study was conducted within the Acupuncture Center of Washington and Acupuncture Center of Maryland.

Acupuncture treatment was effective for the majority of patients with lower back pain, which was shown by the use of short-term controls and long-term controls, although the latter were not intended in the study design. After acupuncture, there was a 51% pain reduction in the average pain score in the immediate treatment group. The short-term controls and the delayed treatment group showed no reduction in their pain scores at the comparable follow-up period. Later, the patients in the delayed treatment group were also treated by acupuncturists, and 62% of patients reported less pain. When these two treatment groups were compared at 40 weeks with long-term controls (inadequate treatment group), the inadequate treatment group still had the same pain scores, on the average, as when they enrolled in the study. Both treatment groups, on average, had 30% lower pain scores. Furthermore, 58% of patients in the treatment groups felt that they had definitely improved at 40 weeks, while only 11% of the inadequate treatment group felt definite improvement at 40 weeks. There was a significant difference between the groups.

Another article entitled The acupuncture treatment of neck pain, a randomized controlled trial[6] was reported in 1981 by Dr. Coan and his colleagues.

Thirty patients with cervical spine pain syndromes, course of disease 8 years on average, were assigned randomly equally into treatment and control groups. After 12 weeks, 12 of 15 (80%) of the treatment group felt improvement, some dramatically, with a mean 40% reduction of pain score, 54% reduction of pain pills, 68% reduction of pain hours per day and 32% less limitation of activity. Two of 15 (13%) of the control group reported a slight improvement after 12.8 weeks. The control group had a mean 2% worsening of the pain score, 10% reduction in pain pills, no lessening of pain hours and 12% less limitation of activity.

Such study design may be seen as flawed if judged by today’s criteria. However, they were considered impressive by the researchers at that time, especially the studies were the first time in history endorsed by NIH, the United States Food and Drug Administration (FDA), and the American Medical Association (AMA), whichis the main stream medical society. The reports had been documented in the United States Congress in 1979 and was one of key documents used for FDA relabeling acupuncture needle as a medical device from an investigational device in 1994. The later two studies were conducted by local acupuncturists and MDs using their own money, time and labor, with great difficulty, and totally followed the restrict NIH clinical trial rule (control, and random) at that time, which might be the only case in the United States medical research history. Dr. Coan was invited to give lectures throughout the United States. Such studies do therefore have some value. Dr. Coan said, “Acupuncture is a process of a needle piercing the body, to some extent, it is similar to a small operation. As a clinical doctor, I strongly believe it cannot be compared with so-called ‘sham’ acupuncture (which is used as a placebo, mimicking that in medication’s clinical trials; however, it is a real piercing or similar to that). We used the methods of comparing the effectiveness and adverse effects before and after acupuncture in the same patient group, or between the treatment group and waiting-list group. Like an operation, how can we compare the cut of a scalpel with the ‘sham scalpel cut’?”

I agree with him. Indeed, acupuncture is very different from medication; the design of the study should not be the same as the drug model, the so-called “golden criteria”.

4 A key person in establishing acupuncture as a profession in Maryland

“I was an MD who had witnessed so many patients getting better after acupuncture treatment and became an acupuncture believer. In the 1970s, I had strong motivation — I felt that I should do something to push the acupuncture profession forward in the United States. I decided to change something at the local level first. I convinced ten more local acupuncturists, and established a professional organization Acupuncture Association of Washington Metropolitan (AAWM). I was its president for more than 10 years. We met every Saturday morning to share news with each other and discuss the role of the acupuncturists. One day, we met in SuburbanHospital (which was the affiliated hospital of NIH). We were aware that the first quarter of each year is the legislation season in every state, so we decided to remove the obstacle in law for acupuncture in Maryland.” Dr. Coan recalled.

The members of AAWM included local acupuncturists mainly from Hong Kong and Taiwan of China and Korea, such as Grace Wong, In-Su Kim, Hansheng Gu (Hanson Koo) and Sumei Zhang. They met once a month in China Garden Restaurant on Wisconsin Avenue, Bethesda, Maryland. The basic procedure was: ate lunch together (about half hour), and then discussed something new and what needed to be done — like most societies today but we met more often and sometimes held seminars. Maryland was one of the earliest states that allowed acupuncturists to practice acupuncture (Fan notes: similar to the nurses working under the supervision of MD, without license) in the United States in 1973. However, in the early 1980s the Board of Medicine with the conservative Western-trained doctors did not want acupuncturists to have a license and wanted to deprive the acupuncturists’ rights. During 1981 to 1982, Dr. Coan and his colleagues were involved in acupuncture licensing legislation in Maryland.

“At that time, there was a five-person committee representing the Governor and State of Maryland in the hearing. The MD’s representative who attended that hearing was a very, very famous neurosurgeon from JohnHopkinsHospital, a ‘top guy’ in the Western medical field, who did not like acupuncture and tried to block the acupuncture licensing legislation.” Dr. Coan reminisced about the great achievement, “I am a nasty person. I knew him well and I knew he would oppose acupuncture. So I brought three local patients who had surgery from him, which is a secret weapon I used later all the time.” The neurosurgeon told the committee: “acupuncture is just a no-use therapy, especially for neurological issues, such as spinal disc problems that cause back pain and sciatica; only surgery could cure such disorders.” Then it was Dr. Coan’s turn. Dr. Coan brought out patients and asked them, “Do you know that doctor (the neurosurgeon)?” The patients replied, “We were patients of his and had operations from him.” “Did the operations help?” Dr. Coan asked. “No, after the operation, the pain got worse. However, acupuncture stopped the pain.” one of patients replied. The surgeon felt embarrassed and left the hearing immediately. And then Dr. Grace Wong, Dr. Coan’s partner and a well-known acupuncturist, made testimonies for acupuncture. So, acupuncture licensing legislation was passed very smoothly and successfully in Maryland in 1982 [Fan notes: due to the special political environment in Maryland, the Acupuncturist Licensing Act was changed to Acupuncturist Registering Act in 1982. So, the legislation passed in that year was the Acupuncturist Registering Act. The Acupuncturist Licencing Legislation was passed at last in 1994, 12 years later].

“You should understand it is so important to bring patients with you when you try to make testimonies in court and convince people about acupuncture. The patients will give you great support,” Dr. Coan said.

Dr. Lixing Lao once was Dr. Coan’s colleague. He recalled, “I participated in the events of AAWM, because I taught a point-locating class for National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) acupuncture examination preparation for the Tai Sophia Institute in 1986 as a part-time job, while I was a PhD candidate of physiology in the University of Maryland. Tai’s teaching, focusing on five-element acupuncture from England, is very different in content from traditional Chinese medicine (TCM), the main stream of current Chinese medicine. Dr. Yin-sue Kim attended that class and invited me to participate in Dr. Coan’s monthly events. I actually joined them in 1987. One day, we got interest to start an acupuncture school with focus on TCM in Maryland. So, several people became involved in this topic. After the normal meeting completed and other acupuncturists left, we discussed the school issue. The school was started in late 1991, and the first class was in 1992.”

The school was called the Acupuncture School of Maryland, and later, Maryland Institute of Traditional Chinese Medicine (MITCM). After eight years of preparation, the school was initially started in a Catholic elementary school where it held lectures in the evening. After several years, it moved into a professional building in Bethesda, Maryland, which was very close to a metro station, and had all lectures during normal hours. “I was the founder and the first president of the school, and ran the school by myself for two years. My daughter worked there as a secretary.” Dr. Coan said. According to Dr. Lao, Dr. Coan spent a lot of energy, time, and even his own money for the school. Before the school could become financially independent, Dr. Coan lent his money to the school for support. The teachers at the school, mostly from mainland China and well-trained in TCM, included Drs. Lixing Lao, Jingyuan Gao, Eugene Zhang, and more. “Dr. Lao and Dr. Gao were fantastic teachers and scholars, when I was the president there, I attended their lectures for two years. I should give them my heartfelt praise,” Dr. Coan said. The first graduates were twelve students in December 17, 1994. MITCM was very sound in its academic and financial condition. It was a prestigious TCM school on the east coast. However, it closed at the end of 2002.

During the 1980s to 1990s, Drs. Coan, Wong, Lao and Bob Duggan (the founder of Tai Sophia Institute) worked as the main board members in the Acupuncture Board of Maryland for many years. The Board is a state government agency that is in charge of acupuncture licensing and administrates acupuncturists’ practice.

5 The founder of the American Association of Acupuncture and Oriental Medicine

Almost ten years passed from the opening of the first acupuncture center of the United States in 1972. In more and more states, such as Nevada, Maryland and Massachusetts, acupuncture legislation got passed. More and more patients considered acupuncture as an option, and more and more students studied acupuncture and Oriental medicine in the United States and became acupuncturists. These led to the birth of a national organization for the acupuncture profession[2].

Dr. Coan and Louis Gasper, PhD, were co-founders of the American Association of Acupuncture and Oriental Medicine (AAAOM). Dr. Gasper, who died in 2004, was a professor at Los AngelesInternationalUniversity. They sent letters nationally to invite people to attend the first AAAOM meeting at the Los AngelesInternationalUniversity on June 27, 1981. Neither Dr. Coan nor Dr. Gasper practiced acupuncture; however, they are acupuncture believers. The 75 attendees included MDs and dentists who used acupuncture, acupuncturists (non-MDs), and MDs who did not use acupuncture themselves but supervised acupuncturists, like Dr. Coan, as well as friends of acupuncture or those with interest in acupuncture, like Dr. Gasper. The first board was elected at that meeting, and consisted of seven members: two MDs, four acupuncturists, and another doctor without indicating designation. Dr. Coan served as the treasurer. At that time, MDs were the largest groups represented at that meeting. The second AAAOM meeting, held at the Del Coronado Hotel in San Diego in March, 1982, had a much higher attendance than the first. Most of attendees were acupuncture and Oriental medicine (AOM) practitioners. In the third AAAOM meeting, held at the Shoreham Hotel in Washington, D.C. in May, 1983, non-MD AOM practitioners strongly protested MD members’ intentional delay of AOM development, tension between the MD acupuncturists or supervisors, and the non-MD practitioners surfaced without resolution, resulting in all of the MD members walking out of AAAOM except for Dr. Coan. In that difficult time, Dr. Coan was elected as the new president of the AAAOM, which just became AOM practitioners’ own organization. “I was president of the second board and then vice-president of AAAOM for over ten years. During those years, I helped thirteen states finalize acupuncture legislations,” Dr. Coan said.

“I gave testimonies in person in twelve states’ hearings for acupuncture legislation, gave testimony over the phone for Alaska (I did not go there, it is too far),” Dr. Coan said. He wrote the name of thirteen states for us on a paper with his hand, slight-shaking due to the stroke: Alaska, Delaware, Maryland, Missouri, New Hampshire, New Jersey, New York, North Carolina, Rhode Island, Utah, Vermont, Virginia, and Washington, D.C.

“In Utah, there were twelve MDs who were strongly against acupuncture that attended the acupuncture legislation hearing. A representative of the AMA came too. The side that is in favor of acupuncture had only two people in attendance: one acupuncturist and me. The MDs tried to make the law to block all non-MD acupuncturists to perform acupuncture. The reason is that such non-MD acupuncturists had not had the appropriate medical education as MDs. I asked, ‘In your MDs’ clinics, there are nurses who use needles. How many years were these nurses required to study in Nurse Schools?’ They replied, ‘Three years.’ ‘Acupuncturists have education and training for four to six years, longer than the nurses. If the nurses have right to use needles, acupuncturists should be overqualified to use the needles under the supervision of a MD.’ I protested. And then, a MD stood up and said, ‘acupuncture is not useful to treat carcinoma. Acupuncture will cause carcinoma patients delay in getting the right treatments. So, acupuncture will harm patients.’ I stood behind the sponsor who wanted to introduce the acupuncture legislation and gave him the reply of our side. He responded according to my words, ‘Okay, you said acupuncture harms patients. Could you call your clinic and let your secretary use expedited mail to mail me a real medical record which indicates that acupuncture harmed your patients by tomorrow? I will pay the shipping fee.’ The doctor could say nothing. So we won the hearing, and acupuncture legislation passed.” Dr. Coan smiled, “Acupuncturists should remember, never say you could treat cancer (by acupuncture only, although you may help such patients to some extent). In the hearings, the MDs always used this as an example to block acupuncture legislations.”?Regarding Vermont, Dr. Coan said, “During the hearing there were also only two people in favor of acupuncture: a local acupuncturist and me. We won. The weather there that year was extremely cold, and this lady (the acupuncturist) had no money to pay for a hotel for me. So, I stayed in her house, without any heating, for one night. I used ten cotton blankets. That is an unforgettable experience.”

“In 1988 in Virginia, there were five surgeons in attendance who tried to block legislation which allows acupuncturists to practice acupuncture; I went there with In-Su Kim, a Korean acupuncturist, to fight with them,” Dr. Coan recalled. According to a report from a newspaper[7], at that time in VirginiaState, the law made by MDs only allowed licensed MDs to practice acupuncture. Such MDs only had 100 hours of study and 100 hours of practice in acupuncture training. The acupuncturists, mostly with 4 to 6 years extensive training, could not practice acupuncture. Dr. Coan protested in the statehouse, “This law is unjust, unfair, and immoral.”

Per the arrangement of Dr. Coan, on June 22, 1979, George Brown, Jr., an acupuncture skeptic, had acupuncture during a hearing in Congress of the United States. Dr. Grace Wong, Dr. Coan’s partner, did acupuncture on him for smoking cessation; it was very successful. At that time, Brown was the Chairman of the House Science, Research, and Technology subcommittee. It was a breaking news, reported in many newspapers[8].

As another pioneer in the acupuncture profession, Dr. Finando, commented on Dr. Coan[9], “He campaigned and lobbied anywhere and everywhere to lobby for acupuncture.” Not only did he campaign and lobby for acupuncture anywhere and everywhere, his mother influenced by him, also became a volunteer lobbyist for acupuncture.

It is true that Dr. Coan is a great hero of the acupuncture profession, even though he did not insert an acupuncture needle in any patient. He is an MD, but he has contributed his dedication and whole life to support and promotion of acupuncture; all of this as a volunteer.

6 Acknowledgements

The authors would like to thank Dr. Lixing Lao, Dr. Yick-chong Chan, Dr. Sherman Cohn, Ms. Judy Coan-Stevens and Mr. John Coan who provided some detail information about Dr. Ralph Coan, and Ms. April Enriquez for English editing. The interviewer was Dr. Arthur Yin Fan.

7 Competing interests

The authors declare that they have no competing interests.


1.         Fan AY. The first acupuncture center in the United States: an interview with Dr. Yao Wu Lee, WashingtonAcupunctureCenter[J] J Chin Integr Med, 2012, 10(5) : 481-492.

2.         Cohn S. Acupuncture, 1965-85: birth of a new organized profession in the United States (pt. 2). Am Acupuncturist. 2011; Spring: 22-25, 29.

3.         Superior Court of the District of Columbia Civil Division. Civil action No. 11005-74. Urie, Coan v. Washington. cited by the records: Lewis v. District of Colombia Court of Appeals (1978). [2012-06-26]. http://www.tx.findacase.com/research/wfrmDocViewer.aspx/xq/fal.19780427-0003.dc.htm/qx.

4.         Sawislak AB (UPI). Two-third of 36 patients treated with acupuncture had pain relief. Williamson Daily News, 1973-09-20 (15).

5.         Coan RM, Wong G, Ku SL, Chan YC, Wang L, Ozer FT, Coan PL. The acupuncture treatment of low back pain: a randomized controlled study[J]. Am J Chin Med, 1980, 8(1-2) : 181-189.

6.         Coan RM, Wong G, Coan PL. The acupuncture treatment of neck pain: a randomized controlled study[J]. Am J Chin Med, 1981, 9(4) : 326-332.

7.         Criticism of acupuncture laws called racist by Asian groups. Afro-American. 1988-08-16(3C). [2012-06-26]. http://news.google.com/newspapers?id=LEpAAAAAIBAJ&sjid=WvUFAAAAIBAJ&pg=2980,674502&dq=ralph+coan+in+su+kim&hl=en.

8.         How to prevent mildew. The Spokesman Review. 1979-06-23(10). [2012-06-26]. http://news.google.com/newspapers?id=yeURAAAAIBAJ&sjid=Ie4DAAAAIBAJ&pg=5438,3626027&dq=wong+grace+acupuncture&hl=en.

9.         Finando S. AOM pioneers and leaders 1982-2007, a commemorative book of challenge and courage. Vol. 1. AAAOM, NCCAOM, CCAOM & ACAOM. 2007: 29-32. [2012-06-26]. http://www.aaaomonline.info/docs/pioneers_and_leaders_vol1.pdf.

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只能称针灸师 美国加州业者推立法为中医师正名

2012年09月10日 10:48 来源:中国新闻网  http://www.chinanews.com/hr/2012/09-10/4171203.shtml

  中新网9月10日电 据美国《世界日报》报道,美国加州中医界将州参、众议会通过的SB628法案视为一大胜利,在该法案下,拥有博士(Dr.)学位的合格针灸师可改称为针灸医师。中医界表示,他们下一步是推动“中医师”头衔,中医师在美国一直以针灸师名义行医。








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