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Posts Tagged ‘acupuncture history in the United States’

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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 |

http://www.jcimjournal.com/jim/

June 23, 2015 | Arthur Yin Fan, Sarah Faggert (doi: 10.1016/S2095-4964(15)60186-8)
 | PDF |

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Obama and Dr. Arthur Fan, letter_105723Obama and Dr. Arthur Fan, letter 032015

Click to access S2095-4964(14)60035-2.pdf

Fan AY. “Obamacare” covers fifty-four million Americans for acupuncture as Essential Healthcare Benefit. J Integr Med. 2014; 12(4): 390-393

“Obamacare” is the informal and most-used term for The Patient Protection and Affordable Care Act, also known as the Affordable Care Act (ACA), and is a United States federal statute signed into law by President Barack Obama on March 23, 2010. Together with the Health Care and Education Reconciliation Act, the ACA represents the most significant regulatory overhaul of the United States healthcare system since the passage of Medicare and Medicaid in 1965[1]. This healthcare reform has already begun, with the open enrollment for the first year of the ACA’s healthcare exchange marketplace ending on March 31, 2014. “Obamacare” was enacted with the goals of increasing the quality and affordability of health insurance, lowering the uninsured rate by expanding public and private insurance coverage, and reducing the costs of healthcare for individuals and the government[1]. The ACA introduced a number of mechanisms, such as mandates, subsidies, and insurance exchanges that are meant to increase the coverage and affordability of healthcare. The new healthcare law also requires that insurance companies guarantee coverage for all applicants that fit within new minimum standards and offer the same rates regardless of pre-existing conditions or gender to all applicants. Additional health care reforms are aimed at reducing the cost of healthcare through additional mechanisms such as increasing competition, regulations, and incentives to streamline the delivery of healthcare and move towards a quality-based rather than quantity-based system. The Congressional Budget Office predicts that improved efficiency within the healthcare system, from the new imposed regulations, will help to lower present and future deficits as well as Medicare spending[1,2].  read more at http://www.jcimjournal.com/articles/publishArticles/pdf/S2095-4964(14)60035-2.pdf

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|http://blogs.poz.com/mikebarr/2014/12/bmj_editors_hit_and.html
BMJ Editors Hit–and Hit Hard–Over Careless Interpretation of Acupuncture for Chronic Knee Pain Study (JAMA 10/1/2014)

Let’s start with the conclusion, lest I lose you between here and the end.

Acupuncture is more likely to provide relief for chronic knee pain due to osteoarthritisthan any other modality. Pooled studies (a meta analysis) that compared physical interventions for chronic knee pain showed the following “effect sizes:”

(Electro-) Acupuncture: ES of 0.89
Warm baths: ES 0.65
Exercise: ES 0.55

To put this in perspective, the “Minimum Clinically Important Difference” or minimally significant Effect Size, according to patients suffering from chronic knee pain, is 0.39. And the Effect Size threshold the UK’s National Institute for Health and Care Excellence (NICE) uses to determine reimbursement is 0.50.

Call them acupuncture activists. And really brainy ones.

When an Australian group published (in October 1st JAMA) an impressively large (N=282, but there were 4 groups) clinical trial of 12 weeks of acupuncture for chronic (moderate to severe) knee pain in persons 50 years and older, they concluded no difference between the sham control and actual acupuncture. Editors of the premier acupuncture journal in the world (the BMJ group’s Acupuncture In Medicine), however, cried foul. And lamented the lost opportunity to help millions of chronic knee pain suffers. There were determined to set the record straight.

Their protest and clarification letter to JAMA was summarily rejected.

But guess what? They just happen to have their own journal. (Take that, AMA.) And not one of the enumerable, embarrassing American titles. As noted above, we’re talking The British Medical Journal (Even if the quality of the studies AIM publishes sometimes causes a cringe here and there, the White and his staff are doing the best with what they have to work with.) And so AIM editor and British Medical Acupuncture Society chief Mike Cummings proceeded to publish their quibbles today for inclusion, I imagine, in the January 2015 print edition, and set about to educate folks about how to consider clinically relevant results.

For expediency’s sake, I will extract the key arguments from their brilliantly prepared letter today. Then over the next week or so I will work on paraphrasing and whittling it down.

1. BACKGROUND OF THE CLINICAL PROBLEM. Patients with OA knee pain are suffering the commonest cause of pain and disability in older people. More than half have inadequate pain relief.2 They face a choice between ineffective paracetamol, non-steroidal drugs that can harm the heart, (kidneys) and gastrointestinal tract, gels that scarcely work, physiotherapy, opioids that cause dependency and lose effectiveness, arthroscopic washouts that do nothing or surgery.3 They deserve a fuller, more considered answer to their question: “Is it worth trying acupuncture?”

2. NIFTY DESIGN OF TRIAL. The neat part of the Zelen design that Hinman et al used was that the control group, who were not given acupuncture, were not even aware that their pain scores were used in a trial of acupuncture so disappointment could not influence their scores, as was claimed for other studies. This ‘no acupuncture’ group was compared with acupuncture (manual) and with sham laser (and with real laser, which is not considered here, to keep things simple).

3. WHERE THE ANALYSIS BEGINS TO STUMBLE. The problems started with the trialists’ choice of the threshold minimum clinically important difference (MCID) to estimate sample size. They chose a value based on one chosen by six self-styled ‘expert’ physicians,4 namely a 35% fall in baseline pain score (1.8/sample mean baseline 5.1). This is equivalent to an effect size (ES) of 0.6, calculated using their assumed baseline SD of 30 (the actual SD was 21, giving a higher threshold ES of 0.86). A different figure for MCID was generated by 192 patients with OA, who registered improvement scores as well as changes in pain.5 This showed a more modest MCID, equivalent to an ES of 0.39 (shown in figure 1). The National Institute for Health and Care Excellence (NICE) did not regard any value for MCID as valid6 and chose a generic value of 0.5 (see figure 1). Hinman et al chose a high threshold and also failed to discuss the effect that alternative threshold MCID values would have on the interpretation of their findings. We also note that the MCID for any treatment should be chosen to take account of acceptability, safety and cost-effectiveness,7 which would argue for a lower threshold for acupuncture for knee pain.

4. THE OLD “BETA ERROR” BUGABOO: SHORT ON STATISTICAL POWER. Hinman et alapplied this ‘clinically important’ difference to a ‘clinically irrelevant’ comparison–acupuncture versus sham laser. Sham laser is not an available therapy. The only reason for comparing acupuncture with sham would be to estimate the effects of the needles themselves, but this is already well known from the Cochrane review8 and an individual patient data meta-analysis (figure 1).9 It is known that the effect of needles alone is small, and so is unlikely to be identifiable reliably with sample sizes of less than about 800.10 The sample size in the study by Hinman et al (n=70) clearly appears to be inadequate for the question, according to the existing evidence, and not best use of resources. The resulting ES of acupuncture against sham that was actually found by Hinman is similar to that shown by the best evidence8 (see figure 1), although the wide CI means the data can only be of any importance when they are included in a meta-analysis in the future.

5. WHO DECIDES WHAT TREATMENT EFFECT IS MEANINGFUL? Hinman et al found that, after 12 weeks, knee pain was significantly reduced by acupuncture compared with no acupuncture control, with an ES of 0.6 (data from their table 2; see figure 1). The difference did not quite meet the MCID they had postulated–although the estimated ES is the same size as the MCID–but it more than meets the MCID chosen by patients themselves (ES 0.39) and that selected by NICE (ES 0.5). In interpreting this result, the secondary outcomes should also have been brought into thoughtful consideration: there were significant differences in favour of acupuncture for six out of eight secondary outcomes (see eTable 5 in their paper) and the response rate, which is the most patient-orientated measure of success,7 was 76% in the acupuncture group compared with 32% in the no acupuncture control group.

6. TO MAKE MATTERS WORSE, THE AUSTRALIANS STUDIED THE LEAST EFFECTIVE ACUPUNCTURE TECHNIQUE. Hinman et al did not apply optimal acupuncture. Use of electroacupuncture has been shown superior to manual stimulation for knee pain in 2010.8

A couple of weeks ago, I also came across a study of “needle-less” acupuncture, also for chronic knee pain of the OA variety. Basically it involved warming the knee with these stick on cones of burning mugwort–sort of like (very carefully) burning incense around your knee cap. That too showed clinical effectiveness, although now I am prompted to dig up the original study and see if we can fit that “effect size” into our acupuncture, warm baths, exercise line-up above. Stay tuned.

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Dr. Fan’ s new article was published recently.

GLOBAL VIEWS
Nevada: the first state that fully legalized acupuncture and Chinese medicine in the Unites States — In memory of Arthur Steinberg, Yee Kung Lok and Jim Joyce who made it happen
February 27, 2015 | Arthur Yin Fan | J Integr Med 2015; 13 (2) : 72–79
doi: 10.1016/S2095-4964(15)60158-3
ABSTRACT | FULL TEXT | PDF |

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Title: The earliest acupuncture school of the United States incubated in a Tai Chi Center in Los Angeles
Authors: Arthur Yin Fan
Abstract | Full text | PDF |

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走进美国:美国人的针灸情结

  http://www.voachinese.com/content/wia-20150211/2639359.html
 走进美国:美国人的针灸情结

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The science of oriental medicine (c1902])

eBooks and Texts > California Digital Library > The science of oriental medicine 

https://archive.org/details/scienceoforienta00foowrich

https://archive.org/stream/scienceoforienta00foowrich?ui=embed#mode/2up
fullscreenAuthor: Foo & Wing Herb Company, inc., Los Angeles
Subject: Medicine, Chinese
Publisher: [Los Angeles, Times-Mirror printing and binding house
Possible copyright status: NOT_IN_COPYRIGHT
Language: English
Call number: nrlf_ucb:GLAD-305049
Digitizing sponsor: MSN
Book contributor: University of California Libraries
Collection: cdl; americana

Full catalog record: MARCXML

[Open Library icon]This book has an editable web page on Open Library.

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Title:Curiosity or cure? Chinese medicine and American orientalism in progressive era California and Oregon
Source:Oregon Historical Quarterly. 114.3 (Fall 2013): p265.
Document Type:Essay

Copyright:COPYRIGHT 2013 Oregon Historical Society

Full Text:

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STUDENTS OF OREGON’S HISTORY may be well acquainted with the story of Ing Hay, purveyor of Kam Wah Chung & Co., a Chinese apothecary in the town of John Day. From 1887 to 1948, Kam Wah Chung & Co. served both Chinese and Euro-American patrons hailing from eastern Oregon, southern Washington, and parts of Idaho. Doc Hay–as he was known to patients–diagnosed illnesses, dispensed herbs, and sold sundry goods imported from China. Hay was one of many Chinese doctors who began immigrating to the United States with the first waves of their countrymen during the 1850s. Most Chinese immigrant enclaves had at least one person acting as the community doctor, whether self-taught or formally trained, and their status as merchants protected them from the Chinese Exclusion Act of 1882 that barred immigration by laborers. (1)

Taking a page from Alger Hiss, biographers of Chinese immigrant doctors tend to depict them as men who surmounted anti-Asian racism to become leaders in their communities, respected by their Euro-American neighbors, and financially successful. (2) Recent scholarship by historians Haiming Liu and William M. Bowen, for example, has drawn together disparate local histories of individual practitioners to suggest commonalities in their experiences and the significance of Chinese apothecaries to Asian American history. As Liu summarizes: “By examining the history of herbal medicine in America we learn to appreciate the open, engaged, and cosmopolitan nature of Chinese American life.” (3) Liu and Bowen note that Chinese herbalists tended to be among the best-educated of the immigrants and the most likely to forge ties with Euro-American and other non-Chinese neighbors and patients. As a result, Chinese doctors were often able to avoid the worst of racist exploitation and oppression. Their extraordinary experiences provide the counterpoint to the dominant narrative of anti-Chinese racism and exclusion in United States history. (4)

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Yet a simple triumph-over-adversity narrative does not tell us much about the actual strategies that Chinese doctors deployed to secure allies in a hostile environment and stave off the most energetic campaigns against them during the Progressive Era. Beginning in the 1890s and accelerating during the first decades of the twentieth century, the American Medical Association (AMA) joined forces with state and local governments to drive unlicensed doctors–including Chinese herbalists–out of business. (5) Between 1915 and 1929, Ing Hay was the target of a series of indictments for practicing medicine without a license. (Each time, with the help of sympathetic jurists, the charges were dismissed.) (6) Focusing on California and Oregon, two of the states with the largest Chinese immigrant populations during the late nineteenth and early twentieth centuries, this article examines representations of Chinese medicine during a period of increasing regulatory scrutiny and asks how such representations differentiated “regular” from “irregular” medicine. (7) It argues that Chinese doctors made the practice of irregular medicine a central component of their appeal to white patients. Ironically, then, Chinese doctors found themselves defending their practices in the very language used to attack them.

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The AMA-government partnership to crack down on irregular doctors was, in many ways, a continuation of the AMA’s long-standing mission. Since its founding in 1847, the organization had endeavored to discredit what it deemed unscientific medical practices through various strategies, including penalizing its members for collaborating with irregular doctors. (8) As a private and voluntary association, the AMA had limited coercive power, but the political culture of the Progressive Era, with its impulse toward bureaucracy, created opportunities for the AMA to extend its reach. A widening acceptance for the germ theory of disease, which had yielded advancements for regular doctors in surgery and the containment of infectious diseases, lent justification to the regulatory movement. Beginning in the 1890s, state medical boards composed of AMA-approved physicians administered mandatory licensing exams that focused on recent medical science and pharmacology. At the same time, new laws empowered states and counties to impose fines and jail time on doctors practicing without a license. (9) The 1910 publication of the Carnegie Foundation for the Advancement of Teaching’s Flexner Report, a survey of medical education in America, helped legitimate and galvanize the AMA’s mission to standardize a science-based medical curriculum. The foundation inspected and scored 155 American and Canadian medical schools, both orthodox and unorthodox, reserving the report’s most scathing criticisms for eclectic, homeopathic, and osteopathic institutions. (10) In response, numerous medical schools closed, merged, or reorganized to reduce the number of students and elevate the requirements for admission, training, and graduation. (11)

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AMA physicians pursued an aggressive campaign against irregular doctors because there was so little popular consensus about whether “scientific” medicine was actually superior to other practices. Across the public, faith in science competed with a host of other preferences and fears. Despite real improvements in science-based medicine and surgery, early-twentieth-century patients still associated regular doctors with harsh emetics and risky operations. (12) Irregular doctors tended toward less invasive procedures and often prescribed herbal medicines similar to the homegrown remedies many patients already found familiar. (13) Hay’s Euro-American patients often came to him after their self-fashioned treatments failed. When seeking help for her daughter’s infected finger, for example, Mrs. Fred Deardorff wrote: “I have been using flax seed poultis [sic] and white of egg but without much results.” (14) Another of Hay’s patients, Mrs. M.J. Baker of Burns, Oregon, suffered from a tumor on the left side of her neck. She wrote, beseeching him to treat it with herbs: “I would be so glad if you could reduce that as the dr [sic] are wanting to cut it out and I have such a dread of the knife.” (15) Hay’s patients may have found his approach more regular and familiar, while surgery and other scientific practices were more irregular and scary.

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During the Progressive Era, Chinese doctors became useful subjects for American writers seeking to explain the differences between regular and irregular medicine. By their own admission, Chinese doctors were trained in ancient healing arts that bore little resemblance to modern, scientific medicine. Although health practices in China varied from drug therapy to acupuncture to mystical healing, practitioners in the United States tended to focus on diagnosis by pulse (or pulsology) and herbal remedies. (16) Thus, Chinese medicine became a perfect foil to the AMA-sanctioned scientific medicine.

Descriptions of Chinese medicine drew on American Orientalist ideas and attitudes. American Orientalism was a popular discourse that developed in the context of trade and diplomatic relations between the United States and China over the course of the nineteenth century and that linked unequal power relations between West and East to the presumed racial inferiority of Asian races. American perceptions of Asians as backwards and barbarous, decadent and effeminate, served as justification for exclusionary and discriminatory practices and policies. (17) For white Americans who believed Chinese were racially inferior, it was no stretch to impose the same stereotypes onto Chinese herbal remedies. Attacks on Chinese medicine ridiculed the practice as anti-modern or unscientific and, at best, suited only to serve women’s medical problems.

Yet, American Orientalism’s presumption of Asian racial inferiority went hand-in-hand with an attraction to East Asian arts, material culture, and philosophy. As historian Henry Yu noted in Thinking Orientals, Asians in America “have been both valued and denigrated for what was assumed to be different about them.” (18) While the American elite had a long history of collecting Chinese and Japanese objects and studying eastern religions, by the end of the nineteenth century, the American fascination with “Orientalia” had become a more widespread cultural phenomenon. (19) Chinese and Japanese consumer goods were now available to mass markets through mail-order catalogs and department stores. At the same time, world fairs and travelling shows popularized “Oriental” arts, ideas, and religions. (20)

The contradiction embedded within American Orientalist discourse–that Asian exoticism made the race both inferior and desirable–created an opportunity for Chinese doctors in the United States. For patients who distrusted modern medical science, the doctors realized, Chinese medicine’s perceived otherness could be a mark of superiority to western or regular doctors’ practices. Letters to Hay and other Chinese herbalists from non-Chinese patients often reflected the hope that their remedies might succeed where non-Chinese doctors had failed. (21) It thus could be advantageous for Chinese doctors to adopt the discourse of American Orientalism and use it to their advantage. Uncertainties about modern medical science and American Orientalist attitudes formed both the basis of attacks on Chinese medicine as well as its defense.

Portrayals of Chinese medicine by non-Chinese writers did double duty. They were, at the surface, studies of an exotic culture, and they reinforced racist assumptions about Chinese immigrants. More fundamentally, they reflected anxieties and uncertainties, particularly about modern medical science. An 1869 Overland Monthly article, “Medical Art in the Chinese Quarter,” introduced Chinese medicine to readers so as to instruct them in the very latest in regular medical science. Written by Rev. A.W. Loomis, a former missionary to China and frequent contributor to the magazine on matters related to Chinese immigrant life and culture in San Francisco, the article described Chinese medicine as based more in mysticism than scientific evidence:

So much study by so many learned men on one subject; so many thousands–yea, millions–of life-times spent in this study since the days of Noah until now, it might reasonably be supposed ought to have brought this science in China to a high state of perfection; but such is not the fact … There still remains a higher veneration for ancient than for modern discoveries, and the more smoky, thumb-worn, and worm-eaten a doctor’s library appears, the more reverence, other things being equal, will usually be accorded to his opinions.

According to Loomis, superstition prevented Chinese doctors from acquiring knowledge of anatomy or chemistry. Internal organs, nerves, and vessels, the author claimed, were “terra incognita” to doctors whose veneration for the intact human body prevented them from dissecting even post-mortem. Loomis described the Chinese theory of anatomical correspondences and channels well enough to explain the basis of pulsology, but he summarily dismissed the practice as insufficient for diagnosis: “None but quacks … pretend to trust entirely to the pulse. “Disparaging pulsology provided an opportunity for Loomis to educate readers on modern medical diagnosis: “The regular faculty speak of four methods by which the diagnosis must be obtained, viz.: 1st. By observation … 2d. By hearing … 3d. By questions … and 4th. The pulse. “Loomis concluded his expose of Chinese medical arts by cautioning readers against forsaking “the new theories and freshly discovered medicines of the young nations of the West, for the theories which wise men of the East in the ages long ago invented.” (22) Even Chinese immigrants to San Francisco, he claimed, once introduced to the “American” science of medicine, preferred regular doctors for treatment.

Although other late-nineteenth-century accounts did not make such overt comparisons with regular medicine, they repeated the notion that Chinese medicine was more a curiosity than a science. The intent may have been to entertain a non-Chinese audience of readers, but the effect was to emphasize the arcane and exotic, reinforcing American Orientalist attitudes. The apothecary, with its jumble of jars containing mysterious ingredients, featured prominently in late-nineteenth-century travel accounts to Chinese ethnic enclaves. The Chinese formulary was especially interesting to writers touring Chinatown in the late nineteenth century.

In 1875, Lippincott’s Magazine published a description of Chinese medicine in San Francisco as part of a “stroll” through Chinatown. The author, J.W. Ames, professed no special knowledge of Chinese culture and engaged a policeman to escort him through the darker byways, into restaurants, opium dens, and the apothecary of famed physician Li Po Tai. Ames seemed at first taken aback by the banality of the shop’s appearance, which looked to him like any other drugstore with its drawers and jars, but once the policeman opened a drawer for Ames’s inspection, the difference was apparent: “[The drawer] is divided into four equal compartments, one containing partially charred bones of lions and tigers; another dried bugs … a third, some lentil-like seeds; and the fourth, small fragments of bark.” The presumptuous officer continued opening drawers with no indicated permission from the shopkeeper while Ames marveled at their contents: rhinoceros-horn shavings, elephant’s skin, “and the gallipots–quaint little earthen vessels with red labels in character–contain such sovereign remedies as alligator’s gall, ass’s glue, the flesh of dogs, and many other specifics that a scientific mind alone could appreciate. “Later, gazing upon medical charts of the human body with bemusement, Ames remarked on the visual depiction of the Chinese theory of channels: “something not greatly unlike viscera were plentifully arranged in regular rows of parallels and generously piled up almost to the chin. For such an internal economy no doubt the mixed tigers’ bones and tumblebugs are tonic and effectual. “He also noted the work of Tai’s apprentice, “naked to the waist … compounding some witch’s brew. “Ames reported that he left the shop, not with courteous thanks, but with a cry of terror: “We closed the door with a bang and ran howling to the open air.” (23)

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The fascination with the Chinese formulary continued into the early twentieth century. In 1903, when the San Francisco Chronicle shadowed Hop Lee as he hunted for and processed horned toads for his pharmacy, the reporter described the interior of a “typical” Chinese druggist: “If one takes the trouble or has the impertinence to peek into the shanties in the Chinese quarters of either San Francisco or Los Angeles, he will invariably discover what at first glance appears to be a collection of preserved fruit, but which on closer inspection proves to be canned toads, centipedes, rattlesnakes, worms, scorpions, and bugs.” (24) In 1907, the Los Angeles Times cautioned its readers: “Those who make wry faces at swallowing a blue mass or castor oil may find relief in knowing what the sick Chinaman swallows.” The reporter went on to list Chinese materia medica derived from minerals, vegetables, animals, and even the human body. (25)

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Articles about Chinese doctors often dwelled on their perceived connection to a criminal underworld. Real and imagined connections between Chinese herbs and death-by-poisoning made for exciting newspaper copy and confirmed stereotypes that associated Chinese with barbarity. In 1883, the New York Times published an article on a “Coroners’ Manual” that outlined Chinese methods of murder and suicide by poison: “The commonest poisons are said to be opium, arsenic, and certain noxious essences derived from herbs. But besides these other things are taken by suicides and given by murderers to cause death.” The article went on to describe a special “Golden Silkworm … reared by miscreants” in the southern provinces and the preferred method of suicide among wealthy Chinese men–swallowing gold or silver to effect suffocation or internal bleeding. (26) San Francisco’s Daily Call attributed the murder of Chinatown doctor Ng See Poy to so-called “Chinese highbinders,” a secret society of Chinese American assassins, blackmailers, and assorted criminals. (27)

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Reports of unpalatable ingredients and dubious morality did not seem to diminish the popularity of Chinese medicine, which continued to attract Euro-American patients, much to the consternation of its critics. How could something so barbaric, so retrograde, appeal to civilized Americans? English-language newspapers found their answer in American Orientalist stereotypes: If Chinese doctors were innately deviant, so must be their patients. When Louis Potter, a prominent New York sculptor, died in Seattle in 1912, the coroner identified the culprit as poison extracted from peach trees and prescribed by a Chinese doctor. Articles about Potter’s death lingered over the “mystical” details of Chinese medicine. “Potter,” the reporter lamented, “apparently had great faith in his oriental physician.” The article went on to describe the state of the body: “Dr. Snyder [the coroner] said that in addition to the abrasions of the skin into which the oriental herbs were rubbed and a strong plaster applied, Potter apparently had been taking a strong medicine. … Six large bottles of the black fluid had been consumed in eight days. The Coroner has not determined the nature of the concoction.” (28) The intrigue was only compounded by the presence of a “mysterious companion,” a woman who would not divulge her identity but who admitted that she was not the sculptor’s wife: “The Coroner described the woman as ‘apparently highly intellectual’.” (29) Newspapers covering the Potter death subtly intimated a link between dangerous Chinese medicine and a dissolute lifestyle of artists and “intellectuals.” The implication was that unwholesome and unconventional characters patronized Chinese doctors.

Attacks on Chinese doctors often became attacks on their female clientele, reflecting common anxieties about independent women during the Progressive Era. During the first decades of the twentieth century, American women–especially among the white middle class–achieved greater education and professional prominence. That pattern held true in both California and Oregon, where women’s increasing role in public affairs was evident not only among middle-class women, who helped lead the fight for equal suffrage in California in 1911 and in Oregon in 1912, but also among working-class women, who participated in major strikes of textile workers, restaurant workers, telephone operators, and glove makers. (30) Women’s visibility and power sparked the creation of anti-suffrage leagues and other anti-feminist organizations, all united by fears that women’s rights to self-assertion in political, economic, and personal affairs would subvert traditional male authority. (31)

Female patronage of Chinese doctors seemed like evidence of that subversive trend. In 1907, the Los Angeles Times reported contemptuously on women’s affinity for Chinese doctors:

The oriental “healer” business has increased wonderfully in Los Angeles in the last three years. Chinese “physicians” who formerly were barely able to make a living, came here and waxed fat and rich. The places conducted by some of these smooth-tongued Celestials have been patronized largely by women. They seem to find something “romantic” in visiting the yellow quacks and having a “doctor” with long finger nails, a little round, black cap, with a red topknot, and loose, flowing robes, “prescribe” for their ills. (32)

The Los Angeles Times’ depiction of the apothecary managed to mock both Chinese physicians and their white, female patients. Chinese doctors were foppish and effeminate, and their patients were fools. Decadence and luxury hinted at something nefarious and duplicitous: “Most of these places are beautifully furnished with oriental draperies, teak-wood furniture, Chinese porcelains, and other fittings calculated to create an impression of culture and wealth.” (33) Female patients were, in effect, entranced by Chinese doctors. The article implied that this susceptibility revealed their innate feminine weakness and irrationality and their inability to make sound decisions for their health care.

After a wave of arrests of Chinese doctors practicing medicine without a license in Los Angeles County, coverage of the trials became opportunities for newspapers to underscore the exoticism and gendered deviance of the “irregular” physicians. The Los Angeles Times reported the arrest and arraignment of Tom Leung, “the millionaire Chinese doctor” and proprietor of the Leung Herb Company of Los Angeles. The article lingered over the details of Leung’s appearance (“faultlessly dressed, wearing a frock coat and silk hat”) and soberly noted: “Women have been used to get evidence.” (34) When Leung was arrested yet again a few years later, the same newspaper lavished attention on the “fancy costumes” worn by Leung and his fellow physicians: “The Chinese were arrayed in robes of wonderful richness, and the appointments of the rooms carried the impression of Oriental mystery.” (35) In a 1907 sting operation conducted by the Los Angeles Police Department, a “woman detective” went undercover to get evidence that G.S. Chan was prescribing medicine without a license. The detective became more of a curiosity for the newspaper than the Chinese herbalist, who turned out to be far less exotic than the spectators attending the trial hoped he would be. Chan arrived in court “attired in garments of the latest fashion. … The spectators looked for the long, plaited hair and swishy clothes and were … disappointed.” Bessie K. Hall, the undercover detective, however, happily provided salacious detail for the newspaper, which reported that she “was married in Bakersfield but has not been living with her husband for some years past.” (36) Extraneous information about dress and marital status became a kind of rhetorical shorthand that allowed writers to convey the gender and racial deviance of Chinese physicians and their patients.

Chinese medicine did have some defenders in the English-language press, but they also tended to rely on the well-rehearsed tropes of American Orientalist discourse. In an 1899 article for Lippincott’s Magazine, William Tisdale decried journalists who described Chinese physicians in terms more befitting a haunted house than a place of business:

Newspaper writers in search of a sensation … thread narrow alleys and climb dark stairways to find him in his secluded den, and relate thrilling stories of wrinkled mummies who felt their quickly-beating pulses and wrote prescriptions for sharks’ fins, or spiders’ eggs, or dried toads and lizards. These fairy tales go the rounds and are read by thousands who shudder at their imaginary horrors. (37)

Tisdale was careful to distinguish trained Chinese physicians from pretenders, and he spoke highly of diagnosis by pulse: “Whether it is based on some form of chicanery or upon science, it is certainly successful.” (38) Yet, even as Tisdale commended Chinese medicine for its efficacy, he could not resist embellishing his praise with references to the mystical and supernatural. The ability to diagnose by pulse, he claimed, was “analogous to the sixth sense which the blind sometimes possess.” (39) Tisdale’s article alternated between describing the apothecary as an ordinary, American doctor’s office and lingering on the most exotic details of the doctor’s costume and herbal formulary, indicating a fundamental uncertainty about how to extol the virtues of Chinese medicine: Did it work because it was like American medicine or because it was not? Tisdale’s ambivalence was reflected in how he excerpted his interviews with white patients. He included the full gamut of responses, from those who “freely assert that the Chinese system of medicine is more rational” than regular medicine to those who marveled at what “these degraded heathen can do with their herbs, which our own doctors with all their skill and knowledge cannot.” (40) Tisdale found ways to promote Chinese medicine by both denying and affirming its racial otherness. Defenders of Chinese medicine, thus, could use the vocabulary of American Orientalism to signal its distance from modern medical practice and its more dubious innovations.

In addition to court proceedings and newspaper interviews, Chinese doctors in California and Oregon spoke publicly for their own practices through printed advertisements, where they had the most control over their message. Doctors could convey the nature of their work through self-selected words and images. Typically, advertisements underscored the effectiveness and safety of Chinese herbal remedies. Most advertisements featured a photograph of the physician, usually wearing distinctly Chinese garb but sometimes dressed in a western coat and tie. (41) Many included fawning testimonials from white patients recounting near-miraculous cures through the application of herbal remedies.

In short- and long-form advertisements, Chinese doctors consciously employed and reinterpreted racist stereotypes used by their attackers. Li Wing, for example, published in 1902 The Science of Oriental Medicine, Diet, and Hygiene, a 326-page advertisement for his Chinese pharmacy in Los Angeles, the Foo & Wing Herb Company. Using the word science in its title, The Science of Oriental Medicine aimed to dispel the stereotypes that Chinese medicine was behind the times and its doctors barbaric, but it did so in an unexpected way: The book embraced backwardness and barbarism as virtues, not weaknesses. The Science of Oriental Medicine introduced readers to the Oriental system of medicine, including how its general principles and treatments compared to American medicine. (42) According to Li, the “science” of The Science of Oriental Medicine was based on ancient and seemingly inhumane practices. Counter to prevailing myths that the Chinese did not understand how the human body worked, The Science of Oriental Medicine insisted that their anatomical knowledge was superior to that of regular, American doctors because Chinese doctors dissected live humans, not cadavers:

When the Chinese commenced to study medicine they went at once to the root of different questions involved by practicing vivisection. Thousands of condemned criminals were taken and cut to pieces for the benefit of the living. In this way the functions of the vital organs such as the kidneys, the liver, the stomach, the spleen, and the heart were studied in the living person. The intensely important questions involved in the digestion of foods were determined as well as the effects of different drugs. These investigations, made while the man was still alive, were a thousand times more thorough and reliable than the guesswork which civilized physicians have practiced for many years by cutting up the bodies of dead men, when heat, motion, and life are gone and death has destroyed every function. (43)

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In reality, Chinese doctors probably did not perform vivisections on condemned criminals or anyone else; early Chinese medical texts, like non-Chinese medical texts of the same era, relied on postmortem analysis of internal organs. (44) Nevertheless, the effect of such an anecdote might have been both shocking and comforting for potential white patients. Chinese doctors, supposedly racially inclined toward barbarity, had used their unsavory predilection for the advancement of medical science. They could, therefore, comprehend what civility and morality prevented regular, Euro-American doctors from comprehending: how medications actually worked on the living body.

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Similarly, advertisements for Chinese doctors played on racist assumptions about their effeminacy. Where critics of Chinese medicine saw gender deviance, Chinese doctors saw business opportunities and deliberately targeted female patients in their advertisements. In the case of doctors and brothers T. Foo Yuen and Tom Leung in Los Angeles, most early-twentieth-century advertisements they published in the Los Angeles Times showed a doctor in traditional Chinese garb, seated and practicing diagnosis by pulse (pulsology) on a white male patient. The drawing reproduced a photograph that appeared in The Science of Oriental Medicine, and it inspired a nearly identical advertisement featuring a drawing of a white woman. The patient is clothed in attire and coiffed in a way that bespeaks of Victorian affluence and respectability. (45) There is no hint of impropriety in the relationship between the male Chinese doctor and female white patient. Whereas in the original ad, the male patient and doctor’s faces were slightly turned in, suggesting the possibility of making eye contact, the female patient and her doctor connect only at the wrist. The woman’s face is tilted toward her doctor, but the doctor looks out toward the viewer and unquestionably does not meet her gaze. Diagnosis by pulse required no disrobing, no intimate touching, and–as this particular ad suggested–not even locking eyes.

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Business cards from the 1910s advertising Kam Wah Chung & Co. likewise appealed to female clientele and their desires. In the advertisements, Kam Wah Chung & Co. was not just selling “medical herbs, groceries, Chinese goods and general merchandise”; it also was selling a vision of modern femininity. (46) Each card portrays a white woman: “Lillian” dressed for a game of golf, “Clara” posing in a fur-trimmed coat, “Dorothy” gaily ice skating, and “Margaret” looking regal in finely draped robes and upswept hair. These were not images of the eastern Oregon ranching and farm wives who patronized Kam Wah Chung & Co. but perhaps representations of what they aspired to be. It is difficult to determine how successful these images were at drawing women to Chinese medicine, but we can tell from patient letters that Hay likely served more female patients than male. (47) Perhaps such images of sophistication and affluence appealed to Hay’s non-Chinese clientele, who tended to come from eastern Oregon merchant, farming, and ranching families with some wealth. Some of his patients had descended from the most prominent pioneers of Grant County and its neighboring counties, including the Deardorffs, the Keerins, the Van Bibbers, and onetime Mayor of Burns, Oregon, J.C. Welcome, among others. The middling status of these non-Chinese patients is not surprising; the initial visit and diagnosis cost $25, and patients typically paid anywhere between $7.50 and $15.00 for a supply of medicine to last them two weeks. (48)

In longer form advertisements, both Li Wing in Los Angeles and C. Gee Wo in Portland spoke directly to female patients through promotional books. Their depiction of femininity was much narrower than that of Kam Wah Chung & Co.’s business cards and conformed more closely to the old-fashioned Victorian ideal of “true womanhood,” which identified domesticity (along with piety, purity, and submissiveness) as the source of women’s social power and moral authority. While a woman might express her domesticity as a wife, daughter, or sister, the mother was the ultimate manifestation of Victorian femininity. (49) In advertisements targeting English-speaking clientele, Wing and Wo appealed to that tradition by highlighting Chinese medicine’s capacity to restore fertility to women. (50)

Li’s The Science of Oriental Medicine included a chapter specifically addressing “The Diseases of Women” in which he decried gynecological surgeries as “a fad pure and simple.” (51) The Science of Oriental Medicine emphasized herbs’ capacity to defend natural womanhood against “modern ways of life.” (52) Wing attributed women’s ailments–such as irregular periods to cancers–to excessive food, alcohol, and parties; “overwork” and anxiety; and the use of contraceptives, which The Science of Oriental Medicine called “various perversions of marriage.” (53) Chinese herbs, Wing claimed, were “particularly adapted” to counter the poisonous effects of modern living and modern medicine. (54)

Wo’s Things Chinese, a hundred-page book that publicized his office and herb shop in downtown Portland, similarly denounced modern birth control and other forms of interventionist medicine for their detrimental effects on women’s health: “Why is it that the women of the twentieth century are not strong, healthy, and robust as the women of the first part of the nineteenth century? And why not mothers of a large family of strong, rosy-cheeked, and healthy children, as their mothers and grandmothers had been before them?” (55) The answer, according to Wo, was modern medicine’s tendency to “unsex” women by encouraging them to interrupt menses, seek abortions, or otherwise alter their reproductive systems. Wo declared that his herbal remedies could strengthen women’s organs, eliminating menstrual pains and tumors and restoring fertility.

Advertisements for Chinese medicine also frequently played on seeming contradictions, combining characteristics derived from American Orientalism with their opposite. In the discussion of vivisection, for example, readers of The Science of Oriental Medicine learned in later pages that the “condemned criminals” had voted to submit to live vivisection. What might have seemed barbaric was in fact democratic. (56) More commonly, advertisements portrayed Chinese herbal remedies as both modern (based on science) and old-fashioned (based on ancient folkways). In The Science of Oriental Medicine, Wing cited “an exhaustive study” from Berkeley chemistry professor Walter C. Blasdale on the medicinal benefits of Chinese vegetables: “He believes that many of these will ultimately become of general use and of great value to American and European nations.” Wing asserted that the knowledge of those healing vegetables was “ancient” but also confirmed by a modern scientist, in this case a chemist. (57) Similarly, Portland-based doctor C. Gee Wo advertised that he moved his business to a building that could house his “modern equipment” and laboratory. (58) Like The Science of Oriental Medicine, Things Chinese played up the “scientific” aspects of his practice. The fifth edition included an article by a white doctor on the medicinal value of vitamins, a recent discovery in 1924:

Our grandmothers had “herb teas” that shamed the apothecary’s art. The Indians’ “roots and herbs” were the Puritans’ delight. The Chinese have a remarkable faculty for choosing out matchless herbal remedies. At Portland, Oregon the well-known C. Gee Wo Chinese Medicine Company has the acme of reputation for giving out the very best of such preparations, and best because they are rich in remedial vitamins. (59)

Pairing references to grandmothers, Indians, and Puritans with vitamins simultaneously underscored the deep, historical roots of Chinese herbal remedies and connected them to Americans’ evolving understanding of diet and nutrition. Chinese herbs were both old-fashioned and newfangled.

The concept of nature helped Wing and Wo articulate the benefits of their “ancient science.” What was natural or unnatural could have many meanings for Chinese doctors in the early twentieth century. Broadly speaking, in the Chinese tradition, nature’s laws balanced the various elements believed to control bodily functions. In practice, how Chinese doctors went about restoring balance varied widely depending on their individual interpretations and applications of classical medical texts. (60) In the context of promoting Chinese medicine to American audiences, Wing and Wo both used nature to cast doubt on modern medical science. In The Science of Oriental Medicine, Wing claimed that herbal remedies were “founded upon a complete understanding of Nature’s laws. Americans carry their theories of science to extremes and get too far away from the simple, fundamental facts upon which health depends.” (61) Wo insisted that his prescriptions were “nature’s own remedies, and contain no poisonous minerals or drugs.” (62) As in many literary traditions, nature could be an antidote to modernity.

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Nature also helped Wing and Wo combat sensationalist descriptions of Chinese apothecaries packed with desiccated animal and human body parts. In Things Chinese, Wo repeatedly described his ingredients as “roots, bark, herbs, vegetables, and flowers,” nothing strange or noxious. (63) Indeed, most of the Chinese physician’s formulary at this time likely would have been medicinal herbs and vegetables with rarer, more expensive ingredients such as deer antler and tiger’s bone used only sparingly. (64) In The Science of Oriental Medicine, Wing explained that Chinese herbs were essentially common vegetables, and consuming them was as natural as eating regular food:

Now compare the use of these substances as medicines with the use of minerals or local applications of mechanical devices. We can understand how a vegetable substance which is in the nature of a food can be taken into the blood and carried to the weakened portion of the body which needs special feeding and will there render the necessary assistance. But we cannot understand anything of the sort in reference to a mineral which is indigestible or to a poison which is injurious to a well person. Here is the whole difference in the methods of treatment in a nutshell. (65)

Wo described how Chinese herbs were harvested wild and then tended in farmyards “in the same manner as a gardener tends to his choicest flowers.” (66) Such pastoral images aimed to diminish the exoticism of Chinese herbal remedies. In contrast to the simple cultivation of medicinal herb gardens, the derivation of regular medicine from minerals and metals might have seemed strange and potentially dangerous to potential patients.

Thus, in print advertisements, Chinese doctors crafted an image of Chinese medicine as based on an ancient science, with herbal remedies that were simultaneously familiar and exotic, natural and strange. Where popular stereotypes denigrated the Chinese by associating them with femininity, Chinese doctors highlighted their close connection with women and special knowledge of their ailments. Such was the source of Chinese medicine’s efficacy, Chinese doctors’ authority, and their superiority to the so-called regular medicine.

Biographies of Chinese doctors quite rightly marvel at the ability of some individuals to form long-standing and successful businesses in the United States. Ing Hay, Li Po Tai, and others weathered economic depressions, anti-Chinese violence, and other ordeals. They did so not by overcoming racism but rather finding ways to use it to their advantage. American Orientalist tropes of backwardness, barbarity, and effeminacy furnished Chinese doctors and their patients with a common language. Although it took some rhetorical effort to transform flaws into features, the ability to speak to and attract white patients helped Chinese doctors survive and prosper, even in an era of increased regulatory scrutiny and prosecution for practicing irregular medicine.

Yet, the reliance of Chinese doctors on American Orientalist thinking was a devil’s bargain. Chinese doctors capitalized on their perceived exoticism, but in doing so, they limited themselves and their practices to the margins of American medicine. With very few exceptions, Chinese herbalists did not acquire medical licenses; nor did state boards create alternative examinations for Chinese doctors as they did for other irregular practitioners such as homeopaths, chiropractors, and osteopaths. (67) By conforming to American Orientalist expectations, Chinese doctors helped cement their medicine’s marginal status for generations to come.

During the 1970s, improved foreign relations with China combined with the countercultural embrace of eastern philosophies and renewed American public interest in Chinese medicine, particularly acupuncture. Whereas acupuncture had traditionally served as preventive medicine for poor and rural populations unable to afford other treatments, during the 1970s and increasingly during the 1980s, acupuncture became a hallmark of what anthropologist Mei Zhan has called “hip, middle-class, cosmopolitan lifestyles that emphasize overall well-being and mind-body health.” (68) During the 1980s and 1990s, schools for Oriental medicine began to open across the United States, with Portland, Oregon, becoming home to two major training centers, the Oregon College of Oriental Medicine, founded in 1983, and a new program in classical Chinese medicine initiated in 1992 at the National College of Natural Medicine. (69) In the 1990s, Chinese medicine received a further boost when Congress decided to exempt herbal remedies from Food and Drug Administration (FDA) regulation despite pressure from the AMA. Around the same time, the National Institutes of Health established a permanent office for the study of “alternative medicine,” including traditionally Chinese practices. (70) Since its American renaissance in the 1970s, Chinese medicine has been the subject of increasing interest among American medical researchers and doctors. It remains to be seen if this attention will lead to greater acceptance for Chinese medicine in mainstream health care. That acceptance will have to overcome a long historical campaign to define Chinese medicine in opposition to regular medicine, a campaign in which Chinese doctors played a significant part.

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Caption: A visitor examines a framed copy of the Declaration of Independence on display in the Oregon Historical Society’s Windows on America echibition.

Caption: T. Foo Yuen (right), President of the Foo & Wing Herb Company, and his son Tom How Wing (center) diagnosed the pulse of friend W.A Hallowell. The photo appeared in Li Wing’s 326-page promotional pamphlet The Science of Oriental Medicine, Diet, and Hygiene in 1902.

Caption: Kam Wah Chung & Co., show here in a 1909 photograph, was located in the Chinese district of John Day, Oregon, which was home to five or six hundred inhabitants in the 1880s. Drawn to eastern Oregon by a mining boom, Chinese immigrants used Kam Wah Chung & Co. as a meeting place, post office, and apothecary.

Caption: Abraham Flexner (pictured in 1895) authored a 1910 report for the Carnegie Foundation for the Advancement of Teaching. The Flexner Report surveyed medical education in the United States and helped justify increased regulation of the medical profession according to strict, science-based guidelines.

Caption: “Doc” Ing Hay meets with an unidentified woman outside the Kam Wah Chung building.

Caption: The above image from about 1900 shows one of the many apothecaries in San Francisco’s Chinatown. The herbalist behind the counter filled prescriptions by selecting from hundreds of herbs contained in the many containers and drawers lining the walls. This image was featured on a postcard, suggesting the popularity of visiting such a shop on a tour of Chinatown in the early twentieth century.

Caption: Mortars and pestles were used to prepare herbal remedies at Kam Wah Chung & Co. (The photo was taken after the building was made a historic landmark and restored in the 1970s.)

Caption: A postcard from the early 1900s depicts the interior of a “Chinese Drugstore” in San Francisco’s Chinatown.

Caption: The “Twelve Pulse [sic] of the Human Body,” in The Science of Oriental Medicine illustrates twelve vital organs within the human body and their corresponding pulses. Chinese doctors examine patients’ pulses to determine the condition of the vital organs and the person’s overall health.

Caption: A 1912 advertisement for the Foo & Wing Herb Co. targeted Euro-American women patients by dispelling any fears of impropriety associated with diagnosis by pulse.

Caption: A 1904 advertisement for the Foo & Wing Herb Co. shows diagnosis by pulse. The drawing was based on a photograph originally printed in The Science of Oriental Medicine, Diet, and Hygiene.

Caption: Examples of Kam Wah Chung & Co.’s business cards, featuring “Dorothy” and “Clara,” were intended to appeal to the apothecary’s Euro-American, female clientele.

Caption: The back cover of C. Gee Wo’s promotional booklet, Things Chinese, displayed a photograph of the physician’s disembodied head floating over his newly expanded apothecary located on the corner of Alder and Third streets in downtown Portland, Oregon.

Caption: Ing Hay was photographed as a young man in Baker City, Oregon, shortly after he emigrated from Toisan County in China’s Kwantung Province. (Courtesy of Kam Wah Chung Museum.)

Caption: The Kam Wah Chung & Co. building in Canyon City, Oregon in the 1990 s. (Courtesy of Kam Wah Chung Museum.)

NOTES

(1.) William M. Bowen, “The Five Eras of Chinese Medicine in California,” in The Chinese in America: A History from Gold Mountain to the Millennium, ed. Susie Lan Cassel (Walnut Creek, Cal.: AltaMira Press, 2002), 175.

(2.) At present, most of the historical work on Chinese medicine in the American West has focused on individual doctors and their shops, including most famously Ing Hay but also Wah Hing of Fiddletown, California, Ah Fong of Boise, Idaho, and Li Po Tai of San Francisco, California. See, for example, Jeffrey Barlow and Christine Richardson, China Doctor of John Day (Portland, Ore.: Binford and Mort, 1979); Ramona Kimbrell, “Ah Sang–The Chinese Doctor,” Tales of the Paradise Ridge, 13:2 (December 1972): 25-32; Will Sarvis, “Gifted Healer Ing Hay and the Chinese Medical Tradition in Eastern Oregon,” Journal of the West, 44:3 (Summer 2005): 62-69; Aminda M. Smith, “Choosing Chinese Medicine,” Journal of the West, 46:3 (Summer 2007): 24-31; and Kenneth H. Marcus and Yong Chen, “Inside and Outside Chinatown: Chinese Elites in Exclusion Era California,” Pacific Historical Review, 80:3 (August 2011): 369-400.

(3.) Haiming Liu, “Chinese Herbalists in America,” in Chinese American Transnationalism: The Flow of People, Resources, ed. Sucheng Chan (Philadelphia, Penn.: Temple University Press, 2006), 155.

(4.) Bowen, “The Five Eras of Chinese Medicine in California,” 189-90; Haiming Liu, The Transnational History of a Chinese Family: Immigrant Letters, Family Business, and Reverse Migration (New Brunswick, N.J.: Rutgers University Press, 2005); Haiming Liu, “The Resilience of Ethnic Culture: Chinese Herbalists in the American Medical Profession,” Journal of Asian American Studies (1998): 173-91.

(5.) John S. Haller, Jr., American Medicine in Transition, 1840-1910 (Urbana: University of Illinois Press, 1981), 223.

(6.) As quoted in Sarvis, “Gifted Healer Ing Hay,” 67.

(7.) Historians use the terms regular, western, allopathic, or orthodox medicine to define a set of practices sanctioned by professional associations of doctors and public health institutions, state licensing boards, and major medical schools. Terms such as irregular or alternative medicine define other practices. These terms are problematic and ahistorical. At the end of the nineteenth and beginning of the twentieth centuries, American medicine was a mosaic of allopaths and homeopaths, emergent practices of osteopathy, naturopathy, and chiropractic, distributors of proprietary drugs and devices, and faith healers. Nonetheless, the distinction between “regular” doctors and “irregular” doctors was apparent to their patients even if it was not well defined, and for the historian, such terms become impossible to avoid. For a survey of “alternative” medicine and its interactions with “regular” or “orthodox medicine” from the eighteenth century to the near present, see James C. Whorton, Nature Cures: The History of Alternative Medicine in America (Oxford: Oxford University Press, 2002).

(8.) Whorton, Nature Cures, 68-69.

(9.) James Gordon Burrow, Organized Medicine in the Progressive Era: The Move Toward Monopoly, 12; Whorton, Nature Cures, 135.

(10.) Burrow, Organized Medicine in the Progressive Era, 42-43.

(11.) Haller, American Medicine in Transition, 229.

(12.) Historians of medicine have demonstrated the declining use of mineral cathartics by American regular physicians by the 1860s and major strides in surgical techniques and sterilization by the 1890s, but patient testimonials and articles in the popular press show that fears about “regular” practices persisted well into the twentieth century. John Harley Warner, The Therapeutic Perspective: Medical Practice, Knowledge, and Identity in America, 1820-1885 (Cambridge, Mass.: Harvard University Press, 1986), 5-6; Charles E. Rosenberg, The Care of Strangers: The Rise of America’s Hospital System (Baltimore, Md.: Johns Hopkins University Press, 1987), 148-49.

(13.) For more on Indian herbal remedies see William G. Rothstein, “The Botanical Movements and Orthodox Medicine,” in Other Healers: Unorthodox Medicine in Modern America, ed. Norman Gevitz (Baltimore, Md.: Johns Hopkins University Press, 1988).

(14.) Mrs. Fred Deardorff to Ing Hay, n.d., Kam Wah Chung Papers [microform], reel 2, Oregon Historical Society Research Library, Portland [hereafter Kam Wah Chung Papers].

(15.) Mrs. M.J. Baker to Ing Hay, November 3, 1911, Kam Wah Chung Papers, reel 1. See also James F. Draplan to Ing Hay, October 8, n.d., Kam Wah Chung Papers, reel 2.

(16.) Ted Kaptchuk, O.M.D., The Web That Has No Weaver (Chicago: Contemporary Books, 2000), 18-19; Paul S. Unschuld, Medicine in China: A History of Ideas (Berkeley: University of California Press, 1985), 4-5.

(17.) John Kuo Wei Tchen, New York Before Chinatown: Orientalism and the Shaping of American Culture, 1776-1882 (Baltimore, Md.: Johns Hopkins University Press, 1999); Mari Yoshihara, Embracing the East: White Women and American Orientalism (Oxford: Oxford University Press, 2003); Karen J. Leong, The China Mystique: Pearl S. Buck, Anna May Wong, Mayling Soong, and the Transformation of American Orientalism (Berkeley: University of California Press, 2005).

(18.) Henry Yu, Thinking Orientals: Migration, Contact, and Exoticism in Modern America (Oxford: Oxford University Press, 2001), 10-11.

(19.) Jonathan Goldstein, “Cantonese Artifacts, Chinoiserie, and the Early American Idealization of China,” in America Views China: American Images of China Then and Now, ed. Jonathan Goldstein, et. al. (Bethlehem, Penn.: Lehigh University Press, 1991), 48-50; T.J. Jackson Lears, No Place of Grace: Antimodernism and the Transformation of American Culture, 1880-1920 (Chicago: The University of Chicago Press, 1981), 225-41.

(20.) James Edward Ketelaar, Of Heretics and Martyrs in Meiji Japan: Buddhism and its Persecution (Princeton, N.J.: Princeton University Press, 1993), 153; Yoshihara, Embracing the East, 18-19.

(21.) For examples of letters from white patients to Ing Hay, see Ethel Carter to Ing Hay, May 19, 1906; P.A. Harbusto to Ing Hay, November 9, 1907; Alvia W. Peters to Ing Hay and Lung On, December 29, 1930; Dorcas Breeding to Ing Hay, May 16, 1941; and Mrs. Albert Morse to Ing Hay, December 21, 1941, Kam Wah Chung Papers, reels 1 and 2.

(22.) Rev. A.W. Loomis, “Medical Art in the Chinese Quarter,” Overland Monthly, 2:6 (1869): 497-502.

(23.) J.W. Ames, “A Day in Chinatown,” Lippincott’s Magazine, 16 (October 1875): 500-501.

(24.) “The Pacific Coast Trade in Chinese Medicines and How a Celestial Pharmacist Makes Drugs Out of Horned Toads,” San Francisco Chronicle Magazine, March 29, 1903.

(25.) “Queer Chinese Medicines,” Los Angeles Times, reprinted in the Washington Post, August 11, 1907.

(26.) “Chinese Poisons,” New York Times, May 20, 1883.

(27.) “Chinese Shot by Highbinder,” The Daily Call, January 27, 1904.

(28.) “Potter Death Still a Mystery,” Los Angeles Times, August 31, 1912.

(29.) “Peach Poison Killed Potter,” New York Times, September 1, 1912.

(30.) Joan M. Jenson and Gloria Ricci Lothrop, California Women: A History (San Francisco, Cal.: Boyd and Fraser, 1987), 58-64; Robert D. Johnston, The Radical Middle Class: Populist Democracy and the Question of Capitalism in Progressive Era Portland, Oregon (Princeton, N.J.: Princeton University Press, 2003), 147.

(31.) Nancy F. Cott, The Grounding of Modern Feminism (New Haven, Conn.: Yale University Press, 1987), 44.

(32.) “Herb Quacks in Law Net,” Los Angeles Times, June 4, 1907.

(33.) Ibid.

(34.) “In a Frock Coat and High Hat,” Los Angeles Times, March 10, 1908.

(35.) “Herb ‘Doctors’ Taken,” Los Angeles Times, December 10, 1913.

(36.) “Doctor Chan Talks Fight,” Los Angeles Times, July 31, 1907.

(37.) William Tisdale, “Chinese Physicians in California,” Lippincott’s Magazine, vol. 63 (March 1899): 412.

(38.) Ibid., 414.

(39.) Ibid.

(40.) Ibid., 16.

(41.) For one example, see images on pages 280 and 281. There are also two examples from Los Angeles-area physicians reproduced in Bowen, “The Five Eras of Chinese Medicine in California,” 182-83.

(42.) Li Wing, The Science of Oriental Medicine, Diet, and Hygiene, 1902, California Digital Library, http://archive.org/details/ scienceoforientaOOfoowrich (accessed June 28, 2012), 14-15.

(43.) Ibid., 8-9.

(44.) Unschuld, Medicine in China, 78.

(45.) Classified Ad 21–No Title, Los Angeles Times, March 2, 1904; Display Ad 220–No Title, Los Angeles Times, November 17, 1912; ProQuest Historical Newspapers: Los Angeles Times (1881-1987).

(46.) Reprinted in Chia-lin Chen, “The Golden Flower of Prosperity,” October 1, 1971, Portland State University, prepared for Oregon Historical Society, Kam Wah Chung Papers.

(47.) Although Ing Hay was essentially the family doctor in many instances, prescribing and sending medicines for the different ailments of husband, wives, children, and grandparents in the same family, an analysis of patient letters suggests that he treated more women than men. I chose a sample of 117 letters based on the following three criteria: The sample roughly approximated the sex distribution of the entire collection of 249 letters (55 percent male and 45 percent female); I could easily identify both the name and sex of the letter writer and eliminate double counting; letters primarily concerned medical issues and had clear and substantive information about the patients and their treatment. From the data, we can observe that male and female patients wrote to Kam Wah Chung in roughly equal numbers. In both groups, roughly two thirds of the letter writers were themselves patients. The letters from non-patients are arguably more suggestive about the ratio of male to female patients under Ing Hay’s care. Thirty percent of male letter writers were not patients but were writing on behalf of their family members. Among these writers, two thirds of them were writing for female family members only, usually a wife or mother, sometimes a daughter. About the same percentage of female letter writers who were not patients wrote on behalf of family members (26.5 percent). As with their male counterparts, these letters tended to address the needs of female family members (14 percent vs. 9 percent). This suggests that even though male and female letter writers are about equally represented in the collection, women constituted the majority of Ing Hay’s patients. Kam Wah Chung Papers, reels 1 and 2.

(48.) Oregon Historical Society Scrapbook 21, p. 59; Oregon Historical Society Scrapbook 48, p. 126; J. Southworth, A History of Grant County (Dallas: Taylor Publishing Company, 1983), 55, 87-88; Kam Wah Chung Papers, reels 1 and 2; United States Federal Census [database online], Provo, Utah: Ancestry.com Operations, Inc., 2004 (accessed February 28, 2013).

(49.) The “Cult of True Womanhood” is a nineteenth-century phrase first revived in historical scholarship by Barbara Welter, “The Cult of True Womanhood, 1820-1860,” American Quarterly, 18:2 (Summer 1966): 152. See also Elizabeth Jameson, “Women as Workers, Women as Civilizers: True Womanhood in the American West,” in The Women’s West, ed. Susan Armitage and Elizabeth Jameson (Norman: University of Oklahoma Press, 1984). The doctors’ emphasis on motherhood was undeniably out of touch with the “New Woman” of the 1920s. In the wake of the Nineteenth Amendment, a new icon of white femininity had burst onto the scene. Sexually liberated, empowered by the right to vote, and often depicted in a “flapper” costume, the “New Woman” seemed omnipresent in popular media. It is difficult to say whether Chinese doctors’ emphasis on “true womanhood” attracted or repeled the “New Woman” due to the absence of first-person accounts. The “New Woman” of the 1920s did not wholly replace Victorian “true womanhood,” with its emphasis on sexual purity and pious domesticity. See Ellen Carol DuBois and Lynn Dumenil, Through Women’s Eyes: An American History with Documents (Boston: Bedford/St. Martins, 2005), 483.

(50.) Gynecology as a distinct field of study within Chinese medicine first developed in the Song Dynasty (960-1279). See Charlotte Furth, A Flourishing Yin: Gender in Chinas Medical History, 960-1665 (Berkeley: University of California Press, 1999).

(51.) Wing, The Science of Oriental Medicine, 167.

(52.) Ibid., 150.

(53.) Ibid.

(54.) Ibid.

(55.) C. Gee Wo, Things Chinese, Fifth Edition, 1924, 49, Oregon Historical Society.

(56.) Wing, The Science of Oriental Medicine, 143.

(57.) Ibid., 70.

(58.) Wo, Things Chinese, 28.

(59.) Ibid., 47-48.

(60.) Unschuld, Medicine in China, 223.

(61.) Wing, The Science of Oriental Medicine, 15.

(62.) Wo, Things Chinese, 30.

(63.) Ibid., 28-30, 38-40.

(64.) Tisdale, “Chinese Physicians in California,” 415. A survey of Kam Wah Chung’s materia medica seems to corroborate Tis dale’s observation. Beth Howlett, Oregon College of Oriental Medicine, interview with author, September 8, 2011.

(65.) Wing, The Science of Oriental Medicine, 154.

(66.) Wo, Things Chinese, 23.

(67.) Whorton, Nature Cures, 155. Boise doctor C.K. Ah Fong successfully sued to have his license reinstated after the Idaho State Board of Medical Examiners stripped it from him in 1899. Smith, “Choosing Chinese Medicine,” 27-28.

(68.) Mei Zhan, Other-worldly: Making Chinese Medicine Through Transnational Frames (Durham, N.C.: Duke University Press, 2009), 14.

(69.) “National College of Natural Medicine,”http://ocom.edu/; http://www. ncnm.edu/academic-programs/school-of-classical-chinese-medicine/about-the-medicine.php (accessed June 13, 2013).

(70.) Terri A. Winnick, “From Quackery to ‘Complementary’ Medicine: The American Medical Profession Confronts Alternative Therapies,” Social Problems, 52:1 (February 2005): 53-54.

Research for this article was supported by the Oregon Historical Society’s Donald J. Sterling, Jr., Memorial Senior Research Fellowship.

Source Citation   (MLA 7th Edition)

Shelton, Tamara Venit. “Curiosity or cure? Chinese medicine and American orientalism in progressive era California and Oregon.” Oregon Historical Quarterly Fall 2013: 265. Academic OneFile. Web. 29 Nov. 2014.

Gale Document Number: GALE|A348216141

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IMG_3661

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Our new article was published recently on Journal of Integrative Medicine: Volume 12, 2014   Issue 4

http://www.jcimjournal.com/jim/FullText2.aspx?articleID=S2095-4964(14)60035-2

 

“Obamacare” covers fifty-four million Americans for acupuncture as Essential Healthcare Benefit
Arthur Yin Fan (McLean Center for Complementary and Alternative Medicine, PLC, Vienna, VA 22182, USA )

http://www.jcimjournal.com/jim/currentIssue.aspx

 

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Dr.Fan’s new article about Miriam Lee published recently. 

“Dr. Miriam Lee: A heroine for the start of acupuncture
as a profession in the State of California.
You could read the detail at:

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Yesterday, a 44 years old lady came and hugged me very tightly for three minutes. And then told me she got pregnant naturally after my acupuncture treatment.

She said she should be my no.76 clients got pregnant–because she had seen there was a notes on the office board-75 pregnancy since 2007.

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Original article at http://www.jcimjournal.com/jim/FullText2.aspx?articleID=jintegrmed2013041
Journal of Integrative Medicine: Volume 11, 2013   Issue 4
Dialogue with Dr. Lixing Lao: from a factory electrician to an international scholar of Chinese medicine
Arthur Yin Fan (McLean Center for Complementary and Alternative Medicine, PLC Vienna, VA 22182, USA )

DOI: 10.3736/jintegrmed2013041

Fan AY. Dialogue with Dr. Lixing Lao: from a factory electrician to an international scholar of Chinese medicine. J Integr Med. 2013; 11(4): 278-284.

Received May 12, 2013; accepted June 6, 2013.

Open-access article copyright ? 2013 Arthur Yin Fan.

Correspondence: Arthur Yin Fan, PhD, MD, LAc; Tel: +1-703-499-4428; Fax: +1-703-547-8197; E-mail: ArthurFan@ChineseMedicineDoctor.US

Dr. Lixing Lao, an internationally known scholar of Chinese medicine renowned for his clinical and mechanisms research, is the Director of the Traditional Chinese Medicine (TCM) Program at the Center for Integrative Medicine, University of Maryland (UM) School of Medicine; the Co-Chair of the Acupuncture Research Society; and the former Editor-in-Chief of the American Acupuncturist, the official journal of the American Association of Acupuncture and Oriental Medicine. The Baltimore Magazine has listed Dr. Lao as one of the nation’s top acupuncture practitioners (Figure 1).
Dr. Lao has played a pivotal role in the advancement of TCM in the United States. As the first full professor of acupuncture and TCM appointed to a conventional medical school in the United States, he was invited to be a key speaker at both the 1994 United States Food and Drug Administration (FDA) hearing on acupuncture[1,2] and the 1997 National Institutes of Health (NIH) consensus conference on acupuncture[2]. As a result of the hearing, the FDA reclassified acupuncture needles as a medical device, no longer an investigational device. The NIH conference led to preliminary confirmation of the safety and efficacy of acupuncture. These two conferences were milestones that opened the way to wider clinical use of acupuncture.
Besides research and clinical practice, Dr. Lao has been involved in TCM education for over 20 years. On October 20, 2012, the author, Arthur Yin Fan, interviewed him in the President’s Office of the Virginia University of Oriental Medicine in Annandale, Virginia, USA.
Fan: Dr. Lao, it is nice to see you again. What have you been doing recently?
Lao: As a professor in UM’s Center of Integrative Medicine, I’ve mainly been doing research, and conducting clinical trials and experiments on the safety and efficacy of acupuncture and herbs. As an academic, I’m also involved in teaching.
Fan: I heard you’ve attended some conferences recently.
Lao: Yes, I have participated in quite a number of conferences, domestically and internationally. In November, I will go to Beijing, China, for the anniversary celebration of the Beijing University of Chinese Medicine, which will be combined with an international acupuncture conference. I’ll be one of the main speakers.
Fan: You have been involved in TCM for over thirty years. Now you are an international, leading scholar in this field. What led you to this profession?
Lao: It’s a long story. During the Chinese Cultural Revolution in the late 1960s, formal education stopped. All students became involved in what was called “Stopping Class to Conduct the Revolution” [停课闹革命; Dr. Fan notes: This was similar to school strikes and student occupations in the West, from December 1966 to October 1967]. At that time, “barefoot doctors”— practitioners using acupuncture, herbal medicine, and basic medical procedures like first aid — began to treat the poor rural farmers [Fan notes: more than 90% of the Chinese population lived in impoverished rural areas and lacked basic health care before the barefoot doctors movement]. Such a career was attractive to many young people, including me. There was no strict regulation of acupuncture during the Chinese Cultural Revolution (Fan notes: because the traditional or “old” regulations were dismantled by Chairman Mao Zedong, who was a supporter of barefoot doctors). Many young adults learned TCM in various ways and became barefoot doctors during that period. There was no formal schooling during the Cultural Revolution, and I long to learn something real and useful. I became interested in acupuncture because I had heard many moving stories about the barefoot doctors, which triggered my interest in medicine and health care.
Another reason for me to learn acupuncture or TCM was because of an incident in 1970 during the so-called “Returning to School to Make Revolution (复课闹革命, Fan notes: after October, 1967)”. It was what would have been my last year of high school; students were assigned to factories for half a year and rural areas for the other half to get “real knowledge.” First I was sent to learn farming on Chongming Island, a county of Shanghai City, in the middle of the Yangzi River. One night I began experiencing severe acute abdominal pain, which was later diagnosed as an intestinal obstruction. It was the middle of the night. With great difficulty and the help of my classmates, I walked for miles to see a doctor, Madam Lin, a very nice, extremely proficient old lady who was the doctor assigned to provide medical care for the students from my high school on the island. At that time there was no highway to Shanghai, and the Shanghai ferry ran only during the day. So there was no choice — I could not go to Shanghai despite the emergency. Acupuncture was the only treatment available. It was really magical: Dr. Lin needled me in two places. The pain quickly disappeared and then I slept. I woke up the next morning with no pain. After asking me several questions, Dr. Lin felt there was no need to send me to the hospital in Shanghai and let me go back with the other students. That experience affected me greatly.
Later, during a down period when there was not much to do on the farm, Dr. Lin arranged a class for students. She taught us basic medical knowledge, including the prevention of illness and some basic treatments. I wanted to see how she treated patients and handled difficult cases, so I carried her medical kit when she made home visits. In effect, I was her apprentice, although it was not a formal apprenticeship.
The second half of that year was spent in a factory in the city of Shanghai. There was an elective project —learning medical knowledge. As high school students we had a chance to participate in a three-month training program for suburban barefoot doctors at a district hospital, but only two students per class could be enrolled. I was the class president and had a strong interest in medicine, so I got the chance to attend, and I learned a lot. At that time we were 16 or 17 years old and eager to learn. The school no longer taught normal classes, and the students wanted something to fill their empty brains. The program started with two weeks of classroom teaching; teachers (they were medical doctors) with different specialties taught acupuncture and Western medicine as well as topics such as rescue methods to be used after atomic bomb explosions, how to hold a scalpel when performing an operation, how to interpret an electrocardiogram, and so forth. I remember that when the doctor taught acupuncture, he taught us 30 acupoints a day, including point location, main effects, and insertion techniques for each point. The next day, we would have to stand up to answer questions. We two high school students were always very participatory and liked to answer the questions, while the barefoot doctor candidates, mostly young suburban mothers, were afraid to answer. They were so busy with field and house work after class and they had little time to go over the lessons. That class gave me great pleasure.
After the classroom learning, we interned in each department, starting with the pharmacy. Under supervision, we prepared Western drugs and patent herbs according to the prescriptions that patients brought in. After three days, we were familiar with the names of many drugs and patent herbs and their actions. Then we went to the department of internal medicine. The first few days we copied the doctor’s prescriptions and observed the physical examinations. After that, we could see patients and prescribe medicine under the doctor’s supervision. I started seeing patients on the second day because my supervising doctor considered me ready to practice. We were in a district hospital, patients often came from local factories and the illnesses and disorders were simple. Mostly, I took a patient’s blood pressure, asked some questions, and then refilled a previous prescription; or something like low back pain and patients just wanted pain killers or an excuse for sick leave; rather simple stuff; that was it. My classmate and I sat at two office tables all morning and counted up our patients, competing as to who had seen the most — that was fun and got me interested in medicine.
After that department, we interned in injection room and then in the acupuncture and moxibustion department. There was a doctor, half blind, a graduate of the Tuina (Chinese therapeutic massage) Program from the Shanghai College of TCM. Maybe because of his poor vision, his memory was very strong; he could recall all the acupuncture points and tuina manipulations. At that time, he was single and lived in the hospital dorm near my home. So every night I went to his dorm and learned from him. He talked about the acupuncture and tuina he had learned in college, and I took notes. I became very interested in acupuncture at that time, and it was something like a real apprenticeship. We became good friends.
In 1971, the “old-three grades (老三届) settling in the countryside and mountains” movement (上山下乡; launched by the government) stopped, and middle and high school students and graduates again had a chance to stay in the city. One reason I’d learned acupuncture and moxibustion was to give me a way to take care of myself if I had to live in the countryside. I wanted to be prepared to serve rural patients and my fellow schoolmates who might be resettled there. But when I graduated from high school, I was assigned to the Shanghai Xingzhong Power Machinery Factory (新中动力机器厂) as a factory worker. After training in several jobs, I became an electrician, maintaining the normal operation of the electronic devices there. If there were problems with a device, I would have to work very hard to fix it as quickly as possible in order to avoid a delay of production; otherwise, I’d wait in the office without much to do.
My Shifu (teacher and supervisor) graduated from Shanghai Jiao Tong University. He preferred being an electrician to being a technician, and he taught me a lot. He was a nice man, and to this day we remain friends. My Shifu not only taught me practical skill of repairing electronic devices but also taught me theory of electricity, so I learned faster because I understood the mechanisms. One night, he invited me and his good friend and former classmate, to dinner at his home. His friend arrived with acute low back pain, which began during his bus trip over to dinner. He said to me, “I heard you know acupuncture. Please give me a treatment; I am very hurt.” At that time, I carried acupuncture needles around with me in a pen-like tube. There were no regulations for doing acupuncture at that time, so I gave him a treatment and after removing the needles asked him to move his back as much as possible. To his surprise, his pain was gone; the back muscle spasms disappeared immediately after the treatment. The result pleased him and my Shifu, so by word of mouth, many people found out that I was good at acupuncture.
A few days later, a very old employee in the finance department of the factory came to see me. He had bad intercostal neuralgia. He said he had had three onsets: the first had been cured by a famous TCM doctor, Shi Xiaoshan (石筱山); the second was cured by another famous doctor — I forget the name. Now it was the third onset; he said he’d already seen many doctors and tried many medications, both Chinese and Western, and nothing helped. So he used a lot of pain-killers that only masked the pain for two to three hours, and also upset his stomach. He wanted me to give him acupuncture. I told him I had not treated anyone with such a condition but I would try. His pain was active, so I treated him. He got immediate results and was very pleased. After that, I became very busy — before, people called me only for something electrical, and now people began to call me for their health issues too, especially low back pain and sciatic pain. I had to keep two sets of equipment — my electrician’s tools plus the acupuncture needles and some alcohol swabs for disinfection. I enjoyed helping people for their illness and treated them for free, as a colleague.
Fan: How old were you at that time and when you started your college study?
Lao: I started at that factory when I was 17, and stayed about 7 years. The college entrance examination (CEE) started up again in 1977 after the Culture Revolution stopped in 1976. So I was 24 when I entered college in the fall of 1978. During the Cultural Revolution, I had had formal education only up to actual fifth grade level (although I was a high school graduate) because the classes were disbanded to “make revolution.” I did not think I had enough knowledge to pass the CEE, but my high school math teacher encouraged me to try. I then borrowed middle and high school textbooks and started self-study with some help from my math teacher and my Shifu. I was lucky enough to pass the exam in July 1978 after about 5 months of extensive study.
Fan: How was your experience in college?
Lao: I was accepted and admitted to the Shanghai College of TCM and assigned to the acupuncture major. I initially thought I already knew enough acupuncture and wanted to the major in Chinese herbal medicine. But soon after I started the course work, I found I actually knew very little about acupuncture. The clinical experience I had earlier helped me to better understand TCM and acupuncture theory as well as other courses, including Western medicine. I studied hard and enjoyed the five-year learning opportunity and did not want to waste time that had been lost during the Cultural Revolution. I was elected president of our class and vice president of the Student Union of the college.
Fan: Very impressive experience. Then you enrolled in the University of Maryland for PhD study in physiology and also got your acupuncture license in the State of Maryland?
Lao: After graduating in 1983, I was appointed to the Acupuncture Department of my college as a teacher and researcher. Then China encouraged young people to go abroad for study, which was one of the important policies of the reform. I applied to the Physiology Department of the Dental School at UM because it has a pain research group as I was interested in the mechanisms of acupuncture for pain relief. At that time, the National Certification Commission of Acupuncture and Oriental Medicine (NCCAOM) initiated an acupuncture certificate examination oriented mostly toward TCM. Because of my teaching background, I was invited to review point locations for a group of a local acupuncture school students who were preparing for that examination. Local acupuncturists also told me I was eligible to apply for an acupuncture license in the State of Maryland. So in 1988 I became licensed as No. 300, the 200th licensed acupuncturist in Maryland (the license number starts at No. 101). Later I also passed the exams and obtained NCCAOM certification of acupuncture and Chinese herbal medicine.
Fan: At that time, acupuncturists worked under the supervision of an MD. How did you start your clinic?
Lao: I had to work under an MD’s supervision. A local acupuncturist referred me to Dr. Sores, a very nice Filipino-American doctor. She told me that she had just visited China with a group of American physicians and was deeply impressed by the acupuncture anesthesia she’d observed. One MD could supervise three acupuncturists at that time; I became her second one. Dr. Sores was so kind to let me use her clinic, which was near the Johns Hopkins University, when there were rooms available. She waived the rent for the first several months; even later, she charged a fairly low rent. I studied for my Ph.D. during the day and worked in the clinic from 6:00 to 9:00 pm two or three days a week until graduation.
Fan: How did you get your academic appointment at the University of Maryland School of Medicine?
Lao: A year before my graduation, I had a period of deep confusion. If I took a postdoc position in a laboratory for physiological research, I’d have to move (to other states) and leave my flourishing acupuncture practice; if I stayed in my Maryland practice, I’d have to leave my academic career. I’d studied acupuncture for five years and spent five more on my PhD in physiology. Giving up either would be a pity. By luck, in 1991 I saw an announcement in the school magazine and the Baltimore Sun saying that an MD, Brian Berman, had been awarded a million dollars to set up a complementary medicine program to study the safety and efficacy of acupuncture, Chinese and other traditional medicine, and alternative medicine in the Department of Anesthesia, UM School of Medicine. After I talked to him about possibility to work with him, he offered me a research assistant professor position and wanted me to start work at once. I still hadn’t completed my dissertation and actually couldn’t. But we became friends. In one occasion, I successfully treated his two-year-old daughter with tuina and became his family acupuncturist. On June 15, 1992, the day after my dissertation defense, I started work as an assistant professor in his program.
It was the right time, right place, and right people. In 1992, the NIH established the Office of Alternative Medicine (OAM). Dr. Berman was on their advisory board and took me to many meetings. In 1993, the OAM formally started to award fairly small, $30 000 research grants to about thirty awardees. We applied and were awarded two grants in 1994. I was the principal investigator (PI) of one project named “Acupuncture and Postoperative Oral Surgery Pain”; Dr. Berman was the PI and I was the co-investigator of the second program “Acupuncture Safety/efficacy in Knee Osteoarthritis”. After this seed funding, we got bigger grants, NIH Research Project Grants, also known as R01 grants, to continue both these projects. The clinical trial of acupuncture on knee osteoarthritis (OA) had a great impact. This large sample (N=570) trial found that acupuncture was significantly more beneficial for patients with knee OA than those in sham control[3]. We continued such work on arthritic pain and now are involved in other modalities such as Chinese herbal medicine, laser acupuncture, and moxibustion.
In 1998, we got a Center Grant known as P50 from the National Center for Complementary and Alternative Medicine (NCCAM, former OAM), which consists of funding for three projects focused on a research question; I served as the Project Leader on mechanisms of acupuncture in inflammatory pain and established our first laboratory for the basic science research on acupuncture and TCM. Since the establishment of the lab, we have published many basic science studies on acupuncture and herbology. You were there three years, Arthur. Thank you for your great contribution to our lab’s research on the mechanisms of Chinese herbal medicine. Because of our significant achievements from earlier, we’ve gotten several big grants (known as P50, P01 and U19) over the last ten years and also many smaller ones.
Fan: Your clinical trials, especially on acupuncture for knee OA[3] and on nausea and vomiting caused by chemotherapy, made great contributions toward persuading commercial healthcare insurance companies to cover the use of acupuncture for such illnesses. Since then, more and more insurance companies have begun to pay for acupuncture treatments.
Lao: You’re right. I feel we have done the right thing — choosing to study illnesses commonly seen in clinic and publishing our results in major medical journals. Positive results give practitioners great support.
Some acupuncturists and research colleagues didn’t understand why we chose to study arthritis. They told us, “We use acupuncture to treat arthritis every day. It’s been done for thousands of years, especially in China, and with good results. Unquestionably, acupuncture can treat arthritis. Why waste time doing a clinical trial on that?” The fact is, although there is a consensus among acupuncturists and Oriental medicine professionals and some patients, many Western-trained doctors and their patients have no understanding of the safety and efficacy of acupuncture. We need to demonstrate the effect and safety of acupuncture in treating common illnesses for which medications aren’t too effective. In America there is a high incidence of arthritis, which doesn’t respond well to conventional medication. Most arthritis, especially knee OA, is chronic. Pain medications are only briefly effective, and must be used long term, which lead to serious adverse effects. And the safety and effectiveness of acupuncture on OA is easy to evaluate. In an illness such as diabetes, which has many complications, treatment results may be hard to measure.
Our strategy was to study the condition most suitable to acupuncture treatment first. Positive results would help the mainstream medical profession to start accepting acupuncture, and then we can tackle more difficult diseases. If we had chosen a difficult one first and not gotten a positive result, people might believe that acupuncture is simply ineffective, not that we got a poor result because we didn’t choose a suitable subject. So we picked something less complex first. Also, we wanted to pick a common disease, and there are many OA patients.
I researched textbooks, clinical trials, and case reports to decide which acupoints and acupuncture strategies we should use, and then tested these in a small group of patients to ensure they’d be effective in clinical conditions. Additionally, as you know, success depends on the “right time, right place, and right people”. There was a strong need to show whether acupuncture is safe and effective, and we had a good team. Besides Dr. Berman, me, and our TCM research personnel, we invited Dr. Marc C. Hochberg, a doctor in our school of medicine at UM and an internationally known knee expert, to provide a set of evaluation and assessment methods for knee OA. His support was essential to the project’s success.
Acupuncture and Chinese medicine professionals might also feel that a study on acupuncture for dental extractions[4] is unnecessary since doctors and researchers in China have done acupuncture anesthesia studies showing that acupuncture is an effective anesthetic in major operations. Dental pain is a very small topic. But when I designed the dental project, I wanted to refute the preconceptions of the conventional medicine practitioners and some others who believe that acupuncture is a placebo, i.e., that its apparent effectiveness is only a result of psychological expectation.
In designing that study, I found that there were advantages to doing acupuncture immediately after an extraction. The novel control was established; patients couldn’t easily differentiate between real, needle insertion, and sham, no insertion, acupuncture — right after extraction, the local anesthesia hadn’t worn off and patients were blindfolded, so when acupuncture was performed on Jiache (ST6), Xiaguan (ST7), Yifeng (SJ17) and Hegu (LI4), the patient didn’t see or feel the procedure. Establishing an effective control is a difficult thing in acupuncture studies; sham acupuncture isn’t like a pill that can be the same shape and size as a drug being tested. Although we could have used shallow needle insertion at the real point, these can induce physiological reactions. The best control is non-insertion. Patients might be able to distinguish between insertion and no insertion, but it was not in this project when our subjects were still under local anesthetic.
I modified the model a little for our clinical trial. In the original model, the researchers administered medication about an hour after tooth extraction, when moderate pain starts. I decided to use acupuncture as prevention, with pain-free time being the main indicator, and pain level as the secondary indicator. Before the trial, I did a preliminary study using several patients undergoing tooth extraction. Most actually had no pain after the acupuncture and didn’t need pain medication. My second modification was patient blinding — patients were literally blindfolded during the acupuncture. The test period was only 6 h, very short. A long period might cause a patient to realize if he had received real acupuncture.
The reason I chose postoperative dental pain was because I graduated from the dental school’s PhD program and knew the dental doctors there. I contacted Dr. Bergman, who is an oral surgeon who is interested in acupuncture. We did a few patients to obtain preliminary study data and observed that acupuncture was very good for dental pain after tooth extraction. Then we started a formal collaboration and applied for a research grant from the NIH. Our study showed acupuncture to be much better than sham — or placebo — acupuncture. That study might not have much clinical significance, but it is scientifically significant. It addresses a few questions, such as whether acupuncture is a placebo.
Fan: Those clinical trials that show acupuncture to be no better than placebo — there have been many, such as that of the trial published by a Seattle Group[5]; the results were all similar — I consider the problem to be one of design. First of all, is so-called sham acupuncture really sham? And are its results really placebo effects? Needle insertion effects are not like effects of oral or i.v. medication. Applying a medication model and trial design in an acupuncture study might not produce good research. Also, acupuncture’s time-point effectiveness varies; some effects show up immediately; others require a 10- or 16-session course or six months. Giving 10 sessions of so-called sham and expecting patients not to know if she/he is getting real acupuncture is difficult if not impossible. As you say, if you expect to blind patients but use strong “sham” stimulation, that could induce physiological reactions and amount to actual acupuncture. Also, if the statistical design is wrong, differences won’t show up; this can happen especially if a sample is too small.
Lao: True. I’ll give you an example with a sound methodology, because study methodology is improving so we can have more confidence in the results. A group of researchers in New York led by Vickers did a well-known literature review published in the Archives of Internal Medicine in 2012[6]. Archives of Internal Medicine is one of the archives of the Journal of American Medical Association (JAMA), which is a very prominent journal, and this review was widely reported by the media. Vickers got NIH funding five years ago. He asked researchers who published papers on large acupuncture clinical trials to give him the raw data from their studies. Using those data, Vickers’ team repeated the original statistical analyses to see if they could get the results that were originally published. Twenty-nine high quality acupuncture trials were analyzed, which involved four types of chronic pain lasting more than four weeks: knee OA inflammatory pain; musculoskeletal pain — low back and neck pain; headache — migraine and tension; and shoulder pain. The 29 studies used yielded a total of 18 000 chronic patients divided into at least three groups: acupuncture, sham acupuncture, and routine conventional medicine. The results showed that acupuncture performed much better than the routine conventional treatments and better than sham. The most interesting thing from this paper was that Vickers predicted that if this study were repeated after a few years, the chance of overturning these conclusions would be very low or almost impossible because, statistically, it would take 47 trials of more than 100 patients each, with an effective size of 0.25 in favor of sham controls, to obtain negative results. This study is convincing because it accounted for all possibilities.
Fan: We are both clinical practitioners. So you might agree with my feeling — that the so-called sham acupuncture used in so many clinical trials[5,6]actually is a variation on real acupuncture. Each school of acupuncture has a different style; some use gentle or shallow stimulation in which the patient might not feel the needling sensation at all; some use extra-meridian acupoints. I myself, in different patients and even in the same patient according to different circumstances, conditions, or body parts, might use different stimulation strategies. So it seems to me that gentle or shallow insertion, non-insertion, or extra-meridian insertion isn’t necessarily sham acupuncture. If using a toothpick to mimic acupuncture is sham, then how do we explain the action of the Bian Shi (stone needle), an alternative to the filiform needle? I feel that if metal needles or toothpicks induce a physiological reaction, that’s real acupuncture. In a drug trial the researcher can use an inert pill.
Lao: You are correct. These factors make it more difficult to design an adequate acupuncture sham control. Since the mechanism of acupuncture effectiveness itself is not clear, one can’t design a control that has no such mechanism (like an inert placebo pill). For a conventional medication, its mechanism is relatively clear, such as it works on certain receptors or certain pathways, so it is easy to design a control that does not have that function on these targeted receptors and pathways.
Fan: Why do we still use sham acupuncture in clinical trials?
Lao: The concept of sham control is not bad. The problem is we just don’t know what would be an appropriate “sham”. Some people in the mainstream medical field who have the “speaking rights,” insist on adding so-called sham controls. Although this is not good practice, we have no choice. We have to conform to the status quo. However, in recent years, patient-centered, comparative effectiveness research that more accurately reflects daily acupuncture practice, not using a sham control, has been drawing the attention of many researchers. I believe that type of research will be the next step of acupuncture research – to determine which conditions are most suitable for acupuncture treatment, as compared to conventional treatment.
Fan: What are your comments on the acupuncture research going on in China?
Lao: TCM’s birthplace is China, although none of the papers we’ve discussed were published by scholars in China. I hope that one day soon scholars there will be performing high-quality research. This is why I am so eager to help young scholars in China with study design. As the Chinese economy improves, the Chinese people should take more responsibility for TCM research and produce studies that can’t be dismissed because of poor quality. I want to foster the development of acupuncture and TCM because they really do help patients, are easy to use, and are cost effective. I would like to see researchers in China to conduct more serious and vigorous high-quality studies.
Fan: I admire you. You have been an acupuncture and Chinese herbal medicine researcher for over 20 years and are regarded internationally as a spokesman of TCM research. You’ve met so many difficulties and still have remained mentally strong. What gives you the strength to do so well?
Lao: I am very confident about the development of acupuncture as well as TCM as a whole. Success is based on small daily accumulations. The current situation of acupuncture and herbology is much better than it was a few years ago. Although our profession still has some problems, we should stay optimistic. I believe the proverb: real gold doesn’t fear the fire that smelts it.
Fan: I hope you continue to make contributions, in acupuncture research, in education, and in legislative and political activities.
Lao: Thanks for your interview.
Fan notes: Between June, 1992 (one year after the Center was established) and the present, the center where Dr. Lao works has received more than?35?million dollars in funding from the NIH and other different sources, for carrying out research on acupuncture and Chinese medicine. As a principal investigator or co-investigator, Dr. Lao has been on 28 grants or research projects. Dr. Lao so far has published 142 peer-reviewed papers, 26 non-peer reviewed, invited papers, and 10 book chapters. He is a co-editor of a new acupuncture and moxibustion textbook that will be published by the end of this year. He was the chair of the 2007 Society for Acupuncture annual meeting – “The Status and Future of Acupuncture Research: 10 Years Post-NIH Consensus Conference”, and also chaired the 2010 WFAS (World Federation of Acupuncture and Moxibustion Societies) annual conference in San Francisco, CA.
AcknowledgementsThe author would like to thank Ms. Lyn Lowry for English editing. The interviewer was Dr. Arthur Yin Fan.
Competing interestsDr. Arthur Fan worked in Dr. Lixing Lao’s laboratory and participated in acupuncture and Chinese herbal mechanism studies from 2002 to 2005 as an NIH Fellow in Chinese medicine. The author declares that he has no competing interests.

Figures and Tables in this article: 



Figure 1  Dr Lixing Lao at Virginia University of Oriental Medicine This picture was taken by Byung Kim.

References

1. Fan AY, Fan Z. Dr. Wu: a beautiful, moving and meditative song — in memory of Dr. Jing Nuan Wu, a pioneer of acupuncture and a Chinese medicine doctor in the United States[J] J Chin Integr Med, 2012, 10(8) : 837-840.
2. Fan AY, Fan Z. The beginning of acupuncture in Washington, D.C. and Maryland: an interview with Dr. Yeh-chong Chan[J] J Integr Med, 2013, 11(3) : 220-228.
3. Berman BM, Lao L, Langenberg P, Lee WL, Gilpin AM, Hochberg MC. Effectiveness of acupuncture as adjunctive therapy in osteoarthritis of the knee: a randomized, controlled trial[J]. Ann Intern Med, 2004, 141(12) : 901-910.
4. Lao L, Bergman S, Langenberg P, Wong RH, Berman B. Efficacy of Chinese acupuncture on postoperative oral surgery pain[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 1995, 79(4) : 423-428.
5. Cherkin DC, Sherman KJ, Avins AL, Erro JH, Ichikawa L, Barlow WE, Delaney K, Hawkes R, Hamilton L, Pressman A, Khalsa PS, Deyo RA. A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain[J]. Arch Intern Med, 2009, 169(9) : 858-866.
6. Vickers AJ, Cronin AM, Maschino AC, Lewith G, MacPherson H, Foster NE, Sherman KJ, Witt CM, Linde K; Acupuncture Trialists’ Collaboration. Acupuncture for chronic pain: individual patient data meta-analysis[J]. Arch Intern Med, 2012, 172(19) : 1444-1453.

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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

http://www.jcimjournal.com/jim/FullText2.aspx?articleID=jintegrmed2013007

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.

References

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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