Posted in Acupuncture History in the United States of America, Acupuncture in USA, tagged Acupuncture, acupuncture coverage, acupuncture history in the United States, Alaska, california, Maryland, New Mexico, Obamacare, Washington on August 3, 2014| Leave a Comment »
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
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Posted in Acupuncture history in America, Acupuncture History in the United States of America, Acupuncture in USA, Articles from online, History, tagged Acupuncture, acupuncture legislation, acupuncturist title, california, SB628 on January 10, 2013| Leave a Comment »
中新网9月10日电 据美国《世界日报》报道，美国加州中医界将州参、众议会通过的SB628法案视为一大胜利，在该法案下，拥有博士(Dr.)学位的合格针灸师可改称为针灸医师。中医界表示，他们下一步是推动“中医师”头衔，中医师在美国一直以针灸师名义行医。
在SB628法案下，凡取得针灸师执业资格前，已获得博士学位者，其正式职衔可改为“针灸医师”。无博士学位者则续称为“针灸师”，在回学校进修取得博士学位后，职衔可改为“针灸医师”。
事实上，从针灸师升格为针灸医师的背后是中医界十几年的努力。中医政治联盟主席刘美嫦表示，过去西医批评中医教育水平不够，所以中医界逐步推动硕士和博士学位，并且同时从立法角度为医师正名。她说，根据目前加州针灸管理局的规定，针灸师完成硕士学位即可获发针灸师执照，要提高为医师就得通过更高的学位考试。
全美有3万合格针灸师，一半在加州。
针灸与东方医学学院院长巫文硕说，据他了解，美国之所以用针灸师而非中医师的头衔，是因为在尼克松访问中国前一年，一名纽约时报记者到中国采访时，染上肠胃炎开刀，当地医师以针灸为他麻醉，他回到美国后大篇幅报导针灸，所以美国人对中医的概念就是针灸。
巫文硕指出，美国针灸师的行医范围包括中药、推拿、太极、气功，这都是法律允许的，实质上等同于中医师。他认为，名正言顺固然重要，但提升中医的内涵更重要，与其争取正名，还不如努力将学生水平提高。(赖至巧)
Posted in Acupuncture history in America, Acupuncture History in the United States of America, Acupuncture in USA, tagged Acupuncture, acupuncture legislation, california on January 7, 2013| Leave a Comment »
World Journal of Tradiitonal Chinese Orthopedics page 208-210; No.2, V0l. 7 and No.1, V0l. 8.
http://file.lw23.com/8/89/89c/89ccd8f3-a76c-4e28-a3fb-e0042b3752cd.pdf; retrieved on 01/06/2012
美 国加州 中医针灸立法概况及新挑战
罗志长 (美国加州中医师联合总会名誉会长、世界中医骨科联合会资深主席)
中医针灸在 中国是 国宝，但到 了外国却成 了外来文化，如何使这个外来文化在所在国立足、生根、发展，就成 了各 国中医界必须经历和认真探讨的 问题．我们在美国也经历过艰难 的立法过程 。
美国中医针灸 的发展，虽然全国轰动，但是美 国民众思想最开明，针灸发展最迅速，中医队伍最庞大，中医立法最完整 的，要数加州 。 因此加州中医针灸立法过程的成功经验和失败教训，有一定的参考价值。
非法 时期
在 1971年 以前 的一百多年间，加州和全美 国一样，中医针灸基本上是空 白的。早期随着华裔劳工 的输入，中医针灸也被传入了美 国，为劳工们解决 自身 的病痛 问题．虽然那时也有一 些中草药铺和针灸，但他们没有法律 的保障。
1971年 7月 以后 出现的 “针灸热”，使加卅的中医针灸展现一片前所未有 的景象，但是一些 中医师常遭告发，尤其一些老 中医前辈不时受到骚扰 、威胁 、诽谤，并 以 “无牌行医”等罪名被拘捕起诉 。为了争取中医针灸师的合法权益，加州一批 中医精英前辈，开始 了艰辛的针灸职业合法化运动 。
半合法时期
1972 年，在加卅I西医师公会的策划 下， 由杜 菲(Duffy)众议 员提 出第一条针灸法案 (AB15o0)，该法案规定 ：没有西医执照的人可做为医师助手进行针灸治疗，但必须在某些核准的医学院校 内，在西医的直接监督下施术，并且必须 以科研为 目的。该法案获顺利通过议会，并由美国前总统里根即当时的加州州长签署成为法律。 这条法律成为加州的第一个针灸立法。
在此后的两年 间，中医界先后提 出五条法案，法案要求 ：
1．允许针灸治疗在校园以外 的地方进行 。
2．拨款四十万元供作针灸研究之用。
3．承认针灸师资格，针灸师可 以独立进行针灸治疗，但事先必须有西医或牙医的诊断和介绍 。
4．成立有七名成员的针灸顾问委 员会，专司管理针灸 事 务 。
No．2V0|7andNo.1V0L8
在 当时的条件下，上述条款对针灸医师是有利的，参 、众两 院都顺利通过，但却遭里根州长一一予以否决 。
正式立法
上述失败，激发起大家的抗争锐气，使大家更加团结一致 ，决定再次委托马斯可尼提出 SB86提案，提案规定 ： “凡是有证据证 明曾经从事针灸治疗五年 以上经验者”，或 “在医学院校的针灸研究项 目中从事针灸治疗三年以上者 ”，均有资格申请注册成为针灸师。
经过一年半的激烈辩论，终于在 1975年 6月 27日，这条法案，成功地通过 了上 、下议 院的全部审议过程，并于 1975年 6月 30日上午十时送交州长办公室 。7 月 12 日，当时刚上任不久的民主党籍 的布朗(JerryBrown)州长签署成为法律，并立 即生效。这一历史性的胜利，成为加州中医针灸顺利发展的里程碑 。
成立管理机构
1976年，布朗州长正式任命七位 中、西医师，成立 『加州针灸顾 问委员会 J1980年，被立法升格为 『加州针灸考试委员会 J.1989年，由于当时针灸考试委员会一位韩裔委员柳在佑 的卖题舞弊案，引发将针灸考试委 员会降格为『加州针灸委员会 J，取消执行考试之权力，并规定今后五年 内，针灸执照考试将由独立 的专业考试顾 问负责执行。 此后数年， 由于中医针灸 的发展形势健康良好，随于 1998年，经过立法，把针灸考试委员会升格为独立的 『加州针灸局 J(CALIFORNIAACUPUNCTURE BOARD)，摆脱 了原来隶属于加州医务部辅助 医疗职业处的管辖，但仍受加州消费者委员会的领导．2002年，由于外州利益集 团的干预，立法当局顾请 小胡佛委员会(LittleHooverCommission)对针灸局的工作重新审核评估，评估内容为。
1．针灸需要的教育学时；
2．针灸师之行医范围；
3．全 国针灸执照在加州之通行性；
4．针灸局对针灸学校之审核权 。
小胡佛委员会的评估报告对针灸局持负面结论，加上立法院的复杂斗争，消费者委员会决定取消针灸局，形势十分险峻。2005年，经过 中医专业界的团结、斗争、游说和妥协，终于和立法议员达成协议，有条件地保 留了针灸局．
争取独立行医权
1979年， 由加州针灸联合总会策划，委托众议员托利斯 (Torres)先生提 出并通过 了f针灸师独立行医法案J即 AB1391法案，取消了针灸师诊治病人必须先经西医、牙医、足医或整脊医师诊断或转诊的限制，使针灸师的权力提高了一步 。
中医行医职业规范化
1980年，由美国针灸协会策划，委托众议员诺克斯 (Knox)先生提 出并通过了 『中医行医规范法案j即AB3040法案．这项 内容广泛的法案要点如下 ：
1．针灸师具有 “第一线医务工作者”(PRIMARY HEALTHCARE PROVIDER)的身份 。
2．针灸师可以合法使用 电针疗法，艾灸疗法，拔罐疗法 。
3．针灸师可以使用推拿，气功，太极拳等治疗手段。
4。针灸师可以使用中草药以 “促进患者之健康 ”。
到了 2001年 2月 20日，加州参议员普拉塔再次提 出{2001年中医师行医规范提案》即 SB341法案，其目的在于肯定和在文字上澄清上述法案的 内容，并进一步扩大中医师可以使用的行医方式。例如可以使用营养物品、草药 以及膳饮辅助食品等，特别注明中医师在临床治疗中可 以处方使用各种植物 、动物及矿物产品．除了 AB3040法案规定的内容外，新法案还要求增加一项磁疗法．该法案顺利通过参、众两院，并于同年九月二十七 日获得州长 GeayDavis签署成为法律。
发展业务，开拓病源
1．经 过立 法努 力，取 得 了加州 医疗 补助 计划(Medi—Cal)提供针灸福利；
2．允许不持有针灸证书的外 国或外州针灸专家在教学或示范 中可从事针灸治疗 ；
3．规定 “健保组织 ”或 “自身保险 ”或 “残障保险”计划，都必须具备供选择 的针灸治疗福利。
4． 将 针 灸 师 在 工 伤 保 险 系 统 中 列 为 医 师(Physician)，有权治疗受伤雇员，针灸师 以医师 资格，永久保留在工伤医疗保险系统之中．此外中医立法还取得了下列进展 ：
(1)1997年 ，由Napolitano提 出的 AB174法案。
规定禁止其它医务人员(整脊医师 、护士和物理治疗员)等未经正规训练就从事针灸治疗 。
(2)1998年 Cedillo提出 AB2120法案，规定针灸医师有权拥有其它医疗职业公司股权。
(3)1998年 Migden提出 AB21M 法案，规定在工伤法 中明确规定雇主及管制医疗组织 向工伤雇员提供的医疗服务 中都必须加上针灸福利项 目：a．雇员有权选定的 “私人针灸医师”；b．工伤员者在转换主治医师时有权选择针灸师。
(4)1999年 Wildman提案要求在加州工伤补偿处产业医务委员会 中添加一名足医委员和一名针灸医师委员。
(5)2001年 《豁免中药销售税提案》先后提 出四次，前三次因经济理 由皆被搁置在拨款委员会中，第四次 以AB249案提 出，于九月十三 日以 40：0的绝对 比数通过 ，完成 了参众两院的全部审议程序，可是戴维斯州长也以经济理由予 以否决。
(6)SB573 <<2001年中医保 险法案》由参议院议长 JohnBurton提 出。在八十年代初，加州几乎所有的医疗保险公司都拒绝支付针灸服务．1984年，以华裔中医界为核心，联络 了各族裔针灸 团体，组成 了 f加州针灸大同盟j，并通过 Torres和罗森陀两位参议员共同提出 SB2179 『针灸保险法案 J，规定所有保险公司的医疗保险计划都必须包括针灸福利。当时预算需要运作经费二十余万美元，经过一年多的努力 ，只筹得十五万美元 。因经费不敷所支，致使原本提 出的要求所有商业医疗保险 “需要提供 ” (PROVIDE)针灸福利的条款，被修 改为保险公司要有 “可供选择 ”(OFFER)的针灸福利 。一字之差，二十年来，使中医业者在经济上损失惨重。20o5年曾再度努，可惜尚未成功。
(7) 联邦医疗补助 Medi—care即老年医疗保险，此保险支付中医针灸治疗费用需由美国国会通过，是全 国性的大问题 ，已有HR7 47提案，多年来加州中医同业及全 国性组织都在不 断努力，动员各州国会议员参加联署。
教育改革
二十年前，加州中医针灸的教育标准为 2370学时，这个实行多年的标准已经不能适应形势的发展。故有赵美心 JudyChu众议员提出 《针灸师教育标准提案》，其 目的在保证针灸 中医师的专业水平。这条提案 自从2002年 2月 14日提出后， 已经通过参、众两院，并已于九月由州长签署成为法律。这条法案规定在 2005年，中医针灸的基本训练将达 3，000小时，到 2010年则将达
4，000小时，最终 目的是要把中医教育提高到博士水平．
目前。教育水平较高的加州和教育水平偏低的全 国组织正为此展开剧烈的争议。
关于学位和中医师称呼问题
多年来一直 困扰着许多年资高，资历深，但英语欠佳的医师们。目前美国除了内华达州，佛罗里达州以及加州工伤保险系统之外，美 国中医针灸师并无医师身份。1983年间，加州有一百多位中医针灸师经过两年 的艰 苦 进 修 学 习 ， 取 得 了 “东 方 医 学 博 士 ”(DoctorofOrientalMedicine)的头衔．经过反复的争论，总算可 以有条件地使用 Dr．和 OMD．现在许多学校正在朝这个方向努力之中。 展望未来，美国中医针灸医师将普遍达到博士水平。而只有这样，才能逐步进身美 国主流社会．
中医针灸专业面临新挑战
进入新世纪以来，就在中医事业得到美国主流社会认 同和接纳的同时，加州中医专业的发展却遇到接二连三的挫折，例如 ：中医业界要求提高教育水平的努力遇到障碍；中医师做为第一线医疗提供者的资格受到非议；中医师诊断的能力受到质疑；开医嘱化验单和做医学影像检查的权力受到挑战；转诊特殊病人给西医或其它医务人员的资格受到反对，等等。
原因何在?
1． 中医针灸在美国，尤其是加州，已经形成一个可观的行业，占据了一定的市场，引起非中医业者的垂青，许多其它专业如西医、牙医、足医、整脊医、营养医，甚至护士，都想从中分一杯羹， 因此凡对中医针灸专业有利的事都要受到阻挠 。
2． 外州一些私人利益集团，专营以低标准招考
针灸、中药 、按摩等执照而谋利者，同时以低标准入学门坎招生， 以保证学校生源，这与加州中医界主张必须大力提高中医水平的宗旨背道而驰。然而加州中医业人数众 多，几 乎占全 国的一半，是外州利益集团所虎视眈眈 的大市场， 因此利用其财力千方百计地阻挠加州中医针灸的发展 。
3． 可笑的矛盾 ：当中医业者争取评估工伤员者
的权力时，西医认为中医水平太低 ；当我们主张提高教育水平时，利益集团为保护招生来源而加以反对．使中医师处于前后夹攻的境地。
以上所叙述 的主要是加州的情况，美国其它各州也有类似程序的立法过程 。
加州经验教训仅供参考，今后加州还要 向其它州和各国学习好的经验，只有互相学习，互相促进，才能在全国范围内取得中医针灸立法 的全面胜利。
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Posted in Acupuncture history in America, Acupuncture History in the United States of America, Acupuncture in USA, Articles from online, History, tagged Acupuncture, california on January 7, 2013| Leave a Comment »
【大纪元2012年08月31日讯】（大纪元记者盛元洛杉矶报导）40年前，《纽约时报》名记者詹姆斯访华，期间因阑尾炎手术后腹部胀痛而接受了中医的针灸和艾灸治疗。奇特的治疗效果使他对中医产生了兴趣，回国后他将自己在华接受中医药治疗的经历写成报导发表在《纽约时报》头版上，从此，美国大众知道了在西医之外还有这样一种古老而神奇的疗病方法。中药和针灸也开始在美国传播并热俏起 来。近日，著名中医药专家、加州中医工会创会会长陈炯明先生接受本报记者采访，介绍了中医药发展的相关情况和他的见解。
加州州长为中医药在美发展见证人
《纽约时报》记者詹姆斯关于中医药介绍的报导发表后，中药针灸开始在美国成为一种风行治疗方法，但那时没有立法，中医师还不能合法行医。使用 一根小小的银针和一把草药能治病，在许多洋人看来多少还有点天方夜谭。但许多痛症吃止痛药不起作用的却通过针灸治好，这使喜欢实证的美国人渐渐喜欢和接受了中医。
1975年，新任的年轻加州州长杰瑞‧布朗 (Jerry Brown)签署了中医合法化的第一个法案。当时，加州和内 华达州是美国最早为中医立法的两个州。之后美国各州陆续立法承认中医针灸合法化，目前已超过45个州立法承认中医。时光流转37年，杰瑞‧布朗 又再次当选为加州州长，成为中医药在美国发展的见证人。为此他也被业界称为“美国加州针灸之父”。
疑难病及痛症 中医针灸靠疗效说话
洛杉矶儿童医院是全美乃至世界的儿童顶级医院，每年都有许多外地患者从世界各地乘飞机前来就诊。然而两年多前，有一例疑难病症被儿童医院宣布救治无望的情况下，靠中医救活生命。那是一位两岁多的患儿，因先天性血管瘤破裂在幼儿园突然昏迷被送儿童医院急救。
经过9天的抢救，第三脑室仍然充满积水。存活的希望仅 剩3%。在各种抢救方法都用尽的情况下，医院准备拔管放弃救治。那时孩子已经满脸发黑，眼白上翻。孩子的父亲提出能否请中医师再试一下，经医院同意找到了陈炯明医师。陈医师为孩子调好中药从胃管里灌进去，同时为其针灸。6小时后孩子排出了一堆又臭又黑的大便，情况开始好转。一个月后孩子醒过来脱离了危险，继续用中医针灸治疗一个月后做CT检查，脑淤血化掉90%。儿童医院的专家也对中医的神奇疗效感到不可思议和惊奇。这名女孩住院花掉了近50万美金的西医治疗费，而陈炯明为其治疗24次，仅收4500美元的费用。
中医药在美发展有瓶颈
中医针灸在美国受欢迎是因为其独特的疗效和低廉的收费。然而，由于目前美国医疗体制的限制使中医药在走俏发展中遇到瓶颈。在美国，看病都要通过保险公司。而保险有PPO和HMO两种。PPO病人可根据自己的喜欢选择医生，但这种病人的保 险公司80%不包含中医针灸，只有不超过20%的公司可报销中医针灸费。像以上列举的小女孩， 虽然在医院花掉近50万美金，但保险公司可予以报销，而中医虽然只花4500美元治好了病，却不能报销。
HMO是通过管理公司来管理病人和医生，病人看病要通 过家庭医生介绍。一方面有的家庭医生习惯于介绍西医，另一方面即使介绍中医，收费也要通过中介管理公司来管理和分配，中介管理公司通常给中医师的费用尽量少，这样使中医的生存空间变得局限和窄小。
中医药愈显优势
据陈医师介绍，中华传统医药分为中药和针灸两部分，针灸治疗是由外到内，而中药治疗是由内到外，两者结合收到的疗效甚好。而西医作为实证科学，很难理解源于中华传统文化、有着深厚哲学思想内涵的中医。陈医师认为，中医和西医是两个不同的理论体系，站在西医的角度去研究理解不 了。国外曾有学者想通过科学的实验来检测中医却根本检测不了。中国大陆花费天文数字的钱去研究中西医结合，耗时几十年，结果是牛头不对马嘴，耗财耗力无进展。而根植于中华大地的传统中医却以其自身的实力传遍全球。
加州是美国拥有中医诊所最多的地方，被称为针灸重镇。目前南加州约有2800个持证中医诊所。约占全美中医诊所的40%。这些诊所为无数的病人治好了顽症，解除了痛苦。随着西药毒副作用的显露和医药费用的昂贵，中医愈加显出优势。但目前在美中医师还远远少于西医。
南加州约有10万名执照西医师，中医师仅有1万3千名。好在加州拥有16所中医针灸大学，可源源不断为中医输送人才。在这些大学完成3200学时课程并获得学士学位后，就有资格参加州政府 的执照考试，获得执照后就可加入到美国中医队伍，成为用中华传统医学救人的白衣天使。
Posted in Acupuncture in USA, Articles from online, tagged 2012, Acupuncture, california, essential health benefits on December 8, 2012| Leave a Comment »
By Jim Roope, CNN
(CNN) – Acupuncture history is about to be made for a second time in California.
Governor Jerry Brown is expected to sign two bills that would, for the first time in US history, put acupuncture in the list of essential health benefits.
That means health insurance providers would have to pay for acupuncture treatments like they pay for x-rays or flu shots.
[:46] “I’ve personally seen the evolution of this profession in California and basically in the United States,”said Jacques MoraMarco, acupuncture practitioner and Dean of Emperor’s Collegein Santa Monica.
In 1976, then Governor Jerry Brown signed a bill that legalized the practice of acupuncture. MoraMarco was among those who took the first licensing test 35 years ago.
Before 1976, MoraMarco said acupuncturists practiced illegally.
Elvis Presley, who studied with the same Martial Arts teachers as MoraMarco, received acupuncture treatment for an injured ankle.
Bonanza’s Lorne Green also received clandestine acupuncture treatments from the same acupuncturist that treated Elvis.
[2:29] “…every so often he would have to be bailed out and Lorne Green would go and bail him out,” MoraMarco said. “He was arrested for practicing medical procedure without a license.”
Today acupuncture is integrated in many Western medicine facilities.
Posted in Acupuncture history in America, Acupuncture History in the United States of America, Acupuncture in USA, Articles from online, History, tagged Acupuncture, california, Chen Daren, history on November 22, 2012| Leave a Comment »
加 州 中 医 立 法 历 史 年 表 加州中醫歷史文獻館 陳 大 仁 教授（撰稿）
一九九九年十月初搞; 二零零五年十月定稿 二零一零年八月補訂.（原文http://www.caam.us/resources/califonria_legislation082510.pdf）
美國的中醫藥事業當首推加州，這里的醫師人數、學術水平及政治潛力均遙遙領先于其他數十個州，成為發展美國中醫的主要推動力量。而加州的中醫事業，則首先受惠于前輩們的英勇奮斗，成功立法，開創了在異鄉公開傳播這門古老醫學的新紀元；再加上三十多年來廣大中醫師的辛勤耕耘，通過活躍而又艱辛的政治行動，進一步取得了顯著的進步。其中為數眾多的華人中醫師為在海外傳播中華文化更是作出了不可磨滅的貢獻。中醫今天已經成為美國社會最受歡迎的替代醫學之一。
請看近四十年來加州中醫界所策動的一百多項立法動議或者是立法抗爭所經歷的坎坷事實。這些轟轟烈烈的政治行動對確保加州中醫師的基本行醫權益和廣大病家的合法福利都具有非常重要的意義。以下就是近代加州中醫師們組織起來爭取權益，服務人民的動人歷史﹕
AB 1500 (Duffy, 1972) —— 加州西醫學會(CMA)策劃
加州第一個針灸立法﹕規定沒有西醫執照的人員(稱之為“醫師助手＂）可以進行針灸治療。但是醫師助手必須在西醫的直接監督之下施術，而且針灸治療必須在核准的醫學院校之內進行，並以科學研究為目的。本案由加州西醫師公會策劃，雷根州長簽署成為法律。
AB 976 (Duffy, 1972) —— 加州中醫藥針灸學會策劃
內容同 AB 1500，但增加一項條款即針灸治療除了可以在核准的醫學院校之內進行，還可在該醫學院校的“校園以外＂地方進行。雷根州長予以否決。
AB 1841 (Duffy, 1972) —— 加州中醫藥針灸學會策劃
內容同 AB 976。同時要求撥款四十萬元供作針灸研究之用。雷根州長再次予以否決。
AB 1691 (Duffy, 1972) —— 加州中醫藥針灸學會策劃
要求在醫療職業中增加一種新的醫師助手資格，稱為“針灸醫助＂(PHYSICIAN ASSISTANT—ACUPUNCTURE)。承認這種非西醫人員可以在西醫的直接監督之下進行針灸治療，但必須以科學研究為目的。同時規定成立針灸顧問委員會，專司管理“針灸醫助＂事務。本案受到針灸界人士的強烈反對，雷根州長亦予以否決。
SB 2117 (Mascone, 1973) —— 加州中醫藥針灸學會策劃
承認針灸師資格，規定非西醫的針灸師可以獨立進行針灸治療，但事先必須有西醫或牙醫的診斷和介紹。提案順利通過參、眾兩院，但繼續被雷根州長予以否決。
SB 2118 (Mascone, 1973) —— 加州中醫藥針灸學會策劃
規定成立有七名成員的針灸顧問委員會，專司管理針灸事務。提案順利通過參、眾兩院，但同樣被雷根州長予以否決。
SB 86 (Moscone, 1975) —— 加州中醫藥針灸學會策劃
內容與 SB2117 及 SB-2118 兩案基本相同。這是加州第一個成功的由中醫界自行推動的針灸職業合法化提案。布朗州長七月十二日簽署成為法律。
AB 2424 (Keysor, 1978) —— 加州針灸聯合總會策劃
授權加州醫療補助計劃（Medi-Cal）提供針灸福利，布朗州長簽署成為法律。
AB 3105 (Suitt, 1978) —— 加州針灸顧問委員會策劃
本案取消根據經驗頒發針灸師證書的條例。規定要對所有申請針灸師證書者實行考試。本提案還規定考試要包括有實際操作的口試。布朗州長簽署成為法律。
AB 3568 (Torres, 1978) ——加州針灸顧問委員會策劃
取消針灸師診治病人必需先經西醫、牙醫、足醫或整脊醫師診斷或轉診的規定。此案由加州針灸針灸顧問委員會主席丘德陽醫師開始策劃。當時并未得到西醫公會的諒解，審議中遇到很大阻力，此提案未得通過。
SB 1488 (Sieroty, 1978) —— 美國針灸協會策劃
法案允許持有證書的針灸師注冊成立針灸公司。布朗州長簽署成為法律。
SB 1106 (Song, 1978) —— 美國針灸協會策劃
規定針灸顧問委員會的工作細則﹕包括委員會中增加四名公眾委員，建立針灸學徒制度，建立繼續教育制度，診所必需展示針灸師證書，證書每兩年更新一次，五年沒有更新證書者要重新考試等。並規定針灸顧問委員會的行政關係直接隸屬於加州醫療品質保障部屬下的輔助醫療職業處，專施管理針灸師執業的問題。布朗州長簽署成為法律。
SB 1790 (Campbell, 1978) —— （法案策劃者待查）
允許西醫以外的醫療職業者從事營養及輔助食品咨詢，但必需聲明並非診斷或治療等醫療行為。布朗州長簽署成為法律。
AB 1391 (Torres, 1979) ——加州針灸顧問委員會策劃
取消針灸師診治病人必需先經西醫，牙醫，足醫或整脊醫師診斷或轉診的規定。此案主要由加州針灸針灸顧問委員會主席丘德陽醫師策劃，后獲得西醫公會的諒解，并取得州長的支持。該案交由托里斯眾議員提出，布朗州長簽署成為法律。
AB 3040 (Knox, 1980) —— 美國針灸協會策劃
將針灸執業範圍擴充至包括電針療法，東方式按摩及艾灸療法，並授權針灸師開中藥處方。此提案還將針灸顧問委員會升格為針灸考試委員會，授予更大的權力。此案主要由美國針灸協會策劃，諾克斯眾議員提出，布朗州長簽署成為法律。
AB 538 (Rosenthal, 1981) —— 美國針灸協會策劃
規定牙醫和足醫必需接受針灸訓練方能施行針灸。布朗州長簽署成為法律。
AB 901 (Rosenthal, 1981) —— 美國針灸協會策劃
建議設立針灸戒酒試驗計劃。該提案因過去類似計劃之結果不夠滿意而未通過。
AB 837 (Rosenthal, 1981) —— 美國針灸協會策劃
加州議會第一項涉及針灸醫療保險的提案。根據保險業界的建議，議案規定患者每一種疾病每年可以接受 24 次針灸治療。後來由于業界人士不同意數目限制，此提案被撤銷。
AB 3601 (Rosenthal, 1982) ——（法案策劃者待查）
要求醫療保險支付針灸治療費用。曾在議會舉行廣泛聽證，包括向議會人士及西醫示范針灸技術。
此提案未得通過。
AB 3806 (Rosenthal, 1982) —— 美國針灸協會策劃
允許不持有針灸師證書的外國或外州針灸專家在教學或示範中從事針灸治療。布朗州長簽署後立即生效。
SB 1158 (Torres, 1983) ——（法案策劃者待查）
規定針灸師可以使用“東方醫學博士＂的名銜以提高針灸專業的地位。由于加州西醫學會強力反對，此提案未得通過。
AB 3827 (Filante, 1984) —— 美國針灸協會策劃
建立針灸戒酒戒毒試驗計劃的第二個提案。此提案曾獲得議會通過，但杜美津州長將其否決。
SB 314 (Rosenthal, 1984) ——（法案策劃者待查）
規定針灸師必需每兩年修有 30 個學時的繼續教育學分，提案獲得通過并由杜美津州長簽署成為法律。
SB 2179 (Torres and Rosenthal, 1984) —— 加州針灸大同盟策劃
提案規定健保組織（HMO）或自身保險或殘障保險計劃以外的醫療保險計劃，包括非營利醫院等集體性的醫療保險計劃都必需具備供選購的針灸治療福利。杜美津州長簽署成為法律。
AB 272 (Filante, 1985) ——美國針灸協會策劃
取消國外訓練的針灸師需在加州先做住院醫師的要求，但規定他們必須在美國內至少住滿九個月才能參加針灸執照考試。杜美津州長簽署成為法律。
SB 1642 (Rosenthal, 1986) ——加州針灸大同盟策劃
將針灸師在工傷保險系統中列為醫師（PHYSICIAN），有權治療受傷雇員。另外規定要向州政府和公立校區之雇員提供針灸醫療福利。此案未獲成功。
SB 839 (Torres, 1987) ——加州中醫政治聯盟策劃
規定針灸治療必須由持有法定合格證書的針灸師執行。禁止無執照者進行針灸。杜美津州長簽署成為法律。
SB 840 (Torres, 1987) ——加州中醫政治聯盟策劃
將針灸師在工傷保險系統中列為醫師（PHYSICIAN），有權治療受傷雇員。該案排除針灸師對患者作殘障評估，此外還附有四年期限的“日落條款＂。杜美津州長於 1988 年 9 月簽署成為法律。
SB 841 (Torres, 1987) ——加州中醫政治聯盟策劃
要求所有的健保服務計劃，非營利性醫院服務計劃和集體殘障保險提供針灸治療福利。此案未獲成功。
SB 1362 (Rosenthal, 1987) ——加州中醫政治聯盟策劃
要求針灸考試委員會每年舉行兩次針灸執照考試，委員會必需向考生提供筆試及口試有關內容範圍（包括中藥的內容範圍）的書面通知，考生可查詢自己所考各科成績，設立考生的上訴程序。杜美津州長簽署成為法律。
SB 1544 (Marks, 1987) ——（法案策劃者待查）
將針灸師證書法令改為針灸師執照法令，即針灸師需持有執照方能行醫。杜美津州長簽署成為法律。
AB 4671 (Elder, 1988) ——（法案策劃者待查）
修訂批准針灸考試委員會所提的教育和訓練計劃。杜美津州長簽署成為法律。
AB 2367 (Filante and Rosenthal, 1989) ——加州中醫政治聯盟策劃
針灸考試委員會舞弊案引發之機構改組提案，規定將針灸考試委員會改稱針灸委員會，取消執行執照考試之權力；針灸師委員資格從十年經驗改為五年經驗；委員會中針灸師委員要反映族裔比例。杜美津州長簽署成為法律。
SB 633 (Rosenthal, 1989) ——（法案策劃者待查）
要求針灸考試委員會聘請獨立專家對現行針灸學徒制度以及國外訓練的針灸考生資格進行分析評估。同時要求所有 1988 年 1 月 1 日以 前獲得執照的針灸師在 1993 年 1 月 1 日前完成包括各中西醫學科目的 40 學時繼續教育。杜美津州長簽署成為法律。
SB 654 (Torres, 1989) —— 加州中醫政治聯盟策劃
提案規定健保組織（HMO）或自身保險或殘障保險計劃以外的醫療保險計劃，包括非營利醫院等集體性的醫療保險計劃都必需自 1990 年 1 月 1 日起一律提供針灸醫療福利。此案未獲成功。
AB 3836 (Eastin, 1990) —— 加州中醫政治聯盟策劃
規定將隸屬于加州醫務部屬下之輔助醫療職業處的針灸委員會升格為獨立的加州針灸局（ACUPUNCTURE BOARD）。此案未獲成功。
AB 4368 (Filante, 1990) ——（法案策劃者待查）
所有針灸委員會核准的教育課程必需在 1992 年 12 月 31 日以前，或在針灸委員會核准後 5 年內，再獲得公共教育總監的批准。
AB 400 (Margolin, 1992) —— 加州中醫政治聯盟策劃
將四年前通過的針灸工傷保險法案（SB840）延長四年。威爾遜州長簽署成為法律。
ACR 150 (Burton, 1993) ——（法案策劃者待查）
建立有十六名成員的傳統中草藥顧問委員會，專施管理中草藥品的有關事務。此議案未獲通過。
AB 2494 (Conroy, 1994) ——（法案策劃者待查）
規定針灸師使用中草藥為藥用。此案未獲成功。
SB 1279 (Torre, 1994) —— CSOM 策劃，加州中醫政治聯盟支持
規定執照針灸醫師可以建立針灸專業仲裁委員會（PEER REVIEW COMMITTEE）。威爾遜州長簽署成為法律。
AB 1002 (Burrton, 1995) —— CSOM 策劃，加州中醫政治聯盟支持
要求廢除現行勞工法中有關針灸師醫師身份的”日落條款”。此案被修訂為將日落條款再延長兩年。威爾遜州長簽署成為法律。
AB 1003 (Burrton, 1995) —— CSOM 策劃
要求針灸師可以在工傷保險系統中作殘障評估。由于阻力太大，作者後來主動將此案撤消。
SB 1360 (Watson, 1996) ——加州中醫政治聯盟策劃
要求廢除現行勞工法中有關針灸師醫師身份的 “日落條款”。此案未獲成功。
SB 863 (Lee, 1997) ——法案策劃者待查，加州中醫政治聯盟反對
規定西醫不必取得針灸執照即可進行針灸治療；同時規定將針灸委員會改為針灸局。此案未能通告議會。
SB 212 (Burton et al, 1997) —— CSOM 策劃，加州中醫政治聯盟支持
廢除現行勞工法中有關針灸師醫師身份的”日落條款”，使針灸師得以醫師資格永久保留在工傷醫療保險系統之中。威爾遜州長簽署成為法律。
AB 174 (Napolitano 1997) —— 加州中醫政治聯盟策劃
規定禁止其他醫務人員（諸如整脊醫師、護士、理療師等）未經正規訓練就從事針灸治療，目的在於保障中醫師的基本行醫權利，並確保病家獲得可靠專業治療。威爾遜州長簽署成為法律。
AB 410 (Gallegos et al, 1997) —— CSOM 策劃，加州中醫政治聯盟支持
《豁免中藥銷售稅提案》。此案目的在於爭取豁免中醫師發售中藥的零售稅，如同其他醫務人員銷售維他命等時免收零售稅一樣。此案未能通過議會而失敗。
SB 1255 (Polanco, 1997) —— 加州整脊醫師公會策劃，加州中醫政治聯盟支持
規定有執照的醫務工作者有權對及時付款的患者以及對無力購買醫療保險的患者給予折扣優惠。此案由加州整脊醫師公會策劃，威爾遜州長簽署成為法律。
AB 2120 (Cedillo, 1998) —— CAAOM 策劃，加州中醫政治聯盟支持
規定針灸醫師有權擁有其他醫療職業公司的股權。威爾遜州長簽署成為法律。
AB 2721 (Miller, 1998) ——（法案策劃者待查）
制裁任何涉及色情活動的醫療職業者。針灸醫師必須向加州針灸局注冊診所地址。威爾遜州長簽署
SB 1980 (Greene, 1998) —— 加州中醫政治聯盟策劃
規定將隸屬于加州醫務部之輔助醫療職業處管轄下的針灸委員會升格為獨立的加 州針灸局。威爾遜州長簽署成為法律。
AB 204 (Migden, 1998) —— 加州中醫政治聯盟策劃
在工傷法中明確規定雇主及管制醫療組織向工傷雇員提供的醫療服務中都必須加上針灸福利項目；規定雇員有權選定自己的 “私人針灸醫師＂；規定工傷患者在要求轉換主治醫師時有權選擇針灸師。威爾遜州長簽署成為法律。
AB 1185 (Baugh,1998) —— 加州中醫政治聯盟策劃
在加州工傷補償處產業醫務委員會中添加一名針灸醫師委員，同時允許針灸師經過規定的專業訓練及考核後可以對工傷患者進行殘障評估。此案未能通過議會而失敗。
AB 1252 (Wildman, 1999) —— 加州足醫公會策劃，加州中醫政治聯盟支持
AB 1252 法案案的內容之一是規定在加州工傷補償處的產業醫務委員會中增加四名委員，包括兩名西醫、一名足醫和一名針灸醫師。戴維斯州長將之簽署成為法律。並於 2000 年一月任命聯合總會名譽會長楊自國醫師為首位中醫委員。
AB 231 (Battin, 1999) —— 外州利益團體策劃，加州中醫政治聯盟反對
試圖立例允許非執照人員從事戒毒耳針治療。此案遭到加州中醫界的強烈反對，因而遭到挫敗。
SB 466 (Perata, 1999) —— 加州中醫政治聯盟策劃
《中醫師行醫規範提案》，明確並擴大中醫師可以使用的行醫手段。 例如可以使用營養物品、草
藥以及膳飲輔助食品等，特別注明中醫師在臨床治療中可以處方使用各種植物、動物及礦物產品。
除了過去已經取得合法地位的電針療法，艾灸療法與拔罐療法，以及使用東方式按摩（推拿）、呼
吸技術（氣功）、醫療體育（太極拳等）等各治療手段等項外，新法案還要求增加小能量激光療法
和磁療法。此案順利通過議會，但被戴維斯州長予以否決。
AB 1751 (Kuehl, 1999) ——（法案策劃者待查）
即《保障患者訴訟權力法案》。禁止保險公司在合約中強行病家在糾紛中接受仲裁，賦予患者必要 時采取法庭訴訟的權力。這是年來眾多旨在對付管制醫療體制的法案之一。該案未能通過議會而失敗。
AB 2764 (Knox, 2000) —— 加州中醫政治聯盟策劃
《豁免中藥銷售稅提案》，内容同 AB410 (Gallegos et al, 1997)。此案目的在於爭取豁免中醫師發售中藥的零售稅，如同其他醫務人員銷售維他命等時免收零售稅一樣。此案未能通過議會而失敗。
SB 341 (Perata, 2001) —— 加州中醫政治聯盟策劃
泊拉塔參議員重新提出《中醫師行醫規範提案》，内容大致同去年的 SB 466。新法案還要求增加一項磁療法。戴維斯州長於二零零一年九月將之簽署成為法律。
AB 208 (Frommer, 2001) —— 加州中醫政治聯盟策劃
《豁免中藥銷售稅提案》，内容同 AB410 (Gallegos et al, 1997) 及 AB 2764 (Knox, 2000)。此案目的在於爭取豁免中醫師發售中藥的零售稅，如同其他醫務人員銷售維他命等時免收零售稅一樣。此案未能通過議會而失敗。
AB 249 (Matthews, 2002) —— 加州中醫政治聯盟策劃
《豁免中藥銷售稅提案》此案目的在於爭取豁免中醫師發售中藥的零售稅，如同其他醫務人員銷售維他命等時免收零售稅一樣。AB410 在一九九八年失敗後，AB 2764 在二零零零年再失敗，AB 208 二零零一年也未能通過議會。二零零二年改由馬修斯眾議員重新提出，即 AB 249 法案，終於順利完成了參、眾兩院的全部審議程序。但是戴維斯州長最後以財政短缺為由否決了此項提案。至此，中醫界努力運作近五年的《 豁免中藥銷售稅提案》再次受到挫折。
抗議刪除針灸醫療補助 (2002) —— 加州中醫政治聯盟參與修訂
戴維斯州長在其財政預算中曾一度將針灸醫療補助（MEDI-CAL）在於預算中予以刪除。后經廣大同業的努力遊說，參眾兩院聯合預算委員會曾將此決定否決，使針灸福利得以保留至 2003 年 7 月。
SB 573 (Burton, 2002) —— 加州中醫政治聯盟策劃
內容是將目前只要求商業醫療保險具備“可供選購＂( OFFER ) 的針灸福利條款，改成規定所有保險公司都“需要提供＂( PROVIDE ) 針灸福利。此案未能通過議會而失敗。
SB 1951 (Figueroa, 2002) —— 外州利益團體支持，加州中醫政治聯盟反對
即“修理加州針灸局提案＂。該案給加州針灸局設定諸多苛刻條件，例如謹批准給予針灸局兩年的再復審期限（按慣例應為四年）、要求針灸局召開會議至少必需有五名委員出席方為有效（但針灸局尚有多位委員名額空缺）、要求針灸局必需有一名委員是中醫院校教師（ 針灸局為避免利益沖突，歷來不得任用現職教師）等。此外提案還要求由消費者事務廳對加州針灸局工作進行全面審查﹕包括中醫師職業規範、中醫師教育標準、 要求 對外州私人團體的考試權及中醫院校審批權進行評估其適用于加州的可能性，等等。全部評估過程所需之費用要由針灸局支付（來自中醫師的執照費）。戴維斯州長簽署成為法律。
SB 1705 (Burton, 2002) —— 加州中醫政治聯盟策劃
授權通過附加培訓的中醫師參加合格醫療評估醫師資格考試後從事殘障評估工作。此案未能通過議會而失敗。
AB 1943 (Chu, 2002) —— 加州中醫政治聯盟策劃並參與修訂，外州利益團體反對。
《中醫專業教育改革法案》規定目前加州官方有關中醫 針灸事務的法律文件一律統稱之為『針灸與東方醫學』，較為符合中醫師的臨床實踐。 AB1943 的最主要條款是對中醫院校的教學大綱及教育課程提出了明 確的要求： 2003 年至 2007 年間入學的新生必需完成 3200 學時專業教育，而從2007 年開始中醫專業教育課程將增加至 4000 學時。由於外州利益團體的強力反對，本案被大幅刪改后通過，（如刪除有關專業名稱之規定，將必修學時減為 3000 等）戴維斯州長簽署成為法律。
SB 582 (Speier, 2003) —— 加州中醫政治聯盟參與修訂
根據中醫政治聯盟提出的修正案，SB582 將添加兩項豁免條款：（1）執照醫務工作者在其行醫規範内的治療過程中可以開麻黃處方或配藥。（2）含有麻黃成分的食物補充產品只能銷售給執照醫務工作者作為治療之用。如此，中醫師繼續使用麻黃的專業權力遂得以保全。戴維斯州長簽署成為法律。
SB 228 (Alarcon, 2003) —— 加州保險業界策劃，加州中醫政治聯盟參與修訂
由參議員阿拉坎提出的 SB228 提案強行將工傷醫療服務的收費標準和明顯低於市場價格的『聯邦醫療照顧』(MEDICARE) 支付標準直接挂鉤。更有甚者，凡聯邦醫療照顧並不提供的醫療項目，例如針灸，其收費則只能和用來救濟低收入家庭的『加州醫療補助』(MEDI-CAL)的支付標準直接挂鉤。
中醫政治聯盟成功提出的修正案，中醫師將不受此條款限制。斯瓦玆内格州長簽署成為法律。
SB 867 (Burton 2003) —— 加州中醫政治聯盟策劃
內容是要求商業醫療保險 提供針灸福利。此案未能通過議會而失敗。
SB 907 (Burton, 2003) —— 加州中醫政治聯盟參與修訂
根據最新版本的 SB907 修正案 ，自然療法醫師的行醫規範有了更加明確的限制：即自然療法醫師
將不得從事執照中醫師根據加州商業及職業法第 4927(c) 條授權從事的各種醫療項目，包括針灸，
中藥及推拿等。如此，加州中醫師的基本行醫權益終于得以免受自然療法醫師可能的侵犯。戴維斯
州長簽署成為法律。
小胡佛委員會評估加州中醫行業 (2003-2004) —— 加州中醫政治聯盟積極參與
由於加州中醫界和外州利益團體在如何在加州施行中醫服務的基本政策發生尖銳的衝突，州政府決定將矛盾交給小胡佛委員會進行分析評估。中醫界曾經多次總動員，出席聽證會，投寄請願書，力圖協助小胡佛委員更全面地了解加州中醫行業的實際情況。五位聯合總會成員參加了顧問委員會工作。他們是劉美嫦（加州中醫政治聯盟主席），楊自國（國家衛生署輔助醫學顧問委員會委員），屠英（全美華裔中醫組織聯合會主席），羅志長（聯合總會秘書長）以及陳大仁（聯合總會名譽會長）。可惜小胡佛委員會一直忽視乃至排斥中醫專業團體的意見，最後編寫出明顯偏袒一方的報告。
SB 899 (Poochigian, 2004) —— 加州商會策劃，加州中醫政治聯盟堅決反對並參與修訂
治療工傷患者仍必須一律按照《美國職業及環境醫學學院指引》的標準施行。這份完全由西醫編訂出來的指引，完全忽視中醫藥在治療工傷疾病中的價值和療效，嚴重妨礙工傷患者獲得針灸治療的機會。斯瓦玆内格州長簽署成為法律。
SB 356 (Alarcon, 2004) ——AIMS 策劃，加州中醫政治聯盟支持
肯定中醫診斷權提案。此案未能通過議會。
SB 840 (Kueh, 2004) —— 加州中醫政治聯盟支持
要求建立『加州健康保險機構』以提供全加州的醫療保險。此案未能通過議會。
AB 681 (Vargas, 2005) —— 加州中醫政治聯盟支持
要求將當前工商補償醫療費用標準延長三年（及至 2007 年。）此案未能通過議會。
AB 1549 (Koretz, 2005) —— AIMS 策劃，加州中醫政治聯盟支持
授權通過附加培訓的中醫師參加合格醫療評估醫師資格考試後從事殘障評估工作。此案未能通過議會。
SB 233 (Figueroa, 2005) ——外州利益團體支持，加州中醫政治聯盟反對
“日落＂（撤銷）加州針灸局，並取消中醫師診斷權。經加州中醫政治聯盟發動全體同業堅決反對，此案最終被迫被擱置。
AB 871 (Keene, 2005) —— 由保險業者策劃，加州中醫政治聯盟反對
取消針灸師及整脊醫師被工傷患者自選為『指定醫師』的資格。
AB 1113 (Yee, 2005) —— 加州中醫政治聯盟策劃
肯定中醫診斷權提案；本案涉及中醫師最基本的行醫權益，至關重要。最終實施余胤良議長的這些提案對提高中醫素質，更好服務社會將起到積極作用。本案以壓倒性多數通過議會。斯瓦玆內格州長以法案措辭含糊為由否決此案。
AB 1114 (Yee, 2005) —— 加州中醫政治聯盟策劃
增加中醫師繼續教育提案；將每兩年需要 30 學時繼續教育增加至 50 學時。本案以壓倒性多數通過議會。斯瓦玆內格州長簽署成為法律。
AB 1115 (Yee, 2005) —— 加州中醫政治聯盟策劃
針灸師助理提案；要求針灸師助理具備一定的培訓資格。本案以壓倒性多數通過議會。斯瓦玆內格州長否決此案。
AB 1116 (Yee, 2005) —— 加州中醫政治聯盟策劃
針灸師臨床訓練提案；要求中醫院校畢業生必須先參加一定期限期臨床實習方有資格參加執照考試。由於外州利益團體的強力反對，本案未能通過議會。
AB 1117 (Yee, 2005) —— 加州中醫政治聯盟策劃
用『亞洲醫學』代替 『東方醫學』提案。本案以壓倒性多數通過議會。斯瓦玆內格州長簽署成為法律。
SB 248 (Figueroa, 2005) —— 加州中醫政治聯盟參與修訂
加州中醫政治聯盟為保全針灸局進行了非常艱巨的政治運作。我們不但成功動員了中醫界自己的力量，我們還成功結合了社會各界的力量，形成了一股前所未有的政治勢力。終于和菲格儸阿參議員達成重建針灸局的妥協。本案以壓倒性多數通過議會。斯瓦玆內格州長簽署成為法律。
AB 2287 (Chu, 2006) —— 加州中醫政治聯盟策劃
要求使用明確的法律條文重申：加州工傷補償系統必須包括中醫治療福利，並將加州中醫政治聯盟負責編訂的『中醫工傷治療指引』納入加州工傷補償系統的執行條款之中。該案以壓倒性多數通過參眾兩院，斯瓦玆内格州長最終在二零零六年十月予以否決。但州長同時明確地強調指出“鑒于針灸治療的重要性，我指示工傷補償處採取任何必要的措施，加速制定一個重新確保針灸合法地位的工傷醫療指引，以便讓工傷患者獲得針灸治療。……＂工傷補償處主要官員多次和政治聯盟負責人舉行會談，態度也十分友好，在整個編寫過程中和中醫政治聯盟負責人和諧合作，二零零六年十二月七日，工傷補償處公佈了勞工法修訂草案文本，包括針灸治療在内的新『工傷醫療標準程序』遂于二零零七年六月十五日正式生效。
AB 2152 (Chan, 2006) —— 加州中醫政治聯盟策劃
眾議院衛生委員會主席陳煥英議員提出的『針灸師執照行醫法案』(AB2152)，將使用明確的法律條文重申任何人必須擁有加州中醫執照方可施行針灸治療的規定。這項由加州中醫政治聯盟策劃的，專門為保障中醫師基本行醫權益的提案對確保加州公眾獲得安 全可靠的中醫服務意義十分重大。 由於『針灸師執照行醫法案』牽涉到其他醫療職業者的既得利益，特別是勢力強大的西醫界的既得利益，因此我們很清楚：這是一項極具挑戰性的法案。審議一開始就面臨西醫牙醫足醫三大反對勢力強大的聯合攻勢，形勢十分嚴峻。更遺憾的是，業界中又有少數人持有相反意見：以白人針灸師為主体的加州中醫協會（CSOMA）對此案表示不支持，還斷言此案將絕對不會成功。而針灸產業醫學專家協會（AIMS）的米勒醫師則在聽證會上宣稱他希望本提案失敗。所幸絕大多數中醫專業團體（包括華裔，韓裔，日裔，越南裔等職業公會）都認為這項提案完全合情、合理、合法，它宣示了中醫界要維護病家利益及保衛自身權力的堅定決心，明知有難度和風險，但還是要堅決推行。由於外州利益團體的強力反對，本案未能通過議會。
AB 2821 (Huff, 2006) —— 加州中醫政治聯盟策劃
眾議院教育委員會委員哈福議員提出的“成立亞洲醫學局法案＂要求將目前的『針灸局』改稱『亞洲醫學局』。正如我們多年來一再強調﹕美國今天一直沿用的『針灸師』（ACUPUNCTURIST）這一職業名稱具有相當大的誤導成分，因為它在很大程度上不能正確反映當前中醫師服務的實際業務，因而造成社會、尤其是西方社會的許多混淆。本提案將有效澄清誤解，有利於中醫事業的繼續發展。非常遺憾的是：西醫公會堅持要壟斷“醫學＂（MEDICINE）一詞,不准其它醫療專業使用。『亞洲醫學局』使用了醫學一詞，因此此案已被西醫公會所封殺。
AB 3014 (Koretz, 2006) —— 針灸與綜合醫學專家協會策劃
備受爭議的“亞洲按摩法案＂是針灸與綜合醫學專家協會策劃的一項提案。考慮到這個法案有可能限制中醫師的行醫範圍；同時，“亞洲按摩＂一詞在社會上與色情行業密切相關，將嚴重破壞中醫專業形象，加州中醫政治聯盟對此一直保持“不支持＂的中立立場。該案通過議會後被阿諾州長予以否決。
SB 840 (Kuehl, 2006) —— 加州全民醫療保險法案 提案人：庫尤爾參議員
加州目前尚無全民保健體制，奇尤爾參議員希望建立這樣的新體制已保證低收入家庭也能獲得醫療保險。這個法案引起我們的關注是因為其中有一個條款規定：患者看中醫針灸必須事先得到西醫的介紹或轉診。這是和三十五年前的『針灸職業合法化提案』（SB86）的條款如出一轍，中醫界對此有所保留。該案通過議會後被阿諾州長予以否決。
SB1476 (Figueroa, 2006) —— 醫療職業局日落條款案 提案人：費格洛亞參議員
參議院商業與職業委員會就各醫療職業局或委員會之日落條款生效日期作出延期一年至三年的調整。
加州針灸局僅獲得一年之延期。即有效期從原來的2008年順延至2009年。
AB 54 (Dymally, 2007) —— 加州中醫政治聯盟策劃
加州中醫政治聯盟委託第五十二選區眾議員戴馬力先生在加州衆議院提出新的針灸保險法案要求將現行保險法中的歧視性條款（只要求醫療保險計劃備有“可供選購＂的針灸福利）改為“規定提供＂針灸福利﹐以保障投保人獲得針灸治療的權利。該案通過議會後被阿諾州長予以否決。
爭取豁免中藥銷售稅 (1997 – 2009) —— 加州中醫政治聯盟與北加州中藥聯商會共同推動
1997年，加州中醫界曾委托加州眾議員格里高斯醫師提出《豁免中藥銷售稅提案》，編號為AB410案。但未獲成功。後來在1999年，加州中醫政治聯盟又委托加州眾議員諾克斯提出了內容相同的 AB2764 法案作為繼續，也宣告失敗。中醫界再接再厲，在2001年又委托加州眾議員法魯
莫重新提出此案，編號 AB208 。可惜法案第三度被擱置。2002年由加州眾議員馬修斯接手辦理此案，改編號 AB249 。該法案雖然順利完成了參、眾兩院的全部審議程序，但是當年的州長戴維斯卻以財政短缺為由否決了此項提案，最後還是以失敗告終。2008年，中藥課稅問題的不合理性得到平等稅務局（BOARD OF EQUOLIZATION）趙美心局長和余淑婷副局長的關注，終于取得突破性的進展：二零零八年九月四日，中醫藥界代表與平等稅務局官員以及平稅局法律部門和稽查部門的負責人在沙加緬度進行了一次很有成果的會議。隨後，在二零零八年十二月，平等稅務局修改條例，不再將“聲稱有治療疾病功效的中藥定位為藥品＂而予以課稅，並宣佈：既然中藥材在加州一向被列為“食物＂，就應當按食物免徵銷售稅，立即生效。至於“加工后中藥＂（如粉劑、片劑、膠囊等產品）的食品定義問題，經過加州中醫政治聯盟的進一步交涉，平稅局法律部門最近提出了新的法律補充解釋：加工過的中藥材只要在其包裝或説明標簽上沒有“SUPPLEMENT”或“ADJUNCT”等字樣，則平稅局將認定此等產品仍然屬於“食品”，免予課稅。至此，抗爭多年的豁免中藥銷售稅問題終于獲得圓滿解決。
AB 1260 (Huffman, 2009) —— 加州中醫政治聯盟反對
意圖修改加州針灸局職能的 AB1260 法案提出取消對考生臨床實習的要求，以及要讓外州的認證機構參與加州針灸局對中醫院校的審批工作等項，有可能降低加州中醫師素質，從而對加州中醫事業帶來負面影響。加州中醫政治聯盟予以反對。作者賀弗曼眾議員后來對本案條文作出重大的修訂—僅保留原提案的第一部分，（即將七人加州針灸局的議事法定人數由五名降為四名，包括至少一名針灸師）；其餘不利加州中醫事業的條款已經全部予以刪除。
AB 1391 (Eng, then McLeod, 2010) —— 加州中醫政治聯盟支持
允許加州針灸局繼續運作至2013年的 AB1391 提案由伍國慶眾議員提出，其內容後來納入麥克利歐的 SB294.目前該案已經通過參眾兩院，等待州長的簽署。
爭取農夫保險公司支付針灸 (Eng, 2010) —— 加州中醫政治聯盟參與推動
加州針灸合法化以來，作為美國最大汽車保險公司之一的農夫保險公司 (FARMER INSURANCE COMPANY) 數十年來堅持不支付汽車意外受傷者針灸醫療費用。伍國慶眾議員通過和農夫保險公司高層領導人的多次直接溝通、協商、交涉，終於獲得公司方面的讓步，同意改變公司的理賠政策，
從今年六月十五日起支付汽車意外受傷者的針灸醫療費用。
聯邦層面的立法進展：
針灸針在美國醫療體系中的地位
1973 – 1975年間，針灸在美國許多州已經取得合法地位。但是，政治上的合法化并不等于學銜上的被承認。代表西醫界的美國醫學會直到1996年還不承認針灸的醫學價值。其官方立場是“針灸在美國還屬實驗性質”。基于這種立場，負責管制醫療器械的美國食品及藥物管理局（FOOD AND DRUG ADMINISTRATION）只能勉強將針灸針列為“三級醫療器具”，即所謂的“實驗研究用器具”（INVESTIGATIONAL DEVICE），規定只能用于科學研究目的。1994年，針灸界人士委托華盛頓的斯萬金-陀諾（SWANKIN & TURNER）律師事務所，采取公民請願（CITIZEN PETETION）的法律程序嚴正要求藥管局根據專家們提出的研究報告，重新考慮針灸針在美國醫療保健體系中的地位，將之從三級器具提升為二級即 “核准醫療器具”（APROVED MEDICAL DEVICE)。藥管局的專家們足足用了近一年半時間對針灸界提出的研究報告進行分析評估，終于在1996年3月作出了裁決。
聯邦針灸保險法案（FEDERAL ACUPUNCTURE COVERAGE ACT）
HR1038 (Hinchey, 1996) ~ HR646 (Hinchey, 2009) —— 加州中醫政治聯盟支持
這條稱為『聯邦針灸福利法案』規定聯邦醫療照顧計劃（MEDI-CARE）以及聯邦雇員健康福利計劃都要給有資格的針灸醫師支付醫療費用。本案如果獲得成功，將在全國範圍内有力地推動中醫事業的發展。十幾年來由興奇聯邦眾議員多次提出，至今未獲成功。在全國中醫師，包括加州中醫政治聯盟的積極支持下，本案在國會逐步取得進展。但距離成功還有一段距離。
聯邦健保改革法案（FEDERAL HEALTH CARE REFORM ACT, 2009-2010）—— 加州中醫政治聯盟支持
加州中醫政治聯盟認為歐巴馬總統正在推動的這場醫療改革也是中醫界爭取納入美國主流醫療體制的時機。改革如果成功，則中醫界必須在法案審議過程中確保中醫福利納入其中。政治聯盟聯絡全國中醫界人士發動大規模的請願活動：說服政要們認識到接納中醫不僅可以提高醫療品質，還可以降低以醫藥費用，完全符合醫療改革的目標。相關法案目前仍在國會審議辯論之中。
http://www.caam.us/resources/califonria_legislation082510.pdf
【大紀元2012年08月30日訊】(大紀元記者李歐費利蒙採訪報導)導言：中醫在美國爭取正名幾經波折，SB628今年終於通過加州參眾兩院的投票，並進一步等待州長布朗簽署正式立法。雖然這是一項好消息，但並非所有針灸師都適用，加州中醫師聯合總會榮譽會長陳大仁表示，其實真正提昇中醫的專業教育才能獲得美國主流社會的重視，也才是正名的根本。
加州最早的中醫法案可推溯到1972年，而且還是西醫主張立法，但當時只是西醫的助手，陳大仁說，那時有針灸熱的歷史背景，結果造成中醫的混亂，過後的40年間透過在美中醫師的努力，至今針灸師可以獨立行醫，還可納入保險給付。
但可惜的是，目前博大精深的中醫只能被侷限在「針灸局」（Acupuncture Board）底下，中醫師也只能稱針灸技師，醫術方面也受到限制，有多種中醫方濟還有正骨手法不可使用。因此陳大仁表示，現在最急迫的其實是趕快對中醫正名，並且提昇中醫的專業教育。他說，連眼鏡驗光師都得是博士學位，中醫當然更要是具有完備的教育體制。
陳大仁一家幾乎都是醫生，對中醫尤其專精，他說，針灸師其實早已超出針灸的範圍，是真正在行使中醫職業的專業人士，廣大中醫師都期望以中醫（Chinese Medicine）或東方醫學（ Oriental Medicine）來取代針灸（Acupuncture）一詞。但在2002年及2006年分別有提出立法，都遭到西醫的阻撓而失敗。
美國是一個重視教育且術業專精的國家，陳大仁表示，中醫經過這幾十年的努力，終於從原本的不用執照到現今需通過3,200個學時的課程，再通過考試方可成為合格的針灸師，但仍是不足以獲得西方社會的認同，這也立法失敗的主因之一。現在加州中醫師聯合總會主張提升為4,000個學時，並且獲得博士學位才能有中醫考試資格。
儘管現在美國白人學針灸的人數多餘亞洲人，但有鑑於中醫在美仍被是為一門「替補醫學」，陳大仁說其關鍵原因就是──中醫教育制度的缺陷。因此盡快完善中醫教育制度才是根本的正名之道。
而目前的SB628法案僅僅只是讓具有中醫博士學位的針灸師合法使用「Doctor」一詞，陳大仁感嘆這種被「贈予」的地位，並非真正的認同。在教育上的提昇且進一步為「針灸局」改名為「中醫局」或「東方醫學局」才是廣大加州中醫界所樂見。http://www.epochtimes.com/b5/12/8/30/n3670966.htm%E9%99%B3%E5%A4%A7%E4%BB%81-%E5%AE%8C%E5%96%84%E4%B8%AD%E9%86%AB%E6%95%99%E8%82%B2-%E6%89%8D%E6%98%AF%E6%AD%A3%E5%90%8D%E6%A0%B9%E6%9C%AC
Posted in Acupuncture history in America, Acupuncture History in the United States of America, Acupuncture in USA, tagged Acupuncture, Acupuncture arrested, acupuncture history in the United States, Acupuncture in the USA, acupuncturist, arrested, california, history, illegal, mirian Lee, USA on June 15, 2010| 1 Comment »
In 1976, Miriam Lee was one of the first people to be licensed as an acupuncturist in the state of California. In 1974, she was arrested for practicing medicine without a license.
At her trial, her patients filled the courtroom in protest of her arrest, claiming their right to the only medicine that had truly helped them. Within a few days of Dr. Lee’s trial, acupuncture was authorized as an experimental procedure in California. In 1976, Governor Jerry Brown signed the legislation that finally legalized acupuncture.
The Acupuncture Association of America was founded by Dr. Miriam Lee in July 1980; Dr. Lee continued to lead the organization until her retirement in 1998. The Acupuncture Association of America was created to promote public education about acupuncture, provide continuing education classes for licensed practitioners, to guide and support legislative advocacy, and to promote research in the field of acupuncture.
For nearly a decade, the Acupuncture Association of America supported Art Krause, a California lobbyist whose primary work has been on behalf of acupuncturists. Dr. Lee offered classes in order to raise funds needed to support this legislative work. Mr. Krause, well respected in Sacramento, was able to negotiate agreements with influential politicians. Among the friends of the Acupuncture Association of America and acupuncture were Dr. Bill Filante, Senators Art Torres and Herschel Rosenthal, all instrumental in getting many acupuncture bills made into law. It is because of the monumental efforts of Dr. Miriam Lee, Art Krause and others that California acupuncturists are now licensed, have a very comprehensive scope of practice, primary care physician status, primary insurance coverage and have been able to accept Medi-Cal.
In 1989, the Council of Acupuncture Organizations was formed to unite the profession in the legislative process. This group was composed of nine different acupuncture organizations throughout California, including three Chinese, two Japanese, two Korean and two Caucasian groups. This was the first attempt to bring together these different acupuncture communities. Unfortunately, the group met for only two years, but during that time, the Council of Acupuncture Organizations was able to procure acupuncture coverage through Worker’s Compensation.
Many new acupuncture organizations were formed during the 1990’s, both in California and nationwide. The Acupuncture Association of America, having had a very significant role in the early formation and legalization of California acupuncture, was then able to focus on providing continuing education classes. Dr. Miriam Lee sponsored many well-known practitioners from China to come to her clinic in Palo Alto to teach seminars. These courses covered a variety of topics such as Tung’s Points, herbal formulation, scalp acupuncture, wrist and ankle points, and Traditional Chinese Medicine gynecology and oncology.
Dr. Miriam Lee retired in 1998, and moved to Southern California to be with her family. Dr. Lee passed away June 24th, 2009. Miriam Lee was a pioneering doctor whose tireless work led to the recognition and legalization of the medical practice of acupuncture in California.
http://news.sina.com 2009年07月03日 00:09 中國日報
葬禮將於七月三日下午一時於洛杉磯玫瑰崗Hillside Chapel教堂舉行
（本報訊）加州第一位針灸醫師李傳真(Miriam Lee)博士，不幸於二零零九年六月二十四日於洛杉磯托倫斯家中與世長辭，由於李醫師三十多年前的努力，促成加州針灸醫師合法化，進而影響針灸在全美國的發展與推動。更難能者，李醫師與其學生Susan Johnson、Esthersu等在美國與歐洲極力推展發揮董氏奇穴，使董氏奇穴因而風行全美及歐洲，帶動了美國及歐洲針灸界更大的進步。
李傳真醫師，加州針灸的先驅，是促成加州針灸合法化的醫師，出生於中國，1949離開大陸，來美前曾住在新加坡十七年，當她來到加州時，針灸仍是不合法的，他先是在家靜靜的治療病人，之後她與支持她的西醫共用診室，1974年李傳真因為沒有開業執照而被逮捕，開庭時，她的病人擠滿了法庭，抗議她被拘捕，他們聲明只有針灸能真正的幫助他們，他們有權力接受這種治療。之後在幾天內針灸被州長Ronald Reagan列為合法的試驗性的治療方法。1976年，州長Jerry Brown簽字使針灸在加州正式合法化，這使Miriam Lee成為加州第一位針灸醫師。經過三十多年，今日加州的針灸醫師已到達一萬四千多人。
在七零年代及八零年代早期，她以她老師（有名的董景昌，曾治癒高棉總統之半身不遂）的特殊的董氏奇穴為主進行治療，董氏奇穴被西方人名之為「董氏魔術穴位」，她著有有關的英文著作經Blue Poppy出版，這其中有不少創造與革新，該書在美國及歐洲皆極為暢銷。在她的職業生涯中，當其臨床巔峰時期，每小時看十個病人，每周工作八十小時。九零年代起李醫師與其學生Susan Johnson，Esthersu等在美國與歐洲極力推展發揮董氏奇穴，使董氏奇穴因而風行全美及歐洲，帶動了美國及歐洲針灸界更大的進步。
1980美國針灸學會(Acupuncture Association of America)創立，學會的宗旨在提供針灸醫師再教育，支持針灸立法及推廣針灸研究，李醫師被推為會長直至1998年，李醫師近幾年退休後定居於洛杉磯托倫斯(She died peacefully, in her home in Torrance, CA. with her family around her.)直至去逝。李醫師之葬禮將於七月三日下午一時於洛杉磯玫瑰崗Hillside Chapel教堂舉行，然後葬於玫瑰崗墓園。
By Shaun Bishop
Daily News Staff Writer
Miriam Lee, a prominent acupuncturist who pushed for licensing the practice in California and treated patients for two decades in Palo Alto, died last week. She was 82.
Lee suffered a severe stroke in recent weeks and died June 24 in Southern California, where she lived after retiring in 1997, said Susan Johnson, a former student and longtime friend.
Lee’s 1974 arrest in Palo Alto for practicing medicine without a license made her an icon for the movement to allow acupuncture to be legalized in the United States, Johnson said.
She also had a lifelong desire to learn, traveling across the world to pick up new skills and passing on her knowledge to many of her students.
“She was an extraordinary practitioner, a one-of-a-kind pioneer in terms of techniques and teaching,” said Johnson, who was an intern under Lee in 1982.
Born Dec. 8, 1926, in China, Lee studied in her late teenage years to be a midwife. She moved to Singapore in 1953, where she worked as a bank teller until she immigrated to the United States in 1969, Johnson said.
Lee settled in Palo Alto and worked on an assembly line in a Hewlett-Packard factory, treating co-workers who complained of shoulder or neck pain with acupuncture in her home, Johnson said.
As word of her in-home acupuncture practice spread, Lee attracted a growing number of patients. But authorities caught wind of her popularity, and in 1974 arrested her for practicing medicine without a license.
According to Lee’s 1992 book, “Insights of a Senior Acupuncturist,” she was acquitted after supporters came to her defense at a court hearing. Lee then pushed for legislation that eventually established acupuncture licensing in California in 1976.
She founded an acupuncture practice on Cambridge Avenue, where she treated a variety of illnesses, from thyroid problems to migraine headaches, said Jean Leong, who observed Lee’s treatments as an adolescent while her mother worked as Lee’s assistant.
Lee started her day early and treated as many as 10 patients every hour using different tables in different rooms, Leong said.
Throughout her career, Lee studied with acupuncture masters in China, learning new skills that she took back to the United States, including unusual techniques not taught in acupuncture schools, Johnson said.
In 1997 she retired and moved to the Los Angeles area after suffering her first stroke, Johnson said.
“I just think Miriam was the pioneer,” Leong said. “If it wasn’t for her, I don’t know if acupuncture would have been introduced to the U.S. — and certainly not to California — at the time it happened.”
A memorial service for Lee will be held 1 p.m. Friday at Rose Hills Park and Mortuary, 3888 Workman Mill Road, Whittier, Calif.
for more:
http://www.360doc.com/content/11/0124/01/4702178_88614597.shtml
http://sarana-acu.blogspot.com/2009/11/miriam-lee-tribute-day-free-acupuncture.html(09142013)
WWW.SARANACOMMUNITYACUPUNCTURE.COM
In Lee’s memory, several Community Acupuncture clinics in the Bay Area will provide her treatment protocol (known as the “Miriam Lee tune up”) free to clients on December 9, 2009.Participating clinics are listed below. Contact them directly for business hours and other details.
| Acupuncture Today September, 2009, Vol. 10, Issue 09 |
http://www.acupuncturetoday.com/mpacms/at/article.php?id=32021(09142013)
By Susan Johnson, LAc
My relationship with Miriam began in 1982, when I was privileged enough to begin an internship with her. Through my many years with Dr. Lee, I was trained extensively in her unique style of acupuncture.
In 1987, we traveled together to Hefei, China, to study bleeding techniques with Dr. Wang Su-Jen. We journeyed together through the “wild ride” of acupuncture politics in the 1980s and 1990s. She was my teacher and my friend, and a pioneer in the field of Chinese medicine in America.
Miriam was perhaps best known for her work with Master Tung’s “Magic Points.” Master Tung Ching Chang, widely viewed as the greatest acupuncture technician who ever lived, practiced a method of acupuncture that was passed down to him through his family from Shandong, China, for more than 300 years. This system is renowned for the spontaneous and miraculous results obtained using just a few needles. This method is unique in that points are located opposite the affected area, and patients tend to notice effects immediately upon needle insertion. Master Tung broke convention after the Chinese Cultural Revolution and began teaching this amazing system of points outside of his immediate family. Dr. Young Wei-Chieh and Dr. Miriam Lee, both students of Master Tung’s, are responsible for bringing this body of work to America.
In 1976, Miriam was one of the very first to be licensed as an acupuncturist in the state of California. In 1974, she was arrested for practicing medicine without a license. At her trial, her patients filled the courtroom in protest of her arrest, claiming their right to the only medicine that had truly helped them. Within a few days, acupuncture was legally made an “experimental procedure” by Governor Ronald Reagan. In 1976, Governor Jerry Brown signed the legislation that once and for all, legalized acupuncture.
It is through the untiring efforts of people like Miriam Lee, founder of the Acupuncture Association of America (AAA), and lobbyist Art Krause, that we here in California can boast acupuncture licensure, primary care physician status and primary insurance coverage. Although I feel personally and eternally indebted to Miriam, we should all remember the work that Miriam and Art did together, for our profession, for more than 30 years.
For nearly a decade, the AAA single-handedly supported Krause. Dr. Lee would offer Master Tung’s Points classes for her students and licensed practitioners, in order to raise the money needed to support this legislative work. Krause, well-respected in Sacramento, was able to negotiate agreements with influential politicians over a cup of coffee. Things were very different in those days. State senators Art Torres (D) and Herschel Rosenthal (D), both instrumental in getting many acupuncture bills made into law, were among the friends of AAA and acupuncture. It is directly through the efforts of all of the above people, and a few others, that we can boast having the one of the most comprehensive scopes of practice in the country.
In 1989, The Council of Acupuncture Organizations (CAO) was formed to unite the profession statewide in the legislative process and share Krause’s financial support. This group was composed of nine different acupuncture organizations throughout California; three Chinese, two Japanese, two Korean and two Caucasian. This was the first and only real attempt to date of which I am aware, to bring these different acupuncture communities together. Unfortunately, the group only met for two years, but during that time, the CAO was able to procure acupuncture coverage through worker’s compensation.
As acupuncture politics evolved through the 90’s, many new organizations were formed, both state and nationwide. The AAA, having had a very significant role in the early formation of California acupuncture, was then able to focus primarily on its purpose of providing quality continuing-education classes. Dr. Lee sponsored many different well-known practitioners from China to come to her clinic in Palo Alto, Calif., to teach. These courses covered a variety of topics, such as Tung’s Points, herbal formulations, scalp acupuncture, wrist and ankle points, TCM gynecology and oncology.
Upon retiring, Miriam moved to Southern California with her family. As her student of many years I have stepped forward to carry on the work of teaching Dr. Tung’s Points and Miriam’s style of acupuncture, and to continue the work of the AAA. It is my hope that the future will find Tung’s Points available and familiar to all those seeking more than “textbook” acupuncture techniques. They are unique not only because they are so extraordinarily, immediately effective, but also because they are very simple to learn and apply. As Miriam always said: “The important thing is to learn which key opens which lock.” May Master Tung’s Points open as many doors for you as they have for me and for generations before us all.
Susan Johnson has been practicing Tung’s style of acupuncture since 1982 and licensed in California, since 1985. She studied Master Tung’s Points with Dr. Young Wei-Chieh and Dr. Miriam Lee for more than 12 years and has been using them almost exclusively in her practice since that time. Susan maintains a private practice in Santa Cruz, Calif.
CALIFORNIA GETS THE POINT
by Colin Elbasani
Special thanks to:
Paul West
Linda Barnes, PhD
Joel Harvey Schreck, LAc
Susan Johnson, LAc
Benson You, LAc
Contents
1. Introduction
2. Acupuncture Enters the American Mainstream
3. The Evolution of Acupuncture in China
4. Approving Acupuncture Research in California
5. Medical Issues in the Regulation of Acupuncture
6. Health Care Delivery Issues in Acupuncture Regulation
7. Criticism of Acupuncture Regulation
8. Conclusion
Appendix. The Practice of Acupuncture: A Legislative Position Paper
Geographically, California is the last stop in the continental United States before Asia. It is not surprising, then, that the medicine, philosophy, and other aspects of Asian culture constitute such a prominent part of the California experience. Although acupuncture is portrayed by some academics—perhaps because of their perspective from the East Coast—as having resulted in a tremendous culture clash between established Western medicine and Eastern exotic medicine, the historical record shows that their differences were more easily reconciled than these critics would have us believe; over the course of the last forty years, acupuncture has been completely integrated into California’s medical delivery system.
While it may be true that “professions institutionalize control over social capital by establishing licensing procedures, internally run educational institutions, and self-regulation,” they do not exist first and foremost to do so. This is especially the case in the medical profession, where incompetence, carelessness, or plain ignorance can and sometimes does result in the injury or even death of a patient. Rather, these structures are in place to provide standards and safeguards that insure quality patient care. In fact, the evolving legislation regarding acupuncture in California reveals a steady progression from cautious, close scrutiny by the medical profession to its current state, which integrates acupuncture into mainstream healthcare while providing for autonomy of the government’s oversight of the acupuncture profession.
Given how little scientific basis there was for the argument that acupuncture was effective at all, the medical community was actually quite tolerant, accommodating, and even encouraging of incorporating it into mainstream medical practice. Many members of the California Medical Association (CMA) and the American Medical Association (AMA) shared with laypeople the same curiosity and enthusiasm about the potential benefits of acupuncture to Western medicine in the early 1970s. Nevertheless, they hesitated to accept it as an effective form of therapy. Their reasons for doing so were well-founded, and their concerns over numerous issues raised by the public’s fascination with acupuncture were warranted.
This thesis will explore the tensions between Western medicine and acupuncture in California, and how the latter came to be accepted as a form of alternative medicine and granted a great degree of professional independence and autonomy by the state. The chronology of acupuncture legislation will provide the framework for the narrative, drawing on the original legislative documents from the California State Archives in Sacramento, articles in newspapers and magazines, articles from the AMA, and the secondary literature available on the history of acupuncture and on the authority structure of established Western medicine.
2. Acupuncture Enters the American Mainstream
During the Cultural Revolution under Mao Tse Tung in the 1960s, diplomatic, cultural, and scientific relations between China and the United States relations were all but cut off completely. At this time, American fears of Communist hegemony overshadowed the public’s curiosity about Chinese culture. These Cold War tensions were finally eased by Ping-Pong Diplomacy in April of 1971, and Nixon’s subsequent meeting with Mao Tse Tung in late February of 1972, ultimately lifting the Bamboo Curtain (the Asian equivalent of the Iron Curtain), and opening up a flood of Chinese culture into America. Shortly after the Nixon visit in 1972, a sudden warming of relations between “red” China and the “imperialist” United States caused a surge in American public interest and fascination with many things Chinese.
The two decades of Chinese isolation from the West only increased American curiosity about all things Asian. Acupuncture, a mysterious healing art that was that bore no relation whatsoever to Western medicine, piqued the curiosity of Americans more than most other subjects. The renewed interest Americans maintained for a seemingly exotic Chinese “other” was quite unlike what Edward Said calls Orientalism; the form of their interest was not imperialist, but anti-imperialist, taking place in a context that followed America’s own Cultural Revolution: the Civil Rights Movement. Many Americans, especially in academia, were revisiting the exoticness of the Chinese, not only with heightened curiosity, but with humility and a new appreciation and respect for non-Western cultures, political ideologies, and even medicine.
This new China craze led to an avalanche of enquiries for travel visas from Chinese embassies in the United States. In the Bay Area, the San Francisco-based Women for International Understanding, the Asian Art Commission of San Francisco, and local 771 of the American Federation of Teachers, with the support of the California Federation of Teachers State Council in Oakland, Berkeley, and San Francisco, rushed to organize large group trips. In many universities, enrollment in Chinese language courses as much as doubled, numerous seminars and symposia on China were scheduled, and a survey of 165 universities found that the vast majority of students favored exchange programs with China. The New York Times reported, “Scientists are falling all over themselves wanting to go to China even those who know nothing about China.” One professional group particularly affected by the China craze was medical researchers.
In 1971, the New York Times reporter James Reston’s article, “Now, About My Operation in Peking,” marked a turning point in the acceptance of Chinese medicine in America. Reston and his wife were invited to visit Beijing by the Chinese Government. On July 15, at 10:30 A.M., while speaking to foreign ministers at the Peking International Club, Reston suddenly felt a stab of pain go through his groin. Later that evening, he was bedridden with a temperature of one hundred and three degrees. The next day he was admitted to the Anti-Imperialist Hospital for examination. An hour later, consultants summoned by Premier Chou En Lai gathered around Reston to listen to a troubling irregular heartbeat pointed out by one of the doctors. After a moment’s deliberation the eleven leading medical specialists in Peking returned with their assessment: “Acute appendicitis. Should be operated on as soon as possible.” The two-and-a-half hour surgery was successfully carried out with the use of the anesthetics Xylocaine and Benzocaine. However, later that evening, as Reston lay in bed recovering, he began to experience abdominal discomfort from postoperative gas pains. Li Changyuan, a doctor of acupuncture at the Anti-Imperialist Hospital, inserted three long, thin needles into the outer part of his elbow and below his knees in order to stimulate the intestine and relieve pressure and distension of the stomach. Reston writes of the procedure,
[it] sent ripples of pain racing through my limbs and, at least, had the effect of diverting my attention from the distress in my stomach. Meanwhile, Doctor Li lit two pieces of an herb called “ai,” which looked like the burning stump of a cheap cigar, and held them close to my abdomen while occasionally twirling the needles into action. All this took about twenty minutes, during which I remember thinking it was a rather complicated way of getting rid of gas on the stomach, but there was a noticeable relaxation of the pressure and distension within an hour and no recurrence of the problem thereafter.
Reston goes on to assure his readers that his condition was genuine, and not some ‘journalistic trick’ to do investigative reporting of the Chinese medical system, quipping, “This is not only untrue, but greatly overrates my gifts of imagination, courage, and self-sacrifice. There are many things I will do for a good story, but getting slit open in the night or offering myself up as an experimental porcupine is not among them.”
Although his account of Chinese medicine was met with skepticism, Reston’s personal experience as a patient of acupuncture anesthesia made him living, Western proof to physicians and the American public that acupuncture might be more than propaganda and hype. For the first time, academics and legislators were compelled to seriously consider investigating its potential as a tool in American operating rooms. Given the excitement in the media and curiosity of the public concerning acupuncture that followed, it is generally agreed that Reston’s article for the Times introduced the West to modern acupuncture. As Assemblyman Gordon Duffy, author of the first piece of acupuncture legislation, remarked the following year, “Especially since the self-recorded treatment of Mr. James Reston’s appendicitis by acupuncturists, we have been bombarded with stories about traditional Chinese medicine.” Though it is commonly believed President Nixon’s trip was responsible for introducing acupuncture to the United States in 1972, scholars such as Dr. Li Yongming, president of the Traditional Chinese Medicine Association in the United States have argued otherwise. The China Daily, China’s largest English-language newspaper, has quoted Dr. Li as saying that “acupuncture fever” really began with James Reston a year earlier in 1971.
3. The Evolution of Acupuncture in China
American citizens were unknowingly embracing a form of acupuncture that was not a 5,000-year old science, as many believed it to be, but a modern adaptation that was still in an experimental phase of development. Their enthusiasm was partly based on the mystique associated with all things Oriental, but was also due to most coverage in the media describing it as ancient, with the rare exception of the occasional newspaper article that drew the distinction between traditional Chinese medicine and the modern version of it that was now being practiced in China. It is important at this point to give a brief overview of the recent history of acupuncture in China.
China’s sovereignty became severely compromised by British aggression throughout the nineteenth century. As a result, the shattered perception of cultural superiority that she had maintained for over two millennia led many Chinese, for the first time in the nation’s history, to reevaluate their traditional cultural traditions, especially in regard to science and medicine. It quickly became apparent to the Mandarins that China would have to embrace Western technologies to compete militarily and economically in the modern world. Western medicine was spread by Christian missionaries, who established 340 hospitals in China between 1828 and 1949.
In the 1920s, following the overthrow of the Emperor, traditional Chinese medicine came under fire by the liberal intellectuals as a vestige of the backwards, failed regime and as having no real benefit compared to the medicine practiced in Europe and the United States. Western medicine was soon referred to as the “new medicine” and traditional Chinese medicine as the “old medicine.” Chen Kuo-fu, a nationalist ideologue aligned with Chiang Kai-shek, condemned the radicals’ seeming renunciation of all things Chinese in favor of all things foreign as unpatriotic. Aware that traditional Chinese medicine had many shortcomings in comparison with modern medicine, Chen advocated a vision of a scientificized version of it, blending Eastern and Western knowledge into a new and superior discipline. Chen’s vision, however, would never come to fruition, as the conservative old and leftist new schools of medicine were too politically and ideologically polarized to reconcile their differences.
Acupuncture and herbal medicine began to be favored once more with the rise of the People’s Republic of China (PRC) in 1949. While making use of the national resources in the numerous traditionally trained doctors was in line with Mao Tse Tung’s philosophy of self reliance and served to bolster national pride, it was also a necessary measure to address the problem of drastic shortages in Western medicine and trained physicians. Unlike earlier versions, acupuncture in the PRC was stripped of any religious or folkloric overtones, and revisited as something to be applied in the field of paramedicine, and as a subject worthy of research within China.
By 1963, the PRC had an estimated one trained physician for every ten thousand people (compared to one per nine hundred people in the United States). This considerable gap was addressed by implementing a program of paramedicine, in which traditional healers would provide basic care to their local communities after receiving an elementary education in the fundamentals of first aid. Western-trained physicians were encouraged to “broaden their knowledge” in traditional healing and to create a new scientificized Chinese medicine, ironically echoing Chen Kuo-fu’s proposal decades earlier. By 1966, China boasted twenty institutions of traditional Chinese medicine with an enrollment of over ten thousand students, and an estimated sixty thousand apprentices training under practicing doctors. Apart from the immediate need to address the health care crisis in the countryside, experiments were being done with traditional Chinese medicine, especially acupuncture hypalgesia.
“Acupuncture hypalgesia,” the proper medical term for pain management by acupuncture, was discussed in the findings of a study group sponsored by the Committee on Scholarly Communication with the People’s Republic of China of the American Council of Learned Societies, the National Academy of Sciences, and the Social Science Research Council, who made a three-week visit to the People’s Republic of China in May of 1974 to witness forty-eight operations involving acupuncture-based pain management in sixteen hospitals. The group concluded “it must be clearly understood that acupuncture does not produce conventional surgical anesthesia. In no instance is sensation totally abolished or consciousness disturbed; thus ‘acupuncture anesthesia’ is a misnomer. There is considerable evidence, however, that acupuncture does affect the pain experience, although our observations suggest complete analgesia may not occur. Therefore the term ‘acupuncture analgesia’ is similarly inappropriate. In view of these limitations, it seems more reasonable to refer to the phenomenon as ‘acupuncture hypalgesia’.” Hypalgesia refers to diminishment of sensitivity to pain, rather than pain itself.
It is in the context of pain management that acupuncture came to be introduced to mainstream medicine in the United States. In the 1970s, acupuncture was still very new as a mechanism of hypalgesia even in China, with its earliest successful use in this capacity dating back only to 1958 in a tooth extraction in Chansi Province. The first assertions that acupuncture was a science still in its experimental stages were not made by elite members of the American medical profession in the United States in some sort of effort to wrest medical authority from Chinese-Americans who had been practicing acupuncture in insular Chinatown communities, but by Chinese physicians such as Dr. Wei-Jan Wu, the deputy chief of surgery at Capital Hospital of the Chinese Academy of Sciences in Beijing and leader of a Chinese medical delegation to the United States. In November of 1972, Wu told a press conference in San Francisco that acupuncture was still fraught with numerous unanswered questions that had to be addressed, that acupuncture could not replace other methods of hypalgesia, and was not indicated for every patient or every operation in China. “On the other hand,” Wu added, “we couldn’t say it is useless. We can say it is a new kind of anesthesia that can be added to conventional methods with promising prospects.” Wu’s clarification, that acupuncture as an hypalgesic was still experimental, was echoed in reports from American and Canadian delegations returning from China, who had been similarly informed by Chinese physicians during their visits.
Dr. Samuel Rosen, an otologist at Mt. Sinai Hospital in New York, was one of the first American physicians permitted into China to witness major operations performed using acupuncture hypalgesia. In September of 1971, Rosen, accompanied by cardiologists Paul Dudley White of the University of Boston and E. Grey Dimond of the University of Kansas School of Medicine, were present at fifteen such operations at the Kwangtung Provincial People’s Hospital in Canton and later at the Third Teaching Hospital of the Peking Medical College. They witnessed brain operations, thyroid adenomas, gastrectomies, laryngectomies, and tonsillectomies being performed with acupuncture hypalgesia. The most striking case, for Rosen, was that of a victim of pulmonary tuberculosis. The operating room was much like one would find in any Western hospital and procedures for asepsis and preparation of the patient were consistent with those of Europe and the United States. The only difference, Rosen reported, was the presence of an acupuncturist who placed one needle in the patient’s forearm midway between the elbow and the wrist before surgery. After twirling the needles for twenty minutes to induce the desired effect, the surgeon began to cut into an awake and alert patient. The first incision was made from near the spine across the left side of the chest wall to the sternum. Then, with the use of surgical scissors, each rib was snipped away. Finally, with the use of a thoracic retractor, the chest cavity was exposed, revealing the patients beating heart and the patient’s collapsed lung. All the while the patient sipped tea and conversed with the surgeon, apparently in no pain whatsoever. This was only one of many impressive examples of acupuncture hypalgesia witnessed by Rosen. Others included teeth extractions that appeared to cause no pain to the patient.
Thomas C. Elmendorf, President-elect of the California Medical Association, experimented with acupuncture treatment at the hands of Drs. B. C. Pien, of San Francisco, and Leung Kok-Yuen, a pain specialist and head of the North American College of Acupuncture in Vancouver, at a meeting of the San Francisco Medical Society on May 9, 1972. He had hoped to find relief from severe arthritis pain in his hip, from which he had suffered for over four years. As soon as the treatment was finished, Elmendorf rose to his feet and declared “there’s no question there is considerable relief of pain in my hip – the pain that I had when I came in is essentially and literally gone.” The treatment was repeated a month later by the same doctors at the California State Capitol building in front of an audience of curious legislators. When all was said and done, Elmendorf popped off the improvised operating table, saying to the onlookers, “it hurts, but it feels good.” Later, Elmendorf was flooded with inquiries about acupuncture and where to find similar treatment for pain relief. Regretting what he later considered a bit of a misleading overstatement, Elmendorf addressed the public with this generic letter:
…The problem is simply this: acupuncture itself is a procedure in which the skin is penetrated, and as such must qualify as a medical, or perhaps, even surgical procedure. The Chinese physicians do not have licenses to practice medicine in the state of California or for that matter, anywhere in the United States or North America. Therefore, they are not licensed to practice acupuncture here, although acupuncture is not in itself illegal. A physician who had a license to practice medicine and surgery in the state of California, or in any of the states, who learned the procedure of acupuncture and wished to use it in his practice, could legally do so as long as he observed the ordinary prudence required of all medical practice.
I personally believe that acupuncture has some potential as a technique to relieve pain or even, perhaps, to induce anesthesia for surgical procedures. The truth of the matter is that Western medicine knows very little about acupuncture, and I believe that we should attempt to learn about it. Accordingly, university centers are being encouraged to attempt a scientific evaluation of acupuncture treatment. It may even be possible that enabling legislation will be required; however, we are exploring the situation in depth, and no doubt you will be reading about it in the not too distant future.
I want to make it perfectly clear, that I do not endorse acupuncture at this time. I am sorry that some of the newspaper articles gave this impression. It is only fair to report to you that a Chinese nurse, also part of the demonstration and who was reported to have multiple disc disease with two surgeries, tells me that she has had complete relief of her pain for a period of four weeks.
I am immensely pleased that the medical profession here in California has such an open-minded attitude regarding this technique, about which we know very little; nor do we understand the traditional methods of Chinese medical practice.
I should mention that there are no physicians’ names that I can give to you in the United States who practice acupuncture, although I have heard rumors that there are such physicians in Los Angeles, New York and Philadelphia. I want to emphasize that this is rumor only.
My heart goes out to you, because I cannot do more for you; but if there is any value to the acupuncture treatment, we intend to find out.
4. Approving Acupuncture Research in California
On August 14, 1972, the state legislature passed Assembly Bill 1500 in a 57-0 vote in the assembly and a 35-0 vote in the Senate. It authorized unlicensed practitioners to practice acupuncture under the direct supervision of a licensed physician in an approved medical school in California for the sole purpose of scientific investigation and research. The bill also required medical schools that conducted research on acupuncture to report their research findings to the legislature annually. Finally, it extended the same authority to supervise such experimentation to surgeons and dentists.
There were several reasons why early research focused chiefly on acupuncture’s effectiveness in the area of pain management. The main reason for this is the way it was first introduced by the media as a miraculous anesthetic that bypassed all methods used by Western medicine. The main demonstrations of acupuncture to Western doctors were in this context. To test the effectiveness of acupuncture as a hypalgesic was to test its veracity, and it goes without saying that many western doctors were skeptical specifically about its application in this regard. Pain was a simple, easy, and timely criterion to test for.
The prospect of replacing opiates with acupuncture was also appealing to doctors concerned about a host of problems associated with conventional forms of pain management, such as addiction, legal issues with schedule II (highly restricted) drugs, and complications in young, old, allergic or otherwise contraindicated patients. To many medical professionals and politicians during the 1970s, a non-narcotic alternative to pain management drugs could not have come at a better time. On the fourth of July, 1969, President Nixon declared a “war on drugs.” That year, 5.14 percent of college students reported having tried heroin, up from 3.2 percent the previous year. The problem was recognized as not only being limited to countercultural youths; American Vietnam veterans were returning from the Golden Triangle addicted to heroin. As the Yale historian of medicine David F. Musto points out in his book Quest for Drug Control: Politics and Federal Policy in a Period of Increasing Substance Abuse, 1963-1981, the problem of heroin abuse continued to increase into the 1970s.
Lastly, physicians in the United States and China began to propose explanations for why acupuncture was working that had a scientific basis and could be understood and debated in terms of Western medical theory. Up until that point, western medicine could do nothing but dismiss the theory of qi flowing along meridians as little more than fantasy; modern, scientifically-based acupuncture was an animal with which Western medicine could finally grapple.
Such an explanation was first given in 1972 to an audience at Caltech by George Wald, a Harvard biology professor and Nobel Laureate, who had recently visited research laboratories in China. Speaking only of modern uses of acupuncture in pain management, and not of traditional Chinese acupuncture for the treatment of disease, which he dismissed as “probably (having) no scientific grounds,” Wald assured the audience that modern acupuncture was “absolutely real” and not the result of hypnotism or suggestion. The research Wald had witnessed on his trip at the Physiological Institute of the Academy of Sciences in Shanghai was based on the recent gate-control theory of pain advanced by the American physician Robert Melzack and the British physician Patrick D. Wall in 1962.
The gate-control theory challenged a more widely accepted and simpler theory of pain known as the specificity theory, which suggests signals are transmitted along nerves from a site of injury from receptors to the brain, where they are finally processed as pain. Gate-control theory, on the other hand, suggests that pain is less straightforward. According to gate-control theory, a gate-like mechanism exists in the pain-signaling system, which may be opened, partly opened, or completely closed. In the last two cases, pain is either reduced or non-existent. In 1973, Melzack hypothesized that acupuncture might close the gate by stimulating large nerve fibers, which in turn override activity in the small nerve fibers responsible for carrying pain signals to the brain.
A debate began in 1972 in the letters to the editor section of the Journal of the American Medical Association about the best way to test the effectiveness of acupuncture in pain management. Bernard C. Adler first wrote to the editor proposing a double-blind study be carried out in which acupuncturists treat one group of patients with the proper set of acupuncture points and a control group using points slightly removed from the proper ones. Lester C. Mark responded that Mark’s suggestion of deceiving the patient by using false points would be inappropriate, as the patient is an active participant in the acupuncturist’s attempt to illicit paresthesis by reporting to the doctor if manually twirling the needles on the points is producing thé chi, a feeling of soreness or distention that indicates acupuncture hypalgesia is beginning to take effect. Doctors Chein and Shapiro responded saying that while manual stimulation might not produce the desired effect by manually twirling the needles at the wrong points, electrostimululation of acupuncture points would mimic the same soreness regardless of which points were chosen, adding that known points along meridians could be selected, making a double-blind test for placebo feasible. Mark responded, insisting once again that before any stimulation of the acupuncture points took place, whether manual or electrical, the needles would have to be correctly placed, and that this could not be counterfeited. Finally, Chein and Shapiro responded to Mark’s letter, saying that the only proposed studies up until that point were single-blind, as only the patient, and never the acupuncturist, was being deceived. They proposed a simple solution to the problem:
…Make the study double-blind by briefly training and hiring naïve technicians, instructed by an acupuncturist without direct contact to the patients. If sufficient numbers of patients are randomly assigned to the specific and non-specific treatments, anomalies, such as grossly abnormal nerve distribution, and other individual differences, would be distributed between the two groups. Since only naïve subjects and acupuncture technicians would interact, the placebo effect of the treatment would affect both groups equally. If the treatment at the presumed acupuncture point resulted in significantly more improvement than at the control or nonspecific acupuncture point, the conclusion would be that acupuncture is better than placebo in the condition under study.
Such a double-blind study was carried out as early as July of 1972 as part of the UCLA School of Medicine’s research project on the efficacy of treating rheumatoid arthritis patients with acupuncture. Candidacy for participating in the study was determined by whether or not sufferers of arthritis pain were not responding well to the latest treatments available to western medicine. Of the two dozen patients observed over the course of ten weeks, half were treated by inserting needles into prescribed acupuncture points that fell along meridians, while the other half were treated using randomly selected points.
5. Medical Issues in the Regulation of Acupuncture
Starting in the 1960s, radical social movements, beginning with the counterculture, then the antiwar movement, and then the women’s liberation movement, emerged on a vast scale in the United States and Europe. Everything that was part of the existing order was questioned and criticized. Medicine, like many other institutions, suffered a stunning loss of confidence in the 1970s. Fantastic accounts coming back from early visits to China by American doctors in 1971 and 1972 set imaginations ablaze and caused physicians as well as laypersons to entertain high hopes that where Western medicine had disappointed traditional Chinese Medicine might succeed.
Western medicine faced a unique challenge in the arena of popular opinion. Only a year after Reston’s article sparked widespread interest in acupuncture, contemporary authors such as Marc Duke were already criticizing the reception of acupuncture by the Medical profession in 1972. Responding to his question about who might practice acupuncture in the United States, Duke quotes the AMA’s science news editor, Frank Chappell, as saying “it would be the practice of medicine, so it would have to be licensed. That is, it would have to be done by licensed physicians.” Duke then goes on to conjecture:
Most physicians are dedicated, hard-working men who earn their pay – and more. If acupuncture were to become common in the United States, doctors’ incomes would fall. Surgeons and anesthesiologists would be the hardest hit if acupuncture replaced general anesthesia, as it might. The huge amount of drugs American doctors prescribe would also fall. Fewer prescriptions would mean less money for drug manufacturers, another powerful lobby in Washington. Drug companies contribute huge sums of money to medical research. They are unlikely to support research into a medical system that is not founded on the use of drugs.
Such scathing remarks about Western doctors’ sentiments about acupuncture were not uncommon in an era when mistrust of government and corporate enterprise was rife. Western medicine was distrusted as part of the ancient régime. However, the comments by Thomas N. Elmendorf, M.D., the President-elect of the California Medical Association, reveal that Chappell’s answer to Duke’s query, if taken as a single-sentence sound bite, is apt to mislead the reader.
It should come as a surprise to no one that in this initial period of regulation, concerned legislators and medical professionals called for a period of restriction and research to safeguard an eager public from engaging in a practice that posed considerable risks in the wrong hands. The California Medical Association and the California Department of Consumer Affairs responded to a seemingly unbridled acupuncture craze with demands that the state legislature pass some sort of regulation on a form of medical service which, up to that point in time, had none.
There is a considerable risk of structural damage due to insertion of acupuncture needles, the most common of which is pneumothorax (collapsed lung) . In 1973 and 1974, six cases of pneumothorax as a result of acupuncture were reported in the Journal of the American Medical Association and the New England Journal of Medicine alone. One of the cases involved a patient seeking acupuncture as a treatment for atypical migraine in August of 1973. When she sought medical attention two days later for pain in her left shoulder blade and increasing shortness of breath, doctors discovered that 35% of her left lung had collapsed, requiring re-expansion with a chest tube. When the California State Assembly was deliberating over legislation to follow AB 1500, the CMA voiced concern about such complications, presenting the legislature with an article from the Journal of the American Medical Association entitled “Complications of Acupuncture,” which dealt chiefly with the problem of pneumothorax.
Other complications leading to structural damage were known to have occurred with acupuncture, including but not limited to cardiac tamponade (an emergency condition in which fluid builds up in the sac containing the heart) caused by too deep of a penetration to an acupuncture point located below the fifth rib, spinal cord damage associated with the ya-men acupuncture point, penetration of the eye as a result of misdirection of needles inserted subpraorbitally or infraoribitally, and damage to the external middle ear.
Elmendorf’s letter gives us another very critical reason why acupuncture, unlike other traditional Chinese therapies such as herbal treatments, came under such close scrutiny: it is an invasive procedure, that is, a procedure that enters the body, by cutting or puncturing the skin or by inserting instruments into the body. Medical expertise is necessary in such an instance because the skin is the body’s first line of defense against bacterial or viral infection. Whereas HIV infection would probably constitute the chief threat to public health from contaminated needles nowadays, in the 1970s the AMA and CMA were concerned about the spread of hepatitis. Outbreaks linked to poorly sanitized, reused needles were known to have occurred in rural parts of China and while such cases were few and far between in the United States, the concern was not unwarranted. In 1984, a rash of hepatitis B infections struck thirty-five patients at an acupuncture clinic in Rhode Island.
The arrival of acupuncture in the United States did not signal the first time medicine had to put its foot down and declare a procedure invasive. The admittedly more extreme case of the lobotomist Walter Freeman sheds light on how the grey area between what is and what is not an invasive procedure can be stretched. Although Freeman was more familiar with neuroanatomy than the average psychiatrist, he was not formally trained as a neurosurgeon and therefore lacked the necessary qualifications to participate in brain surgeries as anything more than a surgeon’s assistant. Rather than put his career on hold to receive surgical training, he devised a new procedure that could be performed in a matter of minutes by anyone with an ice pick. This procedure called for entering the brain through the tear ducts, which are naturally sterile, leading him to reason that, apart from sterilizing the instrument used to perform the lobotomy, there was no need for asepsis.
Knowing he could not perform the new lobotomy in an institutional setting, Freeman began offering his transorbital lobotomy to patients in his private office. Freeman’s critics were often very vocal about how inappropriate they found it for psychiatrists to carry out the work of surgeons. One such critic, David Cleveland, remarked, “the surgeon will shudder, and rightly so, at the thought of cerebral surgery becoming an office procedure in the hands of the usually, very unsurgical psychiatrist.”
Freeman took an adversarial position, asserting that “neurosurgeons were simply trying to stake out the brain as their exclusive property.” In order to reclaim what he perceived as the surgeons’ monopoly on the right to lobotomize, he went to great lengths to proselytize that his new method was so easy, simple, and efficient that anyone from any discipline, not just surgeons, could do it.
It could be argued that Freeman’s lobotomies, although extremely invasive, in fact do not require formal training in surgery to be safe and effective. Acupuncture, too, can indeed be practiced safely and effectively without all of the training of a professional surgeon. Although acupuncture is not lobotomy, is far less invasive, and poses far fewer risks, it technically remains an invasive procedure and complications involving the practice can and have occurred.
The concern about acupuncture being an invasive procedure was not limited to licensed or unlicensed practitioners. The L.A. Times reported that along with the lifting of the Bamboo Curtain, coolie hats, Mao jackets and acupuncture kits were flying off of store shelves. At a hearing on acupuncture in the California State Assembly, legislators expressed concern that laypeople might pick up a book and attempt to practice on themselves. Bob Felt, in an interview with Boston University medical anthropologist Linda L. Barnes, a leading authority on the history of acupuncture in the United States, remarked of informally practicing acupuncture in the 1970s, “we were middle class kids, a lot of us. It was illegal as a practice, and we never thought we would make a living at it. I practiced out of a back room of the bookstore. It was something of an outlaw role. Having gone through our early adult years as outlaws with a feeling of rejection and of not belonging, we probably outlawed it more than it needed to be. But without outlaws, nothing new comes into the culture.” Felt provides an example of the young and naive who dabbled in acupuncture like outlaws in the romantic tradition of Robin Hood. As has been discussed, acupuncture is not a quaint curiosity of the Orient, but a real medical practice with real medical complications. While Felt and others like him might have been well-meaning, acupuncture has no more business being practiced in the back room of a bookstore by amateurs than does a coat hanger abortion.
The public’s disenchantment with Western medicine also made it prey to rampant charlatanism in acupuncture. The flurry of interest in traditional Chinese medicine occasionally led unwitting patients into the offices of opportunists eager to charge an arm and a leg for their seemingly exotic and cutting edge services. From a public health standpoint, what was especially alarming was that many of these “clinics” or “institutes” that seemed to crop up overnight operated more like ‘mills’, processing hundreds of patients daily. These so-called “quackupuncturists” often promised relief from minor afflictions that tend to cure themselves in time, such as headaches, to more permanent problems, such as baldness. One remarkable example of such deception is that of acupuncture ‘institutes’, and ‘centers’ claiming to cure nerve deafness within a few treatments – an experimental procedure that hadn’t shown any clinical success in China.
6. Health Care Delivery Issues in Acupuncture Regulation
AB 1500 was only ten weeks old when the Assembly Committee on Health Manpower held a hearing on acupuncture. The goals of the hearing were to balance their stated desire to help ensure that it became available to the general public to the extent proven therapeutically valuable with the need for protection of public welfare; to protect the public’s right to receive acupuncture on the one hand with the need to protect the public from those who were inadequately trained to administer acupuncture on the other. Dr. Elmendorf was present to represent the California Medical Association’s position:
…I am here to support the second objective of your committee which is really twofold, and that is to protect the public interest, number one, in the sense that if this is of value, let’s find out what that value is, so that the public may receive it, and secondly, that we see to it that they receive it in the proper way, and that they are protected from the development of cult for the exploitation of the public by those who would do so for monetary reasons or whatever.
When asked if the legislature should approach the problem of acupuncture by declaring it a medicine that only physicians could practice, Elmendorf responded:
Well, I would have to struggle with that, as I am sure you are. I would say this, that it would seem that the penetration of the skin with needles does constitute the practice of medicine, although we know of instances where this is done by other than physicians for purposes of diagnosis. We know that earlobes are punctured, for example, by jewelers for ear rings …the procedure of penetrating the skin with needles does carry the risk of infection, it carries risk of penetrating some vital structures, perhaps, and, as you pointed out earlier, it particularly carries the risk of diagnosis and treatment. As you know, we don’t advocate giving morphine for a stomach pain before we know what is causing the pain. One could see the use of acupuncture to relieve a symptom prior to the time an adequate diagnosis was made. So I do believe that the position of the California Medical Association is that this procedure should be in reliable hands. We need to have, in some way, we need to encourage, stimulate, if you would, the medical centers to give a scientific evaluation of this. This is what I think is in legislation now, if it permissive. I would rather not see it mandatory, but if there were some way that we could move this before it gets out of hand, as I think is one of your fears, I would be very much for that, and I am sure the Medical Association would be, too.
In response to questions from Assemblyman William Campbell about how he came to be temporarily relieved of arthritis pains and how acupuncture works, Elmendorf replied:
Whether it is hypnotic or not, which the Chinese vehemently deny, and there seems to be substantial evidence against that theory, as well as some evidence for it, or whether it is a type of somatic phenomenon, I really don’t care, as long as an individual has had adequate diagnosis and is not having a delay in needed treatment, I don’t care how his pain is relieved. There are many people that I have found, from letters all over this country, who are in chronic pain and would like to obtain some way to obtain relief. They will grasp at straws. It is, of course, the fear of this committee, and my fear that they may go too far in this thing. Lets [sic.] try to find out what its value is and how it does work.
A major issue that also came up at the hearing was the impact of AB 1500 on practicing acupuncturists. Dr. William Prensky, Chairman of the Board of the Institute of Taoist Studies, a non-profit organization in California, observed, “we have a major concern that acupuncture, practiced by competent practitioners, not be forced underground in the state of California, and therefore that all practitioners, both competent and incompetent, be forced into the same type of clandestine practice, so that it will forever be impossible to separate those proper practitioners from the improper practitioners.”
Indeed, for the vast majority of Chinese practitioners of acupuncture, AB 1500 effectively stripped them of any autonomy as caregivers to their communities. Whereas they were once largely ignored by the rest of the public as they practiced in the nooks and crannies of their respective Chinatowns across the state, they were now met with interested outsiders seeking relief they could not find elsewhere. Arrests under the new law followed quickly, as the California Department of Consumer Affairs and the Board of Medical Examiners cracked down to emphasize the point that acupuncture was now subject to medical regulation home.
The first such arrest occurred in December of 1972, when a client of George Long, a martial arts instructor and the owner of the George Long School of Kung Fu at 1865 Post Street, San Francisco, notified the Department of Consumer Affairs that Long was offering acupuncture treatment without the proper credentials, and that he had been doing so for quite some time. Long was released on five hundred dollars bail, potentially facing a six hundred dollar fine and up to six months in jail on charges of practicing acupuncture without a medical license.
The most well known of the early arrests of acupuncturists is that of Miriam Lee. On April 16th, 1974, as stunned patients looked on in disbelief, Lee was arrested by agents of the Department of Consumer Affairs on charges of practicing medicine in California without a license in her Palo Alto office at 555 Middlefield Road. She was later freed on five hundred dollars bail and faced an additional five hundred dollar fine and six months in jail if convicted. When Lee appeared at her hearing, over a hundred of her patients showed up as well. News of the widespread support she received drew attention from the legislature, convincing many that the subject of acupuncture was an urgent social and cultural issue as well as a medical one.
Apart from the immediate need to protect the general public from the potential side effects of acupuncture, there was also a need to integrate Chinese medicine into the existing public health model. Members of the acupuncture research project at UCLA maintained in a written statement to the California State Legislature that lifting the restrictions on acupuncture would be premature, as certain measures would have to be taken to ensure that legalization would result in the formation of a safe and ultimately legitimate profession. Their intentions were not to stifle or control acupuncture, but to facilitate a process that would guarantee acupuncturists as much independence and autonomy from the established medical community as possible. They argued, “licensed acupuncturists should operate their own offices, carry their own malpractice insurance, etc., thus allowing them a certain degree of autonomy from other medical practitioners.”
The UCLA research team’s statement summarized the conflict between medical authorities and proponents of acupuncture: the first group believed regulating acupuncture was necessary to prevent exploitation and to minimize harm to the public, while the second group believed physicians were too ignorant about acupuncture and too financially vested in maintaining a status quo to regulate it. These two perspectives, they believed, could be reconciled by legislation that provided licensing of all practitioners, qualifications for licensure, standards of practice, establishment of an Acupuncture Advisory Board, and funds for research. The requirements they believed were necessary for licensure included fluent knowledge of the English language, basic knowledge of anatomy and physiology, basic knowledge of western medicine, basic knowledge of aseptic procedure, and basic knowledge of acupuncture.
The reason they considered a knowledge of anatomy, asepsis, and Western medicine, in general, to be necessary for acupuncturists’ training was solely to prevent complications. In the case of asepsis, for instance, many practitioners of Oriental medicine did not believe in germ theory. In order to prevent the spread of diseases such as hepatitis, the UCLA researchers insisted germ theory should, at least, be respected as plausible until proven otherwise (the document is reproduced in full in the appendix). The incidences of punctured lung, although few and far between, were well known to Western doctors, and this was the chief reason for urging that a basic understanding of anatomical structures be made compulsory in training and certification. That acupuncturists should have a basic understanding of Western medicine may seem ethnocentric, but the researchers argued there were simply too many factors in patient safety, when it came to acupuncture, that Oriental medicine could not account for, such as the ramifications of sticking needles into someone who is taking anticoagulants, or is hemophilic, or the complications that can result from performing electroacupuncture on a patient who has a pacemaker.
Some of these requirements, such as fluent knowledge of the English language, may strike some as excessive or culturally biased. Foreseeing this, the UCLA team argued that it was only fair that patients be able to obtain clear answers from their caregiver, and caregivers must be able to understand the complaints of patients, adding that foreign trained physical therapists, nurses, psychologists, and other caregivers were required to pass examinations by the Medical Board in English, and that acupuncturists should share the same responsibility as there fellow caregivers.
In 1975, legislators deliberated over a new bill that was to have profound impact on acupuncturists. Senate Bill 86 was to move acupuncture from being an experimental procedure performed behind the walls of universities back to private practices. It called for the creation of a governor-appointed, seven-member Acupuncture Advisory Committee, consisting of five non-physicians with at least ten years’ experience in acupuncture and two physicians with at least two years’ experience in acupuncture to assist the California Board of Medical Examiners. It also provided, for the first time, a state certification program for acupuncturists by the Board and the automatic certification of acupuncturists upon proving they were in practice for five years or for three years on condition they participate in a designated acupuncture program. Furthermore, the bill permitted certified acupuncturists to practice on patients with a referral or diagnosis from a physician, surgeon, dentist, podiatrist, or chiropractor, and for the acupuncturist to report back to the referring doctor the nature and effects of the treatment upon its completion. Finally, it called for the dismissal of all pending cases of practicing medicine without a license for all those who met the criteria to qualify as acupuncturists under the new guidelines, and for all convictions of acupuncturists for practicing without a license pending on appeal to be remanded to trial court for the verdicts to be appealed and judgments of acquittal entered.
7. Criticism of Acupuncture by Western Doctors
Some medical anthropologists, including Paul Root Wolpe and Linda L. Barnes, have argued that the call for regulation of acupuncture by medical doctors was an attempt to assert their authority over and defend the dominant paradigm of western medicine against the threat of traditional Chinese medicine. Barnes argues that the medical profession’s adversarial reaction to the public’s sudden interest in acupuncture was twofold: first they asserted control over acupuncture through the demand for research and clinical trials; secondly, they regulated practitioners in what amounted to another form of social control. Of the emphasis on pain management in acupuncture research and the neglect to study other areas in which acupuncture might prove an effective form of treatment, Wolpe additionally argues:
…the entire theoretical framework of traditional Chinese acupuncture had to be replaced … Biomedicine had no means of assessing the validity of these cultural models. Traditional acupuncture theory and treatment philosophy was therefore all but discarded, and acupuncture analgesia/anesthesia—a very small part of traditional acupuncture’s therapeutic claims (acupuncture anesthesia was not used in China until the 1960s)—was presented as acupuncture’s only true potential contribution to Western medicine.
Barnes echoes Wolpe’s suspicion of biomedical “authorities” in her article “The Acupuncture Wars: The Professionalizing of Acupuncture in the United States”:
To control the actual practice of acupuncture, U.S. physicians argued that it should be categorized as an experimental procedure and that it should only be performed in a research setting either by a doctor or under a doctor’s supervision … by appearing to support research, and by creating structured channels through which to engage with this foreign modality, biomedical authorities could claim that the playing field was not only level but also open to new approaches.
Her assessment of the medical profession is unflattering. As we have seen and as Barnes also concedes, between acupuncture and Western medicine, the latter modality was the one that was at a disadvantage, as it was met with challenges posed by the former’s having taken on a special meaning to early lay practitioners, patients, and the American public “as part of a broader cultural stance of resistance in the pursuit of alternative ideals.” As recently as 1999, Wolpe continued to argue that “Modern American biomedicine has been singularly successful in excluding competitors from challenging its legitimacy.”
The case that the medical profession has sought to undermine the profession of acupuncture does not survive scrutiny. As has been described, medical professionals such as Dr. Thomas Elmendorf and the UCLA acupuncture research team demonstrated a sincere willingness to explore the potential of acupuncture and to even see it integrated into mainstream medicine. By 1997, this integration was realized so completely that the National Institute of Health held a two and a half day seminar on acupuncture for the continuing education of physicians.
Not only is this evidenced by historical documents, but by the timeline of acupuncture legislation, which illustrates a trend towards autonomy. The passage of Senate Bill 86 (Moscone-Song), passed in 1975, legally moved acupuncture from an experimental procedure performed behind the walls of California’s universities back to the private offices of community doctors. SB 86 was a major victory for acupuncturists on several counts. By creating an advisory committee answerable to the Board of Medical Examiners and a state certification program, it paved the way for recognizing acupuncture as a legitimate therapeutic profession.
The victory for acupuncturists was bittersweet. To the chagrin of many acupuncturists, the required diagnosis and referral by a Western doctor was difficult for patients to obtain, as few medical doctors were willing to refer patients to acupuncturists for fear of compromising their credibility among their peers, many of whom believed that further experimentation was necessary to determine acupuncture’s effectiveness. The requirement of a Western diagnosis was also seen as counterproductive to acupuncturists, whose methods of diagnosis were radically different.
Legislation that followed between 1978 and 1998, however, reversed many of the initial restrictions placed on acupuncturist, including the requirement of a Western diagnosis and doctor’s referral. The legislation’s trajectory reveals a progression from initial easing up of restrictions, to professionalization via certification, to self-regulation; a path towards recognition and autonomy.
S.B. 1106, passed in 1978, had several effects. It added four public members to the acupuncture board, each of whom would serve a three-year term, authorized the board of Medical Quality Assurance to approve apprenticeship programs for acupuncturists as specified, established standards for continuing education for acupuncturists, required anyone who failed to renew a certificate within five years of its expiration date to demonstrate skills in acupuncture in addition to any required examinations, and called for the retaining of ten percent of the application fee for an acupuncturist’s certificate if the application were to be denied or withdrawn. It deleted the “grandfather” provision, which allowed a certificate to be issued to anyone who had performed acupuncture for five years. Finally, it required acupuncturists to post their certificates in each location of practice and specified the fee for a duplicate certificate.
A.B. 1391, which passed 74-25 in the legislature in 1979, repealed that part of SB86 that required a prior diagnosis or referral from a physician, surgeon, chiropractor, dentist, or podiatrist and the requirement that acupuncturists report back to the referring doctor.
In 1980, A.B. 3040 replaced the Acupuncture Advisory Committee with an Acupuncture Examining Committee, and expanded the scope of practice to include electroacupuncture, herbal remedies and dietary supplements, Oriental massage, and other traditional Chinese therapies. It also articulated a necessity that individuals practicing acupuncture be subject to regulation and control as primary care physicians.
Finally, in 1998, S.B. 1980 and S.B. 1981 removed the Acupuncture Committee from Medical Board jurisdiction, renaming it the California Acupuncture Board.
The published analyses of the American medical profession’s negotiation of the sudden introduction and popularity of acupuncture in the early 1970s do not do justice to what was actually a very and progressive response on its part. Authors like Wolpe and Barnes tend to downplay the open-mindedness with which Western physicians met acupuncture in the 1970s, by reifying the medical community and portraying it as an ignorant, hostile, and monolithic entity bereft of any diversity of opinion. Paul Starr has argued, on the contrary, that the uniformity and cohesiveness of the medical profession broke down in the 1970s, as the influx of foreign doctors transformed it into the most ethnically diverse of the upper-income occupations.
It should not be assumed that this critical evaluation of these authors’ perception of Western medicine’s reaction to acupuncture in the 1970s is only maintained by those partial to the former or suspicious of the latter. In his acupuncture textbook, Understanding Acupuncture, Dr. Stephen Birch echoed similar sentiments:
[Wolpe] proposes that by placing acupuncture in the ‘holding cell’ of experimental status, that threat [to western medicine] was eliminated. For those who participated in acupuncture licensure efforts, it is clear that both physician opposition and internal conflict among acupuncture’s philosophical and ethnic divisions retarded those efforts. However, the extent of any physician-funded opposition is unclear. And, regarding what future in-depth research will reveal regarding the political role of physicians, the contribution if individual physicians should not go unmentioned.
The medical profession did indeed encourage legislative restriction on the promising, exciting, and exotic therapy that the public found to be acupuncture in the early 1970s. As we have seen, their reasons for doing so were chiefly out of concern for public welfare. After a period of investigation by open-minded Western doctors and legislators, however, acupuncture was put on a track which led to it becoming fully integrated into mainstream medical practice.
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National Institute of Health. NIH Consensus Development Conference on Acupuncture, Bethesda, Maryland. November. 3-5, 1997.
Nelson, Harry. “Nobel Winner Explains Use of Acupuncture as Anesthesia.” Los Angeles Times, June 1, 1972.
Nelson, Harry. “Acupuncture Not a Cure-All, Chinese Says.” Los Angeles Times, Nov. 1, 1972.
Oganesoff, Igor. “Drug, MD Shortage Forces China to Turn to Ancient Remedies.” Wall Street Journal. July 10, 1963.
Perlman, David. “500 S.F. Doctors See Acupuncture.” San Francisco Chronicle. May 10, 1972.
Perlman, David. “Acupuncture Tried at UC.” San Francisco Chronicle, October 28, 1972.
Reston, James. “Now, About My Operation in Peking.” New York Times. Jul 26, 1971.
Rosen, Samuel. “I Have Seen the Past and It Works,” New York Times, Nov. 1, 1971.
Rosen, Samuel MD. “On Quackupuncture,” New York Times, May 28, 1974.
Shapiro, Arthur K., MD. and Edmund Y.M. Chein BS. “Evaluation of Acupuncture.” Journal of the American Medical Association. June 11, 1973. Vol. 224, No. 11.
Shapiro, Arthur K., MD., and Edmund Y.M. Chein, BS. “Letter: A Mini Symposium on Acupuncture.” March, 1974. Vol. 227, Pp. 1122-1123.
The Practice of Acupuncture: A Legislative Position Paper. California State Archives. Microfilm drawer 1, reel 4, item 26. Reproduced below. (see Appendix).
Weisser, Peter. “Acupuncture at the Capitol.” San Francisco Chronicle, June 30, 1972.
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Barnes, Linda L. “The Acupuncture wars: The Professionalizing of Acupuncture in the United States – A View from Massachusetts.” Medical Anthropology, Volume 22, Number 3, July-September 2003.
Birch, Stephen J., and Robert L. Felt. Understanding Acupuncture. New York: Churchill Livingstone, 1999.
Commission on California State Government Organization and Economy. Acupuncture: A Complementary Therapy Framework. Sacramento: Little Hoover Commission, 2004.
Duke, Marc. Acupuncture. New York: Pyramid House Books, 1972.
El-Hai, Jack. The Lobotomist: A Maverick Medical Genius and His Tragic Quest to Rid the World of Mental Illness. Hoboken: Wiley, 2005.
Elmar T. Peuker, MD; Adrian White, MD; Edzard Ernst, MD, PhD; Franz Pera, MD. “Traumatic Complications of Acupuncture: Therapists Need to Know Human Anatomy.” Archives of Family Medicine, Vol. 8, No. 6, November, 1999.
Fairbank, John K. and Kwang-Ching Liu, eds. The Cambridge History of China, Vol. 11: Late Ch’ing, 1800-1911, Part 2. Cambridge: Cambridge University Press, 1980.
Kent, George P. “A Large Outbreak of Acupuncture-Associated Hepatitis B.” American Journal of Epidemiology, Vol. 127, No. 3
MacMillian, Margaret. Nixon and Mao: The Week That Changed the World. New York: Random House, 2007.
Melzack, Ronald. “How Acupuncture Works: A Sophisticated Western Theory Takes the Mystery Out.” Psychology Today, 7 1 June 1973.
Musto, David F. Quest for Drug Control : Politics and Federal Policy in a Period of Increasing Substance Abuse, 1963-1981. New Haven: Yale University Press, 2002.
Ortner, Sherry B. “Theory in Anthropology since the Sixties.” Comparative Studies in Society and History, Vol. 26, No. 1, (Jan 1984).
Risse B. Guenter, M.D., Ph.D. Modern China and Traditional Chinese Medicine: A Symposium Held at the University of Wisconsin, Madison. Springfield: Charles C. Thomas, 1973.
Said, Edward. Orientalism, New York: Vintage Books, 1979.
Starr, Paul. The Social Transformation of American Medicine: The Rise of a Sovereign Profession and the Making of a Vast Industry. New York: Basic Books, 1982.
Wall, Patrick D., and Ronald Melzack. “On the Nature of Cutaneous Sensory Mechanisms.” Brain, 85:331, 1962.
Wang, Zhenguo, Chen Ping, and Xie Peiping. History And Development of Traditional Chinese Medicine. Beijing: Beijing Science Press, 1999.
Wolpe, Paul Root. “The Maintenance of Professional Authority: Acupuncture and the American Physician.” Social Problems, Vol. 32, No. 5, June 1985.
Wolpe, Paul Root. “Alternative Medicine and the AMA.” in Robert Baker et al. (eds.), Ethics in American Medicine. The American Medical Ethics Revolution. Johns Hopkins University Press, 1999.
Zhiyong, Chen. “Of Pins, Needles, and Pain Relief”. China Daily, Feb. 15, 2006.
The Practice of Acupuncture: A Legislative Position Paper
Available on microfilm at the California State Archives, file 1, reel 4, item 26
A. The Problem
Although acupuncture is probably the world’s oldest known system of medicine, its introduction into the American healthcare delivery system has been highly controversial. Legislation enacted by different state legislatures has varied from total legalization (Nevada) to specific restrictions even upon licensed physicians (New York). Basically, two opposing (but not necessarily conflicting) points of view have emerged: “medical authorities” argue that some kind of regulatory controls must be exercised over non-physician practitioners to prevent exploitation and/or danger to the public, and they cite published reports of infection, nerve damage, cardiac arrest, pnrumothorax, etc. following acupuncture treatment. On the other hand, non-physician acupuncturists (and their supporters) argue that they should not be regulated by physicians who know almost nothing about it and who have a vested financial interest in maintaining a status quo which allows them to practice legally.
B. The Solution
We believe that these two positions can be reconciled by the enactment of legislation that provides for the following:
(1) Licensure of all practitioners.
(2) Qualifications for licensure.
(3) Standards of practice.
(4) Establishment of an Acupuncture Advisory Board.
(5) Funds for research.
C. Licensure of all Practitioners
Although in some states, non-physician acupuncturists are permitted to practice by referral or under the supervision of licensed physicians, the great majority of physicians are untrained in acupuncture and therefore are unable to evaluate the training, experience, and competence of acupuncturists, nor the appropriateness of any technique which they wish to deploy. Therefore, we feel strongly that all practitioners of acupuncture (including physicians and dentists) should be specifically licensed and regulated by the Board of Medical Examiners, if they are able to meet the minimal qualifications listed above. Acupuncture licenses should be subject to periodic review so that appropriate sanctions can be taken against incompetent or unethical practitioners. Licensure will insure at least minimal training and competence, and will permit acquisition of appropriate malpractice insurance and professional certification of non-physician acupuncturists. Like osteopaths, chiropractors, nurse practitioners, registered physical therapists, and other medical paraprofessionals, licensed acupuncturists should operate their own offices, carry their own malpractice insurance, etc., thus allowing them a certain degree of autonomy from other medical practitioners. The penalty for practicing acupuncture without a valid license should be a misdemeanor offense.
D. Qualification for Licensure
In order to qualify for licensure, all applicants should be required to pass written and practical examinations demonstrating knowledge in the following areas:
(1) Fluent knowledge of the English language. In order to communicate effectively with western patients and referring physicians, fluency in English is essential. It is highly unethical to place patients in a situation in which they cannot communicate easily with the therapist, not obtain clear answers to their questions. In addition, Oriental non-physician acupuncturists may attempt to treat inappropriate symptoms unless they readily understand the specific basis for referral. Just as it is the responsibility of foreign trained physicians, nurses, psychologists, physical therapists, etc. to pass licensing board in English, so should acupuncture applicants be required to pass written and oral examinations in English. Although one may argue that a translator may obviate the need for this requirement, in practice it is not a satisfactory substitute, and in addition, such an arrangement is impossible to enforce.
(2) Basic knowledge of anatomy and physiology. Applicants should demonstrate reasonable knowledge of the locations and functions of the major organs, blood vessels, and the peripheral nerve pathways. For example, the location of the lungs should be well known in order to generate respect for the possibility of pneumothorax following needle insertion in the chest or upper back areas.
(3) Basic knowledge of western medicine. This would include familiarity with western diagnostic terms and disease entities. For example, acupuncturists should know the ramifications for treating a hemophiliac or a patient taking anticoagulants, and that electro-acupuncture across the chest is contraindicated in patients with cardiac pacemakers. In addition, knowledge of basic first aid techniques (e.g. Cardiopulmonary resuscitation, etc.) should be required.
(4) Basic knowledge of aseptic procedures. Although many Oriental practitioners do not believe in the “germ theory” of disease, we feel that this notion should be respected (pending evidence to the contrary), in order to prevent the spread of infectious diseases (e.g. hepatitis). Therefore, familiarity with the techniques and principles underlying the use of needle sterilization equipment and aseptic procedures must be demonstrated.
(5) Basic knowledge of acupuncture. An appropriate examination can be prepared to determine expertise in the principles and practice of acupuncture. Although there are many different systems of acupuncture (e.g. Chinese, Korean, Japanese Kyodoraku, Do-In, Shiatsu, etc.), all are based on fundamental meridian theory, and the point combinations used to treat most illnesses are quite similar. This portion of the licensure should be very fundamental with an emphasis on clinical technique. It is with respect to this item that the Advisory Board can pass judgment on a case by case basis.
E. “Grandfathering” of Applicants
We are strongly opposed to “grandfathering” applicants simply because they have a variety of certificates, licenses, or other documentation certifying prior training and experience. First of all, such “evidence” is obtainable in Hong Kong and elsewhere for a small fee, and it is almost impossible to determine the true validity of such claims. Secondly, many “experience” acupuncturists who insist that certain problems can be treated only by causing third degree burns and nerve damage should not be permitted to practice simply because they have been doing so illegally for an arbitrary period of time. Thirdly, most competent and experienced acupuncturists can easily meet the requirements for licensure listed above. The Board of Medical Examiners should be permitted to waive certain requirements in exceptional cases.
F. Standards of Practice
Licensed non-physician acupuncturists should be permitted to treat patients only on the basis of the diagnosis and written referral of a licensed physician or dentist (who should be prohibited from fee-splitting). This will insure that primary diagnostic responsibility remains in the hands of appropriately trained medical practitioners. Specific standards of practice should be established to delineate clearly the techniques which are permissible (e.g. needle insertion, moxibustion, auriculotherapy, etc.). Finally, appropriate consent forms should be signed by patients, and detailed records of all procedures used should be kept for at least three years.
G. Establishment of an Acupuncture Advisory Board
Given the complexities of determining qualification for licensure and standards of practice, an Acupuncture Advisory Board to the Board of Medical Examiners should be appointed by the Governor. Although it has been said that a camel is a horse that was designed by a committee, a judiciously selected board comprised of well known and highly respected professionals active in the area of acupuncture can be created. For the sake of all practicing acupuncture as a respected medical profession, it is important that the Board be composed of prestigious advocates of acupuncture who will win the support and cooperation of the medical community. Antagonism between the Advisory Board and the Board of Medical Examiners will serve no one’s interest. We recommend that the Advisory Board be composed as follows:
(1) A representative of the Board of Medical Examiners, to serve as a liaison for the Advisory Board.
(2) A representative of the California Medical Association, to serve as a liaison with the CMA.
(3) Two physicians who are trained and experienced in the field of acupuncture.
(4) One dentist who is trained and experienced in the field of acupuncture.
(5) Five non-physician acupuncturists (with at least one Chinese, one Japanese, and one Korean member), all of whom meet the qualifications listed.
(6) A non-physician research scientist who is trained and experienced in acupuncture, and who is readily knowledgeable of the clinical data concerning the proven effectiveness of acupuncture, as well as the potential complications of acupuncture.
(7) A non-physician academician who is trained and experienced in acupuncture, and who is trained and experienced in educational testing and test design.
H. Funds for Research
In light of the fact that much remains to be discovered about the effectiveness, complications, and contraindications of acupuncture, a portion of the fees received from licenses should be distributed to approved, ongoing medical school research projects investigating acupuncture. All licensed acupuncturists should be required to report their results to the Advisory Board on a semiannual basis, which will provide important clinical research information.
I. Urgency
Although some may argue that legislation is urgently needed which will permit non-physician acupuncturists to practice immediately, we feel that the safety and best interests of the people of California are served only if all of the safeguards we have outlined above are enacted, no matter how long it takes to implement them. Acupuncture is now widely available throughout California, and although certain non-physician acupuncturists may achieve better therapeutic results than physicians now practicing, we believe that this is outweighed by the potential dangers which may result to the public if these safeguards are not provided
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灸师李传真医生回忆，她毕业于新加坡针灸学院，l969年移民美国，开始在家里为病人针灸，效果不错，消息传开以后，病人越来越多，应接不暇。她是华裔针灸师中唯一能讲几句英语的中医师，患者基本上都是白人。但是因为针灸的合法性问题，租不到诊所。1972年终于遇到一位好心的西医，敢于将诊所出租给她使用半天，每天从早上5点到下午l点，要看70～80个病人。可是，好景不长，l974年4月16日，里根州长否决了针灸合法化提案的第二天，一大早警察就来到她的诊所，当着十几个病人的面就把她带走，罪名是“无照行医”。开庭那天，她的数百名病人到法庭抗议，说他们都是经过西医治疗无效，才转向针灸并得到了帮助，他们有权利选择针灸疗法。法庭面对挤满屋子的患者，不知所措。其实，就连法官的妻子都是李医生的患者，法官也知道李医生是个好人，最后只好裁定针灸只能作为实验项目进行，罚款500美元，将李医生释放。此事在当时成为轰动一时的社区新闻。
直到第二年，新任州长布朗签署了加州第一个针灸合法化提案，李医生的“罪名”才得以洗清，500美元的罚款也退了回来。但不幸的是，租给她诊所的那位西医师，因为将诊所租给非法行医者，遭到了吊销行医执照的处罚。事情过了数年后，每当想起此事，李医生都感到内疚，对不起那位好心的医生[70]。
现在很多人都不知道，70年代以前，美国医学界一直都十分保守，有很多所谓道德伦理的“行规”。如果一位西医将病人转给非正统医生，也就是没有医生执照的“治疗师”，相当于现在所说的替代补充医学行医者，那是要违反“行规”的，很可能会受到医学会伦理道德委员会的制裁。据1974年加州的一份《针灸新闻》(Acupuncture News，July l974)报道，当时曾有42位执照西医师联名上书旧金山法院，提出“针灸转诊请求”，信中说根据当时已有的科学证据，应当允许医生把适当的患者转给针灸师治疗，而最好的针灸师一般并不是执照医生。
美国西医团体在历史上同其他非正统医学流派历来不合，甚至达到水火不相容的程度。比如，正统西医(MD)过去不承认整骨医生(DO)和整脊医生(DC)为医疗职业，西医主导的医院里不会雇用整骨医生或整脊医生，甚至开诊所也不会跟他们做邻居。后来这两个职业在教育上都做了重大的改革，整骨医生已经逐渐被西医接受，目前的地位已经接近正统的西医了，而整脊医生仍然同正统西医有很大的隔阂和距离。近年来随着医学和社会的变迁，替代补充医学逐渐流行，西医行规也与时俱进，一些过时的老行规也不复存在了。中医针灸作为一种来自东方的传统医学，当年遭受西医的强烈排斥并不奇怪，面对巨大的法律障碍，针灸出师不利，惨遭滑铁卢应在预料之中。
由于法律不规范，在加州还出现过很可笑的情景。因为法律规定只有执照西医师(MD)才能扎针灸，但西医师又不懂针灸，所以只好请针灸师开针灸“处方”，将需要扎针的穴位贴上标签，然后由西医师扎针，执照西医师反倒成了无照针灸师的“小工”，不知真相的患者，搞不清究竟是谁在给谁打工。这种状态虽然没有持续很长时间，但在东西方针灸史上却留下了可笑的一笔。
美国有些州早期的行医法律规定，只有执照医师才可以给病人扎针，或者针灸师只能在医学科研中心，在执照医师的“指导”下，才能从事针灸。这些“不平等待遇”，令从事针灸业者，尤其是华裔针灸师十分气愤，他们采用各种办法表达自己的不满，极力争取权益。最常用的方法包括上书国会议员、请患者写信、收集公众签名、游说政客、借助媒体呼吁、出庭抗争、聘请律师诉讼、甚至坚持秘密行医等等。华裔针灸师当时上书议员最常用的抱怨是，我教会了无数西医
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标题: 美國李醫師簡介（節錄轉載自Wikipedia） [打印本页]
作者: Genie 时间: 2008-12-11 13:14:36 标题: 美國李醫師簡介（節錄轉載自Wikipedia）
美國李醫師簡介（節錄轉載自Wikipedia） 來源：http://en.wikipedia.org/wiki/Miriam_Lee 美國的針灸醫師Miriam Lee 在加州是許多人心目中的英雄，也是美國針灸界的傳奇人物．她不但是針灸界的先鋒也是促使針灸治療在美國合法化的重要影響角色．Miriam Lee出生於中國大陸，於1947年離開中國．她原本是一名助產士後來成為針灸師．在到美國之前她在新加坡住了十七年，當她剛到加州時，針灸治療是非法的，所以她只好到工廠的裝配生產線工作，並在她家門外私下進行針灸治療．１９７４年她因無照行醫而被逮捕，在法庭上那些被她治療過的患者成群結隊地抗議，幾天之後，當時的加州州長雷根（Ronald Reagan）成立針灸醫療的合法化評估，兩年後Miriam Lee拿到了合法針灸醫師執照．據稱１９７０年至１９８０年間加州的針灸醫師至少有百分之七十是她的學生．李醫師以使用董氏奇穴而著名．（按：我認為奇穴翻譯成“Magic Points”並不恰當，因為奇穴乃正經之外的穴位而非“很神奇的穴位”）在她最忙的時候曾經一個小時看診十位患者，一週看診八十小時．（按：每天約看診約十二小時，無週休，真是忙碌到令人難以想像） １９８０年成立的美國針灸協會，李醫師主持該協會自成立至１９９８年，目前李醫師已退休，和家人住在南加州．李醫師的主要著作有： Insights of A Senior Acupuncturist Master Tong’s Acupuncture 以上是Wikipedia對李醫師的介紹，因為看了呂道人前輩所翻譯的“美國李醫師董針醫案”而感興趣，因而上網做了些搜尋．李醫師在加州對針灸界所做的貢獻可謂不小，但是在巴頓格桑醫師(Dr. Palden Carson)的網站 http://www.worldtaa.org/tong.html 世界董氏針灸協會卻發現不同的聲音： 巴頓醫師說李醫師所著的《董氏針灸》一書（１９９２年美國出版）其內容大部份源自於巴頓醫師所翻譯，董景昌醫師所著，於１９７３年台灣出版的《董氏針灸正經奇穴學》．李醫師書中的前言內容還提到巴頓醫師的書是由巴頓醫師和李醫師兩人合著，然而這不是事實，巴頓醫師並不認識這位美國加州的李醫師，也不知道自己的老師有這麼一位私塾的學生，他問過同門師兄弟也沒有人聽過這位李師姊．（按：李醫師１９６４年到美國，離開中國後十七年皆在新加坡，並未說明何時習於董公，但李醫師用的確實是董氏奇穴） 因為尚未拜讀過巴頓醫師所翻譯的書，所以不知道李醫師的書是不是抄他的．但是僅僅是因為她而使針灸在美國合法化，這點貢獻就很偉大了．而且呂道長所翻譯的醫案的確非常實用，在此謝謝前輩的用心．
Virginia Institute of Traditional Chinese Medicine 