“A lot of people will go see their family doctor first. And if the family doctor fails to help he may send them to a specialist. Say a person has a bladder problem. The family doctor may send him to a urologist. If the urologist fails to help he may say, ‘See a psychiatrist. ' And the psychiatrist may give him valium, so the patient doesn't change. Or the urologist may say, ‘See a surgeon.’ And this scares the patient, so he figures he had better see someone else. And this is it. The court of last appeal.”
The person speaking is Dr. K.C. Chan. In his own country he is a licensed physician, trained to diagnose disease, prescribe drugs, and treat all forms of injury and illness according to Western medical practices. In California he is limited to the practice of one specialty radically different in theory and use from his medical school training — a form of Chinese medicine that as late as 1971 Life magazine equated with sorcery — acupuncture
Hanging on the door of Dr. Chan's Shanghai Acupuncture Clinic and Institute in Clairemont is a sign reading ‘‘No Drugs Contained In This Office.” It is less a warning to prospective burglars than a philosophical statement of vast cultural implications guaranteed to make most medical researchers vaguely uneasy. It is not simply that the traditional Chinese tools of the trade are different, but that the accompanying theory is, by most definitions, ‘‘unscientific.”
This does not mean that acupuncture is a fraud and acupuncturists are charlatans. On the contrary, the beneficial aspects of acupuncture have been proven and used in some European countries for more than one hundred years. Acupuncture does work. The question that puzzles most Western researchers is why.
The traditional explanation is inextricably bound up with more than thirty centuries of Chinese philosophy, most notably Confucianism and Taoism. A modern Chinese doctor such as Dr. Chan, even though trained by a Communist government at a Westernized medical school, may have no problem accepting the cosmological suppositions on which acupuncture is based. It is, after all, a product of his culture, an integral facet of his heritage. For Dr. Chan's American patients, however, or his fellow doctors in this country, there is a certain philosophical gap which must be bridged, a particular culture shock that must be softened.
Intensely conscious of the differences between America and the People's Republic, Dr. Chan thus finds himself something of a cultural missionary, bringing the Word, or rather the Needle, to the heathen.
Dr. Chan does not proselytize, nor, more importantly, does he patronize. He explains as clearly as possible, with numerous examples, what he believes acupuncture is capable of. As to why and how acupuncture works, he seems perfectly comfortable on either side of the fence, or for that matter, straddling it holistically.
He mentions the recent beta-endorphin research being carried on at UCLA, the Peripheral Nerve Stimulation Treatment that is used at the Mayo Clinic, and the Yin-Yang harmonic balance of the body, apparently finding no paradox or incompatibility in these three subjects.
“Acupuncture works in the higher level of the brain, of the nervous system, in the cortex area. These two glands, the hypothalamus and the pituitary gland, and the cortex area, virtually control the whole body. The pituitary is the so-called “master gland, but now they've found out the hypothalamus is even more important in controlling internal secretions. The cortex area is the highest level of the nervous system. It controls all the nervous activities. So if acupuncture can manipulate these two things, acupuncture is virtually manipulating the whole body.”
Recent reports from the UCLA Pain Control Unit seem to follow the same theory, citing the existence of narcotic-like chemicals manufactured in the brain. Some scientists believe that the acupuncture needles stimulate nerves that carry impulses to the brain to release endorphin or a similar chemical.
But when explaining the significance of the acupuncture points on the body. Dr. Chan bypasses the nerve messengers theory for a description more in harmony with the traditional acupuncture system of treatment.
“We see these acupuncture points as the points through which the body changes, exchanges its energy with the atmosphere. Sometimes if you have too much energy you release it through these points. Other times when you don't have enough energy you absorb it through the acupuncture points. This is why these points all showed up on Kirlian photographs."
Now, casual talk about exchanging the body's energy with the atmosphere may be fine for a cocktail party in Mill Valley, but generally speaking, it is not the sort of thing heard at the doctor's. But then, K.C. Chan is not exactly your garden-variety product, faithfully ripened on the UCLA Medical School vine.
Dr. Chan was born, raised, and educated in the People's Republic of China. He attended the Wahan Medical School for five years, completing a medical program based on and oriented towards Western-style practice. After graduation he was recruited from his class to participate in a special class at Wupeh Province College of Chinese Medicine.
The accelerated two-year course at Wupeh was an experimental program designed to produce physicians equally comfortable in either mode. Since the training was incorporated into a regular internship program, the pressures on the fledgling doctors were unusually severe.
“It was very fast. They really whipped us. We had to see patients on the side because we were already doctors and then we had to attend political meetings. They wouldn't let us rest. But now, when I think of it. it was a good thing. The training was really good."
Even though Dr. Chan and his classmates were working as trained M.D.s, they were compelled to start again at the beginning, learning how to apply sets of very basic laws, deeply ingrained in Chinese culture, regarding the nature of life and man’s relationship with the universe. There was also a new relationship with their professors.
“We put the needle into the professor’s body. I’m ever grateful to those professors. The first needle is always the hardest: it’s so likely to bend. It’s so fragile you’re afraid that it may be broken. And then you’re treating your teacher. It’s nerve-racking. But after the first needle it’s all right. The first needle is a barrier."
Upon completion of his program. Dr. Chan discovered other difficulties less easily resolved than the “first needle." In addition to his workload and pay (about a hundred patients a day at $50 to $90 per month), he, like his patients, was forced to bend with the political winds sweeping over China.
“There's emotional stress because of the political pressure. You have to attend these stupid meetings all the time." There was also the fear that after spending years of study at government expense to learn a socially vital skill, he might suddenly be whisked away from his hospital and sent to the country to learn how to make compost on a rural farm.
For this reason and others. Dr. Chan decided to flee China. At the age of twenty-seven he slipped into the Pearl River and swam through the murky waters to Macao. He stayed in Hong Kong for a time, working as an acupuncturist, hut kept his sights on eventually moving to the United States. His ultimate goal was California, which must have seemed an impossible dream, achievable only with Divine Assistance.
Assistance arrived in the person of a Venice, California osteopath who helped Dr. Chan work his way through the immigration channels. It was not until two years ago, however, that Dr. Chan finally settled in San Diego and started his practice. With the dream fulfilled, there was a pledge to keep.
“Before I came to California I promised the Almighty that if I go, this is what I will do: I will treat free of charge, once a week, any patient for cancer-related pain or drug addiction. If they need more than one treatment per week then they'll have to pay, because I also have to eat and support the operation."
Since the acupuncture treatment for narcotics addiction is fairly well known, and there is certainly no shortage of addicts, one might expect that Dr. Chan now has more free patients than he can handle. But according to Dick Jacobson of the County Department of Substance Abuse, that is not the case for a variety of reasons. Although there is evidence that acupuncture does have an impact on the withdrawal symptoms of narcotics, Jacobson says, there are still some unanswered questions that prevent any governmental funding.
There have been no comprehensive, long-term studies on such programs, such as the one in Hong Kong. Also there are the psychological, sociological, and
economic factors that contribute to addiction but that acupuncture cannot influence. Finally there is the problem of acceptance on a general level. How many junkies are there willing to switch needles in the arm for needles in the ear? For that matter, how many government leaders or bureaucrats are willing to put their weight behind some faddish foreign import that is based upon a mystical, invisible network of “energy points"?
Even the government of a city like San Francisco, noted for its liberal policies and the largest Chinese population in America, could not suggest an acupuncture program without some angry disagreement. On December 30, 1977, a financial committee authorized the use of $35,000 to establish an acupuncture mental health program, pending approval by the full board. It would make San Francisco the first city in America to sponsor acupuncture, which did not sit well with the committee chairman, John Barbagelata.
“You are making a serious mistake." he told the committee. “This is the first time in the history of the nation. You are experimenting with sticking needles in people's bodies."
Although there is little disagreement that acupuncture involves sticking needles in people’s bodies, to label it “experimenting" may be a bit rash. According to Chinese history, acupuncture has been used since the cloudy mythological beginnings of China. It was invented by Huang Ti (2697 B.C.), also known as the Yellow Emperor, who is also credited with the invention of the Big Dipper-inspired rickshaw as well as a system of musical scales. For forty centuries the Chinese people have relied upon acupuncture based on Huang Ti's text (not the original, naturally, but varying transcriptions).
In the pre-war days of China, when Mao and Chiang were fighting for control, the Generalissimo’s government came out strongly in favor of Western medicine. Western missionary doctors were invited to work in the interior and. under the aegis of John D. Rockefeller, a program for training Western-style physicians was established at the Peking University Medical Center.
Western medicine became the vogue, the politically “correct” method of treatment. Traditional doctors felt the pressure to comply with Chiang’s preferences and began to study the Western style. Since training facilities were few but the demand great, a substantial number of quacks surfaced and the traditional trust between the doctor and patient deteriorated.
Meanwhile, Mao and his Communist army preached the glory of traditional Chinese medicine. Some Western historians explain this by citing a greater awareness of what the people really wanted, but a more likely explanation is that traditional' systems were simply cheaper and easier. During the Long March to the caves, the Red Army relied almost totally on acupuncture and herbalism for treatment of the sick. For an army on the move with almost no access to modern drugs or equipment, there was little choice.
Even today, when trade with China is flourishing, the Chinese government seems acutely aware of the vulnerability of their medical supply lines. The possibility of another embargo, as during the Korean War, remains a potential threat to the health of the nation. As Dr. Chan pointed out, when you have 500 million people and no drug supply, what are you going to do?
“They resorted to herbs and acupuncture and they did wonderful jobs. They surely did. Since the communists took over there’s been another change in acupuncture practice. They try to encourage using acupuncture on a large scale. Because the medicine is socialized, nationalized, the government has the say on what you’re going to get. You want aspirin? No, we don’t make them anymore or we don’t want to make them as much. Take acupuncture, which costs less.”
It seems unlikely that any other national government might establish such a massive public acupuncture program. For the Chinese people, however, it may still be the most practical style of medicine. As missionaries and Peace Corps workers throughout the world have discovered, any form of medicine must be believed in to be effective on a general scale.
For most Chinese acupuncturists, belief in the theory is essential. Basic principles: the mysterious life-energy force Ch’i courses through the body along the acupuncture network: all diseases and illnesses can be attributed to imbalances of the body's Yin and Yang; and most importantly, the human species conforms to the laws of the universe, duplicating them in miniaturized form in every person. As the Chinese Medical History tells us: “The four limbs correspond with the four seasons, the twelve joints with the twelve months. The human skeleton has 360 bones for the simple reason that there are the same number of degrees in a circle.” One Western observer in Hong Kong has suggested that for the traditional doctor, questioning the philosophy (and thus the system of diagnosis and treatment) of acupuncture means questioning the cosmology and logic of thousands of years of Chinese culture. There is also the fact that there is, as yet, no comprehensive Western system adaptable to acupuncture. The discrepancies between the two systems are too great .“Ten mg. of Valium for stress” cannot be translated into “Four Yuan Li Needles along the Arm Sunlight Yang Meridian.”
“Most of the time we discard the diagnosis made by the Western medical practioners,” says Dr. Chan, “because they do not fit into our theory. With acupuncture, we do not have to know what the problem is. That’s a very unusual part of acupuncture. We only have to know what the problem is. We don’t have to know what is causing it.”
He gives as an example the treatment for migraine headaches. Migraines may be caused by a number of things — tumors, allergies, tension, or most commonly, vascular disorders. In most cases, except the tumors, the pain will go away after a few treatments. “Most of the time, even in China, we don’t have to look for the details.”
Some diagnosis must be made, of course, but the standards applied are uniquely anti-standard in nature, focusing on the individual condition, rather than the norm.
“I don’t believe in standardized measurements, because every individual is different. There is no standard in Chinese medicine. We regard the individual as an individual, not as a standard. Even our acupuncture points vary on each person. There is no such thing as absolute in Chinese medicine. Everything is relative.”
There are standards, of course, relating to the flow of Ch’i and the positions of the acupuncture meridians, but they are distinctly individual. “The standard unit for one body depends on the height. There are also relative units. For example, we know that there are eight units between the natural hair lines of the temples.”
Locating the network of meridians is not the most difficult part of acupuncture. Laboratory tests in Korea and the Soviet Union have shown that the meridians exhibit characteristics different from other skin areas, notably in the density and electrical resistance of the skin.
The theory of Ch’i by which the acupuncturist determines where and how to treat a specific malady, is not so easily verified in the laboratory. Dr. Chan, even though trained in the Western style, still has no choice but to rely on the system as it is explained by the theory, for to do otherwise can be dangerous. The practice of acupuncture independent of the theory of Ch’i is mere random pricking, simply “experimenting with sticking needles in people’s bodies.”
It appears that some hospitals attempt to do this, but they are careful not to label the treatment “acupuncture.” This lack of respect for the theory of Ch’i has caused some problems. A local hospital called in Dr. Chan after a patient being treated for post-operational pain responded poorly to an electronic pulse machine commonly used by acupuncturists. The patient was told to hook himself up whenever he felt pain, but after one day he became listless and depressed. Dr. Chan was not surprised at the reaction to the treatment.
“We know that if you take an acupuncture treatment even for fifteen minutes you’re going to be so sleepy and relaxed. How’d you like to have that for sixteen hours?”
To prevent any such misuse by a licensed acupuncturist, the California Board of Medical Quality Assurance demands that any applicant must show proof that he has performed acupuncture for at least five years independently, or at least three years in a program affiliated with an approved medical school. These restrictions do not apply to physicians, surgeons, dentists, or podiatrists already licensed in the state of California.
Dr. San C. Hsieh, another San Diego acupuncturist, believes that, in general, it is best for licensed physicians to perform acupuncture. He himself is a licensed physician, specializing in internal and nuclear medicine. Although he thinks that acupuncture works by stimulating the nerve endings (in accordance with the “Gate Control Theory” advanced by a Canadian doctor), like Dr. Chan he must also adhere to the traditional system. The traditional philosophy creates a stumbling block for Western doctors since it is “obsolete.” Acupuncture is not a total method of medicine, as the theory maintains, simply a “modality.”
“It is a modality. It’s an additional tool. Patients come to me for my tools.” Patients come to Dr. Chan for his tools too — a set of stainless steel needles of varying length, girth, flexibility, and sharpness. There are different ways of inserting the needle, by tapping or twisting for instance, but Dr. Chan says he prefers to put it in fast after first creasing the skin with his thumbnail. Once the needle is inserted, he may stimulate the point by vibration, heat (moxibustion), or electrical pulse. This stimulation of the meridians, according to the traditional theory, affects the endless sporadic flow of Ch’i within the body. The Ch’i is like a river, being either dammed up or released according to the diagnosis. The necessary vital organs are called into action, and like panicked beavers after a flood, they hasten to restore the natural balance.
Following this method, according to a press release in Dr. Chan’s office, at least fifty miscellaneous disorders and diseases are “treatable by acupuncture with satisfactory results.” Included on the list are asthma, baldness, cigarette smoking, emotional depression, frigidity, hemorrhoids, insomnia, impotence, night blindness, obesity, and ulcers. No doubt there would be some disagreement, among acupuncturists as well as other doctors, that certain of these items are “treatable with satisfactory results,” but there are many items, such as deafness, back pains, angina pectoris, and addictions, that are known to respond well to acupuncture.
The problem remains in persuading state governments to sanction acupuncture practice. Dr. Chan would like to see it incorporated into a national health program like Medi-Care. At the present time, acupuncture, unlike chiropractic, is not covered by any government program. One might compare most government health agencies with the rare sort of patient that comes to Dr. Chan:
“Once in a great while I’ll have a patient that is very scared. He’s never had acupuncture. He’s never known anybody that’s had acupuncture. But as soon as they take the first treatment, most of them don’t have any fear.”