plurality

[Guest guest]

May 4,2003

 

Dear Todd and Listmembers,

 

To understand the complex health system in China and the nature of contemporary TCM over there and its relationship with biomedicine or Western medicine, I think it will be instructive to understand the notion of 'integration' or jie he

 

Following the Marxist epistemological dogma of dichotomizing theory from practice, Mao developed the concept (which later evolved into a party and state policy ) of Œintegrating¹ or jie he of the Œtheory of biomedicine¹ with the Œtheory of TCM Œ i.e. Zhong Xi Yi Jie He , the common English translation of which is Œintegrated traditional and Western medicine¹ . In contemporary Chinese communist jargon the term jie he is commonly used to Œcombine¹ , Œintegrate¹, Œunite¹ entities,¹humans¹(as in Œintegrating with the workers, peasants and soldiers¹) concepts orŒtheories¹ in a decontextualized manner. It is used as in Œintegrating¹ or Œcombining; Œtheory with practice¹ or lilun yu shijian xiang jiehe; or in ³integrate(ing ) the universal theory of Marxism with the concrete practice of the Chinese revolution ³ as in ba Makesizhuyi de pubian zhenli yu Zhongguo de juti shijian xiang jiehe. In terms of referring to the integration of TCM and biomedicine , Mao used the term jiehe in l956 in a formal meeting he had with a team of Chinese musicians. However, the content of this meeting was made public only in l977 in the Guang Ming Daily. Mainland Chinese TCM historian Si Yuan Yi , in his review of the work of ³integrating of TCM and biomedicine ¹ (which he pointed out as a duchuang or Œoriginal creation¹ quoted Mao as saying:

We have to learn contemporary foreign things. After studying them, then we study

Chinese things. ³ . We have to accept the strong points that foreign things have.This

will create a Œleap¹ yuejin in our own things. Chinese and foreign things must be

organically integrated youji de jiehe We must not apply mechanically taoyong

foreign things (on to the Chinese situation ). ²

 

In an earlier essay On New Democracy written in January l940, Mao in an elaboration of the notion of a ³national scientific and mass culture² deployed a vivid food-digestive process metaphor to picture this process of Œorganic integration¹. Mao said:

³To nourish her own culture China needs to assimilate a good deal of foreign progressive

culture, not enough of which was done in the past. We should assimilate whatever is useful

to us today not only from the present-day socialist and new-democratic cultures but also from

the earlier cultures of other nations.For example, from the culture of the various capitalist

countries in the Age of Enlightenment. However, we must not gulp any of this foreign

material down uncritically, but must treat it as we do our food- first chewing it, then

submitting it to the working of the stomach and intestines with their juices and secretions,

and separating it into nutrients to be absorbed and waste matter to be discarded before it

can nourish us. To advocate ³wholesale westernization² is wrong. China has suffered a

great deal from this mechanical absorption of foreign material. Similarly in applying

Marxism to China, Chinese communists must fully and properly integrate the universal

truth of Marxism with the concrete practice of the Chinese revolution.²

 

But the ultimate aim of Œreforming¹ TCM through the Œintegration of biomedicine and TCM¹ is to elevate it to a Œscientific¹ level . As the TCM historian Si Yuan Yi pointed out as a background to quoting Mao¹s instructions:

³ As for study of medicine, we have to use Western contemporary science to research

(Œstudy¹ , yan jiu) the guilu pattern of development of China¹s traditional medicine ,

and thus develop China¹s own Œnew medicine¹ .²

 

In communist China, when laboratory experimental technique was first introduced into TCM research in l959 , the program of scientising TCM began. In l960, with the use of of Western pharmaceutical drug cortisone, a Chinese researcher developed a laboratory animal model replicating the TCM clinical pattern zheng of Yang deficiency yang xu . The efficacy of a traditional herbal formula traditionally used to address this clinical pattern was supposedly successfully Œtested¹ using this animal model. This signaled the emergence in PRC China of the so-called school of ³integrated Chinese and Western Medicines² Zhong Xi Yi Jiehe. The standardized universal yardsticks generated in the laboratory became the criteria upon which traditional Chinese medicine (TCM) has to be measured and accepted as scientific. Without due regard for the different contextual requirements of TCM as a body of medical knowledge with a long ancient history, a whole set of research projects were undertaken to make the parameters of TCM more Œscientifically objective¹.

 

Recently, in my quest to trace 'On-line' the footprints of the SARS pestilential Qi in Southern China and Hongkong, I came accross the TCM Forum based in the Chinese Medical School of the Hongkong Baptist University. The Forum has been in existence since l999 and in it are articles in the Chinese language written by invited TCM scholars, TCM Experts and TCM students.

 

One of the pieces that caught my attention was an article below submitted and published recently by a TCM student. have translated the article into English and I have an original hard copy of the Chinese version of it. As far as I can gather, this is hisitorically one of the first critique of the policy of integrating CM with WM in Mainland China (if we go by the recent Sino-British agreement on the reversion of HK to Mainland Chinese rule). As you can see, some prominent veteran TCM practitioners like Jiao Shu De , Yang Wei Yi and Deng Tie Tao have been quoted in this article.

 

Regards.

 

Rey Tiquia

Phd Candidate

Dept. of History and Philosophy of Science

University of Melbourne

Melbourne, Australia

 

 

 

What is the 'Haste ' About Integrating With

Western Medicine

 

Chen Hai Yong - Undergraduate Student

School , Hongkong Baptist University

 

Since the years of the fifties In Mainland China, the movement for TCM zhong yi to go down the path of integrating Chinese medicine (CM) and Western medicine or biomedicine (WM) zhong xi yi jie took off . The tide at that time was considered as 'surging ' xiong yong peng pai ; and the debate as to whether to integrate CM with WM was not limited to being featured in major newspapers and magazines. The focus of the polemics was --can CM and WM really be integrated . Up to now, people are still unable to agree as to what is is right (or wrong) ' mo zhang yi shi . It is really very difficult to form a unified view.

 

Although the integration of CM and WM have been going on for more than half a century, its feasibility and orientation are still pretty blurred. Hence, under this state of affairs, the integration of CM and WM must develop. However, this development must be under the direction of TCM theory. At the same time, this (integration of CM with WM) should not be taken to be the only pathway towards the development of TCM. The integration of CM with WM must be based upon reality xian shi . It should not be 'integration at all cost.'

 

Originally, the purpose of 'integration' was very good i.e. integrating or combining the strong points of both medical systems . This is combining the strength of both i.e. through ' a bit of compulsion' to integrate' qiang qiang lian he and achieve the highest level of medicine and medical therapy , and in this way enriching humanity. Of course, this is a dream of all people in the medical circles . It is also something that society hopes for.

 

In actuality, fifty years since the proposal to integrate CM with WM was put forth, the work in this direction ' like a raging fire' ru h uo ru tu , the great majority of TCM has taken this integrated road. Unfortunately up to this time, the accurate content of this integration ; the feasibility of this integration; whether can they be merged into an outstanding new type of medical system; the question on how this integration should take place; all these questions are still hanging on the balance. Under this very confused situation, we must not act with undue haste cao zhi guo ji to do this integration and do these things blindly.

 

In addition, probably, this integration is Chinese medicine's 'unrequited love dan xiang si i.e Chinese medicine's 'one-sided wish' yi xiang qing yuan . On the other hand, The great majority of colleagues from Western medicine had never thought of integrating with Chinese medicine. Some of them (Western medicine) who have walked into the ranks of TCM research-- I could not speak on their behalf and say that they are not thinking of developing TCM; however, due to a lack of complete and thorough wan zheng understanding of TCM, the fruits of their research became the fruits of WM research and bears no relation whatsoever with TCM. At least, they have no connections with the theory of TCM.

 

At the same time, as TCM uses Western medical discipline to develop the discipline of integrating CM with WM, there also emerged the problem of dovetailing xian jie the fruits of integrated CM and WM research with the theory of TCM. As as result, the materia medica Qing Hao (Artemeisia apiacea) has become Qing Hao Su (Arteannuin). The materia medica Huang Lian (Coptis chinensis) has become Huang Lian su (berberine) . Are these entities still TCM's materia medica zhong yao ? Can these entities still be used under the theoretical frame of TCM ?

 

Western medicine has used berberine to achieve major therapeutic effects . On the other hand, the materia medica Huang Lian is still being used (in its raw form) clinically by TCM. And still with very good clinical therapeutic results. Of course, if there are people who will research the Four Qi Si Qi , Five Flavors Wu Wei and Acupuncture meridian association Gui Jing of these TCM materia medica under the theoretical frame of TCM , generate positive research outcomes and give due credit to TCM theory. This is also possible. If this can be real, this can be a great service to mankind gong de wu liang . Or perhaps we can look at Western pharmaceutical drugs xi yao and research them from the perspective of TCM materia medica zhong yao . This is using things foreign to serve China yang wei zhong yong ! Misters and Mrs. modern TCM practitioners must use the' creative and innovative spirit' kai tuo jing shen of the Divine Farmer Shen Nong of those ancient years who tasted a hundred plants.

 

Western medicine is still developing its own theory. They are still doing their own research. As for us TCM practitioners, however, we cannot contain ourselves to 'form an alliance of marriage' lian yin with the hope of giving birth to a vigorous new baby . The 'creative and innovative spirit ' is already there you le However, poor TCM. On the one hand, it has to play the role of a TCM practitioner ; while on the other , it has to play the role of a biomedical practitioner. Biomedical practitioners can focus on doing Western medicine alone, while TCM practitioners have to think of taking the benefits from both.

 

Humans are not sages and men of virtues sheng xian . In both CM and WM, both study medicine for a number of years. In both, the level of Western medicine studied are more or less the same. About the level of CM that CM students learn compared with those from previous times when they just learn 'pure CM'-- it is hard to say. It is not surprising that both veteran TCM professors Jiao Shu De and Deng Tie Tao in a lecture on August 8, 2001 and featured in the journal Modern Education Journal xian dai jiao yu bao said: " In the past several decades ji shi nian we haven't trained real TCM practitioners zhen zheng de zhong yi . " Studying medicine is like this. Being a medical practitioner zuo yi , generally is also like this. Teachers from both TCM and biomedicine teach to students their respective disciplines . And we the students 'integrate' jie he them .

 

This way of integrating Chinese and Western medicines clearly is being done in a hurry. On the one hand, the conditions are not ripe for it. Western medicine is very reluctant to be part of it. Whether integration is a feasibility, we do not know. However, on the other hand, the work of integrating CM with WM like a honeycomb is unfolding . It is something that we cannot hold ourselves back from doing. LIke building a house, the various construction projects are still being discussed and debated. While the site of construction has not yet been decided , the house is already being hurriedly built. We can imagine the result of all of these. If we say that the results of these several decades of construction projects --the integration of CM with WM, if we say that his project has no achievements at all , then that is treating unjustly yuan wang those industrious and diligent workers. At least one of their achievement is the simultaneous use and application of both TCM and WM. In addition, this integration made TCM a contemporary and fashionable therapy . These benefits (resulting from the integration work) is obvious to everyone. The 'simultaneous use and application of CM and WM' zhong xi yi he yong perhaps can best describe the present state of TCM . Can we also say that this is the essence of the present state of integrating CM with WM?

 

TCM needs A TCM-type of modernization in order to continuously develop itself and satisfy the needs of society . In this way, TCM can have a ' living space ' sheng cun de kong jian. If there comes a time that no one wants it anymore, then society will abandon it. This is the law of social development she hui de biran gui lu . Just like the development of the machine industry. If society does not need the blacksmith, then it disappears from society and enters the museum of history.

 

TCM needs to modernize. However developing its modernization is not equal to developing the notion of integrating CM with WM. Hence modernizing TCM is not equivalent to developing the integration of CM and WM. Prof. Li Zhi Zhong from the School of of the Hongkong Baptist University has a good idea on the modernization xian dai hua of TCM. He once said:

 

" 'Modernity' xian dai is a concept of time. It refers

specifically to a state of backwardness and

slow development. Hua is a concept of space. It refers

to multiplicity of viewpoints points duo jiao du and all-directionality

quan fang wei . "

In his book The Discipline of TCM- Macro Regulative Functional Medicine zhong yi xue- hong guan tiao kong gong neng yi xue Prof. Yang Wei Yi thinks that " the leading discipline in TCM is its foundational theory " . However due to the imperfection of contemporary TCM theory " the present TCM theory cannot shoulder this sort of task at hand " .

 

Everybody is clear about the importance of TCM foundational theory. However, this important foundation gen ji still has many problems. However, many people are busying themselves in building the structure of the building. From my perspective, this building structure is not stable. Everyone who does TCM must clearly see this problem. People should not one sidedly build the structure above ground and forget about the necessity of a strong foundation underground. And the integration of CM with WM must gradually proceed under the direction of TCM's foundational theory. If one takes the wrong road and walks very very far, can TCM still preserve its original nature ?

 

TCM requires an all-sided development. There is no hurry in integrating CM with WM.

[Guest guest]

And I think that is the direction in whichwe should focus and move. Let the differingviews and approaches compete and collideand let the patients benefit from theresults.Ken

Ken,

My interest regarding paradigm collision and harmony is to see how it works, how it is working and also how it is not working ... on behalf of patients, practitioners and the cultures of the world at large. I'm not in a camp that favors discord or favors harmony. Like you I believe that a dynamic tension is probably best. Like Rey, I suspect that the Western paradigm of medicine, business and most other disciplines will tend to obliterate or consume what is in its path simply because it has momentum. I've mentioned that more than once in previous posts. If WM principles are the basis for judging the efficacy of CM, the CM becomes a subset of WM. The unintended results of true collision are what I'm looking at. It's interesting to look at what has happened in China from the interactions of CM and WM where the collisions have been considerably more explored than here. Would you as a patient in Beijing have more chances of a successful treatment for diabetes, cancer, infectious disease or traumatic injury than if you were in San Francisco or San Diego? Would you have access to better WM or better CM? Would their shared presence help you more than not? You are in a better position than some of us to assess that in an ongoing manner. The rest of us here only visit China and Taiwan from time to time. You live there.

The various military adventures of America represent a pretty clear indicator of how Western culture may chose to deal with Eastern culture when it finds it on the horizon. In current times we are all meeting each other militarily, economically and in a host of other ways including clinically. The notion of harmony is not unlike magic. It's two or more very different notes played at the same time in way that's nourishing rather than discordant. Things that are initially in collision can and often do end up in a different relation with each other over time. If they both can remain strong in the presence of the other, then the relationship can become dynamically harmonious. I sense that's they kind of growth we might all hope for.

 

Emmanuel Segmen

[Guest guest]

I don't share your optimism on this point. I've seen too many patients

who were injured or thought acupuncture was ineffective when

administered by poorly trained practitioners. All technology, East or

West, is useless without theory to back it up. WM theory on

acupuncture and herbal medicine is still poorly developed. Empirical

technique is short-sighted, and so are its gains.

 

 

On Sunday, May 4, 2003, at 03:18 PM, James Ramholz wrote:

 

> I would disagree with your and Marnae's point about the techniques

> of CM not having " as much effect without the theory. " In the long

> run, that is true. But clearly, in the short run they do; enough for

> many Chiropractors and MDs to want to add the techniques---if not

> theory as a whole---to their practices and integrate it into WM.

[Guest guest]

Emmanuel,

 

Would you as a patient in Beijing have more chances of a

successful treatment for diabetes, cancer, infectious disease or

traumatic injury than if you were in San Francisco or San Diego?

Would you have access to better WM or better CM? Would their shared

presence help you more than not? You are in a better position than

some of us to assess that in an ongoing manner. The rest of us here

only visit China and Taiwan from time to time. You live there.

 

 

Interesting questions. In some ways the

situations you're comparing in your questions

seem so dissimilar to me that at least we

have to begin to answer them by pointing out

these order of magnitude differences.

 

And in order to make any kind of meaningful

comparisons between health care in Beijing

and San Francisco or San Diego, for example,

we'd have to set down some additional criteria

as guidelines for selecting what to compare.

 

Income brackets. Geographical location

in these cities. And other concrete real

world parameters that determine access to

health care.

 

If you do some sort of whole sum comparison,

well that's where you get into incomparables.

 

There are, what 30 million people in the

whole state of California? Well there are

more than 15 million people in Beijing

alone. Whenever approaching questions

that touch on the zone of " the public "

in China it is important to bear in mind

the meaning of the phrase " order of magnitude " .

 

All that said, my impression is that in

San Francisco or San Diego a relatively

larger percentage of the population if

not a larger actual number of people have

far better access to Western medical care

than in Beijing. Back in the 90s I was

briefly involved in an investigation

with a large American hospital that was

interested in establishing a joint venture

facility in Chengdu. So I got to know the

hospital scene there in some detail.

 

But I don't really know the scene here

in Beijing. I've been in several hospitals

here and have a general impression of

the levels and quantities of care available.

 

The current SARS epidemic has clearly

and bitterly exposed the galling limitations

of the public health network here, and

the authorities are scrambling now to

respond actively. I've mentioned this in

the past, but the real screaming horror

in this scene is what would happen if

the disease were to spread to the countryside

where medical facilities are desperately

inadequate to cope with people's everday

needs, let alone scores or hundreds

in need of emergency therapies and

breathing apparatus.

 

Regarding access to Chinese medicine,

there is less question in my mind that

far, far greater real numbers and percentages

of people in Beijing and other Chinese cities

have far greater access to Chinese medicine

than their opposite numbers in American

cities.

 

Does the shared presence of Chinese and

Western medicine help more than not?

 

Darn good question. I'm going to have to

think about it and take a new look at

what goes on in the clinics here.

 

I could answer from my personal perspective,

but I don't think that's what your question

was trying to evoke. And even to talk about

how I personally approach " integration " of

the two paradigms would turn this into an

even much longer post!

 

Ken

[Guest guest]

At 10:32 PM 5/4/2003 +0000, you wrote:

--- In

, " " wrote:

we will see integration being handled by those who do not understand

 

CM and then our techniques will be separated from our theory.

>>>

:

You are very succinct in making a point that I was trying to make

when talking about the politics of the situation. I believe it is

this, and not academic standards, that is the issue underscored by

the Chinese response to SARS.

 

Jim Ramholz

Jim, ...

I agree that if we do not pitch up and start getting involved in the

integration in this country, we will indeed see our

" techniques " ususrped b the DC's, MD's etc - and yet, (just

playing devil's advocate here) why then do we insist that ACAOM

accredited schools should not be teaching " shortened " programs

for MD's etc. Certainly 200 - 300 hours is insufficient but

mightn't it be better for us to create a 1000 hour program geared to

these folks and teach it ourselves so that they learn from us rather than

from others who did shortened training? This way we might become

the people who are looked to as the really well trained - and we could

work to change the hearts and minds of those in these programs so that

they understand the depth of the theory and how important it is to the

practice.

Marnae

 

 

Groups Sponsor

 

 

 

Chinese Herbal Medicine, a voluntary organization of licensed

healthcare practitioners, matriculated students and postgraduate

academics specializing in Chinese Herbal Medicine, provides a variety of

professional services, including board approved online continuing

education.

 

 

 

[Guest guest]

, " " wrote:

> I don't share your optimism on this point. I've seen too many

patients who were injured or thought acupuncture was ineffective

when administered by poorly trained practitioners. All technology,

East or West, is useless without theory to back it up. WM theory on

acupuncture and herbal medicine is still poorly developed. Empirical

technique is short-sighted, and so are its gains. >>>

 

 

Z'ev:

 

I don't doubt that there are many examples of your point; I've seen

many myself. But competence isn't the deciding factor in being

allowed to practice. Even with the limitations of Medical

acupuncturists' (and Chiropractors') weekend classes, they have

still developed a significant market share.

 

Medical acupuncturists have the added advantage of easy access to

acupuncture as part of their legal scope of practice, get insurance

and medicare reimbursement, have hospital privledges, etc.

 

As you have spoken about before, there is a trend in the profession

to add more biomedical training; not pulse diagnosis or Chinese

language. In one way it makes sense because it puts our industry

more on par with institutionalized medicine intellectually and

provides greater integration with Western institutions. But until

acupuncturists and herbalists have hospital privledges, get to bill

medicare, and are making more than the $20,000 average salary out of

school, the integration of CM into this culture is an illusion or

incomplete.

 

 

Jim Ramholz

[Guest guest]

I would disagree with your and Marnae's point about the techniques

of CM not having " as much effect without the theory. " In the

long

run, that is true. But clearly, in the short run they do; enough for

 

many Chiropractors and MDs to want to add the techniques---if not

theory as a whole---to their practices and integrate it into WM.

 

Jim Ramholz

 

But do they really work as well or do they just think that they will -

and then find that they don't ? This is certainly what I have seen

and heard from physicians - that they really do not find that it works -

perhaps because they are not doing a pattern differentiation.

And, when you talk about who gets paid - well, it is the DC's & MD's

who get paid (and quite well), not us and this is the other reason that

they use the techinques - more to bill for -

I don't think that they are really " integrating " it into their

practice - nor do I think that this is the idea behind integration of CM

& WM but if we are not careful this is exactly what we will get and

then we will be left out in the cold. We have to think about the

" academic " aspect of it - we have to know what it is that we

want this profession and integration to look like in 20 years or we will

be lost. To most physicians, integration does not mean working with

us (L.Ac's) it means learning a little bit and running with it - for

example the Arizona program does not train or admit non-physicians into

their integrative medicine program. The end result of this is that

either we will be working for the MD's as technicians or they will be

doing it ourselves. We have to be very careful.

Marnae

 

 

 

Groups Sponsor

 

 

Chinese Herbal Medicine, a voluntary organization of licensed

healthcare practitioners, matriculated students and postgraduate

academics specializing in Chinese Herbal Medicine, provides a variety of

professional services, including board approved online continuing

education.

 

 

 

[Guest guest]

, Marnae Ergil

<marnae@p...> wrote:

> > Jim, ...

> I agree that if we do not pitch up and start getting involved in

the integration in this country, we will indeed see our " techniques "

ususrped by the DC's, MD's etc - and yet, (just playing devil's

advocate here) why then do we insist that ACAOM accredited schools

should not be teaching " shortened " programs for MD's etc. Certainly

200 - 300 hours is insufficient but mightn't it be better for us to

create a 1000 hour program geared to these folks and teach it

ourselves so that they learn from us rather than from others who did

shortened training? This way we might become the people who are

looked to as the really well trained - and we could work to change

the hearts and minds of those in these programs so that they

understand the depth of the theory and how important it is to the

practice. >>>

 

 

 

Marnae:

 

They don't need to learn from us. Helms and others have gone to

China on their own and have developed their own programs and

accreditation process. At CSTCM where I teach, we've had 7 or 8 MDs

enter the program only to stop short and go to the Medical

acupuncture course. Only one MD, an anesthesiologist, actually

completed the course. Reducing the course work to 1000 hours---say,

eliminate all herb courses---may be attractive to some MDs. Several

others I know may have stayed if herb courses weren't insisted upon.

 

Obviously, in their minds, 200-300 hours isn't shortened; it's

sufficient. Abbreviated courses are often the rule for MDs. How many

investigative TV shows have we seen where they look into the quality

of medical procedures learned over a weekend by MDs?

 

 

Jim Ramholz

[Guest guest]

The point of this is that MD's and DC's who do shortened training

obviously don't look at Chinese medicine as being anything as in-depth

as biomedicine, they see it as a technique only. I know the deep

respect for the vast knowledge base of biomedicine that physicians and

other Western medical professionals have. In that light, I would say

that our job is to show these folks that Chinese medicine has equal

depth of knowledge to tap, and that a 'short course' is woefully

insufficient.

 

 

On Sunday, May 4, 2003, at 05:50 PM, James Ramholz wrote:

 

> Obviously, in their minds, 200-300 hours isn't shortened; it's

> sufficient. Abbreviated courses are often the rule for MDs. How many

> investigative TV shows have we seen where they look into the quality

> of medical procedures learned over a weekend by MDs?

[Guest guest]

I think that people from both campsshould be dogged in their determinationto bring the foibles and fallaciesof both systems to the public's attention.>>>I totally agree and at the same time i think productive integration is quite valid

alon

[Guest guest]

It is an issue of the wholesale rejection of the principles of CM by some of its practitioners. Both CM and IM, as described by Scheid, put great emphasis on preserving what is distinct about CM to greater or lesser degrees. <<<<<How can one wholesale reject the principles of CM and still practice?I have not seen thin in China where i worked. Certianly many of the younger Dr did not choose to do CM, but they still practiced daily using and applying them

alon

[Guest guest]

But I don't really know the scene herein Beijing. I've been in several hospitalshere and have a general impression ofthe levels and quantities of care available

>>>I am often puzzled by listed WM treatments for diseases in published CM J (usually used as a comparison group). Numerous time i have seen so called WM treatments that would not be considered appropriate in US

Alon

[Guest guest]

But do they really work as well or do they just think that they will - and then find that they don't ? This is certainly what I have seen and heard from physicians - that they really do not find that it works - perhaps because they are not doing a pattern differentiation.

<<<And at the same time they are the once publishing both positive and negative papers

alon

[Guest guest]

, " " wrote:

> In that light, I would say that our job is to show these folks

that Chinese medicine has equal depth of knowledge to tap, and that

a 'short course' is woefully insufficient. >>>

 

 

 

 

Z'ev:

 

I think you make a good point here. But, we should go with our

strengths. Rather than trying to rationalize CM scientifically or in

terms of biochemistry, we should think about doing and publishing

studies of various problems; perhaps using the school clinics to get

significant numbers of patients.

 

If we can demonstrate that CM is more effective than OTC drugs, for

example, that would be important because that would help patients

make a choice.

 

 

Jim Ramholz

[Guest guest]

, " Alon Marcus " wrote:

> >>>I totally agree and at the same time i think productive

integration is quite valid. >>>

 

 

 

Alon:

 

I'm still unsure of how people are thinking of integration.

 

While I can see it on a small, personal scale where MDs are hiring a

L.Ac. or we are working with them on the same patients, I don't

think true integration will be achieved until we are paid equally

for these services. If a new acupuncturist or herbalist can only

make $20,000 a year on average after graduating, extending academic

standards will be impossible.

 

 

Jim Ramholz

[Guest guest]

At 12:50 AM 5/5/2003 +0000, you wrote:

--- In

, Marnae Ergil

<marnae@p...> wrote:

> > Jim, ...

> I agree that if we do not pitch up and start getting involved in

 

the integration in this country, we will indeed see our

" techniques "

ususrped by the DC's, MD's etc - and yet, (just playing devil's

advocate here) why then do we insist that ACAOM accredited schools

should not be teaching " shortened " programs for MD's etc.

Certainly

200 - 300 hours is insufficient but mightn't it be better for us to

create a 1000 hour program geared to these folks and teach it

ourselves so that they learn from us rather than from others who did

 

shortened training? This way we might become the people who are

looked to as the really well trained - and we could work to change

the hearts and minds of those in these programs so that they

understand the depth of the theory and how important it is to the

practice. >>>

 

Marnae:

They don't need to learn from us. Helms and others have gone to

China on their own and have developed their own programs and

accreditation process. At CSTCM where I teach, we've had 7 or 8 MDs

enter the program only to stop short and go to the Medical

acupuncture course. Only one MD, an anesthesiologist, actually

completed the course. Reducing the course work to 1000 hours---say,

eliminate all herb courses---may be attractive to some MDs. Several

others I know may have stayed if herb courses weren't insisted

upon.

Obviously, in their minds, 200-300 hours isn't shortened; it's

sufficient. Abbreviated courses are often the rule for MDs. How many

 

investigative TV shows have we seen where they look into the quality

 

of medical procedures learned over a weekend by MDs?

 

Jim Ramholz

 

 

Jim -

I know they don't NEED to learn from us - but shouldn't they be?

And, shouldn't we be establishing ourselves as the experts in the field?

Being board-certified is usually so important in medicine - and that

means us! I too have seen many MD's drop out of Acu and AOM

programs - but that is usually not about the time - it is more because

they are surprised at how much work it really is - its not just sticking

needles in someone. And, if we do not step up to the plate and

start making ourselves the experts and the teachers for everyone, then,

as I said before, and as Z'ev also said, there will continue to be people

out there practicing this medicine in such a way that people who use it

say " it doesn't work " .

Marnae

 

 

 

 

 

Groups Sponsor

 

 

Chinese Herbal Medicine, a voluntary organization of licensed

healthcare practitioners, matriculated students and postgraduate

academics specializing in Chinese Herbal Medicine, provides a variety of

professional services, including board approved online continuing

education.

 

 

 

[Guest guest]

, Marnae Ergil wrote:

>I know they don't NEED to learn from us - but shouldn't they be? >>>

 

The simple answer is " no " . They, like anyone else, have the right to

their own direct connections back to China, their own testing, and

their own licensing criteria. We don't occupy the social or

political high ground in this situation to enforce anything. Except

for a few individual MDs, I doubt if they ever will see us as equals

or collegues---unless someone has a particular expertise they are

interested in.

 

 

<<< And, shouldn't we be establishing ourselves as the experts in

the field? Being board-certified is usually so important in

medicine - and that means us! I too have seen many MD's drop out of

Acu and AOM programs - but that is usually not about the time - it

is more because they are surprised at how much work it really is -

its not just sticking needles in someone. >>>

 

I think this is a very important point you are bring up. This was

the original strength that made acupuncture mainstream in the first

place. Our expertise lies in being able to treat conditions that WM

cannot manage---this is largely their motive, from what MDs tell me,

for wanting to perform these techniques. There's probably a natural

limit in how many MDs will want to perform acupuncture, since the

average time with a patient is about 6 minutes.

 

In order to demonstrate our superior expertise, we first need to

demonstrate it to the public [to help keep the demand up and,

therefore, the pressure up on the legal challenges], and demonstrate

that it works better compared to WM. While the research studies done

are important to show CM's effectiveness to the powers that be

[government committees, doctors, scientists, etc.], we need to have

a concerted effort to get the message out directly to the public. If

schools did clinical studies that dmeonstrated CM's effectiveness,

imagine the impact on TV when it is reported.

 

 

Jim Ramholz

[Guest guest]

, " James Ramholz "

<jramholz> wrote:

> If a new acupuncturist or herbalist can only

> make $20,000 a year on average after graduating, extending academic

> standards will be impossible.

>

>

> Jim Ramholz

 

Jim,

 

I'm interested in where you've gotten this figure, since you've

mentioned it twice. Not that I doubt it at all, just curious if

there's been some kind of survey published.

 

thanks,

robert hayden

[Guest guest]

It's something I remember (corrctly I hope) from a survey done at

least several years ago.

 

Jim Ramholz

 

 

, " kampo36 " wrote:

> I'm interested in where you've gotten this figure, since you've

> mentioned it twice. Not that I doubt it at all, just curious if

> there's been some kind of survey published.

>

> thanks,

> robert hayden

[Guest guest]

, " kampo36 " <kampo36>

wrote:

> , " James Ramholz "

> <jramholz> wrote:

> > If a new acupuncturist or herbalist can only

> > make $20,000 a year on average after graduating, extending academic

> > standards will be impossible.

> >

 

that would be what one would make seeing 15 patients per week at 60 bucks

a pop for 50 weeks on a 50/50 split witha clinic owner (an easy cheap route to

practice). does that number of patients seem low, high or about right for first

year practitioners. From people who are trying, I have seen ranges from 7-20

pt. per week in the big city during the first year. Higher average patient

loads

in low competition areas, but typically lower fees, but also much lower

overhead. I know folks in outlying areas who had packed practices in months

and much better px in the city who could never make ends meet.

 

[Guest guest]

, Marnae Ergil <marnae@p...>

wrote:

>

> >

> >

> >

> >I would disagree with your and Marnae's point about the techniques

> >of CM not having " as much effect without the theory. " In the long

> >run, that is true. But clearly, in the short run they do; enough for

> >many Chiropractors and MDs to want to add the techniques---if not

> >theory as a whole---to their practices and integrate it into WM.

 

I don't think there can be any doubt that acupuncture works without the theory.

Perhaps it does not work as well, but that has not been thoroughly tested.

Much chinese research seems to be empirical and these high success rates

that everybody touts in their practices are often based upon studies that did

NOT use pattern differentiation. A randomized herbal study on IBS which we

have discussed several times on this list showed BETTER short term results

than pattern differentiation. And for most of history, acupuncture has been

practiced empirically by the majority of chinese, most of whom were illiterate

and did not study any classics at all. This is according to unschuld (eye

specialists who learned a few tchniques for eye dz from their dads and so on).

We have inherited the tradition of the literate scholar physicians, a minute %

of china's ancient population. However, the empirical tradition was what most

chinese had access to in the countryside for a thousand years. Acupuncture's

reputation must largely be built on this empirical tradition in the eyes of most

chinese. So it had to work even in this context.

 

Personally I think MD's can practice acupuncture safely with minimal training.

If they are not effective, they will quit, as most seem to do. However some are

clearly effective doing something wholly other than TCM. I think we will have

to prove MD's are unsafe or significantly less effective than ourselves before

states consider yielding to pressure to increase their hours. Most states will

not change laws affecting MD's unless there is a pressing public need that

can be proven. I don't think that proof is forthcoming.

 

[Guest guest]

, " " wrote:

does that number of patients seem low, high or about right for first

> year practitioners. From people who are trying, I have seen ranges

from 7-20 pt. per week in the big city during the first year.

Higher average patient loads in low competition areas, but typically

lower fees, but also much lower overhead. I know folks in outlying

areas who had packed practices in months and much better px in the

city who could never make ends meet.

 

:

 

Southwest Acupuncture College did a survey of their students that

was posted in Acupuncture Today: " Most of the respondents (66%)

charged between $41 to $60 per patient visit; nine percent charged

$40 or less. In terms of starting up a practice, most respondents

showed a gradual annual increase in gross and net income. By the

third year of practice, most acupuncturists grossed between $20,000

and $80,000 per year. At the time of the survey, 79% of those who

answered questions about net income reported making between $21,000

to $80,000 annually; a small percentage made over $100,000. "

 

Payscale.com, on the other hand, shows the acupuncture MEDIAN to be

$80,000.

 

This wide range in numbers probably doesn't show students who don't

go on to practice, nor the differences between (real) acupuncturists

and those who are MDs and Chiros.

 

 

Jim Ramholz

[Guest guest]

While I can see it on a small, personal scale where MDs are hiring a L.Ac. or we are working with them on the same patients, I don't think true integration will be achieved until we are paid equally for these services. If a new acupuncturist or herbalist can only make $20,000 a year on average after graduating, extending academic standards will be impossible

>>>>I am talking from the theoretical clinical application view, not the comertial

James Ramholz <jramholz wrote:

, "Alon Marcus" wrote:> >>>I totally agree and at the same time i think productive integration is quite valid. >>>Alon:I'm still unsure of how people are thinking of integration. While I can see it on a small, personal scale where MDs are hiring a L.Ac. or we are working with them on the same patients, I don't think true integration will be achieved until we are paid equally for these services. If a new acupuncturist or herbalist can only make $20,000 a year on average after graduating, extending academic standards will be impossible.Jim RamholzChinese Herbal Medicine, a voluntary organization of licensed healthcare practitioners, matriculated students and postgraduate academics specializing in Chinese Herbal Medicine, provides a variety of professional services, including board approved online continuing education.

[Guest guest]

, Alon Marcus wrote:

I am talking from the theoretical clinical application view, not the

commercial. >>>

 

 

Alon:

 

From that point of view, I believe we would have a better chance of

integrating the theories. WM will reduce CM to its own terms and, in

doing so, remove it from its foundation.

 

But CM can express the many of the details found in WM in its own

systems approach using yin/yang and 5-Phases. I've written about a

number of the overlapping concepts found in the pulses in my

article, " Organs and Their Associated Pulses. " It is available in

the files section.

 

 

Jim Ramholz