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The Neglected Art of Channel Palpation

by Tony Reid

Introduction

The teaching and practice of Acupuncture has become increasingly 'herbalised' in recent times, (a description first used by Ted Kaptchuk in the mid 1980's) and as a consequence, this has encouraged an increasingly cerebral approach. It is not the intention of this article to entirely disparage this approach; in keeping with the heterogeneous nature of traditional Chinese medicine (TCM) it is acknowledged that important insights into the practice of Acupuncture can be gained from it. However, to neglect the fundamental differences between traditional Chinese herbal medicine and Acupuncture would be to commit a serious error. Therefore I aim to demonstrate the historical precedents for a Channel based and palpatory approach to the practice of Acupuncture as well as to explore the contemporary literature dealing with it. Additionally, this article explores the implications for Chinese medicine education and research.

Since the time of Zhang Yuan-su (a.k.a. Zhang Jie-gu, circa 1151-1234), one of the early the medical 'reformers' of the Jin-Yuan era, there has been a current of thought within TCM that attempts to 'herbalise' traditional Acupuncture theory as well as to 'acupuncturalise' traditional herbal medicine theory. This paper arose as a result of my concern that certain of these teachings have now become mainstream and are accepted as representing a true and perhaps infallible version of traditional theory. These ideas are presented in the curricula of teaching institutions worldwide and appear in all of the major teaching text books, e.g. Cheng's 'Chinese Acupuncture and Moxibustion', which, along with prior editions, was for many years the major English language foundation Acupuncture text to come out of China. (1) While there is no intention to deny the potential usefulness of such teachings, my aim is to caution against the danger that these ideas devolve into dogma, which in the end stifles free and creative thinking. This paper focuses specifically on the Channel (or meridian) based approach to diagnosis and treatment as well as a palpation based approach to point location, and places them in contrast to the standardized 'text-book' Acupuncture that has become prevalent today.

The heterogeneous and pluralistic nature of TCM in general and Acupuncture in particular have been well discussed by Scheid and Bensky (2). This paper attempts to support the 'richness of tradition' in TCM, which should be experienced as 'empowering rather than as a hindrance'. The attempt to restrict one's focus and cling to one or a small group of specific teachings creates limitations both in one's personal development as well as scope of clinical effectiveness. The teaching of TCM and of Acupuncture in particular, should similarly encourage self discovery and personal growth on the one hand, while exposing students to a broad range of theoretical and practical models on the other.

Contemporary teaching institutions in China have adopted a specific orientation, which was developed in China during the Mao era. This consists of a synthesis of several different paradigms and allows these institutions to present both Chinese herbal medicine and Acupuncture within the one theoretical framework. This streamlined approach has been enthusiastically adopted in the West and Acupuncture students or practitioners who wish to find an alternative generally study under exponents of Meridian therapy (or Meridian style Acupuncture), the majority of whom are Japanese. Only a handful of English language authors have published texts on this style of Acupuncture and these will be explored in this paper.

The fact that Meridian style Acupuncture is the main form practiced in Japan and that an ever-increasing number of Western practitioners are earning their livelihood through this method speaks for its efficacy in clinical practice as well as its acceptance - and possibly also preference - by patients. Thus, although lacking a higher level of evidence of efficacy, here we have a style of Acupuncture that has been practiced on a large scale in Japan for several generations and that is gaining support in Western countries. Therefore it is important that modern teaching institutions incorporate a more detailed and in depth study of these methods in their Acupuncture curricula. While there have been some moves in this direction, the majority of teaching materials coming out of China as well as the West are essentially herbal medicine based. Most teaching institutions currently follow this approach, either wholly or predominantly. Thus 'standard practice' for Acupuncture follows this TCM, herbal based model.

This paper explores the place of a Channel based and palpatory approach within Chinese medicine and looks at the possible implications for contemporary clinical practice, the teaching of professional courses as well as research. In the course of the following discussion, several of the major English language teaching texts are examined from the perspective of their orientation towards one or more specific paradigms. Without exception, I regard each of these as fine works that are worthy of the popularity they have gained. There is no intention on my part to belittle their authors' achievements, nor to cast any doubt on the quality of the content of these books.

Courses, teaching methodologies and outcomes

In contemporary teaching institutions in China and the West, the main approach adopted is referred to as 'TCM Acupuncture'. This was developed and implemented in China during the Mao era, allowing institutions to present both Chinese herbal medicine and Acupuncture within the one theoretical framework. Courses typically cover the following aspects of TCM theory:

The concept of Qi, Yin-Yang, Five Phases, Zang-fu, the basic physiological substances, aetiology, pathogenesis, the eight principles, diagnostic methods (including observation, interrogation/case history taking, tongue diagnosis, examination of the pulse, and palpation), syndrome/pattern differentiation, treatment principles, and the basic theories regarding shang han and wen bing. These topics are generally taught under the general heading of 'TCM Theory' as the underlying principles of Chinese medicine as a whole. Historically, some of these theories developed within the specialty of Acupuncture, while others developed within Chinese herbal medicine. Thus, for example, syndrome differentiation with reference to the eight principles, the Zang-fu and the Qi-Blood-Body Fluids is much more relevant to the practice of herbal medicine than Acupuncture, and their wholesale imposition upon it tends to 'herbalise' Acupuncture to a large extent.

The outcome of such courses is that the goal of case history taking and examination is to arrive at a diagnosis based on one or several TCM syndromes. While this is entirely appropriate for the practice of Chinese herbal medicine it may not be in the best interests of students who wish to specialize in Acupuncture. Unless a student receives clinical instruction from an Acupuncture practitioner who uses Channel and point palpation to a significant degree, his/her diagnosis will tend to lean very heavily in the direction of TCM syndromes with an emphasis on selection of appropriate Acupuncture points in terms of point function. In other words, points are selected much like herbs, to form a 'prescription'. Many commonly used clinical textbooks follow this approach, which serves to reinforce the perception of an 'herbalised'  Acupuncture, e.g. those by Cheng (2), Yin & Liu (3), Flaws & Sionneau (4); Flaws & Lake (5)

In Acupuncture, the hegemony of point functions in treatment and TCM syndromes in diagnosis are relatively modern phenomena. According to Ellis et al. the older Acupuncture texts generally discussed points in terms of the symptoms treated. (6) It was not until the 1950's that the modernization and standardization of Chinese medicine resulted in points being assigned specific functions, along the same lines as the traditional Chinese medicinal herbal functions. Although this is not without precedent, by the end of the 20th century it had become the dominant paradigm, replacing the more traditional lists of symptoms that were based on the clinical experience of generations of practitioners. Ease of teaching and learning has ensured the dominance of this approach. However, Ellis et al. caution that if they are taken out of context (i.e. the list of symptoms from which they were derived) point functions can be misleading and even harmful if applied inappropriately. (6) In regard to the argument of this paper, I would assert that the development of point functions is yet another reason why Channel palpation and location of treatment points by tenderness or tissue change has largely been overshadowed in modern Acupuncture curricula and practice, in favour of a more cerebral approach. Typically, the modern TCM Acupuncture only indicates palpation to find a shi points in the treatment of various types of pain.

The approach to point functions adopted in 'A Manual of Acupuncture' includes both the modern TCM actions as well as the historically based indications for each point under discussion. (7) In the chapter headed 'Point Selection Methods', which discusses fifteen principles for selecting Acupuncture points (e.g. local, adjacent and distal points, selecting points below to treat above, etc.), there is only a brief note on palpation in relation to the selection of local points. (8) The only mention of palpatory findings in this text are a) in relation to the Mu-front points, which may 'become tender in response to disharmony in their respective Zang-Fu' (9), and b) the a shi points which are explained in a footnote at the end of the section on point selection. It is worthy of note that a shi points are carefully distinguished from 'regular Acupuncture points'. (10) Thus this text, which is arguably the major foundation Acupuncture text in the West, adopts a primarily intellectual approach to the therapeutic actions and indications of the points and a rigid (i.e. static) approach to point location, very much in line with TCM Acupuncture.

Let us examine the role assigned to palpation in contemporary teaching texts on basic theories of Chinese medicine. Sivin has translated the major portion of the 'Revised Outline of Chinese Medicine' (Hsin pien Chung-i-hsueh kai yao). (11) This is representative of the material that comprises the theory portion of tertiary courses on Chinese medicine in China. In the section on diagnostics in the former text, there is a chapter on palpation of the pulse as well as one small paragraph each on abdominal palpation, skin palpation and palpation of the Channels. In discussing the Channels, the text contains only about four lines devoted to Channel palpation, which basically repeats the information from the section on diagnostics. (12) The basic theory text edited by Chai is an example of Chinese material edited for a specifically Western (i.e. not communist) readership. (13) This book contains only very brief information on Channel palpation. (14) However this series of texts does include a volume on Traditional Chinese Diagnostics. In this volume of some 340 pages there is only a single page on palpation, following the nine chapters on pulse examination. (15) The chapter on 'Differentiation of Syndromes in Accordance with the Theory of Meridians', which describes various symptoms and signs for each of the twelve main and the eight extra Channels, does not include any palpatory findings. (16)

The 'Fundamentals of Chinese Medicine' is a basic theory text based on teaching materials of the Beijing College of Chinese Medicine, Nanjing College of Chinese Medicine and Shanghai College of Chinese Medicine. (17) The material comprises some 450 pages; out of which only two are devoted to general palpation. Palpation of Channels is not mentioned and palpation of acupoints receives eight lines, which describes the relationship between morbidity of internal organs being reflected in tenderness or sensitivity at certain acupoints. (18) Thus we are given an internal medicine (i.e. herbal medicine) cantered approach, not one that relates to the Channels.

'Chinese Medicine: The Web That Has No Weaver' includes only about four and a half lines on palpation of various parts of the body and various Acupuncture points, which is followed by a relatively detailed account of traditional pulse diagnosis. The word 'palpation' does not appear in the book's general index, while the reference to 'touching' refers to the section on pulse examination and the brief outline of other applications of touch. (19)

'The Foundations of Chinese Medicine' is probably the single most popular basic theory text used in Western TCM colleges. (20) The original edition provides a fairly brief mention of palpatory methods apart from pulse examination. In addition, the diagnostic significance of palpatory findings is primarily related to the state of the internal organs, Qi, Blood and body Fluids in accordance with the eight principles paradigm. (21) In the chapter 'Identification of Patterns According to the Channels' the distinction is made between Channel based pathologies and organ based pathologies, along with a detailed exposition of the various causes of Channel problems. The author also points out some of the difficulties that may be encountered with descriptions of Channel pathologies in classical sources, such as the 'Spiritual Axis' (ling shu), which includes symptoms and signs from the relevant organ and sometimes also from other organs. The descriptions of Channel pathologies, however, contain only patient symptoms and include no palpatory findings. (22) The discussion of points functions is predominantly in terms of the TCM Acupuncture paradigm, with palpation only used for finding the a shi points in the treatment of local disorders. (23)

'Practical Diagnosis in Traditional Chinese Medicine' has become a widely used teaching text in Western TCM teaching institutions. (24) This text contains approx. seven pages (out of 520 pages) devoted to general palpation in diagnosis. (25) The topics include palpation of the forehead, head and neck, the forearms, the hands, feet, chest and abdomen, touching the skin, transport points and ear points. The orientation is primarily directed towards eight principle, Zang-Fu and Qi-Blood-Body Fluids type of diagnosis, i.e. there is essentially an herbal medicine bias. This text also includes a chapter on 'Twelve Channel and Networks Pattern Identification'. (26) In the introduction to this chapter the author mentions that 'in the past, this aspect of the content of the theory was discussed only in Acupuncture and moxibustion texts.' Subsequently, the Channel pathologies under discussion are related solely to internal organ syndromes/patterns according to the eight principles, Zang-Fu and Qi-Blood-Body Fluids approach. The Channels are not regarded as entities in themselves, but rather as secondary extensions of the Zang-Fu, and their Qi, Blood, Fluids and Essence. This approach is epitomized in the fact that for each Zang-Fu patterns a specific herbal formula is given as treatment. The Channel patterns are not linked with any specific treatment - neither Acupuncture points nor herbal formulas.

Chen's diagnosis text adopts a similar approach to Deng, in that palpatory findings are discussed solely in terms of the eight principles, Zang-Fu and Qi-Blood-Body Fluids, thus conferring a predominantly herbal medicine bias onto this aspect of diagnosis. (27)

In Maciocia's text on diagnosis, only 13 pages in a text of around 1,000 pages are devoted to palpation of the Channels. (28) The chapter that covers palpation of parts of the body consists of 12 pages. (29) Although the techniques discussed are quite detailed and therefore provide a satisfactory foundation for the ongoing development of palpatory skills, here again the findings are related primarily to the state of the internal organs, Qi, Blood and Body Fluids in accordance to the eight principles paradigm. Only in the discussion of individual Channels in the chapter on Channel palpation are specific pathologies of the Channels mentioned, albeit very briefly. (30) The overall emphasis of this text is on an herbal medicine based approach.

Historical antecedents

The current Chinese trend to unify the theoretical foundations of Acupuncture and herbal medicine appears to have its roots in the writings of Zhang Yuan-su (a.k.a. Zhang Jie-gu, circa 1151-1234), who was the forerunner to the four eminent Jin-Yuan 'reform' doctors. In his book, 'A Bag of Pearls' (zhen zhu nang), Zhang attempted to integrate the principles of Acupuncture with the principles of herbal medicine. He incorporated medicinal substances into the five phase framework, which was the primary organizing principle of Acupuncture theory at the time. In particular, he helped to more clearly define the association of the flavour of each herb and its effects on the different organs. Zhang also initiated the concept of herbs entering into and influencing the Channels, a description that is still included in modern Chinese herbal texts. (31). Later commentators, such as Xu Da-jun have referred to these theories as 'farfetched rhetoric' (32)

The early TCM literature appears to emphasize a Channel based diagnostic system. According to Wang and Robertson, the Ling Shu (ch's 73 and 75), Su Wen (ch. 20) and the Nan Jing (ch.13) refer to palpation along the course of the Channels as an important diagnostic technique, along with palpation of the radial artery at the wrist, (and presumably also other arteries at various locations), all with a view to identifying the condition (i.e. excess or deficiency) of the various Channels. The most detailed reference is from the 13th chapter of the Nan Jing in which palpation of the forearm is used to diagnose various disorders of the internal organs. (33)

The famous eighteenth century scholar-physician Xu Da-jun (Hsu Ta-ch'un) in his critique of contemporary Acupuncture practice, commented that according to the classics, the Channels do not have uniform pathways and that the points are located irregularly. Thus Channels and points need to be located through palpating the contours of each individual's body. He disparaged practitioners who ignored individual differences in form and located Acupuncture points in a linear, text-book fashion in spite of using the individualized cun as a basis for measurement. In the spirit of Lao Zi he declared that the Channels that they identify are not the real Channels and the points they identify are not the real points. Xu also highlights the importance of Channel based treatments rather than treatments that are based on point prescriptions, citing the many classical references to Channels rather than points when discussing various illnesses. (34)

According to Pirog the Ling Shu, chapters 2, 5 and 17 as well as the Nan Jing, chapter 23 describe the circulation of Qi in the Channels flowing in a 'one way centripetal circulation, which began on the extremities and ended on the trunk and the head. The body's supply of Qi was seen to originate in the heavens and flow through the Meridian system to reach the internal organs'. (35) In this connection I would also like to mention Bensky's comments. He reports that as a result of practicing a technique that he calls 'Listening to the Channels' for over 10 years: 'Channel flow is almost always experienced as being centripetal, that is going from the extremities towards the trunk'. (36) Some time during the early Han period the contemporary theory of a 'closed circuit' pattern of circulation of Qi within the Channels overshadowed the previous paradigm which emphasized man's connection with the universe. The new paradigm reflected the dominant view of man as a social being, whose physiology reflected the man made world rather than Nature and whose relations with members of his own species were more important than his connection with the universe. This particular paradigm is elaborated in the 10th chapter of the Ling Shu. (37) Thus the move towards social conformity brought with it the tendency to trust authority rather than one's own thoughts and perceptions. Here, too we can see an early example of Acupuncture theory moving away from hands-on direct perception to a more cerebral and dogmatic model.

Modern palpatory approaches

Japanese Meridian Therapy (JMT) is a classical approach that is based on the Nan Jing, and was revived in Japan in the 1930s. JMT places great importance on palpation. Out of the four diagnostic methods, pulse diagnosis and palpation receive the greatest emphasis. Diagnosis is directed towards detecting imbalances in the Meridians, which are 'ascertained through (palpation of) the pulse, depressions and sensitive points located along the Meridians' ... 'Palpation includes three methods: pulse diagnosis, abdominal diagnosis and Meridian palpation'....'the mastery of which requires years of practice'. (38) The selection of points for treatment is based partly on theoretical considerations, e.g. which point or points will tonify a specific Meridian when deficient, and partly on findings from palpation, e.g. treatment of reactive points or areas. (39) Such points or areas exhibit changes in the skin texture, skin temperature; subcutaneous nodules, indurations or tight bands of tension; tenderness, hyperaesthesia, depression (i.e. a small hollow) or congestion (i.e. a slightly bloated area). (40)

Contemporary Meridian Style Acupuncture (MSA) advocates the primacy of the palpatory approach within the context of TCM. According to Pirog, it is defined as 'any form of Acupuncture that derives its strategies from classical energetic theory as found in the Nei Jing and Nan Jing, rather than the theories of herbalism or modern science.' (41) The key features of MSA are highlighted with reference to the treatment of local pain:

  • Points are located uniquely in each patient according to tenderness or tissue change. These reactive points take precedence over the textbook points, even if they are very close to them.
  • The needles are stimulated mildly and more needles are used
  • It is generally not necessary to elicit Qi sensations. The needles are not manipulated much, if at all
  • Shallow needle insertion
  • All painful points must be needled (42)

Another eminent author and practitioner, Dr Mark Seem, has developed a unique system of Acupuncture that is also palpation based. Dr Seem developed an approach to diagnosis and treatment that integrates Japanese and French Acupuncture with the kinaesthetic logic of manual osteopathy and trigger point release. The author has developed a protocol using Acupuncture as a tool for releasing holding patterns in the body-mind in order to restore functional and structural balance and to relieve chronic pain. The methodology places great importance on palpation by the practitioner to locate local and distant treatment points within the framework of the six Channel system and the eight extra Channels. (43). Dr Seem argues for 'a return to the body and the importance of touch' in the opening chapter of his major work on this approach. Describing his meeting with Dr Janet Travell (who developed 'trigger point therapy' within Western medicine), he summarizes the essence of his system: 'the key to pain and its complex dysfunctions is not to be found in the physician's preconceived, objective knowledge but, time and again, in the very bodies of patients'. He also summarized the current dilemma within Acupuncture as it is taught and practiced in China and the West, when describing the difficulties he encountered with his proposal to introduce Japanese Meridian Acupuncture into the curriculum of the Tri-State Institute of Traditional Chinese Acupuncture: 'In my experience, once one has had too great a taste of TCM Acupuncture with its heady logic, facile abstractions and even more facile repetitive point combinations, a hands-on Meridian-based approach often seems inferior'. In response to members of his faculty who opposed this move on the grounds that students would become confused and that TCM should be the focus of the curriculum: '...Japanese Acupuncture would instil a clinical pragmatism...that was lacking in TCM Acupuncture.' (44)

The place of palpation in Chinese medicine

There are three major issues that pertain to this discussion. The broader one being how to present Chinese medicine to students in such a way that the student is exposed to the heterogeneous nature of traditional Chinese medicine (and Acupuncture, in particular) without the student being overwhelmed or confused by the multitude of different theoretical and practical paradigms, so that he/she may come away with an ability to begin to utilize them. Secondly: to what extent has palpation of the body surface been a feature of Chinese medicine throughout the last 2,000 years? Thirdly, from a clinical practice perspective how does the adoption of a tactile approach influence clinical outcomes?

Taking an historical perspective, one can see that throughout its recorded history Chinese medicine has been characterized by heterogeneity and plurality. As a consequence, competing individuals and groups espousing one aspect or a limited number of aspects of Chinese medical theory and practice, vie with one another for prominence. (2) In addition, one of the notable features of this tradition is that it has continually been in a process of change and development. At times (such as during the Jin-Yuan period and also during the modern era) this has been quite rapid. (45) It is therefore not my intention to try to prove that palpation of the body surface is the key to discovering the 'one and only true Acupuncture'. I have simply aimed to show that this approach comprises a significant strand of thought and practice that forms an important part of the rich tapestry of the Acupuncture tradition. At the one extreme we have the imperial physician who examined the pulse by means of a thread tied around the royal lady's wrist and inserted needles through her garments. While on the other we have the Japanese approach to Acupuncture, strongly influenced by that culture's less significant taboos against physical touch, emphasizing body palpation and Channel based pathologies. (46) Thus, through observing the way in which Acupuncture has developed in Japan as an example of a school of thought within the Acupuncture tradition that has been allowed to develop outside of the cultural influences that have shaped the modern version of traditional Chinese medicine, we can speculate that in pre-modern, and especially in pre Jin-Yuan China, palpation was given greater prominence than it is in present day TCM Acupuncture. The references to palpation in the Ling Shu and Nan Jing, cited above, would serve to lend at least some weight to this argument.

On the other hand, I have looked at forces - both cultural and academic - that have tended to force Acupuncture into the herbal medicine mould, discouraging and minimizing the use of palpation in clinical practice within China. This is not to say that the palpatory approach to Acupuncture is no longer practiced in mainland China. Examples of such practitioners may be found in recent Chinese publications, e.g. 'Essentials of Contemporary Chinese Acupuncturists' Clinical Experiences'. (47) In October-November, 2000, I had the good fortune to train under one such practitioner in Hangzhou, China. However, I can attest to the difficulty - if not sheer impossibility - for such a practitioner to explain what he is doing in terms of any of the items of a 'physician's preconceived, objective knowledge'. It is obviously harder to teach and assess palpation skills, as they rely to a large extent on the ability of the practitioner to develop the requisite sensitivity as well as the ability to interpret his/her findings appropriately. In addition, the process of treatment also involves a level of sensitivity that naturally varies from one individual to another and that also requires ongoing practice over many years in order to develop proficiency. To use the term coined by Volker Scheid, (48) this is one of the 'problematiqes' that underlie our tradition: the fact that effective clinical outcomes depend on both a deep and detailed knowledge of theory as well as an equally deep and refined sensitivity, which needs to be cultivated over a lifetime. Such considerations are anathema to modern scientific reductionism, empiricism, intellectualism and 'evidence based' philosophies. It would seem that the ease of structuring courses, teaching and assessing students as well as the predominantly intellectual approach that is provided by the TCM paradigm has made it very attractive to those who develop, implement and administer courses both in China and the West. One may also consider the fact that after the devastation of the cultural revolution, Chinese academics, policy makers and administrators, conscious of the backwardness of their nation, have rushed to modernize in an attempt to appear acceptable to the more technologically advanced Western nations. This would also contribute to the limiting of a physician's reliance on palpation in Chinese medicine.

As far as clinical practice is concerned, at present the only evidence that I have been able to find is empirical. Practitioners of palpation based Acupuncture cite numerous examples of the clinical efficacy of this approach, particularly in the treatment of chronic pain. (49, 50, 51). In addition, there is the argument put forth by Brown in his preface to 'Introduction to Meridian Therapy' that in Japan the practitioners have to compete professionally against western style doctors and practitioners of herbal medicine, both of whom are covered by the national health program. (52) This speaks for the efficacy of such treatments - although in a very general sense. In addition, we also need to consider the evidence that comes from the experience of experts in the field, such as Dr Seem. His opinion is that hands-on Meridian Acupuncture styles are vastly superior to TCM Acupuncture and indeed any of the other forms of physical based therapies. (53)

Research into Acupuncture is still in its infancy. So far there is reasonable scientific evidence supporting Acupuncture for very few indications, e.g. peri-operative dental pain, neck pain, nausea and vomiting. (54, 55) However, there are several key methodological challenges inherent to Acupuncture trials, such as placebo control and blinding, which are currently being discussed in the literature (56, 57) Therefore it is a little premature to expect any direct comparison between the clinical outcomes of TCM based Acupuncture treatment and that of a Meridian based approach in the literature. However, as far as future directions in research are concerned, it may be worthwhile to consider such comparative studies as they would be useful in determining standards for best practice in Acupuncture.

Looking briefly at teaching and assessing student outcomes, it would not present a major challenge, neither intellectually nor logistically, for Acupuncture teachers to require students to demonstrate knowledge of the standardized locations of Acupuncture points as well as to be able to show the skills in palpation that would enable the location of alternative points in a real life patient. Similarly students can be taught various ways of reading the radial pulses, some of which are more appropriate for TCM Acupuncture, Meridian style Acupuncture or Chinese herbal treatment. In keeping with the heterogeneous nature of traditional Chinese medicine, I believe that students and practitioners are both personally enriched as well as better equipped to serve their patients effectively when they are exposed to several paradigms of both theory and practice. The Seattle Institute of Oriental Medicine adopts this approach and it has proven effective, with no failures in the National Certification Commission for Acupuncture and Oriental Medicine's written exam and over 90% of graduates in practice. (58) Similarly, the Tri-State Institute of Traditional Chinese Acupuncture, although predominantly TCM oriented, also exposes students to Japanese Meridian style Acupuncture as well as Dr Seem's approach, 'Acupuncture Physical Medicine'. Approximately 90% of the students who enter the program go on to graduate of these 99% go on to work in the field. (59)

Concluding remarks

There is one major issue that I have not yet discussed. This is in regard to the future of Acupuncture, i.e. Acupuncture as a discipline that is independent of and distinct from Chinese herbal medicine. According to Seem (53), Acupuncture is serious danger of being lost - partly because it has been reduced to an herbalised form in Western colleges of Chinese medicine and partly because other healthcare providers such as medical practitioners and chiropractors are taking it up with only minimal training. The first part of this 'thrust sees Acupuncture as a mere part of Oriental medicine, in which Oriental medicine is a code word for herbal practice. In this perspective, born when traditional Chinese medicine hit the U.S., Acupuncture is reframed as internal medicine akin to herbs, rather than a hands-on therapy designed as a physical medicine that, through informed touch, can restore integrity not only to the body, but to the body, mind and spirit as a whole.' (53) Colleges teach only a 'watered down version of Acupuncture in which informed touch plays virtually no role at all', which has ended up becoming the major form of Acupuncture practiced in the West. On the other hand there has been the development of 'medical Acupuncture' (Acupuncture practiced by medical doctors with only 200-300 hours of training) as well as 'chiropractic Acupuncture' (often practiced with only 100 hours of study). Because the general public is ill equipped to distinguish between practitioners who have had minimal and inadequate training (who also generally refer to themselves as 'Doctor', thus conferring an elevated social status upon themselves) and those with suitable training, it is inevitable that Acupuncture will eventually come to be regarded as having only a very limited therapeutic value. In addition, because most practitioners of Chinese/Oriental medicine follow the 'watered down' approach, Acupuncture is in serious danger of decline. In Seem's opinion: 'No other physical medicine perspective I am familiar with has as comprehensive and systematic a therapeutic approach, nor as comprehensive a therapeutic effect (as hands-on Meridian Acupuncture styles)'. (53) I would agree with Dr Seem's concluding remarks in the article just cited, that it behoves our profession to rescue Acupuncture and restore it to its rightful place as a powerful therapeutic modality that requires specialist training and the simultaneous development of tactile skills, sensitivity and needling skills along with a broad knowledge base that encompasses the various styles of Acupuncture that have been practiced in the past, together with modern developments.

First published in the NZRA Journal of TCM.

References

1. Cheng, X. (Chief Ed.) (1999). Chinese Acupuncture & Moxibustion (Revised/Enlarged). Beijing: Foreign Languages Press

2. Scheid, V., Bensky, D. Medicine is Signification - Moving towards Healing Power in the Chinese Medical Tradition (reprinted from the European Journal of Oriental Medicine. Retrieved from: http://www.siom.edu/resources/faculty/v-sheid/yizhe

3. Yin, G. & Liu, Z. (2000). Advanced Modern Chinese Acupuncture Therapy – A Practical handbook for Intermediate and Advanced Study. Beijing: New World Press.

4. Flaws, B. & Sionneau, P. (2001). The Treatment of Modern Western Diseases with Chinese Medicine: A Textbook & Clinical Manual. Boulder, CO: Blue Poppy Press

5. Flaws, B. & Lake, J. (2001). Chinese Medical Psychiatry: A Textbook & Clinical Manual. Boulder: Blue Poppy Press

6. Ellis, A., Wiseman, N., Boss, K. (1991). Fundamentals of Chinese Acupuncture. Brookline, Massachusetts: Paradigm Publications (pp.59-60)

7. Deadman, P., Al-Khafaji, M. (1998). A Manual of Acupuncture. Hove, East Essex: JMC Publications.

8. Ibid. (pp.57-61)

9. Ibid.p.44

10. Ibid. p.61

11. Sivin, N. (1987). Traditional Medicine in Contemporary China. Ann Arbor: Centre for Chinese Studies, the University of Michigan.

12. Ibid. pp.326-327, p.257

13. Chai, K. (Chief Ed.) (1998). University textbooks of Traditional Chinese Medicine for Overseas Advanced Students. Basic Theory of Traditional Chinese Medicine. Beijing: People’s Medical Publishing House.

14. Ibid. p. 12

15. Wu, X. (Chief Ed.) (1999). University textbooks of Traditional Chinese Medicine for Overseas Advanced Students. Traditional Chinese Diagnostics. Beijing: People’s Medical Publishing House, p. 211

16. Ibid. pp. 304-309

17. Wiseman, N., Ellis (transl.), A., Zmiewski, P. (Ed.) (1985) Fundamentals of Chinese Medicine. Brookline: Paradigm Publications

18. Ibid. pp.150-152

19. Kaptchuk, T. (Revised Ed. 2001). Chinese Medicine: The Web That Has No Weaver. London: Rider Books, p.194

20. Maciocia, G. (1989). The Foundations of Chinese Medicine: A Comprehensive Text for Acupuncturists & Herbalists. Edinburgh: Churchill Livingstone

21. Ibid. pp.171-174

22. Ibid. pp.307-310

23. Ibid. pp.367-477

24. Deng, T. (trans. Yi, S. & Ergiul, M., Ed Ergil, K.) (1999). Practical Diagnosis in Traditional Chinese Medicine. London: Churchill Livingstone

25. Ibid. pp.155-162

26. Ibid. pp.305-323

27. Chen, P. (2004). Diagnosis in Traditional Chinese Medicine. Taos: Complementary Medicine Press, pp.120-126

28. Maciocia. G. (2004). Diagnosis in Chinese Medicine: A Comprehensive Guide. Edinburgh: Churchill Livingstone, pp.525-537

29. Ibid. pp.509-522

30. Ibid. pp.525-537

31. Dharmananda, S. (2001). The Jin-Yuan Medical Reforms. ITM Online Articles. From: http://www.itmonline.org/arts/jinyuan.htm

32. Unschuld, P. (translated & annotated) (1998). Forgotten Traditions of Ancient Chinese Medicine. Brookline, Massachusetts: Paradigm Publications, p.72

33. Wang, J., Robertson, J. (2007). Channel Palpation. J Chinese Medicine. 83, 18-24

34. Unschuld, P. (translated & annotated) (1998). Forgotten Traditions of Ancient Chinese Medicine. Brookline, Massachusetts: Paradigm Publications, p.244

35. Pirog, J. (1996). A Practical Application of Meridian Style Acupuncture. Berkeley, CA: Pacific View Press, p.33

36. Bensky, D. Listening to the Channels: Preliminary Reflections on the Adaptation of One Form of Osteopathic Palpation to Acupuncture. From SIOM website http://www.siom.edu/resources/faculty/d-bensky/palpation

37. Pirog, J. (1996). A Practical Application of Meridian Style Acupuncture. Berkeley, CA: Pacific View Press, p.35

38. Shudo, D. & Brown (transl.) (1990). Introduction to Meridian Therapy. Seattle: Eastland Press, pp.12, 45

39. Ikeda, M. (2005). The Practice of Japanese Acupuncture and Moxibustion. Classic Principles in Action. Seattle: Eastland Press, pp.65-66

40. Shudo, D. & Brown (transl.) (1990). Introduction to Meridian Therapy. Seattle: Eastland Press, pp.168, 169

41. Pirog, J. (1996). A Practical Application of Meridian Style Acupuncture. Berkeley, CA: Pacific View Press, p.xiv

42. Ibid. p.7

43. Seem, M. (1993). New American Acupuncture: Acupuncture Osteopathy. Boulder: Blue Poppy Press

44. Ibid. pp.vi-vii

45. Sivin, N. (1987). Traditional Medicine in Contemporary China. Ann Arbor: Centre for Chinese Studies, the University of Michigan.

46. MacPherson, H. (1994). Body Palpation and Diagnosis. J Chinese Medicine. 44, 1-7.

47. Chen, Y., Deng, L. (chief eds.), Zhang, K. (chief English Ed.). (1989). Essentials of Contemporary Chinese Acupuncturists’ Clinical Experiences. Beijing: Foreign Languages Press.

48. Rossi, E. (2007). Shen Psycho-emotional aspects of Chinese Medicine. Edinburgh: Churchill Livingstone, Elsevier Ltd., pp. ix-xi

49. MacPherson, H. (1994). Body Palpation and Diagnosis. J Chinese Medicine., p.5

50. Seem, M. (1993). New American Acupuncture: Acupuncture Osteopathy. Boulder: Blue Poppy Press, pp.117, 132-133

51. Shudo, D. & Brown (transl.) (1990). Introduction to Meridian Therapy. Seattle: Eastland Press, pp.209-235

52. Ibid. p. ix

53. Seem, M. (2000) Message from the Front Lines. Acupuncture Today. Vol. 01, Issue 09. From: http://www.Acupuncturetoday.com/mpacms/at/article.php?id=27690

54. Acupuncture. NIH Consensus Statement Online 1997 Nov 3-5. 15(5), 1-34. Retrieved April 25, 2007 from: http://consensus.nih.gov/1997/1997Acupuncture107html.htm

55. Cochrane review search conducted April 2007

56. Birch, S. (2006). A review and Analysis of Placebo Treatments, Placebo Effects and Placebo Controls in Trials of Medical Procedures When Sham is not Inert. J Alt Complem Med. 12(3), 303-310

57. Birch, S. (2007). Reflections on the German Acupuncture Studies. J Chinese Medicine. 83, 12-17

58. Seattle Institute of Oriental Medicine Staff (2004). The Seattle Institute of Oriental Medicine: An Experiment in Acupuncture Education, 10 Years Later. Acupuncture Today. 5(12) fromwww.Acupuncturetoday.com

59. Tri-State College of Acupuncture (2004). Answers to Frequently Asked Questions. From: http://www.tsca.edu/h1-2.htm

60. Cheng, X. (Chief Editor). (1996). Chinese Acupuncture and Moxibustion. Beijing: Foreign Language Press

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