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Harrison VanDolahProfessor EntenmannASIAN 39920 May 2016

Re-defining an Ancient Healing Art:Chinese Medicine in Minnesota

Introduction

As of 2013, Minnesota had 455 licensed acupuncturists practicing in the state,1 with

about that same number of chiropractors and MDs also utilizing acupuncture as well as other

Chinese medicine therapies in their practice. The state also has two schools that offer master’s

degrees in oriental medicine, hospitals around the state employ acupuncturists as part of

“integrative medicine” umbrella programs, and rural farming towns like Northfield even have

three acupuncturists. How did this happen? How could medical practices utilized in dynastic

China come to be so popular globally that practitioners can even be seen in the Midwestern

United States, seemingly the most unlikely of locations? Moreover, can we still call this Chinese

medicine when it is practiced, taught, and utilized by nearly all non-Chinese people?

This paper will attempt to trace the recent history of Chinese medicine in our modern

world, beginning with the Maoist construction of “traditional Chinese medicine,” through to its

rise in America, and ultimately will present the voices of those who practice and teach Chinese

medicine in Minnesota. What comes out is not an organized picture of what Chinese medicine is,

but rather a taste of how complex the world of Chinese medicine is in America. Specifically, two

major tensions are identified. The first is a lack of consensus as to why westerners have become

so interested in utilizing and practicing Chinese medicine. The second and more controversial

question is how to define authentic Chinese medicine. To answer these questions, it is important

to look at the history of Chinese medicine as well as to examine the perspectives of those

1 Statistics according to the 2013 survey by the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM). These numbers are based on how many practitioners were currently licensed to practice through the board examinations offered by Minnesota.

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involved from as many healthcare environments as possible, from independent herbalists to

integrative health acupuncturists working at biomedical hospitals.

The Chinese Perspective on Medicine

The purpose of this paper is not to deconstruct the theories of Chinese medicine and

describe its philosophical and practical differences with Western medicine, hereafter referred to

as biomedicine.2 This has been done many times by scholars of many kinds: acupuncturists

(Beinfield and Korngold 1991, Kaptchuk 2000), medical doctors (Eisenberg 1985), medical

anthropologists (Farquhar 1994), historians (Porkert 1974, Unschuld 1985, Sivin 1995) – the list

goes on. Instead, the aim of this paper is to impart the reader with knowledge of the complexity

and internal tension inherent in the question of “What is traditional Chinese medicine?”

However, there are a few broad generalizations described here to help orient readers who may be

unfamiliar with some of the theories and practices of Chinese medicine.

Since the recent rise of Chinese medical practices in the United States beginning in the

1970s, many books have been written that attempt to demystify traditional Chinese medical

ideas. Two well-known works that are often used to present the fundamental differences in

layman’s terms are Ted Kaptchuk’s The Web That Has No Weaver and Harriet Beinfield and

Efrem Korngold’s Between Heaven and Earth: A Guide to Chinese Medicine. Kaptchuk focuses

much energy on describing the philosophical foundations of Chinese medicine in Daoism and

yinyang theory. Kaptchuk argues that “our medicine parallels our society” (Kaptchuk 297), and

these philosophical and social bases of Chinese medicine make it challenging to comprehend for

2 Much great work has been done to show why this distinction is important. See Arthur Kleinman’s essay “What is Specific to Biomedicine” in Writing at the Margin: Discourse Between Anthropology and Medicine, for a particularly powerful argument. I will follow from Kleinman and many others in not using the term “Western” medicine, as I do not wish to perpetuate, echoing Edward Said’s Orientalism, the myth of the grand dichotomy between East and West, which has been used and abused for too long.

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those not very familiar with these ideas. The important point here is that all medical systems are

practiced in a cultural context, and Kaptchuk argues that Chinese medicine is a particularly

dramatic example of this. In addition, Kaptchuk puts forth the metaphor of Chinese medicine as

an art more than a science, which “does not turn up a disease entity or a precise cause, but

renders up an almost poetic, yet workable description of a whole person” (Kaptchuk 4). Beinfield

and Korngold also echo these sentiments:

What makes Chinese medicine distinct, even more than its needles and herbs, is its metaphysics

(assumptions about reality), epistemology (ways of acquiring knowledge), and ideology (systems

of beliefs and values), all of which find their expression in the Daoist imperatives of preserving

life and living in accord with nature (Beinfield and Korngold xvi).

Chinese medicine’s roots in Daoism and yinyang theory thereby account for its focus on balance

and imbalance in relation to illness, perhaps its most important difference with biomedicine.3

Most agree that the Chinese medical perspective is fundamentally different from

biomedicine, but the differences that are emphasized begins to deviate depending on who you are

speaking to.4 Determining the ability of traditional Chinese medical thinking to integrate with

biomedicine is a source of much of the controversy surrounding the definition of Chinese

medicine in recent years. Perhaps the biggest source of tension is identifying what aspects of

Chinese medicine should be taught and practiced in America, since Chinese medicine has

undergone very dramatic changes over the past century. In order to better understand the

complexities of Chinese medicine in America, it is necessary to examine these changes in the

historical context of modern China and how this collection of ancient medical practices and

theories came to be called “traditional Chinese medicine.”3 Emily Wu points out the telling example that in the Chinese language, the word for treating a disease (zhibing 治病) is actually closer in meaning to “managing” a disease than treating it (Wu 2013). 4 For more detailed examinations of the philosophical differences between Chinese medicine and biomedicine, see Porkert 1974, Unschuld 1985, and Sivin 1995.

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Developing and Defining “Traditional Chinese Medicine” in China

In Charles Leslie’s Asian Medical Systems, Ralph Croizier writes of Chinese medicine:

Among the classical medical systems of Asia, the Chinese is the oldest in history but the newest

in name. Behind this paradox lies an important clue to the significance of the numerous

twentieth-century movements to preserve, develop, and revive this ancient medical system.5

(Leslie, Croizier 341)

As Croizier states above, Chinese medicine has undergone extensive ideological construction in

the 20th century that has been tied in with nationalism and power politics in China. Chinese

medicine has only recently been recognized in this way. Before the arrival of westerners in

China, Chinese medicine was simply medicine. The diversity of practices and theories that were

present is startling, and could hardly have been grouped together in an organized manner as they

often are today under the moniker “traditional Chinese medicine.”6 When westerners began to

introduce biomedical practices into China in the 18th and 19th centuries, Chinese medical

practices began to distinguish themselves more explicitly. However, as China moved towards

modernization following the fall of the Qing dynasty, traditional Chinese medical practices were

pushed away from the state in favor of western biomedicine for political reasons in an effort to

“westernize” (Andrews 1996).7 Despite this, practices like herbal treatments and acupuncture

continued to be prevalent in Chinese society and survived as a folk practice for many years.

5 See his essay titled “The Ideology of Medical Revivalism in Modern China” for more on this topic. He also writes the following: “Medical revivalism in China, as with revivalism movements in general, has not represented the preservation or resurrection of an intact tradition, but rather a reaction to major historical changes that has in turn created something new instead of restoring something old” (Leslie, Croizier 341).6 For example, Paul Unschuld has a fascinating chapter about the demonology present in early Chinese medical practices in his work Medicine in China: A History of Ideas. 7 The most famous event in this regard was what is known as the “Manchurian incident,” in which biomedicine was wildly successful in treating a massive epidemic whereas Chinese medicine failed (Andrews 1996, Lei 2014).

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Following the founding of the People’s Republic of China (PRC), something very

interesting happened to Chinese medicine. At first, the Marxist ideologists under Mao’s

leadership continued the denouncement of Chinese medicine practices as unscientific and

epitomizing the primitive past.8 However, in the 1950s, Mao decided to revive Chinese medicine

as a state-sponsored medicine, as it was a cheap way of providing healthcare to the masses,

which was a desirable goal for the young communist nation (Scheid 2002, Barnes 2005, Lei

2014). The PRC formed what has come to be known as “traditional Chinese medicine” (TCM) at

this time by compiling all the practices they thought fit well within their biomedical model and

did away with anything deemed “superstitious.”9 This system became a rallying symbol for

nationalism in China for the communist government.10 In addition, this history shows that the

process of “westernizing” Chinese medicine was occurring long before the introduction of

Chinese medicine into America in the 1970s.11 At the same time as the PRC was constructing the

TCM medical system in China, the United States was undergoing dramatic social changes in the

1960s that shook the public’s faith in established authorities. It was precisely at this time that

China and the United States came back into contact.

The Introduction of Chinese Medicine into the United States

Just months before Nixon’s historic visit to China in 1972, Pulitzer-prize winning

American journalist James Reston was hospitalized in Beijing for an emergency appendectomy.

8 Mao famously wrote in the 1940s that the “old doctors, circus entertainers, snake oil salesman, and street hawkers are all of the same sort” (quoted in Croizier 1968). 9 For thorough overviews of the fascinating history here, see Croizier 1968, Sivin 1987, Andrews 1996, Scheid 2002, Barnes and Starr 2005, and Lei 2014.10 In his introduction to Asian Medicine and Globalization, Joseph Alter writes about how intertwined these issues of nationalism are with the enforcing of the “traditional” label of Asian medical systems – TCM being the most dramatic example. 11 It should also be noted that this attempted integration of Chinese medical practices into TCM was particularly challenging since they had never been conceived in this way prior and were never meant to be synthesized in this way. See Barnes 1995 P. 326 and Unschuld 1985.

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The events that transpired in the following days were fated to be the spark for Chinese medicine

to capture the American public’s attention. Reston received acupuncture as part of his post-

operation pain management treatment, and described the unexpected and seemingly miraculous

success of the treatment in his famous New York Times article “Now, Let Me Tell You About

My Appendectomy in Peking.”12 Though this was by no means the first introduction of Chinese

medicinal practices into the United States, it certainly was the first mass media exposure for

Chinese medicine in the public’s eye.13 The timing of Reston’s article also contributed to its wild

popularity – the civil rights movement, the Vietnam War, and the rise of the “counter-culture”

society in America provided a window for embracing the radically different as a way to rebel.

“Unconventional medicines” began to rise as part of the “New Age” movement that vowed to

diametrically oppose the monolithic Western cultural model by emphasizing a radical pluralism

of spiritual and medical practices (Barnes 1995, P. 304-310). Chinese medicine practices, in

particular acupuncture, became a major face of this movement.14 The question then becomes:

why did Chinese medicine in particular become so popular so quickly? What about Chinese

medicine made it so appealing to this counterculture movement and to the American public in

general? In order to address these questions, we require a more in depth look at the philosophy

behind biomedicine and its accompanying limits.

12 For a great detailed analysis of the impact Reston’s article had upon the United States public, see Yongming Li’s article “Acupuncture’s Journey to America: A Turning Point in 1971.” 13 See Linda Barnes’s Needles, Herbs, Gods, and Ghosts: China, Healing, and the West to 1848 for the fascinating history of Chinese medicine in the United States prior to 1971. 14 In her 2013 ethnography, Emily Wu discusses other historical reasons for why acupuncture in particular became the face of Chinese medicine. In addition to Reston’s famous article, there also is the fascinating story of the first state legalization of acupuncture, which actually occurred in Nevada in 1973, not California. She writes that these two events, “one commonly mis-referenced and the other mostly forgotten,” sowed the seeds for acupuncture to be the face of Chinese medicine in America (Wu 2013, P. 31).

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Biomedicine, Spirituality, and Chinese Medicine

In his famous work Writing at the Margin: Discourse Between Anthropology and

Medicine, Arthur Kleinman works through the limitations of biomedicine that he argues are due

to its implicit culture and philosophical foundations. He writes that the radical reductionism of

biomedicine, while providing strength in determining pathology and treating specific diseases,

falls short of treating the actual person due to its dehumanizing nature.15 Kleinman also argues

that biomedicine has become so intertwined within society that our entire culture is based around

this kind of thinking – namely that there is only one way to do things, one truth, one true medical

system (Kleinman 1995, P. 27).

Kleinman’s point about biomedicine is not only a powerful consideration for those

practicing healthcare in the modern world, but also helps to explain why so many Americans

have been drawn towards alternative therapies in recent decades. As a result of the close ties

between medicine and society, not only just our medical system but also our society in general

lacks this spiritual aspect to it that addresses existential questions and legitimizes suffering. In

her PhD dissertation, Linda Barnes addresses the appeal of Chinese medicine to the American

public through its fulfillment of the religious and spiritual side of healing that biomedicine

lacks.16 Chinese medicine, with its focus on spiritual-sounding terms such as qi, fit the bill as not

only a spiritual medicine but also for presenting a radically different philosophical outlook on

health and healing from biomedicine.17 Barnes puts it well when she says that:15 This is due to the lack of an identifiable biological counterpart to existential suffering; it is no wonder that people have begun to turn to “spiritual alternatives” in recent years. (Kleinman 1995, P. 35)16 The West is not alone in this regard. See Nancy Chen’s book Breathing Spaces: Qigong, Psychiatry, and Healing in China for insight into the rise of qigong in China, where it seems to fill this same spiritual healing need by creating personal “breathing spaces” for one’s sense of self (Chen 2003, xii). 17 Barnes and Kleinman are very much in conversation here; in fact, Kleinman was one of her PhD dissertation advisors at Harvard, as was Ted Kaptchuk! Barnes argues that the mind-body separation that occurred in the development of Western philosophy also separated medicine from religion – religion became the cure for the mind, and medicine was for the body. This separation never occurred in Chinese medicine, which retains concepts that focus on integrated treatment of mind and body problems (See

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In the American context, however, Chinese practices… have been adopted, particularly by non-

Chinese, precisely because they are not “Western” or “scientific” in the biomedical sense (Barnes

1995, P. 406, emphasis added).

All of this was on top of the easily identifiable practice of acupuncture – for example, needles in

a patient’s face – that often graced the covers of popular newspapers and magazines. Chinese

medicine was well on its way to becoming a staple of the American counter-culture and of the

holistic health movement in general.

The Changing Face of Chinese Medicine in America

After many years of fighting to gain recognition and acceptance by the biomedical

community, acupuncture began to be recognized as a viable healing technique in a state-by-state

fashion, and as a result, America saw the opening of schools around the country as well as the

formation of state licensure boards to standardize practice. It continued to gain popularity for its

successes in treating illnesses that biomedicine could not quite get at, such as chronic pain and

illnesses, curbing addiction, and even mental health issues such as depression and anxiety

(Cassidy 1998, Kaptchuk 2000, Pang 2015).18 It seemed that Chinese medicine was becoming

another aspect of the healthcare system utilized by many people.

But what really was introduced into the United States? Linda Barnes writes that “what

came to America was a tradition in flux, emerging out of China’s own interactions with the West

and with Western practices” (Barnes 1995, P. 318). As interested Americans began to explore

Chinese medicine, most encountered the reformed system of TCM that had been “purged of

Barnes 1995, Introduction vi-x).18 Kaptchuk’s The Web That Has No Weaver has a thorough appendix that compiles scientific studies that have been conducted on Chinese medicine practices and their effectiveness for various conditions. But perhaps this focus on “proving” Chinese medicine misses the point – I have also cited Claire Cassidy’s extensive survey of Chinese medicine users in the United States, which is focused more on why the treatments were sought out in the first place, and if the patients felt “satisfied” with the outcome.

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superstitious elements” by the PRC. This understanding of Chinese medicine had already

undergone significant remodeling under a biomedical framework and featured significantly less

of the “traditional” aspects of the healing system that make it so much different from

biomedicine. As the years went by, curious practitioners and educators began to discover many

aspects of Chinese medicine that were not included in the TCM curriculums in China, which

were also the basis for the American schools and certification boards. This discovery began to

lead to self-reflective questions amongst the Chinese medicine community in America: was the

continuing of integration with biomedicine the right path or was a return to the classics of

Chinese medicine the right path?19

An important aspect of this issue to keep in mind is the fact that the incorporation of

Chinese medicine practices into the United States has changed the nature of those practices from

the norm in China. Linda Barnes describes this well:

In the course of being transplanted from China into the United States, a rich and complex body of

traditional healing practices has been filtered through not only a foreign language, but also a

foreign way of thinking. This is not unique to this particular movement; rather, it has

characterized the passage of any tradition from one culture into another. (Barnes 1995, P. 732)

Specifically, Barnes is referring to the fact that because Americans were looking for a foreign

medicine that would be able to emphasize different things than biomedicine, their construction

and study of Chinese medicine has taken on a new form from the original in China. Chinese

medicine here is therefore more focused on the spiritual aspects than the physical treatments,

which accounts for the relative paucity of interest in herbal remedies in America while herbal

19 One of the most vocal proponents for the return to the classics, which is referred to under the moniker of “classical Chinese medicine,” is Heiner Fruehaf, founding professor at the School of Classical Chinese Medicine at the National College of Natural Medicine in Portland, Oregon. He has formed an impressive group of scholars in both America and China advocating for a renewed look at Chinese medicine through closer adherence to the original texts. See their website https://classicalchinesemedicine.org/ and Fruehaf’s famous article in the Journal of Chinese Medicine (Fruehaf 1999).

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therapies are the most popular traditional Chinese medical practice in China.20 The

anthropologist Mei Zhan writes about how this cross-cultural interaction has actually been the

norm for Chinese medicine, and that these kinds of interactions are what make Chinese medicine

what it is today. She cites, for example, how TCM was originally cast as a medicine for the poor

in rural China under Mao, but after its growth in popularity in the United States, it morphed into

a preventative medicine for the urban middle class (Zhan 2009). There is no doubt that Chinese

medicine in America has begun to take on a life of its own – and Minnesota is no exception.

Chinese Medicine in Minnesota

Though Chinese medicine in America gained its first foothold in California and on the

East Coast, it has gradually spread throughout the nation. As of 2013, 44 states had licensing

systems for practitioners in their states.21 Minnesota stands as one of the leaders in the Midwest

for acupuncturists, but still remains small when compared to the massive communities of

California, New York, and Florida. In the resurgence of alternative medicines in the 1990s,22 two

schools that offer the “master’s in oriental medicine” (MaOM) degree were opened in

Minnesota: Northwestern Health Sciences University (NWHSU) in Bloomington, and the

20 For an examination of the differences of Chinese medicine practices in China and America, see Farquhar 1994 and Hsu 1999. Another reason why herbal therapies have been slow to come in the United States is by their perceived lack of regulation – often rightfully so – by both the biomedical community and patients in general. See Lu et al 2014 for an overview of the issues in Chinese herbal medicine in American society today. 21 See the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) website for more data.22 What is commonly referred to as the “resurgence” of alternative healthcare in the 1990s was actually just a newfound awareness for their popularity by the biomedical community. This awakening was sparked by the publication of the article by Eisenberg et al titled “Unconventional Medicine in the United States” in the New England Journal of Medicine. The article featured data from a survey conducted on American’s use of alternative healthcare practices, showing that 33.8% of Americans had tried an alternative healthcare practice in the past year. This astonished biomedical practitioners across the country and contributed to the perception of a “resurgence” of alternative healthcare in the 1990s, which had really been continually rising for the previous two decades (Eisenberg et al 1993).

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American Academy of Acupuncture and Oriental Medicine (AAAOM) in Roseville.23 Once this

community formed, Chinese medicine practitioners were able to gain state recognition, licensure

boards, and other infrastructure to support them as a legitimate healthcare practice.24 In the two

decades since, acupuncturists and herbalists have become commonplace throughout the state,

mostly centralized around the twin cities area. Chinese medicine seems to be everywhere, from

health food stores to the Mayo Clinic (Bauer 2015). For the ethnographic portion of this paper,

we visited clinics and herbal shops and interviewed practitioners and educators from around the

state in order to put faces to the complexities of defining the presence and practice of Chinese

medicine in Minnesota. There have been a handful of similar ethnographies, albeit more

thorough as ours is still a work in progress, that have been done on Chinese medicine

practitioners, educators, and patients in the United States, but they have been focused on either

California or Boston (Barnes 1995, Zhan 2009, Wu 2013). Our ethnography follows in the

footsteps of these three works and demonstrates that the same issues and conflicts are also

present in Minnesota.25

In Your View, What is Chinese Medicine?

23The first school for Chinese medicine in Minnesota was the Minnesota Institute for Acupuncture and Herbal Studies, founded in 1990. Northwestern Health Sciences University incorporated them into their school in 1999. The AAAOM was founded in 1997. 24 This concept of what defines a “legitimate” healthcare practice is also up for debate. Mei Zhan argues that this concept of “legitimacy” is actually tied into how well the system fits into a biomedical model – hence the presence of licensure boards, integration in hospitals, and extensive medical trials gives Chinese medicine, in particular acupuncture, “legitimacy” in many medical practitioners’ and patients’ eyes (Zhan 2009). To get a sense of how controversial this issue is, take for example Joseph Alter’s comments from Asian Medicine and Globalization: “To question the status of Ayurveda or TCM as medical systems – not just to question their relative efficacy but their systemic integrity – might be regarded as the ultimate postmodern insult added to the injury of colonial and postcolonial Orientalism” (Alter 2005, P. 17).25 It should be noted that this ethnography is still ongoing and likely leaves out many important voices in Minnesota’s Chinese medicine community. We are grateful for those who were willing to be the first participants in this project without knowledge of how the product would turn out.

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The question we started every interview with was simple: “what is Chinese medicine and

what are its major differences with biomedicine?” However, what we thought would be a simple

question turned out to elicit many differing responses. As discussed earlier, Chinese medicine

has many fundamental differences with biomedicine, but the differences emphasized depends on

who you are talking to.

For acupuncturists and herbalists looking to define themselves against the biomedicine-

dominated healthcare system, practitioners will point to not only the dramatic differences

between Chinese medicine and biomedicine, but also especially to the aspects that would be

useful for someone in the biomedical healthcare system looking for an alternative. It is for this

reason that it is uncommon for independent practitioners to describe Chinese medicine in a way

that makes it sound like it would integrate very well with biomedicine. Take how one small-town

practitioner, who we will call Rachel,26 describes Chinese medicine:

TCM looks at the whole person, meaning the body, mind, and spirit or soul. We focus on the

body and mind so that your soul can flourish and be transformed. TCM focuses on restoring

health and bringing the body back into balance through yin and yang, or heaven and earth, as we

encourage the body to do natural healing.

Notice how the description of TCM implies that biomedicine does not treat the body, mind, and

spirit. As discussed earlier with Kleinman’s analysis of the limitations of biomedicine and

Barnes’s analysis of the religious sides of medicine, this description of Chinese medicine is very

strategic in that it hints at the ability of Chinese medicine to account for this spiritual side of

26 Though all participants agreed to allow their names to be used, I have changed their names and purposely kept their identities unknown, as I don’t think it necessary to cite them by name. All of the comments explicitly cited were either from filmed or recorded interviews, or by typed responses to the questions. Any other references to their thoughts were from personal conversations and I take responsibility for any mistakes and misinterpretations made in this paper.

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illness and suffering. This is a great example of how Chinese medicine has continued to adapt to

patients’ desires by becoming more focused on the spiritual aspects of the medicine.

On the other hand, there are those who practice Chinese medicine in conjunction with the

healthcare system, either by working at a biomedical institution or by being a biomedical

physician themselves. While these practitioners will still discuss the differences between Chinese

medicine and biomedicine when asked, their emphasis tends to gravitate more towards Chinese

medicine being another valuable tool in the toolbox to help patients. One biomedical practitioner,

who I will call Kelly and who utilizes acupuncture in her practice, said this about Chinese

medicine in the United States:

It’s not magic. I think there is a portion of the population in the United States that would like to

think that some alternative form of healthcare is magic. Traditional Chinese medicine is not

magic. It is another way of helping people to feel better and to live better.

Not only does Kelly hit at one of the major underlying reasons for the rise in alternative

healthcare practices, but she also presents it not in a mystical form but as simply another

healthcare tool to treat patients.

Why do these two practitioners present Chinese medicine in such different lights? A

possible answer lies in issues of establishing legitimacy and trust amongst their patients, which is

crucial for a medical provider.27 For independent acupuncturists and herbalists who aren’t

explicitly connected with the biomedical healthcare system, their patients will be looking for a

treatment that presents their illness in a completely different framework from biomedicine. It is

no surprise then that these practitioners have learned to craft their pitch about Chinese medicine

to make it as appealing as possible to those patients looking for an approach that takes into

27 I am grateful to Professor Tom Williamson at St. Olaf College for pointing out the importance of this to me.

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account all the things that, as Ted Kaptchuk says, “biomedicine often leaves… in the waiting

room” (Kaptchuk 2000, P. 298).

However, in a biomedical environment like a hospital, most patients are looking for the

standard biomedical presentation and treatment of their illness. Practitioners that use Chinese

medicine in this context are therefore much more likely to present it as simply another treatment

option, and, just like Kelly, will focus less on the mystical aspects and more on the “practical”

side of the medicine.

Why Chinese Medicine?

Why have so many Americans become drawn to Chinese medicine? This was a question

we set out to address before starting the ethnography, but as it became clear that the field was

dominated by the presence of non-Chinese Americans, this question became one of the main

focuses of our research. This question is also one of the main focuses of the other ethnographies

that have been done on Chinese medicine in the United States (Barnes 1995, Zhan 2009, Wu

2013) and we follow their lead with our analysis.

The majority of non-Chinese practitioners will cite some sort of encounter with Chinese

medicine that either healed an ailment of their own or of a close friend or family member. In

addition, most practitioners actual came to Chinese medicine after already having another

career.28 Since Chinese medicine has become so popular as an alternative “last resort” for

patients who cannot seem to be healed by biomedical means, when it works it is often seen as

miraculous to the patients.29 The following stories, while not all explicitly framed in this way,

28 There is not enough room here to go into demographics of those who become Chinese medicine practitioners in America, but the general trend is that they are majority female, majority second-careers, and majority white middle class. See Wu 2013 for an extensive survey of demographics.29 Mei Zhan has documented this phenomenon well in both her journal article on the subject as well as her book Other-Worldly: Making Chinese Medicine Through Trans-national Frames. Not only do the

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either contain hints of the miraculous or at least discuss their decision to pursue Chinese

medicine in a spiritual and religious context.

Rachel, the small-town acupuncturist from earlier, describes her path to Chinese

medicine in the following way:

When I was thirteen years old, I had a motorcycle accident that injured my spine and I developed

chronic allergies at that time. My neck and back pain was always present and dull. For three

decades, I constantly suffered from allergies, bronchitis, and respiratory issues. I was tired and

frustrated… sound familiar? I continued to try other forms of treatments, however my pain

continued to grow in intensity which began to affect my body rotation, mobility, and daily living

activities including driving. My hands, arms and shoulders were falling asleep all the time. At a

high school sports banquet, a friend walked up to me and said, “Why don’t you try acupuncture

as I see you are in a lot of pain?” I was desperate and would try anything! The next day, I went to

an acupuncturist and my pain that I had for years was gone after two hours.

When asked about her plans for the future, Rachel was quick to note the benefits that Chinese

medicine had for her spiritual well-being as well:

I do and will continue to believe in this medicine for my own personal health and it will carry me

long after I am done treating patients. We have to believe in our path on earth from our higher

power, entrust in the journey on the path that we are given and take risks and have faith in what

we are doing… If I become stressed, I have a beautiful non-invasive medicine at my fingertips to

use: TCM. More importantly I have my Christ centered faith to guide me and meditation and

prayer.

For Rachel, not only was her healing experience with Chinese medicine miraculous, she also ties

in her religious faith very tightly with her Chinese medicine practice. Again, this reinforces

Barnes’s argument as to why Chinese medicine has become so popular in the American public

patients seek these miracles, but even the practitioners often portray their successes as miraculous as well (Zhan 2001, 2009).

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due to its focus on the spiritual elements of healing that biomedicine seems to leave out (Barnes

2005).

Another practitioner from the twin cities, who I shall call Andrew, describes his

introduction to Chinese medicine in similar miraculous language:

When I first experienced acupuncture, I had been in a car accident and had neck pain and a

migraine for probably three months. I was at school in Mankato – in a martial arts class – and my

teacher paid for me to go to California to see an acupuncturist, and within the first five minutes

my migraine was gone. It was kind of a strange experience. Then the following day I came back

for another treatment, and just five or six needles were placed in me, and the first one I felt was in

my forehead and it felt like I started bleeding – but there was no blood on my forehead! It still felt

like there was something warm on my face… That was what got me into acupuncture.

Another independent acupuncturist, who I will call Anne, describes her path to Chinese medicine

in the following way:

I knew I was going to be an acupuncturist before I’d even had an acupuncture treatment… I was

taking an Anatomy and Physiology prerequisite and had gone to see the Body Worlds exhibit at

the science museum in Minnesota with a few classmates. I remember sitting outside the museum

afterward, telling them that I was going to be an acupuncturist. Even though I’d never had an

acupuncture treatment, I just knew.

For independent practitioners like Rachel, Andrew, and Anne, building this sense of trust with

their patient hinges upon if the patient believes that it will work, which may explain why they

often resort to this miraculous language in describing their first experiences with Chinese

medicine. For patients looking for a miracle cure, spiritual language may heavily impact their

decision of what practices to try.

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However, as described earlier, this may be different for someone practicing in a

biomedical context. Kelly, the biomedical physician from earlier, does not cite a miraculous

encounter with acupuncture as the reason for her interest in Chinese medicine, but instead cites

the efficacy of Chinese medicine practices in treating illnesses she cannot tackle with

biomedicine.

As wonderful as Western medicine is, there are gaps, there are holes, there are things that we

don’t do well and people that are left suffering. So I was looking for what else is available to help

people that are suffering.

Another healthcare practitioner and Chinese medicine educator, who I will call Page,

encountered Chinese medicine during her training as a chiropractor:

When I graduated with my chiropractic doctorate, I’d had some initial beginnings of education in

acupuncture, and I used it with patients mostly for musculoskeletal and orthopedic types of

conditions, but I knew there was more to the philosophy… I began to use it with my patients from

a more traditional perspective to work with a whole range of conditions.

Both Kelly and Page cite the clinical advantages of adding Chinese medicine therapies into their

practice as a major reason for pursuing Chinese medicine, again since they are in a biomedical

context and therefore are working with patients who usually already have trust in their healthcare

provider and therefore need less convincing.

This tension between how practitioners present Chinese medicine does not stop only at

explaining their interest in Chinese medicine. In fact, the tension between these two camps – the

practitioners who see Chinese medicine as a valuable compliment to biomedicine versus those

that see it as a stand-alone system – has only increased over the last few decades, as Chinese

medicine practitioners struggle to find define their identity in relation to the towering biomedical

healthcare system.

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The Struggle for an “Authentic” Chinese Medicine in Minnesota

In her 2003 article in the journal Medical Anthropology, Linda Barnes wrote about what

she called “The Acupuncture Wars” in Boston, referring to the controversy that had overtaken

the Chinese medicine community in recent years. She begins the article with the following

comment, addressing the developing identity crisis of Chinese medicine practitioners:

Individuals who once saw themselves as counterculture guerilla figures must now undergo

increasingly complex examination and licensing procedures, along with an educational system

that, in certain respects, bears a growing resemblance to biomedical training… Acupuncturists

have confronted the dilemma of how to define themselves not only as practitioners in relation to

an emerging Americanized version of Chinese medicine but also in relation to definitions of

biomedical professional identity, which are currently in flux. In the midst of this mix, some

acupuncturists favor standardizing practice; others adamantly adhere to a pluralistic model

(Barnes 2003, P. 262).

Indeed, this tension between those who favor standardizing Chinese medicine in the United

states into the biomedical system of “integrative medicine” and those who would see Chinese

medicine as a stand-alone system that loses its uniqueness when integrated is what Linda Barnes

calls “The Acupuncture Wars.”

This controversy is alive and well in Minnesota, albeit perhaps in less dramatic fashion

than on the East and West coasts. In an effort to differentiate themselves from each other,

NWHSU and AAAOM have developed two unique pedagogical and philosophical approaches to

teaching Chinese medicine, and in turn seem to represent these two opposing sides described

above. NWHSU looks to define itself as an integrative “health sciences university” and focuses

on extensive clinical experience in biomedical environments as well as a curriculum that features

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many classes in biomedical science. On the other hand, the AAAOM pitches themselves as the

“only authentic Chinese medicine school in Minnesota” with a curricular focus on Chinese

cultural and philosophical foundations of Chinese medicine.30

The Chinese medicine educator Page referenced earlier hints at this tension when

discussing the challenges that Chinese medicine education faces today in the United States:

One of the things that is in danger for the schools is that if you are a single practice and a single

focus school – all you do is the Asian medicine piece – your resources might be a little more

limited. You might teach a more traditional form of the philosophy, which is great, but you may

be more limited because you don't have the connections or a referral system for integrative care…

So then you run the danger of some of those smaller schools being closed. The multipurpose

schools have the bigger problem. Though there are more resources there, there is also this process

of trying to assimilate with other systems… To fight for the continuance of the philosophy of the

traditional medicine, but still acknowledging the need for the integrative and referral process to

happen; that’s a constant battle. You’re either compromising the philosophy of the traditional

medicine or you might lack the resources to keep it going.

Page describes well the two paths that Chinese medicine practitioners feel they must choose

between – either to compromise and support integrative medicine or to guard the traditional

theories with the possibility of getting lost in the massive biomedical healthcare machine.

Tricky Relations with Biomedicine: Integration and Rejection

The Chinese medicine community today seems to be left with two options: integrate with

biomedicine or turn against it and reject all the prestige and recognition it has enjoyed through

30 An exploration of the two schools’ websites and examination of the handouts both schools give to prospective students is telling of this.

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scientific studies, employment at hospitals, and growing state and federal infrastructure. But

perhaps this dichotomy is too extreme. Linda Barnes writes of this issue:

The acupuncture community, in other words, rather than acquiescing to a reductionist version of

practice, is simply making flexible and creative use of it to secure legitimacy. It has been for

similar reasons that courses in anatomy and other aspects of biomedicine have been introduced

into the curricula of acupuncture schools… Nevertheless, most practitioners, when speaking

within their own circles, are clear that biomedical models have little to do with Chinese healing.

(Barnes 2005, P. 326)

In fact, in conversation with educators at the two schools in Minnesota, many in the Chinese

community are very aware of this and will do things like teach classes in the “classical Chinese

medicine” framework, while also encouraging their students to participate in integrative models.

Practitioners we spoke with at biomedical institutions were also quick to note this advantage of

being able to present two systems to their patients depending on what the patient was looking

for. There may not be as much of an “acupuncture war” after all.

Conclusions and Reflections on the Future of Chinese Medicine

There is this dual perception that Chinese medicine is both “the fastest growing

healthcare practice in America” as well as a “frail old man trying to make his way through wind

and rain” (Shengming Shibao 2006, quoted in Zhan 2009). Perhaps both are correct – Chinese

medicine, as it was once known to the peoples of China prior to the fall of the Qing dynasty, is

nearly extinct, whereas something entirely new has developed and continues to grow and change

in both China and the United States.

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Chinese medicine has without a doubt adapted to its environment incredibly well, as

noted earlier in the discussion of Mei Zhan’s argument in Other-Worldly: Making Chinese

Medicine through Transnational Frames.31 For better or worse, Chinese medicine will continue

to integrate with biomedicine, for, as Harriet Beinfield and Efrem Korngold write in Between

Heaven and Earth: A Guide to Chinese Medicine, “Americans, like the Chinese, are quite

pragmatic – Chinese medicine meets their need, so people try it; it helps, so they come back for

more” (Beinfield and Korngold 1992, P. 14).

I think there will also be what I will refer to as “reverse-integration” that will continue to

occur between Chinese medicine and other alternative healthcare practices. This can be seen in

the language that non-Chinese practitioners use to describe Chinese medicine to other non-

Chinese patients – for example, describing qi in concepts like energy or vitality, tying it into the

age-old western traditions of vitalism and homeopathy whether they intend to or not.32 We can

see evidence of this in Rachel’s comments earlier when she tied her religious Christian faith in

with her practice of Chinese medicine – a possibility that would have been unimaginable to the

ancient Chinese physicians who first compiled the Huangdi Neijing.33

Chinese medicine should continued to be studied from a medical anthropologist’s

perspective because its popularity in the United States is indicative of a changing shift in what

the American public wants from their health care system. If the health care system’s true purpose

is to provide the best possible care for the most possible people, then health care providers 31 Zhan also notes how the model of biomedicine as rationalizing and fragmenting traditional practices is not entirely wrong, it does not account for the complexities of how the two have developed and adapted to each other’s presence. Indeed, Zhan agrees that just because Chinese medicine has been forced to become integrated does not mean that there is not ways it can adapt and grow into something new – perhaps even something better (Zhan 2009, P. 72).32 Mei Zhan and Linda Barnes have also pointed this out in their writings, with Barnes being the most thorough in describing the cross-pollination that has occurred between Chinese medicine in the United States and other “new age” practices (Barnes 1995, Barnes and Starr 2005).33 The Huangdi Neijing is the earliest and most important work in the Chinese medicine canon – Ted Kaptchuk refers to it as the “Chinese equivalent of the Hippocratic corpus” (Kaptchuk 2000, P. 25).

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cannot ignore the rise of alternative healthcare practices like Chinese medicine across the nation.

As practices like acupuncture and herbal medicine continue to rise in popularity, they will also

continue to become incorporated and integrated into the biomedical system, whether they desire

to or not.34 As we have seen, this has been the cause of much tension and controversy in the

Chinese medicine community, and Minnesota is no exception.

The presence and practice of Chinese medicine in Minnesota will likely mirror the

national trends discussed above, with perhaps more of a national spotlight coming to Minnesota

in the years ahead. The state is home to many well-respected biomedical institutions that are

exploring integrative health options, employing acupuncturists, and producing studies to help

open the minds of the biomedical community. As for the schools and independent practitioners,

there will continue to be challenges for both until further integration with the biomedical

healthcare system occurs.35 This paper has demonstrated that the same issues of identity within

the Chinese medicine community are present in Minnesota, but there is perhaps less of a

dramatic crisis than has been previously thought.

Chinese medicine will continue to fascinate all of those who come into contact with it,

regardless of background. Medical anthropologists will continue to study the evolution of this

uniquely modern cross-cultural interaction, biomedical researchers and physicians will continue

to document its scientific basis,36 and, of course, many in the American public will continue to be

34 There actually has been some debate as to how quickly Chinese medicine in the United States has been growing (Burke et al 2006). Though it has received a lot of international recognition as well as media attention, how many people actually utilize acupuncture? As of 2012, it seems that the use of Chinese medicine is still steadily increasing, and that the lack of use may not be due to a lack of interest so much as a lack of infrastructure in the healthcare system to support that interest (Zhang 2012). 35 Challenges include underemployment, lack of extensive insurance coverage, and scarcity of solid scientific studies due to MDs being unable to study acupuncture without extensive training, and acupuncturists being unable to provide research studies on their own due to lack of scientific research experience (Stone 2014). 36 For an overview of how Chinese medicine has fared in the scientific community and the status of research of acupuncture and herbalism, see Xu et al 2013.

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drawn towards its newly constructed spiritual approach to healing. Ted Kaptchuk famously said

in 1986 that there has never been a “declaration of independence” by Chinese medicine in the

West from its counterpart in China, but it is hard to deny the complex changes Chinese medicine

has undergone in the United States to make it so radically different from the conception of

Chinese medicine formulated long ago in ancient China.

Acknowledgments, Challenges Faced, and Future Directions

This research would not have been possible without the many friends and colleagues who

assisted us in conducting the research, finding contacts, and encouraging us along the way. Our

website, http://pages.stolaf.edu/tcm/, has a full list of acknowledgments on it and we direct our

readers there.

There were many challenges in trying to conduct this research, the most debilitating of

which was trying to find contacts willing to participate and share personal stories with us.

Without an example product to show them, we were mysterious researchers emailing them to

talk about Chinese medicine. We hope that our website and this paper will help to boost

involvement with the project.

Due to the small window of time that both this research was done in as well as the limits

in scope for this paper, there were many topics related to Chinese medicine in Minnesota that we

were unable to address. In the future, we hope to build off of the topics addressed here as well as

examine two more topics. The first is the stories of ethnic Chinese medicine practitioners, and

their opinions on the changes Chinese medicine has undergone in Minnesota and the United

States in general. From speaking to a few in our research, there is as much disagreement and

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complexity here as within the non-Chinese community. Does one need to know Chinese or be

familiar with Chinese culture to practice true Chinese medicine?37

Secondly, we also hope to address other impacts upon identity in the Chinese medicine

community such as by other healthcare practitioners who are starting to utilize similar practices

to acupuncture. Chinese medicine practitioners in the US have become defensive recently over

different issues such as “dry needling,” the lack of licensure for biomedical physicians, and the

appropriating of Chinese medicine practices by health food gurus, yoga teachers, and others with

little to no background in Chinese medicine practices and theories.38 These issues again raise

interesting questions of status and identity within the Chinese medicine community, which, as

addressed above, are as constantly in flux as the bodies they treat.

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