AMERICAN ACUPUNCTURE COMES OF AGE:
PERSPECTIVE FROM THE FRONT LINES
MARK D. SEEM, PH.D., L.AC., DIPL.AC.

In the Winter of 1977, I encountered acupuncture, and my fate was sealed at that unlikely moment. As iso often happens, as ifby chance but moved by some logic all its own. Some context first, before the story unfolds.

I had recently completed my doctorate in philosophy at the State University of New York in Buffalo. My doctoral thesis, The Logic of Power, explored the influence of Nietzchean thought in the works of the celebrated philosophers Michel Foucault and Gilles Deleuze, and the militant intellectual Felix Guattari. It was the late Foucault who set me on my way. During a critical period in my own personal and intellectual development, Foucault and I became friends when he was teaching at SUNY at Buffalo, in the Fall of 1971.1 asked Foucault what I might read to guide me through my own process, and he gave me Nietzche's Gay Science and Genealogy of Morals. The imprints of these gifts still make their weight felt when I think seriously about anything cultural, political, intellectual. I saw Foucault's work as decidedly Nietzchean, and was fascinated by Foucault's analysis of the relativity, and specificity, inherent in any particular period's attempt to understand the normal and the pathological, sanity and unreason, health and disease, civility and criminality, sexuality and transgression. From Madness and Civilization and The Birth of the Clinic, to the final volumes of The History of Sexuality, Foucault continued the Nietzchean quest after a history of the underside of things, the non-rational, the non-spoken, the discourses of the mad, the incarcerated, the deviant and the sick. What Foucault showed in each instance was that, in investigating the ways in which a culture at a specific time defines what is abnormal, tainted, deranged, criminal, sick, one gains a powerful inside look at that culture's specific way of molding and shaping its reality, its normality, its health, its truth. The relativity of what is termed normal and pathological fascinated me, and led to an interest, first, in the anti-psychiatry movement, which I became an active participant in, and eventually to other modes of defining health and disease, and acupuncture's views in this matter.

This anti-psychiatry stage in my development led me to meet a prominent French anti-psychiatrist, the late Felix Guattari, whose book co-authored with Gilles Deleuze radically transformed my views of reason, insanity and the attempt to treat madness. That book, Anti-Oedipus: Capitalism and Schizophrenia took center stage for two years in my life, while I was cotranslating it with my university friend Robert Hurley, who went on to become Foucault's translator. I wrote the introduction and Foucault wrote the preface to this amazing book which sent shock waves through the French psychoanalytic and leftists worlds. There again, I learned to think by questioning the underside of things and by taking nothing for granted with respect to the attempt to institutionalize the care of the mad, the deviant, the sick.

Fresh from the influence of these powerful thinkers, in the Fall of 1977, I attended a lecture on acupuncture drug detoxification at Lincoln Hospital in New York. The talk was given by former drug counselors who trained in acupuncture in Montreal. When I was introduced to them later by a mutual friend, they learned that I translated and asked if I would translate some things from the French for them. I was immediately struck by the concepts of forces and energetic transformation in the French acupuncture material I translated, and I began to study acupuncture, first at Lincoln with a group of fellow students interested in working against drug addiction and its related problems in the South Bronx, and finally at the Quebec Institute where these teachers had trained. I completed a translation, for my doctoral project at the institute, Dr. Nguyen Van Nghi's seminal Energetic Pat hogenesis and Pathology in Chinese Medicine, which unfortunately was never published.

Shortly after I graduated, I was approached by some faculty and students from the Lincoln detox program, and was asked to teach them from the French texts I studied and translated. This became a branch of the Quebec Institute, and early students were required to attend seminars at the Montreal school with the main French teachers Van Nghi, Schatz and Father Larre. When I explored the legal ramifications of running an acupuncture school in the United States, I realized I had to set up separately from the Quebec Institute, and was delighted to find that Connecticut had no statutes that prevented my new school from becoming approved there, which it was in August 1982.

This move from French philosophy to French acupuncture was an effortless one for me, as it took me right into the middle of medical anthropological matters akin to Foucault's work and my experience in the anti-psychiatry movement. While the English language translations of texts from the People's Republic of China (PRC) bored me with their obvious political indoctrination (Yin/Yang portrayed as early Marxist dialecticts!), the French texts were replete with a careful scrutiny of the entire human energetic story of pathways that could be influenced by external stimulation. The French felt that acupuncture provided a medical model of energy in keeping with Einstein's energy model newly accepted in the field of physics. This pre-Traditional Chinese Medicine (TCM) view of acupuncture began for me with Van Nghi and Chamfrault's concept of three levels of energetic disturbance, wei, ying, and jing, which I term surface energetics, functional energetics and core energetics. Van Nghi stressed in his works that fully 70-75% of an acupuncturist's ambulatory practice consisted of problems at the surface (wei) energetic level., and he advocated tendino-muscular treatment in these cases to free up the surface and resolve the constrained qi inherent in such conditions. Tender points were critical in such cases, and had to be deactivated to restore normal flow of qi through the meridian systems. The Quebec Institute curriculum, which I adopted in toto in my own school from the beginning, focused on the meridian systems (channels and collaterals) in the first year, based on this notion of levels, leading to a study of ZangFu pathology in the second year. But even in ZangFu disturbances, I learned, and still teach, that a large part of the problem is surface energetic in nature, with constrained qi which needs to be located (by palpation of the body) and dispersed.

Then, one Christmas, Ted Kaptchuck's The Web That Has No Weaver appeared. I had met Kaptchuck before the book came out, and reviewed it for the American Journal ofAcupuncture. While it was the most clearly written text on TCM in English, it also held kernels of an American rebelliousness that suggested we ought to question these Chinese concepts, first learning them in their own terms, as we sought to transport this major Chinese, culturally-defined view of health and disease, to the West. While Kaptchuck was already openly critical of the TCM form of Oriental medicine and acupuncture when his book appeared in English, the popularity of the book helped, along with Bensky and O'Connors translation,Acupuncture:A Comprehensive Text, to lead to the establishment, along with the PRC's Essentials of Chinese Acupuncture, of a core curriculum that all schools began to merge into their own programs. Even the National Commission for the Certification of Acupuncturists (NCCA) followed suit, with these three texts listed as main texts for the first examinations administered by the NCCA.

And there is the rub. American practitioners of acupuncture and Oriental medicine, trained in various pre-TCM as well as TCM styles, dedicated themselves to the establishment of an Amen-can acupuncture. They met out of political need, and soon developed an enormous respect for the richness and diversity of American acupuncture. In the early days of the development of the various national acupuncture organizations, those present represented a wide diversity of schools of thought: Bensky and Gamble and Kaptchuck from a TCM tradition; Duggan and McCormick from Worsley's Five Element style; Matsumoto representing various Japanese traditions; Kutchins and Eckman representing an amalgam of traditions that included Korean styles; Seem from the Quebec Institute's French tradition; Manuele from Mary Austin's Five Element tradition; Zmienski and Davis, familiar with many French and English styles; many practitioners influenced by the teachings of Dr. So at the New England School of Acupuncture, including Stephens and Skelton; and a host of others trained with masters here in this country who had fled the communist regime in China. What characterized this early group of pioneers of American acupuncture was a respect for the enormous diversity of acupuncture traditions and styles. This was paralleled by the development of the first serious training program for physicians by Dr. Joseph Helms for the UCLA Extension Division. Helm's training in various French acupuncture styles brought French medical acupuncture into the training of American physicians, and represented another major non-TCM style of teaching and practice. With such a spirit of diversity, how did the American acupuncture profession become monopolized by TCM ideology and politics? The next part of the story unfolds.

A Standardized American Acupuncture?

At the San Diego meeting of the American Association of Acupuncture and Oriental Medicine (AAAOM) in 1982, the National Council was conceptualized by those of us on the Education Committee oftheAAAOM. Afew months later, at a meeting at the Midwest Center in Chicago, the Council was officially established, and those present set themselves the task ofestablishing a national accreditation commission to establish acupuncture schools at the federal level and open the way for federal student loan programs, and a national certification commission to establish a national board examination process in acupuncture. Over the next 8-10 years, many of us served ontwo orthree national groups, devoting the energy and dedication that was needed to make all of these organizations happen. The spirit of diversity was present to a very high degree at every meeting, and we were all forced to recognize and respect diversity and difference in acupuncture practice. At the Chicago meeting, it was agreed that it was not a question of whose teacher or whose style was superior, but of how we could officially establish acupuncture nationally without losing the right to think and teach and practice our own traditions and styles. Edith Davis stressed the need to articulate the basic skills and competencies required for entry-level practice, not for advanced mastery, and those basic skills and competencies were established as a blueprint by the NCCA in cooperation with and guided by the Professional Examination Service. This blueprint was established by a panel of experts representing every tradition practiced in the United States, and no one tradition prevailed. The blueprint was generic and inclusive, and every effort was made to be as open as possible to diversity. When the first examination questions were written, the writers had to cite a published English language reference, and since the majority of English language texts at that time were TCM, the questions were heavily TCM in their orientation. I would venture to say that if Matsumoto and Birch's texts on Japanese acupuncture, along with Denmei's basic text, had been available, more Japanese acupuncture questions would have entered the examination. Likewise, if French texts had been available in English, I certainly would have felt comfortable writing questions on the tradition I learned.

Bob Flaws has written and lectured about the need, perhaps, to revisit the NCCA blueprint, and he and his wife and co-publisher, Honora Wolfe, are hosting a meeting of publishers, translators and authors in the Spring of 1993, to look at this question of the influence of what is published on the national examination and on the teaching of students in acupuncture schools.

In the early days of the national groups, everyone agreed to incorporate the generic curriculum, which included more TCM than perhaps before, into their schools' curricula in their own ways, while still teaching their own styles and traditions. The New England School of Acupuncture still continued to also teach

Dr. So's work and Japanese acupuncture more and more, the Traditional Acupuncture Institute (TM) continued its focus on Worsley's Five Element tradition, and Tri-State still focused heavily on French meridian acupuncture, and incorporated more and more Japanese acupuncture as Matsumoto became a key clinical faculty supervisor at the school. The reason we all agreed to teach the generic core curriculum and more TCM was to establish a basis for communication across traditions, not to supplant those traditions themselves. American acupuncture in the mid 1980s was a true melting pot, and was yet another example of the American spirit. As Paul Unschuld has written, it is impossible to transplant a cultural body of knowledge, in this case acupuncture and oriental medicine, without imbuing this body of knowledge with the receiving culture's own biases, proclivities, views and practices. It is normal and healthy and in keeping with the long story of the development of acupuncture and Oriental medicine, that a culture such as ours would alter these practices from the East to suit our spirit and mentality. And that is a good thing, I feel, for acupuncture, which suffered under the communist TCMization process, and was thereby turned into a second-class citizen with respect to herbs.

American acupuncture had from the start more depth and breath than TCM acupuncture, because TCM acupuncture was an herbalized system with much of the soul and spirit of classical acupuncture removed (no feeling for energetic or psychospiritual considerations). This is changing rapidly as practitioners in the PRC are beginning to speak in their own names and publish accounts of various ways of practicing, and as QiGong receives more attention. In brief then, there is no such thing as standardized acupuncture, neither in the United States nor in the PRC.

Unfortunately, those who espouse TCM as the true acupuncture, are a very vocal group and cite California as the show state, where herbology must be taught and tested and where TCM is the basis of most school courses of study.

What is curious about this position is that these same people agree that we acupuncturists and Oriental medical practitioners should have the right to practice our alternative forms of health care (with respect to allopathic medicine) and lobby for this right to diversity in health care at every turn. Yet, in their own meetings, behind closed doors, they show no signs of this spirit of diversity, instead demanding that all adhere to a politically correct line. And that is what TCM, forged in a dreadfully repressive communist period, inspires: strict allegiance, tyrannical behavior, monopolization and restriction of the right to do things differently. This is in direct opposition to everything acupuncture and Oriental medical philosophy and ethics teaches, and if teachers and practitioners in the PRC are now able to free themselves from the yoke of an ideological TCM to return to diversity in their practice of Chinese Medicine, we should be able to follow suit.

An Acupuncturist's Acupuncture

I for one love acupuncture in its own right, practiced in accordance with classical and modern, Chinese, Japanese, and French styles. I am always amazed at the wide array of possible treatment options with acupuncture, and ever more impressed by the similarity between classical acupuncture and modern connective tissue therapies and concepts, such as Feldenkrais, strain-counterstrain, myofascial release, cranio-sacral therapy, visceral manipulation and so forth. To me, the early acupuncturists were developing a complex myofascial therapy where application of pressure, heat, or needles, on the surface of the body, led to myofascial release, with all the resulting improvements in nervous, arterial, lymphatic and nervous systems and their flows. Acupuncture was a myofascial therapy, a therapy applied to ~ the body surface, and this external therapy made large-scale changes because it restored vital circulatory flows. The morel study concepts from Travell's trigger points to Barral's visceral manipulation to Still's early writings in the osteopathic method, the more I see acupuncture as a brilliant external, myofascial therapy: acupuncture osteopathy. Acupuncture is not internal medicine; it does not involve the ingestion of substances of any sort. So, when a person gets better after acupuncture treatment, it is clear the treatment merely removed some obstructions, cleared the way for the vital flows to move unimpeded. In acupuncture treatment, the patient heals him or herself, and the needle prod just facilitates this healing process. Like osteopathy, chiropractic and myofascial release, acupuncture is drugless therapy. Those who love it often do not wish to use internal remedies, Western medical or herbal, if they can avoid it, because they trust the bodymind's innate capacity to heal itself. They just help to remove obstructions, which acupuncture is especially capable of, and trust the patient will do the rest. Herbology, on the other hand, is an internal medical practice, and unfortunately in our culture often leads its practitioners to act like authoritarian doctors who know what is best for the patient. Scratch the surface of many herbal practitioners of the TCM tradition in the United States and you will find just such an authoritarian stance, quite at odds with the spirit that moves the acupuncturists I admire most.

Bob Flaws coined a term over the past few years that is very useful to describe the spirit of the acupuncturist. He called the acupuncture they practice an "acupuncturist's acupuncture", by which he meant an acupuncture informed by acupuncture concepts, meridian information and channels and collateral strategies. On the other hand, TCM acupuncture, Flaws has clarified, is an "herbalized acupuncture". Look at all the books on non-TCM styles of acupuncture published by Blue Poppy Press and Paradigm Publications over the past few years, and you find a wide diversity of very different approaches to placing needles into human flesh to heal body and soul. This is what an "acupuncturist's acupuncture" is made of: diversity, variations on the theme, integration of differing approaches. I feel fortunate that my school is on the East Coast, for here schools definitely respect this right to diversity. The New England School of Acupuncture still teaches the work of Dr. So, Japanese acupuncture and TCM acupuncture, and the study of herbs is optional. Likewise, at Tn-State Institute of Traditional Chinese Acupuncture, we teach meridian acupuncture from French and Japanese perspectives as our main focus, and integrate TCM acupuncture into this meridian perspective. Finally, at the Traditional Acupuncture Institute, Bob Duggan has always spoken out eloquently for the right to different styles and points of view, and they still teach primarily Five Element acupuncture according to Worsley, with some French influence by way of Father Larre and Elizabeth Rochat de la Vallee and some TCM. At Tn-State and TM, herbs are optional subjects, and are usually taught only to advanced students or graduates who have a firm acupuncture perspective first.

The Future of Acupuncture is at Stake

Those who espouse the California model as the national model are speaking out for 4-year programs (versus the current 3 years), that would include a heavy herbal component. They are also lobbying state organizations to drop acupuncture from their names, replacing the word "acupuncture" with "Oriental medicine". It is clear that they see acupuncture as a second-class citizen subservient to herbology, and it is clear they are moving fast to try to make the entry level into practice be the doctoral level, where one could not practice acupuncture unless one were trained as an Oriental medical practitioner. The current 3-year master's degree would be compelled to add a fourth year and an herbal concentration, or stop functioning, and these same people are prepared to lobby against any abbreviated training, that is to say, training of less than four years.

There are several things wrong with this model. First, it is inspired by the PRC's TCM model, and therefore sees acupuncture as part of Oriental medicine, as it is in China. But in this country, acupuncture developed, much as in Europe and Japan, independently from herbology and has achieved recognition as belonging to American mainstream health care, although admittedly still on the fringes. Secondly, in TCM traditional Chinese disease categories, as Flaws teaches, have been abandoned for Western disease taxonomies. Practitioners of TCM do not usually know how to diagnose a case of "running piglet syndrome", forexample, butratherkliOw how to classifY a case of premenstrual syndrome with angina and dyspnea in TCM pattern terms: but the key diagnosis, of PMS and angina was made by Western medical terms. Look at the textbooks from the PRC and you will see discussion of Western diseases that are then translated into TCM terms. In other words, 72CM acupuncture required close collaboration with a Western medical diagnostician, who needs to make the basic diagnosis before the TCM practitioner can make her or his evaluation in pattern terms and treat the patient. Acupuncturists, on the other hand, who practice any of the various styles of an "acupuncturist's acupuncture", are perfectly capable of making a working diagnosis in acupuncture terms that does not need to be refrained as a Western medical diagnosis for the practitioner to work. These acupuncturists, like.all classical practitioners of acupuncture and pre-TCM Chinese medicine evaluate and treat from acupuncture and Oriental medical categories: they are treating constraint in the liver channel, not prostatitis. They are treating a case of Liver (wood) invading Spleen (earth), not the dyspepsia of Western medicine. Ironically, it is these practitioners who are most capable of working independently from Western physicians, because they are treating constrictions and deficiencies they find on their own terms. Nevertheless, such practitioners are trained to seek a medical diagnosis and make referrals wherever appropriate, because they are very aware that they cannot make the primary Western medical diagnosis. Practitioners of TCM in this country, however, too often believe that if they have increased Western medical course work in their schools, they can make the primary medical diagnosis. This is a dangerous, arrogant, and erroneous assumption. It is not extra course work, but rather countless hours of residency in hospitals that makes Western physicians capable of this primary medical diagnosis. This model, viewing acupuncture as only a small part of the much larger Oriental medicine (read, herbology), is a dangerous trend that would make these practitioners claim to be primary health care physicians, which they are not. Primary acupuncture care providers, yes. But not primary health care. They cannot order or read major lab or other tests, they cannot admit a patient to a hospital, and very few if any of them wear beepers to handle life and death crises. And in the PRC, where this model of practice originates, there is always collaboration with Western medical practitioners, and Western medical diagnosis is the primary medical diagnosis.

Acupuncturists who are content to practice acupuncture in its own right must, therefore, must see that this Oriental medicalization of acupuncture is very dangerous regarding their very right to practice as they do. I believe the real counterpoint to this other trend is to see acupuncture as part of the American health care system and to seek to mainstream its practice as much as possible.

To me this means several things. It means first to articulate what is the nature and scope of acupuncture. What are its underlying premises, what are its modes of gathering and analyzing data? In what ways is it similar and how so, to Western medical practices (physical medicine, osteopathy, chiropractic, physical therapy), and in what ways different? Those of us who practice an "acupuncturist's acupuncture" must clearly articulate an acupuncture perspective free from the TCM acupuncture model, because the latter is only one view, and represents an herbalized perspective: a perspective biased against acupuncture per se! Secondly, we must hold on to the right to continue teaching acupuncture in its own right in the ways we wish. And we must stop pretending there is a standardized form of American acupuncture. The three-year programs have an accepted core curriculum, but can be as different as Five Element acupuncture and TCM. And this must continue. But we must also begin to let these school develop whatever other acupuncture programs they wish to suit their regional needs and to allow them to develop innovative programs to integrate acupuncture into the mainstream health care system. One important example is the training of acupuncture detox technicians, which transformed substance abuse treatment in many areas and has catapulted acupuncture into mainstream health care. Why not develop similar programs for acupuncture technicians in chronic pain management, in birthing, in stress reduction, in HIV and MDS treatment programs? I could easily envision interesting a hospital in New York in developing a satellite training program for acupuncture rehab specialists, aimed at physical therapy assistants and occupational therapists, where they would be trained in one year. Likewise, UCLA Extension's acupuncture program for physicians is an excellent training program for physicians, and serves a very real need to provide quality physician training. Yet national pressure from the Oriental medicine group would claim that acupuncture belongs to Oriental medicine, and that no one can do it except those it designates as qualified. I say acupuncture in America belongs to everyone and no one. If it is a useful technique, then at the technical level it should be able to be adapted to whatever mainstream health care need is identified and taught in a focused, technician-level way. But there must also be those dedicated to teaching acupuncture in its entirety, to train entry-level acupuncture providers. To obligate schools training these practitioners to make their students learn herbology would water down the acupuncture training and lead many to a bias against acupuncture practiced free from herbology. Finally, there should be those who love acupuncture in its ownright,whoworkwithmainstream health care research teams to bring new understanding to this ancient Chinese healing art that is no one's possession and should be made readily available for the common good.

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