The Integrative Quest: Neither, Nor...Medical
Acupuncture Inward, Outward, And Beyond
Steven K.H. Aung, MD
when one conceives or perceives of quality, a natural reaction is to try attaining or obtaining it at the best possible price to ouselves both personally and financially. Everyone is happy to obtain a "bargain," such as a discarded Van Gogh painting, whose surviving works of art are considered among the most priceless treasures of humanity. And we would be extremely happy to possess a piece of calligraphy created and discarded by the "Yellow Emperor," mythical mastermind and obscure, almost apocryphal "editor-in-chief" of the famous Huang Di Nei Jing (Yellow Emperor's Canon of Internal Medicine).
This work apparently began to be compiled during the Zhou Dynasty (1027-777 BCE), attaining its present form during the Han Dynasty (206 BCE-220 CE). It somehow embodies or encompasses an incomplete and challenging project, requiring constant updating, revisions, and renovations. Resembling, perhaps, an anonymous medical or non-medical acupuncturist, constantly trying to learn something from their experiential and experimental experiences with their easiest and also, most challenging patients.1,2 The distinction between "easy" and "difficult" patients, however, is neither simple nor difficult to ascertain.
Acupuncture in Western societies seems to have attained the reputation of being a somewhat interesting, esoteric, ancient type of professed post-modern "New Age" diagnostics and therapeutics tool. An affluent clientele seems attracted to it. Some of those seekers present themselves as patients and sometimes in the guise of devout students. They may become addicted to their regular or irregular acupuncture treatments and clinical engagement with their special physician or other type of "pet" practitioner. This may be termed the "extended placebo effect." The issue here is prevention with respect to treatment. Most relevant medical literature is almost empty in this regard, not only with respect to acupuncture.
As for truly difficult patients from whatever part of the world, who can ever hope to heal them? Acupuncturists can only try their best in light of their education and experience in cooperation with their patients, with both neither failing to learn or "unlearn" from one another. Thus, for example, a patient who presents as a type of diabetic, who is overweight if not obese, and apparently suffering from fibromyalgia as well as a skin condition, osteoarthritis of several joints, and/or bipolar disorder, is not an easy patient to treat. Attempting to cure or alleviate his/her pain and perhaps, the accompanying clinical depression and repressed or expressed anger and frustration, is a challenge.
Therefore, both logically and illogically, quality seems to transform into a kind of quantity. We are pleased if our lives seem qualifiedly quantified and vice versa (quantifiably qualified), according to our inherently innate "standards of value" within the context of our own personal systems.3
When one thinks of or meditates on the quality of life, whether just sitting and facing the wall within our own Karma (so-called "zazen") with the correct postures (perhaps, the "Lotus position") or somehow, more or less actively engaging it (ostensibly "rinzai") with strange koans, then one usually is neither unenviably happy nor inevitably unhappy.
So much misery exists in the world, so much necessary and unnecessary suffering, how can one hope to cope with this? Absolutely no one on this planet, no matter how rich and famous, dead or alive, or unborn or "reborn," is immune to suffering.
If you don't believe this, then read your daily newspaper or tune in to various community, national, and international cable TV news channels and transmissions. Take a trip to your local library and read some of the many print installations and representations available in the original language or translations. And, of course, there are the Internet resources and outlets for many additional informative links.
Yet we all experience from time-to-time brief episodes of pure harmony and happiness - excellent and surprising epiphanies and enlightenments arising from within the context of our education and everyday experiences.4 How can we hope to cope with this as well?
The best-of-the-best medical practitioners, healers, and health care providers from whatever cultural tradition (as well as their most beloved, devoted patients) might choose to engage themselves in these problematics. The essential challenge seems to be to both heal oneself and heal others at the same time.
Some may perceive this as "Zen" (for want of a better word) since Zen is a wordless energy, merely sitting ("zazen") with and within our Karma or more actively attempting to point toward potentiality ("rinzai"). Rinzai is the "healing Buddha" within each of us, a kind of cultivation of awareness beyond the usual stereotypical discourse, the stale texts in whatever language or code.
Zen is defined as merely the emptiness and impermanence of the arts and sciences of healing. Embracing both the hard empirical findings and the soft intuitive feelings within the context of intelligent self-care and prevention. The "Zen of healing" is just that, neither one thing more or less.
Given that I am sometimes a "patient" and can walk out of my personal physician's office (if I am lucky enough to secure the services of a compassionate, competent, and creative caregiver) feeling less pain than when I walked in, and also experiencing more mobility and a more positive motivation (for the most reasonable price), then I am at least half satisfied.
And given that I am a humble physician and can observe my patients leaving in better overall constitutional condition (Shen) than when they entered, then I am at least half satisfied. Then, for whatever price, even if free (which is sometimes the best fee for service), it is better than nothing.
Practitioners and patients alike should try not to be too full of ego and greed in the healing arts and sciences. No person now alive and struggling to understand his/her condition is immune to the impact of illness, injury, evil, old age, and death.
This is rightfully called the "evidence-based perspective." With respect to medical acupuncture, this perspective and therapeutic modality is a useful addition or what may be termed a "tool" in the total healing enterprise.
Integratively speaking, medical acupuncture is best practiced in combination with other like-minded healing endeavors, cultivating right-mindfulness for all concerned. In Traditional Chinese Medicine, the mind is thought to lead the Qi (vital energy holistically expressed as Shen). In Western medicine practice and research, the mind is also central, since the relevant clinical and research choices are based on mental constructs and motivations.
Thus, even the ostensible gold standard of quantitative research, the RCT (randomized controlled trial) is based on the principal investigator's qualitative orientation, which inspires the aspiring scientific research teams. CAM, like RCT, is another currently fashionable acronym, implying "complementary and alternative medicine" modalities.5 Within the context of the integrative medical perspective, RCT and CAM seem to go together in post-modern TCM and beyond - like Yin and Yang and vice versa, and also, in analogous harmony with the Qi-Shen relationship. Moreover, we must not forget or neglect the vital importance of epidemiological studies and the appropriate clinical protocols.6,7
The mind, however, is only approximately one-third of the whole (holistic) story. The body contains the mind and has its own energy; the spirit contains the mind and has its own energy. The body, mind, and spirit, taken together, comprise a kind of super energetics or synergy. These concerns and issues are relatively expressed or non-expressed in the pages of Medical Acupuncture. Yet hopefully, not without a healthy immunomodulating dosage and degree of controversy, and the usual healthy sense of general and special relativity.
Chinese medicine in the end has always manifested an open-minded curriculum and developed clinical protocol and models based on patient satisfaction, encompassing both preventive and curative initiatives. Certainly, these center around case studies, whether on the basis of individual patient satisfaction or various comparative or evaluative studies of selected groups of patients. Paradoxically, in every kind of medical or other health care research, it is not difficult to find studies that contradict each other's results.
In a discerning editorial in Medical Acupuncture,8 the distinguished editor, Dr Richard Niemtzow, expressed the opinion to the effect that the ostensible acupuncture movement requires not just repetition of habitual modes of thought and action, but continuous initiatives to improve the art and science of acupuncture within the context of good medicine and the curative/preventive endeavor. Dr Niemtzow, having already concisely and whole-heartedly expressed this integrative quest, perhaps makes this present "opinion piece" redundant or a kind of residualist or echoing type of phenomenon.9,10
Finally, it is appropriate to thank the unknown God (in all religions, not excluding deist and atheist belief systems) for the various models developed, enacted, and engaged by various physicians, healers, and their patients from whatever cultural tradition throughout the centuries.
It is not an easy task, opportunity, or responsibility to heal another person. After all, people, as we know, are not laboratory rats, but are emotional beings whom we must equally respect.
One day, perhaps, medical acupuncture may be accepted as a legitimate sub-specialty within the biomedical system.11 But, by that time, perhaps the biomedical system will have evolved to become fully integrated into the arts and science of medicine, and both the academic and clinical boundaries will have evaporated (Yin) and/or disappeared (Yang), leaving more than mere remnants or spiral images inward and outward of this difficult but easy, and challenging but routine project.
Last but not least or foremost, I feel it would be appropriate to acknowledge the kind, dedicated efforts of the editors and workers involved in the production of the American Journal of Acupuncture. The journal somehow managed to survive and indeed, flourish, for over 20 years in the last quarter of the 20th century. It then mysteriously ceased publication and apparently disappeared from the scene. The essence of this endeavor was that the editors helped the contributors to achieve excellence and opened their minds to the many different expressions and installations of TCM.
Steven KH Aung, MD, OMD, PhD, FAAFP
- Unschuld PU. Medicine in China: A History of Ideas. Berkeley: University of California Press; 1985.
- Gwei-Djen l, Needham J. Celestial Lancets: A History and Rationale of Acupuncture and Moxa. Cambridge, UK: Cambridge University Press; 1980.
- Porkert M. The Theoretical Foundations of Chinese Medicine: Systems of Correspondence. Cambridge, MA: The MIT Press; 1978.
- Dhammananda KS. Daily Buddhist Devotions. Kuala Lumpur: Buddhist Missionary Society; 1991.
- Jobst KA, Kronenberg F, Wootton J (eds). National Institutes of Health Office of Alternative Medicine - Food and Drug Administration Workshop on Acupuncture. Special Issue: J Altern Complement Med. 1996;2(1).
- Eisenberg DM, Kessler C, Norlock FE, Delbanco, CL. Unconventional medicine in the United States. N Engl J Med. 1993;328:246-252.
- Eisenberg DM. Advising patients who seek alternative medical therapies. Ann Intern Med. 1997;127:61-69.
- Niemtzow RC. In search of a better acupuncture. Medical Acupuncture. 2000;11(2):3.
- Tataryn DJ, Verhoef MJ. Combining conventional, complementary and alternative health care: a vision of integration. In: Health Canada. Perspectives on Complementary and Alternative Health Care: A Collection of Papers Prepared for Health Canada. Ottawa: Health Canada; 2001:VII 87-109.
- Aung SKH. Qigong sounds: medical therapy through phonation. Qi: The Journal of Traditional Eastern Health and Fitness. 2002;11:39-46.
- Aung SKH. The Certificate Program in Medical Acupuncture: focused training for health care professionals. Medical Acupuncture. 2000;12(1):13-16.
GUEST EDITOR INFORMATION
Dr Steven Aung is a Geriatric and Family Practice physician, and a Traditional Chinese Medicine (TCM) practitioner and teacher. At the University of Alberta, Dr Aung is an Associate Clinical Professor in the Departments of Medicine and Family Medicine, and Adjunct Professor of Extension. He is a World Health Organization advisor on TCM. Dr Aung was awarded a Professional Excellency from the Académie Diplomatique de la Paix in 1986, the Alberta Order of Excellence in 2002, and the Queen Elizabeth II Golden Jubilee Medal in 2003. His primary interest is in the integration of TCM and Western biomedicine within the context of a more natural, compassionate approach to health care.
Steven K.H. Aung, MD, OMD, PhD, FAAFP*
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