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The Emergence of an Urban U. S. Chinese Medicine Author(s): Martha L. Hare Source: Medical Anthropology Quarterly, New Series, Vol.
7, No. 1 (Mar., 1993), pp. 30-49 Published by: Wiley on behalf of the American Anthropological Association Stable URL: http://www.jstor.org/stable/649245 . Accessed: 30/09/2013 05:34
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MARTHAL. HARE
The New School for Social Research
The Emergence of an Urban U.S. Chinese Medicine

Fieldworkconductedamong a diverse sample of non-Asianpatients of Chinesemedicine in New YorkCity during 1989 and 1990 showed that theyareformulatingmodels of health, illness, and healing based mainly upon their own bodily experience with therapy. They view the Chinese medicaltherapythat they receive as holistic, in contrastto thefragmentary nature of biomedicine. While some practitioners who were interviewed also spoke of personal encounterswith the healing mechanisms of thisnon-Westernform of treatment,the modelsof bothAsiansand nonAsians in this second category tendedtofocus upon Confucianor Taoist ideals of orderand responsibility.It is hypothesized that, while certainly affectedby socioeconomicand political exigencies, an urban U.S. variant of Chinese medicinemay be emergingfrom the ground up; that is, from the consumersand therapistswho are most intimatelyinvolvedwith the system. [Chinesemedicine, urbanhealth, explanatorymodels]
lthoughstudiesof the practiceof indigenousmedicinehave become common in medicalanthropology,little is known aboutthe process by which a medical system that has developed elsewhere is adoptedby consumers in an areaof extremebiomedicaldominance.In 1989 and 1990, andpractitioners and consumersof I conductedfieldworkin New York City among practitioners Chinese medicine. My main concern was with non-Asian patients:the reasons such patientschoose acupuncture,Chinese herbalmedicine, or acupressureas a partof theirhealthcare and the ways in which the patientsformulatetheirunderstandingof the type of care they have chosen. In addition,I soughtto understand form of Chinese medicine, their choose to practicea particular why practitioners philosophyof health care, and how they explain the healing process to their patients. As Lyng (1990:55) points out, interpersonalencounters affect the larger of healthsystems and health care politics in which they occur. The reproduction Chinesepractitioners and Chinesemedicalknowledgeby Westernand immigrant theirurbanAmericanpatientscan profoundlyinfluencethe developmentof a system of medicine whose roots extend back to antiquity. At the same time, this
Medical AnthropologyQuarterly7(1):30-49. Copyright? 1993, AmericanAnthropologicalAssociation. 30
THE EMERGENCEOF AN URBAN U.S. CHINESE MEDICINE
31
medical system is deeply affected by socioeconomic and political exigencies whereverit is being reproduced.In New York State, for example, the profession of acupuncture was given the rightto form its own boardin 1991. of Chinese medicine in the The focus of this work is on the transformation United States and in New York City in particular,as evidenced by the way that describetheirexperienceof treatment.To betterunderpatientsandpractitioners models of health, standthis process, I soughtto elicit both patientandpractitioner healing, and illness. This strategyallowed the primaryactors in the healing enof their own state of healthand the counterto voice theirevolving understanding medicalcarethey receive or offer. In this process, a numberof ideological issues mechanismsof healemerged:the role of embodiedexperiencein understanding and notion of responsibilityfor of and the order; ing; concepts harmony,balance, oneself in preventingillness and maintaininghealth. These concepts can be seen as mediatingfactors in patient-practitioner relationships,along with other concreteandsymbolicelements, includingpayment,the acupuncture needle, andraw herbs. Kleinmandemonstrated both the theoreticaland practicalusefulness of exillplanatorymodels in the mid-1970s, considering "all attemptsto understand ness and treatment"(1975:645) to be such models. The explanatorymodel was based on the dichotomy between disease (physician's domain) and illness (patient's domain). Its purpose was "to create a single language and discourse for effect that both clinicians and social scientists," but this had the "unanticipated physiciansare claiming both aspects of the sickness experience for the medical domain" (Scheper-Hughesand Lock 1987:10, emphasis in original). In an atof the patients' sphere by physicians, a flaw tempt to preventthe appropriation andLock so aptlydescribe, I askedsimilarquestionsof both thatScheper-Hughes (see Appendix 1 for an example drawnfrom interview patientsand practitioners transcripts).I endeavorto show that such models are fluid for both the professionalandthe layperson;for the personchargedwith interveningin the illness and for the personwho is ill. When conversationsturnedto the ways in which a person can maintainor restorehealth, I became awareof the confluenceof ConfucianandTaoist models belief in individual of orderand moderationwith a generalizedlate-20th-century responsibilityfor the variousexigencies of life. Althoughthis issue is not unique to the applicationof Chinese medicine in the United States, it was clear thatquite a numberof patients and practitionerswere grapplingwith the implications of of Chinese philosophy and the creatinga "hybrid" ideology. This hybridization U.S. emphasison individualismmay be forming the roots of a new synthesis, a U.S. form of "Orientalmedicine." While I focus on the emerging ideologies of individualpatientsand practitioners, the interactionof these two sets of actors is implicit. In the healing encountersthat I observed, as well as others that patients described, the practitiothan models ner's empathytowardthe patientseemed to be even more important andexplanations.This empathy,however, is basedon a certainsharedperception of what it means to be an embodied, emotional, and thinkingbeing undergoing the exigencies of life. As Farquhar (1991:386) puts it: "Chinese medicineaccords a certainimportance while never denyingthe objectto quotidianself-perception; of bodies, it privilegesprocessesof changethattakeplace in personaltime, nature
32
MEDICAL ANTHROPOLOGYQUARTERLY
which can only be enteredinto medical considerationvia the patient's own narrative." Background Chinese medicine originatedbetween 2,000 and 5,000 years ago and evento Europeand more Asia; from there it was transported tually spreadthroughout recentlythe United States (Lu and Needham 1980). Each setting has providedan In fact, Chinese medicine consists of opportunityfor ongoing transformation.1 manymodalities:acupuncture, acupressure, herbology,moxibustion,variousexercise and dietetic regimens, and others that some have called magico-religious interventions(Kao 1979). Partlybecause of its long history, Chinese medicine also containsa multiplicityof paradigms(Unschuld 1985). For example, what is now termed"traditional Chinese medicine" (which reachedthe United States in the 1970s) is a modem variantof acupuncture andherbalmedicinethatdeveloped the Maoist era 1976). (Croizier during Finally, the Chinesemedicinepracticedby a migrantto New York's Chinatownmay be very differentfrom thatpracticedby an Americantrainedin a local acupunctureinstitute. Still, the term "Chinese medicine" serves as an organizingscheme for a continuallyevolving system of care with roots in the classical traditionsof China. Methods and Populations Studied Methodsfor this study includedparticipant observationat a numberof clinical settingsandopen-ended,semistructured interviews, which were informedby researchat the clinics. Participant-observation sites includedtwo municipallyrun detoxification(detox) clinics for persons addictedto alcohol and ilacupuncture who serves a largely legal substances.One Chinese herbalistand acupuncturist, middle-class and affluent non-Asian population, illustratesthe experiences of practitioners recentlyarrivedin the United States as they seek to establisha practice and learnto work in a milieu quite differentfrom the one to which they were accustomed. Three other practitionersof traditionallybased Chinese therapies with diverse backgrounds(a Chinese M.D., a WesternM.D., and a U.S. R.N. who is a certifiedacupuncturist) allowed me to "hang out," watch their work, and talk to patients.Finally, a volunteerclinic for HIV-infectedpersons allowed me to watch a session and encouragedme to speak with clients both individually andin groups.These sites were chosen because of the rangeof practicethey representand because of the diverse patientpopulationsserved at the various locations. Throughthese and relatedactivities, includingmeetings, seminars, and social events, I developed a sample of participantsamong patients (N = 29) and in semistructured interviewsconducted (N = 30). They participated practitioners at clinical settings, in people's homes, in coffee shops, and at meetings. This article is drawnfrom the information obtainedin these interviews.
The Patient Sample
The patientsample is derivedentirelyfrom the non-Asianpopulationof the New Yorkmetropolitan area. Table 1 summarizes this sampleby the type of prac-
THE EMERGENCEOF AN URBAN U.S.
CHINESE MEDICINE
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TABLE 1 The Patient Sample Characteristic Type of Practice Privatea Union-affiliated Detox HIV only
Totalb Ethnic identity
% of Respondents 62 17 17 3 99 76 17 7 100 59 41 100 69 21 10 100 48 17 3 3 28 99
Frequency 18 5 5 1
29
White Hispanic
African American
22 5 2 29 17 12 29 20 6 3 29 14 5
1 1
Total Gender Female

Male
Total
Age
28-44 years 45-60 61-84 Total

Insurance Status Employer-paid insurance
Medicaid Medicare Uninsured Unknown Total
8 29
"Patients seen in these settingshada wide varietyof complaints,includingorthopedic, addictive,or HIV-related problemssimilarto those seen in the specialty clinics. bThetotal percentagesmay vary from 100 due to roundingerror. tice where patients sought treatment, their ethnic identity (very broadly defined), gender, age, and insurance status. With regard to socioeconomic status, informants were extremely hesitant to rank themselves beyond a cursory statement of
being middle class (N = 17) or upper middle class (N = 3).2 Other researchers
(Press and Browner 1992) have found insurance coverage to be a marker for determining socioeconomic status,34 a strategy that proved useful in this case. The sample is heavily middle income with the exception of those persons being treated at the municipally run substance-detoxification clinics and the pos-
34
sible exceptionof some privatepatientsengaged in artsprofessions. Most of the consumersinterviewedare also fairly young, althoughthe rangeof age, 28 to 84, is extensive. The ratioof female to male patientsmay reflectthe fact thatwomen tend to be heavier consumers of health care in general. Finally, it should be pointed out that while the sample is overwhelminglywhite, I interactedwith a much more varied racial and ethnic patientpopulationin the field. In addition, personsfrom the three categories of ethnic identitynoted in Table 1 were found in each type of practice.5
The Practitioner Sample
Samplingwas opportunisticand took advantageof "snowballing." In addition to using the networkI had developed in my own professionalhealth care career, I invited participationthroughletters to practitionersadvertisingin the Yellow Pages and in holistic healthnewsletters.Table 2 summarizesbroadcharacteristicsof the practitioner sample. With regardto entry to practice, the practitionerscan be roughlyassignedto threemajorcategories:East Asians trainedin Chinaor Korea(N = 10), Westernphysicians who laterchose Chinese medical practice(N = 6), and Western nonphysiciansspecializing in Chinese medical practice(N = 14). Appendix2 discusses commonpathwaysof entryinto professional acupuncture. The other Chinese medical modalities are more loosely organizedand thereforeentryto practiceis less regulatedand more individualized. It is impossibleto tell whetherthe practitioner populationin my studyis repin the New York metresentative of the universeof Chinesemedicalpractitioners area.Manypersonshave practiced"irregularly"from 1974 throughthe ropolitan present,seeking to avoid one of the nation's strictestlicensing laws for acupuncture (Riddle 1979). Therefore,even data compiled by licensing agencies do not reflectthe actualnumbersof personspracticingone or more Chinese therapies. The Patient Is a Person Chinese medicine came into the awarenessof the U.S. public in the 1970s, when forcefulcritics, includingthe Ehrenreichs (1970) and Illich (1976), voiced of the body from the mind, as concernwith medical iatrogenesis.Fragmentation well as fragmentation of the body into its parts, was theorizedto be a contributing factorto iatrogenesisbecause it createdthe tendency to lose trackof the human being sufferingfrom illness, especially with increasedrelianceupon technology. In contrast,duringthe 1970s and 1980s, popularizers of Chinese medicinebegan to disseminatea philosophyof practicein which the subjectiveexperienceof the patientwas paramount (Capra1982; Kaptchuk1983; Worsley 1982). Patient discourse illuminates the hypothesis that, in part, the choice of Chinesemedicine is a reactionto the disembodimentassociatedwith technological biomedicine. In this way, Chinese medicine continues to emerge from the groundup throughthe embodiedexperienceof those most affected by it. One of the strikingfeaturesof the patients'attitudestowardChinesemedical treatment in this study was the degree to which efficacy was not necessarilydefined as cure. For example, in three cases in which Chinese medicine was not effective for the patient's presentingsymptom, respondentsspoke highly of the time, nurturing,and attentionthey had received from the practitioner.On the
CHINESE MEDICINE
35
TABLE 2 The PractitionerSample Characteristic Type of Practice Privatea Union-affiliated orthopedic Substancedetoxification Totalb EthnicIdentity Chinese Korean Subtotal White American AfricanAmerican White African West Asian Subtotal Total Gender Male (EastAsian) (Western) Female (EastAsian) (Western) Total % of Respondents 93 3 3 99 30 3 33 53 7 3 3 66 99 57 Frequency 28 1 1 30 9 1 10 16 2 1 1 20 30 17 ( 7) (10) 13 ( 3) (10) 30
43
100
aAs in the patientsample, the privatepractitioner treats a wide variety of problems, includingthose seen in the othertwo categories. In addition,as discussed in the text, such are practitioners may use more than one modality. All ten of the East Asian practitioners here. represented bThetotal percentagesmay vary from 100 due to rounding. other hand, in some orthopedic cases, the acupuncturist did not spend a great deal of time with patients, but they were very pleased with the physical results of treatment. The Patient-Practitioner Relationship The following case study can be characterized as a "success" because the patient experienced both excellent medical results and an empathic relationship with his doctor that led him to change unhealthful behaviors, including an addiction to tranquilizers. I chose this case less for its successful outcome, however,
36
MEDICAL ANTHROPOLOGY QUARTERLY
than for its illustration of subjective aspects of the patient's relationship with his Chinese herbal physician. The physician in this case, Dr. K, had recently arrived from Shanghai, where he had been trained simultaneously in biomedicine and in Chinese herbal medicine. A graduate of "health school" during the Cultural Revolution, he completed his medical degree in the late 1970s and worked as both a surgeon and a specialist in infectious diseases. Bob, a white-collar professional in his mid-forties, began to see Dr. K after meeting him at a friend's house. As someone who characterized himself as "never being into anything holistic," Bob was not actively looking for an alternative to the medical specialist treating him for chronic hepatitis. He had, however, recently lost a friend to liver cancer, a possible end stage of hepatitis B, and was concerned about the fact that his physician could not offer him definitive treatment for the disease. Firstof all, I had hepatitisand it'd been in me for eight years when I startedthe with the virus. When I met the [herbal]treatment.Basically I was asymptomatic man [at a neighbor's on the same block], he talked about the treatmentfor the virus [which he had researchedin China]in such a matter-of-fact way, I figured I'd give it a try. There's nothingin Westernmedicine for it and sure enough as soon as I began the teas, I noticed almost an immediateimprovementin how I felt, but also in my blood tests and so I continuedwith it until such point that I was cured.6It's amazing. At one point, Bob entered a rehabilitation program because of his addiction to tranquilizers. Dr. K told him that the herbal treatment was being compromised by the stress this addiction was placing upon his liver, one of the body's main detoxification organs. Bob's encounter with a dermatologist, whom he saw for a rash he developed at that time, contrasts sharply with his experience of Dr. K's method of diagnosis and treatment: I got a fingernailrash so when it wouldn't go away I went to a dermatologist. They didn't know what the hell it was. Well, they give me all kinds of creams for six months, seven months, nothing worked. So I asked K,7 "Do you have any herbsfor this?" He said, "I do have herbsfor skin rashes, but that's pretty bad . . ." Then I went to my same dermatologistand he wanted to give me a very stronginternalmedicine to kill this nail fungus. I was aboutto take it when, in parting,the doctor said, "You have to take a blood test every month." I said "What for?" He said, "Oh, this medicine is very hard for the liver." I said, "Doctor, you can't give me that medicine. I have a bad liver. I had hepatitisso manyyears." He said, "Oh, my God." He goes out of the room and he comes back with the prescription,handsit to me and says: "Take the medicine at your own risk and take a blood test every two weeks" and walks out. So I ranrightto K-I always go to him rightaway-and I showed him the and he said, "That'll cure your fingernailbut it will put you in the prescription hospitalin two weeks andyou'll maybeeven die if you continuetakingthe medication. You might as well live with the fungus." I value his opinion more than anyoneelse's. The attitude of the dermatologist is a dramatic reflection of the proclivity of technological medicine to lose sight of the person (Foucault 1973[1963]; Lyng
CHINESE MEDICINE
37
1990;Martin1987; Sullivan 1986). In this case, a skin specialistwas dealing only with the presentingsymptom and was unawareof the condition of the patient's liver. This incidentreinforcedBob's high opinion of Dr. K, which was based in large parton the empathythatdeveloped between physician and patient. His descriptionof a typical session depicts traditionalChinese diagnostic techniques (Amber and Babey-Brooke 1966; Kaptchuk 1983; Maciocia 1989). The techsenses while he inquiresinto niquesrequirethe exquisite use of the practitioner's the patient'sexperienceof both illness and mundaneactivities.
He asks a million questionswhen you go in to him. Basically, he wantsto know everythingaboutyou. For example, do you always feel cold or hot? He checks all kinds of differentpressurespots, he takes the blood pressure, looks at the color of your eyes; pays close attentionto your tongue and I guess your skin color. He does a lot thatyou're not even awareof and as he's talkingto you he's picking up psychological things too. So you notice right away that he spends a lot of humantime with you getting to know you and your body and your health condition.
While it was clear thatpatientsvalued the time theirpractitioners spent with them, not all had as intimatea relationshipas Bob and Dr. K. A sociologist suffering from a chronicdigestive illness, also treatedprimarilythroughherbs, was one of the more conservativerespondents,statingthat "Westernmedicine" had the most to offer him of any modality he had tried. Even so, his concern with chemical iatrogenesiswas a primaryfactor in his decision to "try" the services of an Americanpractitioner of Chineseherbalmedicineafternoticingthata friend in similarcircumstanceshad benefitedfrom this treatment.
My healthin generalhas always been poor andI've gone to all [kindsof doctors] and nobody seems to have a clue and the Westerndoctors-it's almost as if unless you're running a fever or have specific symptoms for a specific illness ... nobody seems to be thatknowledgeableaboutwhy your immunesystem is all screwed up; why you're sick all the time. I also had an ongoing attack thatwas draggingon and on and only partlyrespondingto cortisone. The cortisone was making me crazy, the illness was making me crazy, and I heard [a friend]had gone so I decided to try the herbalist.
TheImmune-Compromised Patient Referencesto the immune system were not at all uncommonin both interview situationsandin informalconversationswith bothpatientsandpractitioners. It becameclear that for them the immunesystem involves more than certainbiochemicalentities for fightingdisease. Rather,the "immune system" signifies the deepest level of the person, which must be strengthenedand protectedfrom the onslaughtsof life in postmodernsociety. As Martinpoints out, the immunesystem is consideredan arbiterbetween "self and nonself" that helps to keep the body clean and pure (1990:414, 418). The recurrenceof the immune system as a topic of discourse also reflects concernwith the humanimmunodeficiency virus, a powerfulsymbol of complete devastation.Many of the concernsof HIV-infectedpatientsare the same as those of others;however, these concerns are heightenedby the life-threateningnature of the infection. In addition, there is a level of politicizationassociatedwith the
38
AIDS epidemic that makes it unique. The politicizationis linked to the stigmatizednaturewith which the epidemicexplodedinto nationalconsciousness, which some see as a sourceof empowerment: should "No one knows whatthe treatment be andeach one of those individualsis a pioneertryingto figureout what the path shouldbe for him or herself" (U.S. physician-acupuncturist). Indeed, the needs of HIV-infectedpatientspresenta unique setting for the furtherdevelopmentof Chinese medicine. For example, Dr. K, having specialized in infectiousdisease in China, was confidentabouthis abilityto cure chronic hepatitis. Based on this experience, he speculatedabout the ability of Chinese herbalmedicineto treat, or even cure, HIV infection: asked I cansayyes, I cansayno. mecanyoumakea cureforAIDS? Somebody No, because[we] neverexperienced [this]in China; yes, becausetraditional Chinese medicine theimmune rises. bodyget strong; system helpsthepatient's That means diseasename. youcancureanydisease.[I]don'tcareabout Herethe immunesystem is invokedas the substratum of all disease:if the immune system is strong, the body is strong; if the body is strong, any disease can be cured. Models of Health and Illness One of the most strikingaspectsof the incorporation of Chinesemedicalsystems into WesternhealthcAreis the degree to which thereis a mixing of classical Chinese, otherscholarlyor professionalEast Asian, andmoder Chinesemedical thought, with a variety of folk paradigmsfrom East Asia and the many ethnic streamsof the Westernlocale in which the new "Oriental"medicineis now being practiced.This all occurs within the context of biomedicaldominancewhere scia entificmetaphors are the folk knowledge of late-20th-century Euro-Americans, folk knowledge that emanates paradoxically from powerful authority figures (Aronowitz1988; Leiss 1972; Martin1987, 1990; Rouse 1987). Dr. K's comment that the disease name is not relevant to the problem of developing a cure for an illness is typical of classical Chinese medical thought, which concerns itself with underlyingphysiological and psychological patterns biochemicalmarkers.Thus, Dr. (WisemanandEllis 1985), ratherthanparticular K interwoveclassical Chinese ideology with the biomedical concept of the immune system. Patients, even when invoking a particulartraditionalChinese or Westernmedicaltheory,tendedto develop models of illness andhealingthatwere groundedin what they themselves had felt.
Patients' Models-Theoretical Physics to Bodily Experience
In explainingacupuncture's mechanismof action, patientsoften used images from popular notions about physics, especially electrical metaphors: "It has somethingto do with opening and closing lines of power within the body and directingor redirectingenergy within the body." A patientwith artistictraining called the meridiansthe "electrical system of the body. If I look at the charts,the principleis certainlyobvious. Couldn'tchartlike blood or lymph but the whole conceptis certainlynot foreign."
THE EMERGENCEOF AN URBAN U.S. CHINESE MEDICINE
39
One orthopedic acupuncture patient from the union-affiliated clinic described energy as part of a "field": Have only the vaguest idea. Somethingto do with the energy fields in the body andthe distribution of energy. The needles are meantto directthe blood flow to keep the body whole and to allow the energy to flow continuouslyunimpeded. Another orthopedic patient spoke about nerves and muscles. "I asked [the doctor]. He said the acupuncture activates the healing. It does something to the muscles and the nerves. It accelerates the healing. That I believe because it happened to me." A bodybuilder explained that the needles "stimulate the muscles to allow better blood flow . . . you can actually feel it." Not surprisingly, when substance detoxification patients in this sample volunteered information concerning the etiological factors in their addiction, they focused on social and emotional issues. Although socioeconomic factors were sometimes mentioned as contributing to the difficulty of maintaining recovery, they were not mentioned as initial factors. One woman tied emotional factors to a chemical explanation: Addicts are lacking something-endorphin levels. One thing addicts have in common is that they have no thresholdfor pain. It's weird that you get a bunch of people togetherfrom differentbackgroundsand they all have the same problem. And thatmay be partof why some people become addictedandsome people [use drugs]and never become addicted. A male detoxification patient elaborated on this point of view: When they stick the needle in, it opens up something-I don't know what they call it-and releasesout energyandyourbody can absorbthingsbetter . . . your body has its own medicine. We do have certain chemicals and when you put thesepins in, it releasesout these little medicationsandit curesyou. Once I heard that it's true. Our bodies do have these chemicals that make you feel good-a naturalhigh. I only experiencedthat the firsttime. Another set of images was clearly reminiscent of Mary Douglas's (1966) work concerning the need to demarcate purity in order to avoid danger. The images commonly appeared in patients' discussions of their fears of dirt, as in a fear of infected needles8 or of ingesting unfamiliar-looking herbs in their raw state. Furthermore, both patients and practitioners talked about healing as a cleansing process, just as recovery from addiction is evidenced by having "clean" urine tests. A woman who was receiving treatment from a doctor of traditional medicine in Chinatown for a skin rash invoked images of cleaning when describing her experience with acupuncture and herbal medicine. This imagery was generated and validated by bodily experience. Obviously, acupuncture improvescirculationand releases blockages. As far as the treatmenthe gave me, almost all the needles were on the lower meridians. So between the treatmentand the herbs, they would, as he would say, clean down. So the acupunctureis meant to clean everything out. It's interesting, I don't itch anymorebut in the final stages I would itch only aroundmy ankles which meansthatthe toxins had moved from my upperintestinalregion down to the lower partof my body.
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Excerpts from interviews with all groups of patients show that bodily sensed experience was of primary importance in developing an understanding of the healing process. This is in keeping with the finding that where biomedical therapy is no longer useful (Kaufman 1988) or where the respondent is alienated from the paradigm of laboratory medicine (Martin 1987:108), the patient's own bodily experience forms the basis for medical explanation. Considering that Chinese medicine is still relatively new to most Westerners and has few biomedically accepted theories of efficacy, the strategy of literally referring to one's own body of knowledge makes a great deal of sense. Medicine as Belief System A patient whom Dr. K was treating with both acupuncture and herbs illustrated another issue that came up repeatedly in discourse, especially informal conversation: subscribing to a medical system as a quasi-religious system-something to "believe in." My mother's first reaction when I first told her was, "You should be ashamedof yourself having people put needles in you." I couldn't figure that out, why I shouldbe "ashamed" of myself? Now they think thathe must be a miracle worker. They said that they had begunto believe in him throughme. So now when they saw the resultsthatI was gettingfromthe treatment,an uncle of mine who has high blood pressureand as a result of medication he was receiving from Western doctors had one of his kidneys destroyed, decided that they would go to an acupuncturist.Now my brotherwho has a son who has asthmais interestedin going to see someone to treatthe asthma.It's had a positive effect, in a sense, on the rest of my family. One physician-patient interaction was very amusing, but also quite telling. An 84-year-old woman had suffered a severe episode of back pain due to "spinal deterioration." The pain practically disappeared more than four months after her last acupuncture treatment. In fact, her acupuncturist had been the one to suggest discontinuing treatment because he had not seen any results after six treatments. Still, some months later, she was not quite sure whether she had been the beneficiary of a "delayed reaction." I went to the orthopedistand I said, "I have a confession to make, I went to an He said, "Don't worry, I went to one because I wanted to see acupuncturist." whatit was like."'I said, "Could it be a delayedreaction?"The orthopedist said, "Well, the body compensates." Of course, a doctorwould say that-that's double-talkas far as I'm concerned. Here the patient is confessing to her physician who absolves her, even confessing his own foray into the domain of the "other" (purely for the sake of empirical investigation, of course), but she was not convinced by his lack of explanation. Practitioner Models: Order and Responsibility Aside from the obvious differences in culture between the Chinese and Western practitioner subsamples, a major difference between these two groups was the greater proportion of Chinese practitioners holding M.D.s (70% as compared with
CHINESE MEDICINE
41
30% of the Western sample).9 The Chinese considered themselves to have better training on two counts, biomedicine and Chinese medicine. Both Western and Chinese practitioners questioned the quality of one another's training in both of these domains. In addition, Westerners argued that they were more sensitive to the needs of U.S. patients. They could, for example, better understand the greater tendency of middle-class U.S. patients to psychologize their problems, compared with Asian patients who are characterized as somatizers (Kleinman 1986; Kleinman and Kleinman 1985; Ots 1990). Despite these arguments, there were common features in the ideologies of Chinese-trained and Western-trained practitioners. This includes a certain Confucian pattern of thought in the specification of order as a prerequisite for health, as explained by Dr. K. Three things: (1) Life has the same schedule-very important-meals at the same time, sleeping same time everydayfor a long time. Sometimesin bed at 9, 12, 1-that's no good. (2) Whatyou eat. (3) Cleanlinessincludingenvironment and house. That's from traditional Chinese medicine. ... I always tell my patients you need to keep a normallife. [Whatyou] drink, what time sleeping, get up-[variation]-that's not good for patients. Once Dr. K got to know his patients better, he saw the need to educate them and, in a sense, shifted some of the burden of responsibility for restoring health onto their shoulders. An American nurse-acupuncturist commented on the hectic lifestyle of her patients: A lot of people have a very distortedsense of whatbehavioris laudableand what is guilt-producing.I find people . . . become very guilty staying home when they're sick. It's all right to go to work, to runthemselves ragged, to drinkcoffee, to get four hours' sleep .... But to stay home and actually nurturethemselves is guilt-inducingand it's a distortedperceptionof what life's about .... People have to be told that they are allowed to stay home, are allowed to get eight hours' sleep. I don't really have a very yuppifiedpracticeso I don't know where it comes from. Through educating her patients, this practitioner sought to make them responsible for ordering their lives in such a way that they could assure themselves of appropriate nutrition, adequate rest, and other positive health habits. Dr. B, a locally trained dentist, began his study of acupuncture through a certification course for physicians and dentists. He became dissatisfied, however, with a "modern" approach to acupuncture in which physicians were taught particular points to treat specific biomedically defined illnesses. He then traveled to England to study J. R. Worsley's five-element paradigm.'0 Eventually, he returned to school in New York for a medical degree because of his wish to create a new synthesis, integrating his values and training in biomedicine and Chinese medicine. During our conversation, Dr. B elaborated upon the effect of Taoist thinking in his practice, referring to the I Ching from which "both of the two branches of Chinese philosophy, Confucianism and Taoism, have their common roots" (Wilhelm 1967[1950]:xlvii).
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Lao Tze is also the basis of Chinese acupuncture- affect withoutenforcing." Simplicityis the basis of preventivemedicine;solve it small, keep it simple. The of the I Chingis all aboutfive element acupuncture. foreword"l By invoking the Tao as the fundamental law of the universe or that which is immutable to change, Dr. B created an opposition to contemporary U.S. society in which constant change, often for its own sake, is the norm. Thus, these three practitioners illustrate a concern, voiced by both Chinesetrained and Western-trained respondents, with ordering one's life so as to avoid "extremes," an ideology that is both Confucian and Taoist (Pound 1980[1951]; Wu and Shih 1961). This is in keeping with "the evolving tradition of ancient Chinese medicine," which developed its cosmology from the Taoist tradition and its "concern with social ethics, moral conduct, and the importance of maintaining harmonious relations among individual, family, community, and state" from Confucius (Scheper-Hughes and Lock 1987:12). In general, practitioners tended to be more theoretical in their approach to health, illness, and healing than the patients, whose responses emphasized experience. Practitioners did not slight experience, however; in fact, four of the Western practitioners had encountered Chinese medicine as patients, resulting in their choice of this field as a career. For example, the nurse-acupuncturist called herself "a convert waiting to happen" at the time she first encountered acupuncture. I was totally turnedoff and disappointedin Westernmedicine. ... I went to [the detoxificationclinic to observe] because a friend said they were treating and asked if I wanted to go with him for the day, so I drugs with acupuncture went. I'd had a knee problemfor severalmonthsandI was totallyignorantabout When I was there I asked the head of the programif acupuncture acupuncture. could help my knee. He put some needles into my knee-a very symptomatic approach.That night the pain in my knee got much worse than it had for four months . . . next morningthe pain was 90%gone. Calledhim andtold him what happened.He said I should come back for a few more treatments.I did. By the time my knee was better, I was totally fascinatedwith acupuncture. Thus, the discovery of acupuncture (as opposed to its rationale) came not from theory, but from the person's own body. Discussion In this article the concept of the "emergence" of an urban U.S. Chinese medicine has been used in the sense of an entity developing from the ground up. In this case, the ground has been the patient's own experience. Thus, I have used the notion of experience similarly to the usage in linguistics or cognitive science: Experienceis . . . construedin the broadsense: the totalityof humanexperience and everythingthat plays a role in it-the natureof our bodies, our genetically inheritedcapacities, our modes of physical functioningin the world, our social organization,etc. [Lakoff 1987:266] The entity that is emerging is not something completely new, born solely out of contemporary human needs. Rather, a system of therapy with deep historical roots is reemerging in a context in which certain human needs have been insuffi-
CHINESE MEDICINE
43
ciently met. Thus, an urbanU.S. variantof Chinese medicine logically reflects as well as the the experiencesand ideologies of both consumersand practitioners, generalcultural,economic, and sociopolitical milieu in which it is situated. Lyng (1990:223) arguesthatthe "collective effortof the patientpopulation" can lead to the emergence of more responsive forms of medical care. While his analysislacks a mechanismfor such a collective effort, I agree that in the case of and otherChinese therapies,consumerdemandhas been a powerful acupuncture force in keeping these modes of care availableto the public duringan era of political pressureto circumscribesuch practice. This demand is occurring in the contextof the politicizationof healthproblems,most notablyHIV-related illness, an areathatdeserves a greatdeal of furtherresearchin its own right. Conclusion In conclusion, I should note that New York State has provided a difficult terrainin which to define the scope of a non-Westernform of medical practice. Duringthe time in which the fieldworkdescribedhere was conducted, acupuncturewas underthe aegis of the StateBoardfor Medicine, which strictlycontrolled licensureand certification(New York State EducationDepartment1990:13-15). Despite internecinerivalry between physician and nonphysicianacupuncturists andbetween Chinese and Western-trained acupuncturists, lobbying efforts eventually resulted in the establishmentof a State Board for Acupuncturein 1991 (New York State EducationDepartment1991:15). Even with the establishment of the board,acupuncture has not emergedfully in this particular urbancontext. Rival professionalgroupscontinueto argueover standards of practice,althoughthey have agreeduponexaminationby appropriate the National Commission for the Certificationof Acupuncture(NCCA) as the route of entry (New York State Association of Professional Acupuncturists 1992:3). OutsideNew York State, some attentionis being paid to the certification of herbalmedical practice, a developmentthat some see as an attemptby acuto dominatea field thathas historicallybeen extremelydiverse. In any puncturists it is clear that groups of practitioners,very much in the style of medical event, doctorsimmediatelypriorto the Flexnerera, arejockeying for professionalinfluence and by extension for the dominationof patientmarkets. The political machinations,nonetheless, occur against the backgroundof consumerdemands. Foremostamong these demandswas the desire for healing the fragmentation of both humanbodies and human experience accentuatedby intervention and the biomedicalmodel. At the level of the patienttechnological practitioner relationship,empathydeveloping from a profoundconcern with the exigencies of daily life marks the efficacious Chinese medical encounter. This efficacy may or may not result in the cure of symptoms, but it confirmsand extends the experienceof the person seeking assistance. Empathyis not unique to Chinese medicine, nor is it always present in such settings. The example of Chinesemedicinedoes, however, point to the importance of recognizingthe fundamentalwisdom of the humanbody in treatinghumanills.
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NOTES The authorwishes to thankDr. ArleneMathieuof the Department Acknowledgments. of Anthropology at HunterCollege (CUNY) for hervaluableassistancein refiningthe ideas presentedin the manuscript. Correspondence may be addressedto the authorat 4545 ConnecticutAvenue, NW, #824, Washington,DC 20008. fa'To reflectthe cosmopolitannatureof this medical system, some anthropologists vor the term "East Asian medicine" (Lock 1980:14-15). I have found that practitioners andpatientsdo not use this termlocally. By and large, people in the field and the relevant literature referto Orientalmedicine or Chinese medicine (Duggan 1984; Kaptchuk1983, 1985;Omura1982). The term "Oriental" is both datedand too broadfor the purposesof this research,since it shouldrightlyinclude medical systems indigenousto all of Asia, not just those thatoriginatedin China. Therefore,I favor using the term "Chinese medicine." 2Inaddition,four informantswere known to be receiving public assistance, one was living on disabilitypayments, and three were unemployedbut not receiving public assistance, leaving one of unknownstatus. one clinician, who affordeda wonderfulopportunityfor observing 3Unfortunately, to the office visits andtreatments,specificallyrequestedthatI not discuss issues pertaining (includingeliprecarious legal statusof certaincategoriesof nonphysicianacupuncturists gibility for paymentthroughinsurers)in New York duringthe year in which I was conductingfieldwork.I accededto these wishes ratherthanlose a settingfor such rich clinical insight. 4Ofthe 14 patientswho were known to be insured, 5 were covered for Chinese medical treatment,1 was not sure, and 8 paid for treatmentout-of-pocket. Only those who receivedacupuncture from a licensed M.D. for a recognizedbiomedicaldiagnosis and the were eligible for reimbursement. Medicaidpatientsreceiving detox treatments 5Forexample, three patients interviewed at a substance detoxificationclinic were white;threepatientsinterviewedat the union-affiliated orthopedicclinic were white; and sixteenof the privatepatientswere white. One of the AfricanAmericanpatientswas being seen privately,andI met the otherat a detox clinic. The Hispanicpatientswere interviewed one detox, and throughcontactsat each type of practice(one private,two union-affiliated, one at the specialtyclinic for HIV-infectedpersons). 6Bobcontinuedto visit his biomedical physician duringthe time he was seeing Dr. K. The physician could not provide Bob with an explanationfor his improvement,nor would he characterize this as a cure, since chronic hepatitiscan remit and flare up. Still, Bob's resultswere quite dramaticand he was disappointedbut not surprisedat the physician's unwillingnessto credit herbalmedicine for his normalliver enzymes. On the other hand, Bob was pleased thatthe physiciandid not try to dissuadehim from takingthe teas either. 7Dr.K's patientstendedto addresshim by firstname. use disposableneedles. The only exceptions 8BothWesternand Chinese practitioners who sells a set of needles to his patients, requiring in this study were one acupuncturist detoxificationunit themto disinfectthe needles aftereach use, anda large substance-abuse thatemploys a staff to sterilize the needles. of 9Thisprobablyrepresentsan unusuallylarge proportionof Chinese practitioners traditionalmedicine with M.D. degrees. Most practitionerswhom DuVal (1984) interviewed in Chinatown,for example, had received only traditionaltraining. R. Worsley developed a variant of acupuncturein England during the 1960s "oJ. of Chinese fiveknownas "traditional acupuncture,"which he basedon his interpretation element thinking. Since, as Unschuld (1985) so aptly demonstrates,there can be many traditionsof acupuncture,I am using the appellation"five-element acupuncture"when speakingof adherentsto Worsley's paradigm.This is technicallyincorrectbecause there are other five-elementparadigms.Thus, I am employing this term with reservations,recognizing thatthe appellationreally reflectsemphasisand not a pure school.
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'Theforewordof the Bollingen edition of the I Ching, writtenby CarlJung, is in part a critiqueof Euro-American Wilhelmgives a brief notionsof causality. In the introduction, analysisof the hexagramsthateventuallycame to be used for divining the future. In their most fundamentalstate, the hexagrams represent "certain processes in nature" (Jung 1967[1950]:1),much as the five elements are processes in naturethat can be applied to humanhealth. REFERENCES CITED Amber,Reuben, and A. M. Babey-Brooke 1966 The Pulse in Occident and Orient:Its Philosophyand Practicein Holistic Diagnosis and Treatment.New York:AuroraPress. Aronowitz,Stanley 1988 Science as Power: Discourse and Ideology in Modem Society. Minneapolis: Universityof MinnesotaPress. Capra,Fritjof 1982 The TurningPoint:Science, Society, andthe Rising Culture.New York:Bantam Books. Croizier,RalphC. 1976 Ideology of Medical Revivalism in Modem China. In Asian Medical Systems. CharlesLeslie, ed. Pp. 341-355. Berkeley:Universityof CaliforniaPress. Douglas, Mary 1966 Purityand Danger. New York:Praeger. Duggan, RobertM. 1984 From Apprenticeship to Classroom:Attemptingto Articulatethe Unspeakable. In AmericanAcupuncture:A Collection of Readings. Pp. 78-83. Columbia, MD: Traditional Institute. Acupuncture DuVal, M. Louise 1984 HealersandHealthCareDecision Makersin New York's Chinatown.Ph.D. dissertation,AnthropologyDepartment,Graduate Facultyof the New School for Social Research. Ehrenreich, Barbara,and John Ehrenreich 1970 The AmericanHealthEmpire:Power, Profitsand Politics. New York:Random House. Judith Farquhar, 1991 Objects, Processes, and Female Infertilityin Chinese Medicine. Medical An(n.s.) 5:370-399. thropologyQuarterly Foucault,Michel 1973[1963] The Birthof the Clinic. New York: Vintage Books. Illich, Ivan of Health. New York:PantheonBooks. 1976 MedicalNemesis: The Expropriation Jung, CarlG. 1967[1950] Foreword.In The I Ching or Book of Changes. R. Wilhelm and C. F. Baynes, trans. Pp. xxi-l. Bollingen Series XIX. Princeton,NJ: PrincetonUniversity Press. F. Kao, Frederick 1979 China, ChineseMedicine andthe Chinese Medical System. In Recent Advances in Acupuncture Research. F. Kao and J. Kao, eds. Pp. 1-36. GardenCity, NY: IARASM. Kaptchuk,Ted J. 1983 The Web That Has No Weaver:Understanding Chinese Medicine. New York: Congdonand Weed.
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1985 Introduction-OrientalMedicine:Culture,Historyand Transformation. In Fundamentalsof Chinese Medicine. P. Zmiewski, ed. Pp. xvii-xxxvii. Brookline, MA: Publications. Paradigm Kaufman,Sharon 1988 Towarda Phenomenologyof Boundariesin Medicine: ChronicIllness Experience in the Case of Stroke. Medical AnthropologyQuarterly(n.s.) 2:338-354. Kleinman,Arthur 1975 Social, Culturaland HistoricalThemes in the Study of Medicine in Chinese Societies: ProblemsandProspectsfor the Comparative Study of Medicine and Psychiatry. In Medicine in Chinese Cultures. ArthurKleinman, et al., eds. Pp. 589-658. Center,NIH. Washington,DC: FogartyInternational 1986 Social Originsof Distress andDisease. New Haven, CT: Yale UniversityPress. Kleinman,Arthur,and JoanKleinman 1985 Somatization: in Chinese Society among Culture,DepresThe Interconnections sive Experiences, and the Meanings of Pain. In Cultureand Depression:Studies in the Anthropology and Cross-CulturalPsychiatry of Affect and Disorder. Arthur Kleinmanand Byron Good, eds. Pp. 429-490. Berkeley: University of California Press. Lakoff, George 1987 Women, Fire, and DangerousThings. Chicago:Universityof Chicago Press. Leiss, William 1972 The Dominationof Nature. New York:George Braziller. Lock, Margaret 1980 East Asian Medicine in UrbanJapan.Berkeley:Universityof CaliforniaPress. Lu Gwie-DjenandJosephNeedham 1980 Celestial Lancets: A History and Rationale of Acupunctureand Moxibustion. Cambridge: CambridgeUniversityPress. Lyng, Stephen 1990 HolisticHealthandBiomedicine:A Countersystem Analysis. Albany:StateUniversityof New York Press. Maciocia, Giovanni 1989 The Foundations of Chinese Medicine:A ComprehensiveText for Acupuncturists and Herbalists.New York:ChurchillLivingstone. Martin,Emily 1987 The Woman in the Body: A CulturalAnalysis of Reproduction.Boston, MA: Beacon Press. 1990 Towardan Anthropologyof Immunology:The Body as Nation State. Medical (n.s.) 4:410-426. Anthropology Quarterly New York State Associationof ProfessionalAcupuncturists 1992 NCCA All The Way. The Point 2(1):1. New York State EducationDepartment 1990 Responsibilitiesof the Office of the State Boardfor Medicine. News Bulletin of the Professions4:13-15. 1991 Acupuncture BoardEstablished.News Bulletin of the Professions6:15-16. Omura,Yoshiaki 1982 AcupunctureMedicine: Its Historical and Clinical Background.Tokyo: Japan Publications. Ots, Thomas 1990 The AngryLiver, the Anxious Heartand the MelancholySpleen. Culture,Medicine and Psychiatry. 14:19-56. Pound,Ezra, trans. 1980[1951] ConfucianAnalects. London:PeterOwen, Ltd.
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Press, Nancy Anne, and C. H. Browner 1992 "Collective Fictions": Similaritiesin Reasons for AcceptingMSAFP Screening amongWomenof Diverse Ethnicand Social Class Backgrounds.Fetal Diagnosis and Therapy.(In press.) Riddle, JacksonW. 1979[1974] Reportof the New York State Commission on Acupuncture.In Recent Advances in AcupunctureResearch. F. Kao and J. Kao, eds. Pp. 728-757. Garden City, NY: IARASM. Rouse, Joseph 1987 Knowledge and Power: Towarda Political Philosophyof Science. Ithaca, NY: CornellUniversityPress. M. Lock Scheper-Hughes, Nancy, and Margaret 1987 The MindfulBody: A Prolegomenonto FutureWork in Medical Anthropology. MedicalAnthropologyQuarterly(n.s.) 1:6-41. Sullivan, Mark 1986 In WhatSense Is Contemporary MedicineDualistic?Culture,MedicineandPsychiatry10:331-350. Unschuld,Paul U. 1985 Medicinein China:A Historyof Ideas. Berkeley:Universityof CaliforniaPress. Wilhelm, Richard In The I Ching or Book of Changes. R. Wilhelm and C. F. 1967[1950] Introduction. Baynes, trans. Pp. xlvii-lxii. Bollingen Series XIX. Princeton, NJ: PrincetonUniversityPress. Wiseman,Nigel, and AndrewEllis 1985 Translators' Foreword.In Fundamentals of ChineseMedicine. P. Zmiewski, ed. Pp. i-xvi. Brookline, MA: ParadigmPublications. Worsley, J. R. 1982 TalkingaboutAcupuncture in New York. Longmead:ElementBooks, Ltd. Wu, JohnC. H., with Paul K. T. Shih, eds. and trans. 1961 The Tao Teh Ching of Lao Tze. New York:St. John's Press. Appendix 1: Explanatory Models of Health Problem Question Asked of Patient: What do you think was the cause of your present health problem? Sports Medicine Patient (White male, custodian, weight lifter): Heavy cycle of training. Actually the pain I'm having now is . . . from the tearing of muscle tissue and [new] growth. I'm not able to do enough stretching to get the contraction to stop. The acupuncture helps me to do that. Private Patient (White female, movement therapist, chronic urinary-tract infection): Two years ago, I didn't know what people meant by codependency; emotionally it's a lack of boundaries. ... It was a set-up [because] in Chinese medicine, the bladder is a metaphor for boundary problems. . . .Spiritually, I wasn't listening to my [inner] guides [because of] fear. ... On a physical level, I have a genetic proclivity to bladder and kidney weakness. The Western doctor .. . [said I] have a thousand pinpoint hemorrhages in my bladder lining, so I'm losing my lining. Detox Patient (Black female, HIV +, former injectable drug user, unemployed): After strict upbringing, liked having feeling of being in a private space that heroin gives. [My] husband was a dealer.
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Follow-up Questionfor Patient: How would you say this method [acupuncture, works? herbs, acupressure] SportsMedicinePatient: Basically what I've heardis the needles stimulate the muscle to do what it shoulddo on its own [like] allow betterblood flow. You can actuallyfeel it. If he hits an areathat'srelaxed,you don't even feel the needle. You have to hit areasof tension. techniques, [they] look for stagnantand blocked energy. Stimulatingthe points has a regenerativeeffect. [Also releasing] endorphinsis a small part of what Chinesemedicinedoes-[it's] what Westerndoctorsrecognize. Detox Patient: Works as a mender. It broughtbroken parts together with healingand support. QuestionsAsked of Practitioners:What are some of the conceptions which patients have aboutyour work when beginning treatment? How might you explain the treatment to your patients? Registered Specialist's Assistant-Acupuncture (White female, institutetrained,NCCA certified):I try to give them a little backgroundin what Chinese emotionalpicturegoes with this diagnosis. I thinkit's helpful because when you talk aboutthings thatpeople are alreadyin touch with, it gives people confidence thatwhat you're talkingaboutis not just some weird stuff from China. ChineseLicensedAcupuncturist (Chinese female, M.D. in China):At first they are very skeptical:"I've been to all the Westerndoctors. I have to live with this pain." [They] come to me very doubtfulbut then it works very well .... Usually on the first visit I do a little bit of explanationof Chinese medical approaches.They thinkit's interesting.People accept, they don't thinkit's unscientific. (White female, trainedat local clinic): I'm not sure Physician-Acupuncturist whatthey expect. ... They think it's gonna hurtand it does. ... Some people expect to be cured right away. I always tell them that's not gonna happen. ... I'm more interestedin people reorientingthemselves in life. Why did they have the back pain, etc.? Detox Clinician (White [West Asian immigrant] male, institute-trained, which helps. Some come from NCCAcertified): Most come in via word-of-mouth upstairs[inpatientunit] and are very afraid. [We] have to play with them, build trust, and tell them we don't give a foreign treatment.It's something the body does itself. Appendix II: Educational Pathways to the Practice of Acupuncture in New York State Prior to 1991 This summarydiscusses educationalpathwaysfor the practiceof acupuncture. At this time, thereare no requirements for the practiceof the otherforms of Chinesemedicinediscussed in this article.
medicine looks at and how it sees the body. . . . For example, this psychologist I've been treating for back pains. ... I thought it may be interesting to him what Private Patient: Chinese medicine goes back to the source . . . through the
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LicensedAcupuncturist. The applicantwas requiredto have practicedfor ten yearsoutsideNew York State and have proof of acupuncture education.Nine of the ten East Asian practitioners in this study held this credential. Registered Specialist's Assistant (R.S.A.)-Acupuncture. This route requires five years of practice outside New York State and proof of acupuncture education.R.S.A.s are also requiredto have a physician-preceptor who need not be an acupuncturist or be physicallylocatedin the same office as the R.S.A. Three were R.S.A.s. respondents Physician Certification. Physicians and dentists wishing to practice acupunctureare requiredto take a state-approved,300-hourtrainingcourse consisting of a didacticportion, demonstration,and practice(usually upon each other). Threerespondentswere certifiedphysician-acupuncturists; one also went on for "traditional"trainingin Europe. The other three Western-trained physicians in this studyhad learnedthe practice"on-the-job" and were not certified. National Certification. The National Commission for the Certificationof (NCCA) sponsorsa comprehensiveexam for which applicantsmay Acupuncture sit afterhavingcompletedeitheran NCCA-approved three-yearacupuncture proand classroom instructionacceptableto gramor a combinationof apprenticeship the commission. This was the majorroute of entry for the nonphysicians(N = 8); however, it was not recognizedby New York State at the time of the study. In 1992, an acupuncture lobby prevailed in convincing the state that it should use the NCCA exam and requirementsas the basis for licensing nonphysicianacupuncturists.

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The Emergence of an Urban U. S. Chinese Medicine Author(s): Martha L. Hare Source: Medical Anthropology Quarterly, New Series, Vol.

The New School for Social Research

The Emergence of an Urban U.S. Chinese Medicine

THE EMERGENCEOF AN URBAN U.S. CHINESE MEDICINE

THE EMERGENCEOF AN URBAN U.S.

% of Respondents 62 17 17 3 99 76 17 7 100 59 41 100 69 21 10 100 48 17 3 3 28 99

Total Gender Female

28-44 years 45-60 61-84 Total

Medicaid Medicare Uninsured Unknown Total

THE EMERGENCEOF AN URBAN U.S.

MEDICAL ANTHROPOLOGY QUARTERLY

THE EMERGENCEOF AN URBAN U.S.

THE EMERGENCEOF AN URBAN U.S. CHINESE MEDICINE

THE EMERGENCEOF AN URBAN U.S.

THE EMERGENCEOF AN URBAN U.S.

MEDICAL ANTHROPOLOGY QUARTERLY

THE EMERGENCEOF AN URBAN U.S.

MEDICAL ANTHROPOLOGY QUARTERLY

THE EMERGENCEOF AN URBAN U.S.

THE EMERGENCEOF AN URBAN U.S.

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