The culture of professional Chinese medicine in the US : the reality and use of nature-centrism as a value

This is the third and final portion of the paper I read at the 2017 SPCW annual meeting. You can read the beginning here, and the second portion here. Changes are likely to come to all parts of this paper as I continue to research and revise. The dates of those updates will be reflected on the various posts. Thanks for reading and I look forward to your feedback!

Nature-centeredness in EAM business

Contemporary medicine has a significant ecological cost. Hospitals and other medical facilities can produce tremendous amounts of waste, including toxic waste, requiring specific (and often energy intensive) disposal. For example, sterilization of surfaces and instruments, vital to many aspects of medical practice, often demands single use of manufactured items made from plastic and other materials. Medical waste incineration, the disposal of pharmaceuticals and the use of electricity, water and sewage treatment are all additional issues that medical institutions must face if they intend to reduce their environmental impact.

So, what would it mean for EAM professionals to embrace nature-centeredness in the practical day-to-day operation of our medical facilities? Many of the problems I described in TBM institutions do not apply, or apply differently, to the current form of EAM practice. There is no toxic waste incineration, no manufacture or disposal of medications, and the overall energy usage is limited due in part to the absence of electronic devices in diagnosis and treatment in EAM.

General conservation principles and other consumer level decisions that conserve resources or reduce consumption of course apply to EAM practices. There is one area of special concern, however, the acquisition and use of imported herbs. The vast majority of Chinese herbs are imported from China and Taiwan to distributors in the US. The ecological implications of this practice are numerous and include the impact of transatlantic shipping, industrialized agriculture and, in some cases, the depletion of wild growing plants and animals.

Domestic herbal production in the US is starting to become more viable as the market for these herbs improves, but this will not eliminate the need to consider the various ecological impacts of herbal practice. Embracing the principle of nature centeredness in our acupuncture businesses will require that we look carefully at this – as well as at other aspects of our practice.

Nature centeredness in EAM education

How would taking this aspect of our oath seriously change the nature of medical education for EAM practitioners? There are 63 fully accredited programs for the study of acupuncture and Chinese herbal medicine in the US (ACAOM website). The majority are 3 years master’s level programs, with a few more advanced programs that take 4-5 years.

As I stated earlier in this paper, the structure of the programs, and their basic academic cultures, are very similar to other medical school programs. The flow of the educational year follows the regional standard for all educational institutions. The pressure to specialize, to excel and to do extracurricular education in service of specialization, is as significant as it is in TBM education in some cases. While most would argue that the pace and pressure at most EAM institutions is lower than at equivalent TBM institutions, the draw on students’ internal resources is still significant.

How can we apply the principle of nature-centeredness to good effect in this situation? As an example, consider the flow of the academic year with regards to the seasons. EAM medical schools, like most US schools, begin instruction in the Autumn and continue through the year, leaving the summer free for other activities. The common explanation for this is that the rigors of agriculture, in which children were expected to participate, shaped the flow of education through the year – less during high agricultural season and more during low agricultural season.

But, from a EAM point of view, this is backwards.

In the winter, where there is winter, most plants and non-human animals go into times of reduced activity. Many human beings, too find themselves with reduced energy in the winter months, more prone to eating heavier meals, relaxing with friends and family, and engaging in activities that can be done in cooler temperatures and with reduced sunlight available.

In other foundational literature for EAM professionals, particularly the first official general medical text, the Huangdi neijing, we are informed:

“In the three months of winter….one should be kept warm in the room, dress warmly and take strict preventative measures against the cold, so that the Yang energy may not be disturbed; go to bed early in night and get up late with the sunlight…” (Huangdi neijing suwen CH2, Bing Wang trans. 1997).

So, if EAM administrators and educators were to incorporate the promise to “live in harmony with nature” into the structure of medical school education, a reorientation to make the bulk of the classes in the summer would be ideal. This change would obviously have serious consequences, and may be impossible given the structure of the education system in the US, but it is one area of improvement to consider as EAM practitioners looking to live in harmony with nature.

In this paper, I have tried to describe the contemporary professional environment for acupuncturists in the United States.

While there are hundreds of issues under active debate by the community, many of which could have important consequences for patients, I chose to look specifically at one aspect of EAM’s professional culture – the ethical construct of the oath. Through analyzing that oath, I have tried to demonstrate that it can serve as a scaffolding for the formation of a robust professional culture, and have suggested some ways that this might impact practitioners and institutions in the profession.

Apologies & omissions

I want to mention a few problems I am aware of in this paper, and concerning this field of study in general.

• First, I acknowledge that the practice of EAM is worldwide, and I am only able to present from my perspective as a US practitioner of EAM. My views, my education and my interest lies in the US professional context. This is significant as the practice of EAM is substantially different between countries.
• Second, it is important to understand that I am not a fluent Chinese speaker, a trait I share with most of my US acupuncturist colleagues. Because of this, my understanding of the international community of EAM is limited to the number of well translated resources I can access. So, my account invariably leaves out the most current research and understanding of EAM as an international system of medicine.
• Third, this paper is also limited to investigating the professional / licensed practice of the medicine in the US. This omits, for instance, the history and character of EAM as practiced by immigrant communities in the US long before the government ever considered licensure. For these reasons, more research would be necessary to generalize my assertions to the international practice of EAM.
• Finally, I acknowledge the many issues involved in this type of intercultural exchange and development. The tendency to fetishize aspects of SE Asian culture is common among my colleagues. Even more common is what I can only call cultural appropriation as some individuals and organizations cherry pick aspects of the cultures behind the creation of EAM, simplify or combine them with other cultural aspects, and otherwise fail to be respectful recipients of traditional information that has been kindly shared. I do not have any idea how to resolve these issues, but I think an overt discussion of them is important in the formation of the EAM professional culture in the US.