Acupuncture's balancing act

Traditional Chinese medicine punctures the mainstream at the New England School of Acupuncture

by Marcus Wohlsen

In a former convent in Watertown, Brookline physician Richard Foster is pushing micro-thin, one-inch needles into the muscular shoulder of an all-American-looking undergraduate, a rower on the University of Rhode Island crew team with a torn rotator cuff.

"Do you feel it?" Foster asks as he pushes a needle in further.

The patient is silent for a moment. Then he nods. "There it is," he says to Foster. "There's the qi."

Qi (pronounced "chee"), according to the principles of acupuncture, is the vital force of which life itself is a function. Its ebb and flow through the body is what causes -- and relieves -- poor health. Redirecting qi is not the usual way to mend a torn rotator cuff, but then again, a torn rotator cuff often doesn't respond to simple Western treatments like immobilization or physical therapy. Foster's patient says he had been suffering for months, with noninvasive Western therapies yielding little improvement; not yet ready to try surgery, he turned to acupuncture. After several sessions, he says he notices a slight improvement, but nothing miraculous.

Neither Foster nor the rower is the kind of crunchy-looking "true believer" that people tend to associate with alternative medicine. They look as if they'd feel more at home in Fenway Park than in yoga class, and their presence here -- doctor and patient in a needling session -- seems to confirm acupuncture's place in a very '90s American cultural category: like Pearl Jam, and Starbucks, acupuncture is now quasi-alternative. In November of 1997, the National Institutes of Health (NIH) even gave acupuncture its blessing, concluding in a consensus statement that "there is sufficient evidence . . . of acupuncture's value to expand its use into conventional medicine."

At that time, Foster, a Washington University-trained emergency physician, was already in his second year at the New England School of Acupuncture (NESA) in Watertown, and the New England School of Acupuncture was in its 22nd year -- the oldest acupuncture school in the country. It is at NESA, as much as anywhere, that traditional Chinese medicine is making its peace with Western medical culture.

In a community that boasts some of the nation's most prestigious Western medical facilities, the signs of NESA's success are manifold: an all-time high of 250 students enrolled this fall; a refurbished 30-bed teaching facility treating hundreds of patients weekly; and a new partnership with the Boston Regional Medical Center, in Stoneham, the first of its kind in the hospital's history and the only acupuncture center at a Western medical hospital in the Boston area.

---

NESA was founded in 1975, just a few years after a New York Times reporter accompanied Nixon to China and made a media splash when he told the story of how traditional Chinese practitioners had cured his appendicitis by sticking multiple needles into his skin.

A decade later, in the mid-'80s, NESA received state accreditation to grant a Master of Acupuncture degree; last year, its teaching clinic moved from the classroom building on Common Street to a newly refurbished treatment facility just down the road, a tranquil retreat not far from Mount Auburn Street's commuter scramble. The old St. Patrick's convent is now thick with the odor of moxa, a pungent herbal aromatic that acupuncturists burn at the ends of their needles for the dual purpose of sending heat to the pressure points and creating a calming atmosphere.

Acupuncture is one part of the overall system of traditional Chinese medicine (TCM, to its practitioners), a holistic approach that also includes herbalism, meditation, massage, and fitness. At NESA, where all these items are on the curriculum, health is a matter of balance and acupuncture is a matter of qi. If you imagine qi to be like electricity, a healthy body is a closed circuit where the qi flows harmoniously and unhindered. What needles do, the theory goes, is conduct qi along the body's qi pathways, just like electricity on a wire, to right a qi imbalance and thereby overcome the ailment.

This is not the foundation of your average medical education, but in other respects NESA looks a lot like a medical school. Its three-year Master of Acupuncture program is a rigorous, year-round course that includes classes in both traditional Chinese medicine and the Western disciplines of biochemistry, physiology, and pharmacology. Detailed wall charts hang in almost every room at the school, showing not the Gray's Anatomy version of the human body but the traditional Chinese version: a system of energy meridians, pathways for qi. At the student café, brightly packaged over-the-counter-style Chinese herbal medications are sold alongside tea and sandwiches, much the way Excedrin or No Doz or Tums might appear in another cafeteria. The message is clear: any resistance a Western-educated mind might have to the holistic science taught here is simply an issue of inherited cultural differences, the kind of discomfort someone raised on hamburgers might have when encountering dim sum for the first time.

To the skeptic, TCM might sound a lot like alchemy, the protoscientific efforts of European esotericists to transmute common metals into gold. Alchemy, after all, was also richly systematic; it also dealt with concrete physical phenomena interacting with ambiguous, unseen forces. Having abandoned alchemy as a legitimate pursuit centuries ago, Western science would seem to have little room for a discipline like TCM. Then again, alchemy was also famous for not yielding gold. Acupuncture, on the other hand, seems to work.

Diane Iuliano, a NESA graduate and faculty member, was a graphic designer in her mid-20s when a Western doctor diagnosed her with ovarian fibroid tumors and recommended a hysterectomy. She tried acupuncture instead, and the tumors shrank enough for her to avoid the surgery. "That was enough for me to close down my graphic design studio and apply to school," she says.

Even Parade magazine, the middle-of-the-road Sunday newspaper supplement, ran an article recently whose headline declared acupuncture "Mainstream (Almost)," and in which a genial doctor -- while never quite asserting that acupuncture worked -- flatly encouraged "any properly diagnosed patient" to try acupuncture for a number of chronic ailments.

According to NESA president Dan Seitz, "a lot of people are open-minded skeptics and trust their experience. When their experience is one of getting better, they realize [TCM] is worthwhile."

---

Looking around Seitz's office, you get the impression that Eastern spirituality is never too far from the school's sense of its intellectual heritage. A photograph of a Tibetan Buddhist mandala hangs on the wall near a small statue of Kuan Yin, the Chinese Buddhist personification of compassion.

Seitz -- aware of the doubts TCM still faces among many Western doctors -- has no trouble asserting that what NESA teaches is science. "In some ways," he says, "Chinese medicine is the ultimate scientifically proven medicine, because it's been based on several thousand years of empirical study.

"Over the centuries, Chinese physicians used an empirical process of trial and error and careful observation, a correlation of success with certain treatments, and created what was actually a very sophisticated, interconnected, theoretically precise type of medicine. So in that sense, anyone who says Chinese medicine is not scientific I think doesn't really understand what science is about."

Seitz is a lawyer by training, and his affable, enthusiastic advocacy of TCM would play well to a jury of skeptics. The divide between Western medicine and TCM is deep, and Seitz doesn't try to paper it over. (The difference, after all, is part of its appeal.) But he does set out a convincing vision of how conventional and alternative medical practices can integrate.

"What I ultimately actually hope to see," he says, "is not that people choose acupuncturists over Western physicians necessarily, but that people develop the awareness to know who to see when."

You can see it in the course catalogue. High on the list of NESA's official educational objectives is the goal of graduating students who are "knowledgeable about Western medical terminology, pathophysiology, and approaches to treating illness." Even advocates of traditional Chinese medicine concede that when you have a heart attack, you want to be taken to a Western emergency room. So NESA requires its students to have a semester each of the major Western sciences and basic Western medicine. This is smart both medically and politically; by setting up a program that gives Western medicine due credit, the school makes a preemptive strike against any criticism that the school is more about religious conversion than education.

But integration works both ways. If acupuncturists are willing to concede the superiority of Western medicine in emergency cases, Seitz would like to see Western doctors admit that their system also has its limits. In other words, American medical schools should teach that there is a time for Western medicine and a time to refer patients to an acupuncturist.

"The first important goal for [medical] schools to consider," says Seitz, "is having enough coursework on the theory of acupuncture or Chinese medicine -- or, for that matter, other forms of alternative medicine, chiropractic or massage -- to know when they should refer their patients out for treatment in those areas."

Seitz is equally concerned to point out that Western medical research is not based on pure science either. "The large majority of Western techniques and interventions have not undergone careful clinical testing either," he says. "There, too, people rely on clinical judgment and clinical experience."

Seitz would like to see TCM go head-to-head with conventional Western treatments in comparative clinical trials to see which therapy most effectively fights ailments that don't have established Western medical cures. Migraine headaches, stroke, carpal tunnel syndrome, arthritis, lower back pain, and asthma -- illnesses that are usually at the top of acupuncturists' "most commonly treated" lists -- are all problems against which he believes TCM would hold its own beside Western techniques.

Even if such trials haven't happened yet, it's clear the establishment is taking acupuncture more seriously. The NIH has recommended further study of acupuncture; two years ago, the FDA declared that acupuncture needles were no longer an "experimental medical device" and thus were acceptable for general use by qualified practitioners. Closer to home, the Massachusetts state legislature recently passed a bill striking a provision requiring all patients to get a referral from a Western physician before seeing an acupuncturist.

"We thought we'd have a big fight to try to get this through," Seitz says of the legislation, which was signed by Acting Governor Paul Cellucci in May. "If a bill like that had been introduced five or ten years ago, I think it wouldn't have survived."

---

Yet even with acupuncture's credibility at an all-time high, its reception in the trenches of medicine has not always been warm. Doctors, after all, aren't the ones inviting acupuncture inside; Lorie Miller, director of the complementary medicine program at the Boston Regional Medical Center, sees acupuncture's acceptance as "a combination of patient interest and economics."

"Managed care puts more and more pressure on you to do things economically," she says. "Certainly an acupuncturist is cheaper than an anesthesiologist." And "patients want it. The demand for this medicine is incredible and still growing."

Miller, the driving force behind the hospital's NESA-run acupuncture clinic, acknowledges the difficulty of bringing acupuncture into a hospital's standard regimen of treatment possibilities. "A lot of people, and doctors are included in that, believe that [acupuncture] is a placebo effect at best and shamanism at worst," she says.

This impression is probably reinforced by the look of the clinic's rooms, which are furnished with lamps, leafy floor plants, and oriental rugs. The clinic is more homey than sterile -- not at all like a typical hospital floor.

Students practicing at the clinic report little interaction with other hospital physicians thus far. Still, in-house patient referrals increased from around 100 in May to around 200 in June, according to Miller. For the new fall semester, the clinic is planning to expand its operation from two to four days a week. And, perhaps more tellingly, many Western-trained nurses and doctors on the Boston Regional staff have sought out NESA's in-house acupuncture service to help with stress reduction, according to NESA students practicing there.

Boston Regional isn't the only hospital to offer some access to TCM; many local hospitals now offer pain-management centers as subsidiaries of their anesthesiology departments, where practitioners of conventional and alternative medicine work together to help patients manage chronic pain problems. But Boston Regional is one of the few, Miller says, where acupuncturists can be affiliate members of the hospital medical staff. As affiliates, acupuncturists have access to patients' medical charts and can recommend treatment in an official capacity. To become an affiliate, acupuncturists are subject to the same lengthy accreditation guidelines as any other member of the medical staff.

That acupuncturists have made it past accreditation at the hospital at all, according to Miller, is evidence that the Western-trained doctors are becoming receptive to TCM. "It's a fairly cumbersome process," she says. "If you don't have physician support, it's not going to happen."

---

Some local physicians are so supportive that they actually enroll: typically, four or five MDs enter NESA's program every year. Richard Foster, the Brookline doctor needling the URI rower, is one. His day job is in the emergency room at Faulkner Hospital, in Jamaica Plain, where he had to limit himself to weekend shifts so that he could attend NESA.

To him, acupuncture is an answer to a problem that grew to plague him in his 20 years as a physician. "I started to see patients where basically we had done all we could for them and their problems just persisted," he says. "I was looking for other ways to deal with that."

He says it's not unusual for him to see patients in the emergency room who are on 10 prescription medications simultaneously, leaving them so tormented by side effects that they're not much better than they were before taking the drugs.

Western medicine, he says, doesn't have much to offer chronic pain sufferers besides pills to dull their symptoms. "We would have way more effective ways of treating that here. For me, [TCM] is an incredible complement to what I know."

A wiry, thoughtful man of 46, Foster seems sincerely convinced of acupuncture's objective worth as a treatment. "Acupuncture," he asserts, "works even when people don't believe in it at all." But the TCM tradition is equally important to him as a tool for developing a less quantifiable kind of well-being that is as beneficial to the doctor as it is to the patient. "In order to do this kind of medicine," he says, "you have to cultivate your own personal energy. It's a very intensive kind of medicine." To develop his own qi sensitivity, Foster began a regular regimen of tai chi, the well-publicized slow-motion Chinese martial art, and qi gong, a system of meditative Chinese breathing exercises.

"The healthier that I've gotten, the more insight I've gained into the health of other people," he says. "You can't necessarily live a hectic Western lifestyle and have what TCM would say is good health."

He says his goal after he leaves NESA is "to integrate what I know so that I can open up a practice where I have a big bag of tricks." To illustrate how that might work, he offers the example of a patient who comes to him with pneumonia. With his Western medical background, he would know to treat the patient with antibiotics. He would also augment that treatment with acupuncture to "rebuild energy" and speed healing.

For the diehard Western rationalist, to whom "rebuilding energy" sounds like so much hocus-pocus, the qi-based model of health that NESA students learn is probably irredeemably marked by its imprecision. Qi won't register on an EKG or a blood test; there is no chemical formula or biological diagram to illustrate it. According to the NIH consensus statement, the closest thing researchers have to a physiological theory of acupuncture is research showing that the body usually releases its own built-in painkillers, called "endogenous opioids," during acupuncture treatment. No study to date has proven anything conclusive.

But for patients -- and some doctors -- the appeal of TCM is exactly the part that can't be pinned down. The point of Western medicine is to ferret out sickness and attack it; the point of TCM -- with acupuncture, with massage and plants and meditation -- is to foster the much more elusive thing called health. And in a revolving-door medical climate, it fosters something else as well: human contact.

According to Seitz, every initial consultation at NESA lasts "at least an hour"; every acupuncture session requires a minimum of 20 minutes. "With the holistic approach," says Seitz, "the bottom line -- apart from knowledge and understanding and experience that's required -- is that you have to spend time with patients."

That's part of the appeal for Cynthia Kahn, a pain specialist at Beth Israel Deaconess Hospital and a NESA student. "I think that it's made me a better doctor overall," she says of her training.

TCM, she says, is "like learning to use two sides of your brain. It's like learning to be a healer."

Marcus Wohlsen is a freelance writer living in New York.