J. TECHNICAL WRITING AND COMMUNICATION,Vol. 27(1) 69-85, 1997

DESCRIBING ACUPUNCTURE: A NEW CHALLENGE FOR TECHNICAL COMMUNICATORS

MARIANTHE KARANIKAS Southwest Missouri State University

ABSTRACT

Acupuncture is increasingly popular as an alternative medical therapy. Its description presents a challenge for technical communicators. Traditional Chinese medical explanations of acupuncture are unscientific, and scientific explanations of acupuncture are inconclusive. Technical communicators must translate acupuncture theory (traditional and scientific) for not only laypeople, but also for both traditional Chinese and Western health practitioners. Further research is needed.

Acupuncture is increasingly popular as an alternative medical therapy. In 1994, Americans “made some 9 to 12 million visits t o acupuncturists-forailments as diverse as arthritis . . . back pain, and morning sickness” [l, p. 741. A recent study in The New England Journal of Medicine reported 30 percent of Americans used some kind of alternative therapy in 1990, spending around $13.7 billion dollars, three-fourths ($10.3 billion) from out of pocket [2, p. 2461. The January 1994 issue of Consumer Reports notes “an estimated 3000 medical doctors and osteopaths have studied acupuncture and use it in practice-up from 500 a decade ago. In addition, some 7000 nonphysicians use acupuncture for a wide array of health problems, sometimes in conjunction with herbs, massage, and other traditional Eastern techniques” [3, p. 541. Acupuncture needles have recently gained FDA approval as medical tools, allowing insurance coverage of acupuncture [4, p. 421. While traditional Chinese medical explanations are unscientific, scientific explanations are inconclusive [l, p. 76; 4, p. 307; 5, p. 181; 6, pp. 96-98]. There is a growing body of evidence that acupuncture works, although its scientific mechanism is not clearly understood [l, p. 711. 69 0 1997,Baywood Publishing Co.,Inc. doi: 10.2190/G5MR-JPJM-WRHU-PWDB

http://baywood.com

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Describing acupuncture presents a special challenge for technical communicators who must not only translate acupuncture theory (traditional and scientific) for Iaypeople, but also for both traditional Chinese and Western health practitioners. This article analyses this problem and discusses six writers who have addressed this challenge. I discuss four difficulties encountered in integrating traditional Chinese medical theory with Western science and medicine: 1) Traditional Chinese medical theory tends to be either devalued or over-valued-both extremes mystify rather than elucidate an understanding of acupuncture; 2) Traditional Chinese medical terminology is necessarily ambiguous and is therefore especially difficult to translate; 3) Traditional Chinese medical theory and Western medicine arise from different philosophical views, complicating the ability to construct scientific demonstrations of acupuncture’s efficacy; 4) Traditional Chinese medical theory and Western medicine provide different perspectives of the human body. Then I illustrate how six communicators have resolved these difficulties in three descriptions of acupuncture: 1) Dr. David Eisenberg in an interview with journalist Bill Moyers; 2) Dr. Charles Lo in an interview with writer Bryan Miller; 3) Health editor Rick Weiss in a recent popular science article. FOUR DIFFICULTIES IN INTEGRATING TRADITIONAL CHINESE MEDICAL THEORY WITH WESTERN SCIENCE AND MEDICINE 1) Devaluing or Overvaluing Traditional Chinese Medical Theory

In The Web That Has No Weaver, Dr. Ted J. Kaptchuk begins with a story about a Chinese peasant who once worked as a maintenance man in a Western missionary hospital. When he retired to his remote village, the former maintenance man brought back hypodermic needles and many antibiotics. He proceeded to treat his fellow villagers by injecting them with antibiotics. A remarkable number of villagers recovered from illness although this healer knew almost nothing about Western medicine. Then Kaptchuk makes the analogy: In the West today, much of what passes for Chinese medicine is not very different from the so-called Western medicine practiced by this Chinese peasant. Out of a complex medical system, only the bare essentials of acupuncture technique have reached the West. Patients often get well from such treatment because acupuncture, like Western antibiotics, is strong medicine. But the theoretical depth and full clinical potential of Chinese medicine remain virtually unknown [7, p. I].

According to Kaptchuk, any communicator attempting to help integrate traditional Chinese and Western perspectives will encounter two extreme views of

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Chinese medicine and acupuncture. The first is that traditional Chinese medicine is “hocus-pocus-the product of primitive or magical thinking” [7, p. 13. Science writer Kurt Butler supports this position. Butler maintains that acupuncture, while effective in some cases of chronic pain and in easing the symptoms of withdrawal from drug addiction, is “nothing more than a potent placebo” [6, p. 1001. He considers traditional Chinese theory to be silly primitive animism, “dreamed’up centuries ago by people who had no idea how the human body works” [6, pp. 96 and 2681. Here it is assumed that Western science and medicine have the only approach to Truth and any other system is primitive superstition. The second view, according to Kaptchuk, is equally erroneous. It is the assumption that “the Chinese system, because it is felt to be more ancient, more spiritual, or more holistic, is also more ‘true’ than Western medicine. This attitude threatens to turn Chinese medicine from a rational body of knowledge into a religious faith system” [7, p. 21. An article in the National Council Against Health Fraud (NCAHF) Newsletter concurs that the “Eastern” versus “Western” dichotomy in science and medicine is false. Both Eastern and Western cultures have made contributions to science and medicine. Both cultures also have had their share of “fanciful metaphysical healing” [8, p. 31. In A Consumer’s Guide to Alternative Medicine, Butler attacks several health practitioners who hold the second extreme view [6, pp. 93-1041. Kaptchuk argues that both “attitudes mystify the subject-one by arrogantly undervaluing it (traditional Chinese medicine), the other by setting it on a pedestal. Both are barriers to understanding” [7, p. 21.’ Kaptchuk, like Manfred Porkert, a medical doctor who writes about Chinese medicine, prefers a middle ground [111. This integrative view recognizes the contributions of both Western and traditional Chinese medicine, while noting the different terminologies and philosophical views of nature which distinguish the one approach from the other. For Kaptchuk and Porkert, Western and traditional Chinese medicine are complementary; together they provide two mutually beneficial approaches to healing. Porkert holds that traditional Chinese medicine “can only be understood, applied in practice, criticized and elaborated on the basis of a Chinese diagnosis conforming to the specific methodology used to develop these methods in the course of more than two millennia” 111, p. 1].2 Kaptchuk notes Chinese medicine uses “terminology that is strange to the

Kaptchuk holds a doctorate in Oriental medicine, a degree which is not recognized by the National Council Against Health Fraud [9, p. 1651. This degree, however, is recognized in a large number of states which allow the licensure of non-physician acupuncturists. Traditional Chinese medical theory is also recognized by the World Health Organization [lo, p. 671.

*

Porkert argues for the complementarity .of Western and traditional Chinese medicines. He does not argue traditional Chinese medicine is superior, although he does suggest Chinese diagnostics have a lower error rate than Western diagnostics [I 1, p. 11.

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Western ear” [7, p. 31. It is also rooted in “the philosophy . . . of a civilization entirely foreign to our own. It has therefore developed its own perception of the body” [7, p. 21. 2) The Necessary Ambiguity of Traditional Chinese Medical Terminology

Traditional Chinese medical explanations are considered unscientific by scientists and acupuncturists alike. To many Western readers, Chinese terminology appears vague, imprecise, muddled, speculative, or flat out wrong. In 1985, Dr. Petr Skrabanek characterized the bulk of literature on acupuncture as a “hermetic doctrine” written in an “esoteric jargon, liberally peppered with Chinese words” [5, p. 1811. A decade later, while there is greater understanding of traditional Chinese medical terminology, and more evidence that acupuncture works, critics still question its efficacy and legitimacy [ l , 31. At least 3000 years old, acupuncture is one branch of traditional Chinese medicine which also includes herbal remedies, massage, dietary therapy, physical exercise, and consideration of one’s environment. In modem science, precise measurement and conceptualization are the ideal. Traditional Chinese thought, however, has an affinity for ambiguity, for the multiplicity of meaning. “This is due to an appreciation that in nature things are rarely cut and dried, but instead are rather blurred” [12, p. 31. Ambiguous Chinese terms are often translated into English terms with definite meanings, failing to evoke a more complete sense of the idea. A major example here is the term Qi or Ch’i or Chi (pronounced chee or key), a word translated as life force or energy. The Shanghai College of Traditional Medicine considers “Qi” to be an untranslatable word which has two main senses: On the one hand, Qi is . . . matter without form. When this substance is diseased certain symptoms appear. Qi is also a term for the functional, active aspect of the body . . . When acupuncture is used, the Qi is said to be ‘obtained’ and then manipulated [ 12, p. 81.

The above translation is very difficult to understand. Matter without form? The functional, active aspect of the body? As the next section discusses, the terms “life force” or “energy” are easier to understand, but they bring with them associations with vitalism and animism, two Western philosophical systems which differ from Chinese thought. Traditional Chinese medicine arises from a philosophical view known as “organic materialism?

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3) Different PhilosophicalViews of Nature Western and traditional Chinese medicine arise from different philosophical views of n a t ~ r e According .~ to Kaptchuk, Western medicine is concerned with isolable causes of disease. The Western doctor starts with a symptom and then searches for an underlying mechanism. The Western physician’s logic is analytic. The Chinese physician’s logic, meanwhile, is organismic or synthetic:. All relevant information, including the symptom as well as the patient’s other general characteristics, is gathered and woven together until it forms what Chinese medicine calls a “pattern of disharmony” [which] describes a situation of “imbalance” in a patient’s body. Oriental diagnostic technique does not turn up a specific disease entity or a precise cause, but renders an almost poetic, yet workable, description of a whole person . . . One does not ask, “What X is causing Y?”but rather, “What is the relationship between X and Y?”. . . The total configurations, the patterns of disharmony, provide the framework for treatment. The therapy then attempts to bring the configuration into balance, to restore harmony to the individual [7, p. 41.

While Western medicine arises from a philosophical view which might be called “mechanistic materialism,” traditional Chinese medicine arises from a view the sinologist Joseph Needham calls “organic materialism”: “Metaphysical idealism was never dominant in China, nor did the mechanical view of the world exist in Chinese thought. [What prevailed was] the organicist conception in which every phenomenon was connected with every other” [13, p. 141. Central to Chinese organicism is the notion of Qi or Ch’i. A passage from Dr. Diane Connelly’s classic on Traditional Acupuncture: The Law of the Five Elements illustrates more aspects of this notion: Now, when I speak of Energy, I am speaking of the force which we call life. The Chinese term it Chyi Energy and liken it to the streams, brooks, rivers, lakes, seas, and oceans of Earth. The Life Force flows in us via interconnected pathways. In a way it is like electricity. It flows in a current, though we can not actually see it, we can see the manifestations of it, and feel the effects of it. In a way it is like the blood flow which, though we usually do not see it, pulses life through us. All life has it, and it converses with every aspect of life . . . It is only by Ch’i that the planets move, the sun shines, the wind blows . . . When Ch’i is flowing all of life’s processes are in operation in a rhythmic and harmonious way . . . if it goes awry, it becomes the basis of I am over-simplifying here for the sake of brevity. Practitioners in any discipline have diverse philosophical views. They cannot be lumped into two categories.

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disease . . . It is this that the Traditional Acupuncturist speaks of balancing if some aspect of this life energy is no longer in harmony with the totality [14, pp. 11-12].

Connelly’s talk of the “Life Force” sounds vitalistic or animistic. Many doctors and scientists point to the progress science and medicine achieved when liberated from what Francis Crick calls “the remaining shadowy sanctuaries of vitalistic illusions” [15, p. 1091. From this view, the notion of Ch’i seems a step backward. The NCAHF Newsletter considers Ch’ito be mystical [8, p. 31. Traditional Chinese philosophy, however, is neither vitalistic nor animistic. Recall the difficulty in translating Chinese terms, especially the term “Ch’i”which is also thought to be “matter without form” [12, p. 81. The notion of Ch’iis not vitalistic because Ch’imoves planets, the sun, and the wind, as well as living things. Vitalism splits the living from the non-living. The notion of Ch’iis not animistic, although it certainly sounds so in transition, because there is great emphasis on avoiding projecting one’s concepts of things onto nature. Animism involves the projection of human concepts onto non-human organisms or inanimate objects. The traditional Chinese emphasis is on the integration of body, mind, and spirit. The “bodymindspirit,” as Connelly calls it, differs from Western notions which split the three. In traditional Chinese thought, body is a manifestation of energy, thought is a projection of energy, and spirit can be thought of as subtle energy [14, p. 151. Since the Chinese do not divide the ideal from the real, “spirit” does not have supernatural connotations. It is a practical matter concerning vitality in daily life [16, p. 131. These different philosophical views become even more apparent when we consider the proposed scientific mechanisms to explain “acupuncture’s presumed action on pain”: Release of endorphins (narcoticlike substances of the body) . . . [Some studies suggest endorphin release occurs. Others do not.] The “gate theory.” This suggests that if pain fibers carry impulses from an acupuncture site, impulses from a painful body organ will be unable to reach the brain. [While this proposed mechanism has been widely published in introductory textbooks, the NCAHF still considers it to lack adequate anatomical and physiological basis.J I

Counter-irritation. Attention can be diverted from a symptom by stimulating or irritating another part of the body [9, pp. 163-1641. Psychological mechanisms. [Dr. William Jarvis, President of the NCAHF, considers acupuncture to be a powerful “psychological aid” to medical treatment, one which may “go beyond placebo effects, serving as a means of reinforcement or a way of diverting a patient’s focus from inner resources that

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may have failed hidher in the past, to outer influences that can be called upon in times of weakness [17, p. 681. In Beyond the Relaxation Response [18], Dr. Herbert Benson suggests that faith may play an important role in healing. Perhaps the notion of Ch’i helps a patient psychologically] [17, p. 681.

The Western explanations focus on mechanism, the Chinese on interrelationship, balance, and harmony. The Chinese terms are akin to those used in psychotherapy, supporting Jarvis’ suggestion that acupuncture may well be a very effective psychological aid to medical treatment. It is very difficult to construct scientific demonstrations of acupuncture’s efficacy. A standard scientific experimental model for testing the validity of a medical treatment is the double-blind study where both patient and health practitioner are unaware of the identity of the medicine. This sort of study may work well for pharmaceuticals where placebos and drugs can be manufactured to look the same. It does not work well for acupuncture where the very emphasis on energetic interconnection, not only among parts of the same organism, but also between healer and patient, is vital to effective treatment. The NCAHF notes the difficulties in constructing double-blind studies of acupuncture: “If an experienced acupuncturist locates the points, the practitioner’s expectations may be transmitted to the patient. If an inexperienced person inserts the points, misplaced needles may undermine the results’’ [9, p. 1641. But, in traditional Chinese medical theory, which does not separate mind from physical mechanism, the energetic interchange between healer and patient is part of the treatment. The body is a manifestation of Qi. 4) Two Different Perspectives of the Human Body

Traditional Chinese medicine emphasizes aspects of the human body which are not significant to Western medicine. Similarly, Western medicine emphasizes aspects of the human body insignificant or unnoticed by traditional Chinese medicine. The latter has a different concept of the Organ (the word is capitalized to indicate the Chinese usage), which is seen more as a functional aspect rather than as an anatomical location. Because the Chinese did not dissect human bodies, but instead studied live human beings, their medicine does not have the same anatomical understanding as Western medicine. Thus traditional Chinese medicine speaks neither of the nervous system nor of the endocrine system. Instead it speaks of the body’s secreting “toxins” when stressed and “nectar” when in balance. These almost poetic terms may refer to Western medicine calls neuropeptides, the small molecules associated with emotions like grief and joy. (The previously mentioned endorphins are types of neuropeptides.) Traditional Chinese medicine also speaks of the channels which are three-dimensional passageways through which Qi flows. “The channels also delineate the Organs’

spheres of influence in the body" [12, pp. 15-16]. The channels do not appear to correspond directly with anything in Western anatomy. From a Western perspective, the channels appear to be imaginary. They cannot, by definition, be located in a cadaver. In the living human being, this "system of channels . . . integratels] all the bdy's separate parts and functions into a unified organism . . . The channels form a web which crisscrosses the body vertically and horizontally. They join the internal Organs with the skin, flesh, bones and all other tissues, and integrate each part with the whole. . . . Channel theory reflects the holistic attitude of Chinese medicine, with great emphasis placed upon the interrelationships among all parts of the organism" [12, p. 351. The channels connect .the body's interior with the exterior, thus forming the basis of acupuncture theory. Qi circulates "through the channels, communicating with acupuncture points in the skin" [12, p. 1051. As Kaptchuk says, working with acupuncture "points on the surface of the body will affect what goes on inside the body, because it affects the activity of [what is] traveling through the" channels [7, pp. 77-78]. Each Organ has a corresponding channel. The channel affects the Organ and the Organ affects the channel. A Stomach disorder may cause upper toothache since the Stomach channel passes through the upper gums, while a lower toothache may result from an imbalance in the Large intestine. "The basic idea behind acupuncture . . . is that the insertion of very fine needles into points along the . . . [channels] can rebalance bodily disharmonies" [7, pp. 78-79]. Clearly traditional Chinese and Western medicines arise from very different perspectives. Let us now briefly explore how three descriptions of acupuncture have resolved these difficulties. RESOLVING THE DIFFICULTIES: THREE DESCRIPTIONS OF ACUPUNCTURE 1) Acupuncture in its Cultural Context: An American Journalist and Doctor Visit China

In the first description, television journalist Bill Moyers interviews Dr. David Eisenberg, a Harvard-trained internist who was the first American medical exchange student to visit the People's Republic of China. Moyers' interview is part of a popular television program on Healing and the Mind. This article uses the companion text to the program, published in Moyers' best-selling book of the same title. Moyers' interview with Eisenberg takes place in China, beginning in the herbal pharmacy and the herbal kitchen of the Beijing hospital where he trained eleven years earlier. It continues in the acupuncture ward and the massage unit of the same hospital, and then moves to a park in Shanghai at dawn where hundreds of people do exercises to harmonize their Ch'i. This sequence of encounters shows that acupuncture is but a small part of traditional Chinese

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medicine where body, mind, and spirit are integrated. This approach extends the realm of medicine to the entire realm of life. Each individual is responsible for his or her health. The doctor is at once healer, teacher, and spiritual guide. Eisenberg and Moyers neither overvalue nor undervalue traditional Chinese medicine. Instead they tour the Chinese hospitals with open minds. But both Eisenberg and Moyers are aware of their biases. “This is the herbal pharmacy,,, Eisenberg beings, “the nerve center of the whole hospital . . . Many of these herbs have been administered for thousands of years and the effects have been well-documented and well-studied‘, [16, p. 2571. Moyers, entranced with all the strange herbs, discovers a dried gecko lizard is also a medicine. He asks, “What is it good for?’ The pharmacist replies, “It halts a cold and reduces phlegm” [16, p. 2581. In the “kitchen,” where herbal teas are prepared, Moyers remarks, “Some scientifically grounded person walking here would be reminded of the witches in Macbeth: Boil, boil” [16, p. 2611. Eisenberg corroborates, “And until these remedies are tested scientifically, that would be a fair sentiment” [16, p. 2611. Moyers marvels, “I feel as if I’ve walked into a medieval alchemist’s shopboiling roots, boiling gecko” [ 16, p. 2611. Eisenberg and Moyers note their reactions to the look, feel, and smell of Chinese herbology, how this context appears to them almost mythological, perhaps even a witches’ den or alchemist’s shop. But they are in a hospital and these ancient arts of healing are also professions. Acupuncture, one such art, is used both as an anesthetic and as a means to treat “hundreds of different disease” [16, p. 2621. Eisenberg explains the strange-sounding Chinese terminology to Moyers: The body is a series of energy conduits. Chi, the Chinese name for this energy, flows along systematic . . . [channels], which do not coincide with any known physiologic structures. When a patient is ill, our Western doctors search look for physical or chemical abnormalities. Chinese doctors search for hidden forces that are out of balance. Their task, as they describe it, is to restore unseen harmonies. Sticking needles into the body is obviously a physical intervention to Westerners, but not to the Chinese. They see it as intervening in an energy system [ 16, p. 2531.

Note how Eisenberg explains Chinese terminology through an immediate contrast between Western and Chinese medical epistemologies. The expressions like Chi, hidden forces, unseen harmonies, which sound vague and imprecise to Western ears, are literally seen in their philosophical and cultural context. For example, we see a woman with paralysis of the face being treated by acupuncture.

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Eisenberg says, ‘The doctor is putting needles into her arm and face, into what is called the ‘large intestine’ ” . . . [channel]. “I don’t understand that,” Moyers remarks [16, p. 2621. Eisenberg explains that each channel of energy corresponds to one organ. They ask the patient what she is feeling. “I feel a swelling during treatment. Then I feel better. When I came in, I was dizzy, and my arms had no strength” [16, p. 2643. Moyers and Eisenberg employ an empirical approach to describing acupuncture. They see the procedure in action and ask for a definition of terms as the process is happening. Moyers immediately recognizes the Chinese have a different perspective of the human body. He asks, “What have nerve charts. Do they correspond to the pathways of chi in the Chinese system?’ [16, p. 2641. Eisenberg replies no, the channel system “does not correspond to any anatomic map we have in the West . . . Their diagnostic and therapeutic roadmap-the way they describe the workings of the human body-is totally different tiom ours” [16, p. 2641. Eisenberg’s use of the term “roadmap” concretizes the seemingly vague Chinese terminology in an analogy palpable to Western ears. His analogy describing Ch’i,which focuses on its almost tactile properties, is equally palpable. “How does the doctor know he’s hitting the right point?” Moyers asks. Eisenberg replies, “It’s an incredibly difficult thing to do. He asks whether she feels the chi, and if she has a sensation, that’s how he knows. He also has to feel it. My acupuncture teacher said it’s like fishing. You must know the difference between a nibble and a bite. You put the needle in, and if gets a little stuck, if there is a tension pulling back, then you know, without even asking the patient” [16, p. 2641. Here the notion of Ch’ias “matter without form” seems almost tangible, the feel of a fish bite. Organic materialism, which is traditional Chinese medicine’s underlying philosophy, recognizes the equivalence of matter and energy, the integration of body, mind, and spirit. Eisenberg remarks, “In Chinese medicine, the medical masters, the people who’ understand material things, were also the spiritual leaders. They never split the two. Imagine if Harvard Medical School were placed inside a large theological seminary and classes were taught jointly. That’s in a large part what Chinese medicine is about” [ 16, p. 2971. But the spiritual knowledge is also practical. Countless Chinese exercise daily to harmonize their Ch’i. They often take herbs and receive acupuncture when exercises and diet do not alleviate their difficulties. Moyers questions what keeps such a “rational” man as Eisenberg coming back to traditional Chinese medicine. Eisenberg answers, “if you interview dozens and dozens of people who seem very credible and realistic and practical, [and they say these practices have made them better], you have to wonder-are they all following some fantasy, or is

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there something here to be studied? That’s why I keep coming back” [16, p. 2911. Eisenberg notes that millions of Americans are also using massage, meditation, acupuncture, and herbal remedies of all kinds, without their doctors’ recommendations, because they are “eager for a more complete way of seeing health” [16, pp. 306-3071. But, for Eisenberg, “Physicians have many legitimate reasons for being cautious before recommending these techniques. They don’t understand them. They’ve not tested them. They don’t have enough evidence that these technologies help . . . And until they know that, they can’t in good conscience recommend these techniques to any of their patients [16, p. 3071. Moyers comments, “You know, I think millions of Americans are ahead of your profession in the practice of mindhody medicine” [16, p. 3091. “Yes,” Eisenberg agrees. “Science often lags behind popular experience” [17, p. 3091. He concludes, “China . . . taught me that we in the West don’t have a monopoly on understanding the human body or the relationship between the mind and the body. I am more and more convinced that to understand health, I can’t limit by study just to the physical body. I also have to understand the mind and spirit” [16, p. 3141. Moyers and Eisenberg resolve the difficulties in describing acupuncture by keeping an open-minded skepticism as they view the procedure in action. They attempt to understand acupuncture on its own terms through an exploration of traditional Chinese medical theory. They discuss the philosophical differences between Chinese and Western medicine, respecting both traditions. They note the different perspectives of the human body and use both camera and tactile analogies to illustrate different medical epistemologies and to explain untranslatable terms. 2) A Chinese-Born, U.S.-Trained MD Turns to the Way of His Ancestors

In the second description, writer Bryan Miller interviews Dr. Charles Lo, a U.S.-trained internist who has become an acupuncturist. The interview appears in The Chicago Reader, an alternative newspaper serving that metropolitan community. Lo’s definition of Qi begins the article: “People think of energy as something we get out of the Middle East, or out of the wall plug . . . but everything living has energy-what the Chinese call qi. ‘Energy’ is really a poor translation, [because the Chinese term encompasses a number of phenomena; for example, qi also means ‘air’]” [19, p. 131. In order to understand qi, one has to feel it. Lo says, “You have to experience it yourself’ [19, p. 131. Lo agrees with Chinese concepts, but thinks the “terminology makes it all too mystical, and muddles the ideas” [19, p. 131. Again, the emphasis is on practical understanding. “In China, a lot of patients know all the acupuncture

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theories: they know all the [acupuncture] points . . . It’s a people’s medicine; it’s not an ivory-tower kind of medicine like it is here, because Western medicine is practiced so that the patients don’t understand what you’re doing” f19, p. 131. The notions, like qi, which seem so impenetrable to Westerners, are commonly understood among the Chinese patients Lo describes. While he agrees with Chinese concepts, Lo also concurs with a mechanistic Western explanation of how acupuncture works: “When the needles go into the muscle, it stimulates certain nerve fibers, which send a signal to the spinal cord. In turn, the spinal cord releases endorphin[s] . . . to send off a signal to the thalamus and a couple of other areas in the brain” [19, p. 131. Nonetheless, Lo says, the Western doctor finds Chinese medicine hard to understand. Because the Chinese treat each patient differently, the diagnosis and treatment vary for each person and there are no repeatable results. According to Lo, Western doctors “expect set treatments for a set problem . . . but there’s an infinite number of variations in people . . . That’s the beauty of Chinese medicine: you can’t put everybody into the same box” [19, p. 141. Lo suggests Western medicine is limited because of its “chemical, mechanistic viewpoint of the body” which does not integrate the psychological, physical, and spiritual aspects of a person [19, p. 141. Lo explains he does not mean something religious when he uses the term “spiritual.” For him, being spiritual is a “reflection of the will of the person to have a positive life-style, a positive consciousness” [19, p. 141. For Lo, Western medicine is still rooted in Newtonian physics, with a mechanistic, reductionist view of nature. He suggests doctors take a quantum-mechanical view, “that there is no such thing as [the] material but only energy” [19, p. 221. Lo predicts doctors will move away from viewing the body as a machine, when the “more balanced energetic view of the body becomes popular . . . It’s going to take a long time, because there’s too much invested in the . . . [mechanistic] view of the w o r l d t o o much money, too much technology, too many people’s jobs” [19, p. 221. There is a problem in suggesting doctors take a quantum approach to medicine. As Douglas Stalker and Clark Glymour point out, “quantum mechanics simply cannot be applied to the levels at which biomedical researchers work” [20, p. 1241. The order of magnitude at which quantum mechanics operates is much smaller that the order of magnitude at which medicine operates. Even if a “quantum view” is inapplicable, studies on biofeedback, the relaxation response, and in psycho-neuroimmunology suggest the mind may play a role in healing [16, 18, 211. Acupuncture may lead to relaxation which, in turn, may help the patient heal. Whatever the case, Lo does not view acupuncture as a panacea. He would not treat cancer with acupuncture, nor would he treat a structural problem of the body. “If you have a broken arm, you have to have it set” [19, p. 221.

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Like Moyers and Eisenberg, Miller and Lo resolve the difficulties in describing acupuncture by offering as concrete definitions of Chinese terminology as possible, taking care to show its practical emphasis. While Lo is clearly biased toward Chinese medicine (he considers acupuncture and herbs to be safer than pharmaceuticals), he sees it as complementary with, not superior to, Western medicine. He notes that in China, both Western and traditional Chinese techniques are used, the Western to fight the disease, the Chinese to balance energy and to improve health [19, p. 241. Although Lo’s discussion of Chinese medicine’s kinship with the quantum view is problematical, his analogy helps to distinguish the Chinese focus on energy from the Western focus on matter. 3) A Health Editor Recommends Acupuncture to Americans

In the third description, Rick Weiss, a contributing editor to Health magazine, dissolves the distinction between East and West in the very title of his article describing acupuncture as “Medicine’s Latest Miracle” [1, p. 7 13. Weiss begins with an anecdote about cancer patient Nancy Rosenstadt, who responded well to surgery, chemotherapy, and radiation, but suffered Erom shrinking muscles and withering nerves after her cancer was finally obliterated. Her condition was considered hopeless when Rosenstadt was referred to the National Institutes of Health Clinical Center where she experienced recovery “at the hands of acupuncturist and M.D., Xiao-Ming Tian” [l, p. 711. Weiss then reports that in 1994, Americans “made some 9 to 12 million visits to acupuncturists for ailments as diverse as arthritis, bladder infections, back pain, and morning sickness” [l, p. 721. Weiss’ focus is not so much an exploration of how acupuncture works, but an argument that acupuncture does work. He mentions traditional Chinese explanations but surrounds them with results of clinical studies and interviews with experts (both proponents and skeptics). Throughout the piece, the narrative about Xiao-Ming Tian and his patients illustrates acupuncture in action. Weiss contends that acupuncture’s safety has drawn needle-phobic Americans to consider it as a treatment. “There’s something to be said for a medical practice that’s been around for 5000 years, with billions of satisfied patients. If acupuncture were dangerous, even its stodgiest critics concede, somebody would have noticed by now” [ l , p. 721. To Weiss, the claims of traditional Chinese medicine are “unconventional,” but because many doctors are now learning the art and referring patients to acupuncturists, Americans are encouraged to try it. Weiss keeps his definitions of traditional Chinese theory concise and concrete: “Acupuncturists say health is simply a matter of tweaking into balance a mysterious life force called qi” which moves through channels in the body [l, p. 721. “That’s hardly a mainstream view,” says Weiss, “yet of the 9,000 practicing acupuncturists in this country, fully a third are M.D.’s” [l, p. 721.

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Weiss follows the brief mention of qi with the results of clinical studies of how acupuncture offered short-term relief for “50 to 80 percent of patients with acute or chronic pain . . . Other studies have shown that acupuncture may be useful in treating nausea, asthma, and a host of other common ills” p. 721. Punctuating the explanations of studies are the descriptions of Ming’s giving Rosenstadt an acupuncture treatment. He inserts the needles about a quarter of an inch deep and they do not hurt. Rather than use vague phrases like “feeling the qi,” Weiss lets Rosenstadt describe the actual sensation: “as a tingling or mild buzz, especially noticeable when Ming begins to twirl the needles clockwise and counterclockwise in her skin, a technique that is said to help the needles do their job of moving qi through the body” [ 1, p. 721. Ming tells of the Chinese roadmap of the body in numerical terms: “There are nearly 400 acupuncture points along the body’s major . . . energy-carrying channels . . . and each has a Chinese name that describes the kind of energy or organ it affects” [ l , p. 721. Again, Weiss immediately returns to the tactile, concrete detail. “But to know if he [Ming] is in exactly the right spot, he must twirl the needle after inserting it and be sure that he gets a response from the patient-a report of feeling a deep heaviness or numbness in the area, or more commonly, a simple ‘yes’ *’ [ l , p. 721. Weiss then gives details of numerous studies. First, the skeptical physiologist Bruce Pomeranz sets out to prove acupuncture is a placebo, that it works only because people believe it works. He performs acupuncture on animals and uses electrodes to measure the pain responses in individual nerve cells. “To my chagrin,* he says, ‘it worked.’ Pain-transmitting nerves just didn’t fire in the animals given acupuncture**[ 1, p. 721. After scientists discovered endorphins, Pomeranz and others “showed that acupuncture’s pain-reducing effects are largely due to its ability to stimulate the release of endorphins’*[l, p. 721. Weiss then describes “one of the best studies published in 1987, [by] Joseph Helms, a physician and acupuncturist in Berkeley, California [who] gave weekly acupuncture treatments to a group of women with a long history of painful menstrual cramps. After three months of treatment, ten out of eleven women reported at least 50 percent less pain, only two of eleven untreated women, and one of ten women who received weekly counseling (included to see if the benefits of acupuncture were simply from regular contact with a doctor), improved as much” [I, pp. 72-73]. Weiss goes on to describe studies showing acupuncture’s relieving nausea, helping drug addicts kick their habits, speeding patients* recoveries from strokes and heart attacks, and “helping to ease the shortness of breath that comes with asthma and other respiratory problems” [l, pp. 74-76]. Weiss also notes that facial paralysis, some skin conditions, sleeplessness, restlessness, some vision and hearing problems, and impotence have “all yielded in one report or another to the power of the needle” 11, P. 761.

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Nonetheless, Weiss concedes that this “bounty of riches” is to critics “precisely what constitutes grounds for suspicion. How could one kind of treatment, one simple needle, treat ,such a wide variety of ailments?’ [l, p. 761. According to Weiss, many “mainstream doctors still shake their heads . . . when asked about acupuncture. After all, there is no objective evidence that qi exists, and there is nothing resembling Chinese . . . [channels] in Western physiology or anatomy books” [l, p. 761. Weiss prefers Western explanations involving endorphins and neurophysiology. Ming, meanwhile, contends that acupuncture is too complicated to understand. “Besides’, he points out, ‘it’s not as if Western medicine makes so much more sense: Nobody understands how anesthesia works’, he says, ‘but nobody says we should stop using it’ ” El, p. 761. According to Ming, to become entangled in the question of how acupuncture works is “to m i s s the point. The proper question to ask, Ming suggests, is Does it work?’ The answer to that question, the article concludes, is yes. Like Moyers and Miller, Weiss uses interviews with an M.D. acupuncturist to illustrate acupuncture’s efficacy. He also augments his description with clinical studies. Weiss is far more concise than the other authors in his explanation of traditional Chinese medical theory. His brevity may actually enhance understanding of the Chinese thought, especially since Weiss immediately illustrates the practical experience of Chinese terms and theories. He uses very concrete descriptions of actual sensations to define qi. While he notes the different Chinese perspective of the body, he focuses on Western explanations for acupuncture’s mechanism and clinical studies demonstrating acupuncture’s efficacy. Weiss does not undervalue traditional Chinese theory; he simply speaks in the epistemological terms that will best persuade his American readers. Finally, Weiss offers his readers an invaluable service. He tells them how to find a good acupuncturist: Check credentials. A state license is a starting point. Twenty-five states set rigorous standards for licensure. In the other states, choose an acupuncturist who is certified by the National Commission for the Certification of Acupuncturists. Because acupuncture licensing for doctors is more lenient than for non-M.D.’s, “it’s best to choose a physician who is a member of the American Academy of Medical Acupuncture” [ 1, p. 781. Weiss urges readers to insist on disposable needles and reassures that most acupuncturists now use them. Learn and ask about different treatment styles and check out the cost. Weiss states that first visits to nonphysician acupuncturist&m range from $40 to $100 with follow-ups from $30 to $70, while physician acupuncturists generally charge more. Since only a few insurance companies now cover acupuncture, it is important to check one’s policy before having treatment [ 1, p. 781. Weiss also advises readers to “be realistic,” to discuss expectations and goals. with acupuncturist and physician [l, p. 781. This pragmatic advice augments the concrete and succinct description of acupuncture as practiced and experienced in America.

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FURTHER RESEARCH IS NEEDED Further research is needed, both in understanding acupuncture’s mechanism and efficacy and in learning how to describe it for different audiences. Particularly important is the continued conversation between Western scientists and doctors and those scientists, doctors, and nonphysician practitioners who understand Chinese theory and know how to feel and experience qi. Western critics contend that Chinese explanations are fanciful, metaphysical, and imaginary. Meanwhile, these critics contend, scientific explanations, like those involving endorphins and the gate theory, are still inconclusive. “Endorphins alone can’t explain the mechanism of acupuncture. Something more complicated is going on,” insists J.P., a former bio-engineer who now practices acupuncture (interview with this author). J.P. is a certified acupuncturist (California license) who practices acupuncture for federally sponsored projects in a state where acupuncturists are not licensed. “How can a patient who comes in exhausted, sad, or anxious feel better so quickly after an acupuncture treatment? And how does the patient stay feeling better? It seems to me an endorphin rush alone would have a more temporary duration.” “I have a hunch the key lies in the work of scientists like Candace Pert,” J.P. speculates, “in the conformational changes of the neuropeptide receptors. Somehow the acupuncture needles trigger electrical changes that cause neuropeptide receptors to change their conformations. With the present technology, it’d be terribly difficult, if not impossible, to identify such a sequence of events. But, from my observations of patients’ reactions to acupuncture treatments, that’s my guess as to what’s happening.’’ Whatever the scientific mechanism, acupuncture differs from Western medical treatments. Clear technical communication is urgently needed to continue to illustrate, describe, and explain these differences to patients interested in maximizing their health. REFERENCES 1. R. Weiss, Medicine’s Latest Miracle in Health, pp. 7 1-78, January-February 1995. 2. D. Eisenberg, R. C. Kessler, C. Foster, F. E. Norlock, D. R. Calkins, and T. L. Delbanco, Unconventional Medicine in the United States, in The New England Journal of Medicine, 238:4, pp. 246-252, 1993. 3. Acupuncture, in Consumer Reports, 59:1, pp. 54-59,1994. 4. J. Langone, Alternative Therapies: Challenging the Mainstream, in Erne, Special Issue, pp. 40-43, Fall 1996. 5. I? Skrabanek, Acupuncture: Past, Present, and Future, in Examining Holistic Medicine, D. Stalker and C. Glymour (eds.), Prometheus Books, Buffalo, New York, pp. 181-196, 1985. 6. K. Butler, A ConsurnerS Guide to “Alternative Medicine, ” Prometheus Books, Buffalo, New York, 1992.

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7. T. Kaptchuk, The Web That Has No Weaver, Congdon & Weed, New York, 1983.

8. National Council Against Health Fraud, The False “Eastern” versus “Western” Dichotomy in Science and Medicine, in National Council Against Health Fraud Newsletter; 165, 1993. 9. National Council Against Health Fraud, Acupuncture: The Position Paper of the National Council Against Health Fraud, in The Clinical Journal of Pain, 7 2 , pp. 162-166, 1991. 10. B. Bouch, T. Smith, and A. Trachtenberg, In Response to the Position Paper by the National Council Against Health Fraud, The Clinical Journal of Pain, 8:1, pp. 66-67,

1992. 11. M. Porkert, Chinese Medicine, MOKOW,New York, 1982. 12. Shanghai College of Traditional Medicine, Acupuncture: A Comprehensive Text, Eastland Press, Seattle, Washington, 1981. 13. J. Needham, Science in Traditional China, Harvard University Press, Cambridge, Massachusetts, 1981. 14. D. Connelly, Traditional Acupuncture: The Law of the Five Elements, The Centre for Traditional Acupuncture, Columbia, Maryland, 1979. 15, H. F. Judson, The Eighth Day of Creation, Simon and Schuster, Inc., New York, 1979. 16. B. Moyers, Healing and the Mind, Doubleday, New York, 1993. 17. W. Jarvis, author’s reply in The Clinical Journal of Pain, 8:1, pp. 67-68, 1992. 18. H. Benson, Beyond the Relaxation Response, Times Books, New York, 1984. 19. B. Miller, A Conversation with Dr. Charles Lo, A Chinese-Born, U.S.-Trained MD Who has lhmed to the Way of His Ancestors, in The Chicago Reader; 20:15, pp. 13-24, 1991.

20. D. Stalker and C. Glymour, Quantum Medicine, in Examining Holistic Medicine, D. Stalker and C. Glymour (eds.), Prometheus Books, Buffalo, New York, pp. 107-125, 1985. 21. H. Benson, The Relaxation Response, William Morrow, New York, 1975.

Other Articles On Communication By This Author Karanikas, Marianthe. The Lesson of Larkspur: Science and Meditation: Language and the Mind, book manuscript in progress. Karanikas, Marianthe. “Spiritual Empowerment in the Technical Writing Class,” to be published in Spiritual Empowerment in Pedagogy, edited by Susan Schiller and Regina Foehr, Heinemann-Cook, Fall 1996. Karanikas, Marianthe. “Science and Metaphor,” PMLA, May 1993.

Direct reprint requests to: Marianthe Karanikas English Department Southwest Missouri State University Springfield, MO 65804