On Integrating Like Bamboo

Daniel Schulman

/ 9 min read

Our profession has been striving to emerge within Western society for at least half a century. While national, regional, state and provincial details vary, the profile of Chinese Medicine throughout most of the West is now expanding remarkably. This includes developments in popular culture, private insurance coverage, government recognition, regulation, credentialing, research, and training and education.

It’s been tough toiling away on the fringes. A hunger for recognition has understandably accumulated. And the intoxication of it’s eventual release can be powerful. Recognition most certainly warrants celebration. But it is not without risks. As we establish the infrastructure for our mainstream integration, we we must moderate the eagerness to comply with cultural demands of our growing professional recognition with candid and critical foresight about the future we want to build.

Regulation is a central pillar by which professions generate legitimacy in our culture. Accreditation and licensing frameworks for both schools and practitioners are the infrastructure we build to earn that legitimacy. But, once in place, structures can be rigid, unwieldy, difficult to change and even ultimately self-serving to a degree that exceeds that by which the profession is served. So it is critical in the early stages of such structural development that we bring full awareness of the many cultural, social and political drivers, motivations, intentions and agendas in play.

Two essentially contradictory demands face institutions and their leadership. On the one hand, safeguarding against errors, abuses and harm and ensuring a minimum baseline level of consistency is required. On the other hand, development, creativity, and innovation must be fostered, nurtured, promoted and allowed. Put another way, we are simultaneously pulled to prevent the perils potentially inflicted by the worst of ourselves and liberate the promise potentially generated by the best of ourselves. This conflicting tension has deep roots in Classical Chinese thought. The contrast between two towering Zhou Dynasty Confucian figures exemplifies the tension. Mencius (382-289 BCE) took the position human nature is fundamentally good and emphasized the primary importance of education to enable this inherent potential. Xunzi (310-220 BCE), on the other hand, took the position that human nature is fundamentally bad and emphasized the primary importance of laws and punishments to restrain, control and manage this inherent potential. So this is by no means a new tension.

In most public and private spheres, the structures in place are heavily weighted towards protecting ourselves from the worst of ourselves. There is generally (on the surface anyway) much more concern with safety, protection from bad behaviour and avoidance of errors than there is concern with excellence, innovation, creativity and enablement of exemplary behaviour. This is what regulation does best. It is just a lot easier to build such structures and generate the enforcement and measurement tools around them.

Certainly, the worst of us needs rules. But, the best of us needs to be set free. When we put in place rules, the frameworks often implicitly stifle the fire and even the very pilot light of freedom. This is the paradox, the conundrum we face as we create the structures of our profession and subject ourselves to the powerful forces at play with integration into the mainstream matrix. It is an uncommonly rare public or private institution that manages to fully balance these two impulses. It is no easy task because over emphasis on one typically undermines the other.

The typical acupuncture practice context presents a particularly complex set of potential conflicts into the mix. The realities of serving patients with medical care, the intimacy of the relationships involved, the potentials for abuse, and the financial needs of successfully managing a business all pull and tug on each other. Many of these conflicts are common to all medical professions.

Unique to the emergence of the Chinese Medicine profession is an additional very important layer of complexity. Ours is a 2000 year old medicine. That is a LOT of history, many dynastic rises and falls, comings and goings and consequently, many versions of Chinese Medicine – all with legitimacy. “TCM” is a mere sliver of the vast thing that is Chinese Medicine (whether acupuncture or herbal medicine) – reflecting an ever so narrow few decades of a multi-millennial unfolding process. To freeze-frame that thin sliver into our regulatory scaffolding is to contract ourselves into some very diminished version of what we could and should be. Unique to our medicine is the current reality that ‘innovation’ is often not developing something ‘new’, but engaging more deeply with something ‘old’ and sometimes actually doing both at the same time. Modern medicine is not faced with such a circumstance.

When upon learning I am heading off on a course, my patients often ask me if I am “going to keep up-to-date with the latest developments”. I laugh and reply, “more like keeping up-to-date with the latest revelations and understandings of old developments”.

Practitioners can feed their development with an increasing array of Classical versions of our medicine. Here in the West, Shang Han Lun teachings via Arnaud Versluys, Nei Jing teachings via Ed Neal, the Taoist lineage teachings coming through Jeffrey Yuen, the palpation teachings of Wang Ju Yi, Kiiko Matsumoto, Charles Chace and Dan Bensky to name just a few. There are also very compelling syntheses of classical and modern medicine, Kiiko Matsumoto’s Ling Shu / modern psychoneuroimmunology synthesis, Leon Hammer’s Chinese Medicine / modern anatomy / psychology synthesis, Dan Keown’s Chinese Medicine / modern embryology synthesis and Lonny Jarrett’s 5 element / bio-psycho-social development synthesis just for example. These are all spreading, growing, and infusing our profession. We need to and must give them all time and space to breathe, expand, contract, develop, permeate, integrate, ripen, mature and even in some cases, wither away.

Our emergence is still very embryonic. Given this reality, the governing frameworks we erect today must be designed to minimize constraint, encourage development and of course, simultaneously, provide the baseline necessary for protection and safety.

To highlight just some (there are many) of the complex conflicts we must take care to reflect in the structures we generate, consider my own professional trajectory as an example. I graduated from one of the oldest and highest ranked North American acupuncture schools, have participated extensively in professional governance, written and published professionally in respected journals, presented professional webinars, addressed hospital rounds, given courses and myself, taken hundreds of hours of continuing education programs from the best and brightest leaders in our profession. Fully trained in the TCM framework, I passed the TCM-based national American certification exam, upon graduating.

Within weeks of entering my private practice, I relegated the ‘textbook’ TCM model I had learned in school to the background of my practice. It just did not match the patients I was seeing very well, nor did it seem to point me towards potent channel interventions. I found in my practice the daily application of the Japanese palpatory approaches I had learned to be far more applicable, relevant, focused and powerful. This meant within weeks of graduating, I was not differentiating patients according to TCM pattern discrimination (except in the background as what I would call loosely supportive information), my treatment choices were not based on such a process and my clinical notes did little to reflect TCM. But I most certainly was making full use of the channel systems of acupuncture, assessing their function in my patients and administering very effective treatments. Since then, I have layered upon and integrated frameworks and approaches from 5 phase teachings (Lonny Jarrett), Taoist lineage channel dynamics (Jeffrey Yuen), channel palpation teachings (Wang Ju Yi), and Nei Jing channel principles (Ed Neal) and I continue to study, undertake clinical inquiry and pursue personal cultivation central to my practice.

To be honest, in 17 years of practice, I have rarely written down a TCM Zang Fu pattern differentiation in my clinical notes. (This is a complex conversation requiring extensive understanding of history and of the different requirements of didactics for beginners contrasted with post-training clinical reality). Yet, I can demonstrate my clinical practice is powerful, effective and successful by any one of many metrics. And thousands of patients over two decades can attest to this. Furthermore, my practice is rooted in classical understandings, principles and frameworks.

Meanwhile, there are presently regulatory frameworks in parts of Canada that require the practitioner to clearly include TCM Zang Fu pattern differentiation in clinical notes and indicate how the treatment provided to the patient, specifically addresses the pattern(s) noted. Were I to practice in such jurisdictions, I would have to take away from my well-honed and evolving clinical focus repeatedly every day for the sole purpose of satisfying regulatory requirements with an exercise that has very little relationship to my clinical practice or effectiveness.

Consider another domain of regulation, that of clinical hygiene. Clean needle technique typically includes alcohol swabbing of points prior to needling and a variety of protocols for not touching the needle base, both of which are enforced requirements in some jurisdictions. Yet we know alcohol does not sterilize the skin. Furthermore, it’s cooling action may well adversely affect local Qi around the needling site. There are also many acupuncture styles (some of which I practice) where intimate contact between the practitioner’s fingers, the needle base and the needling location is essential. Do over zealous regulatory hygiene frameworks in our profession compromise the feeling and management of Qi and the cultivation of nuanced palpatory capacity? Is swabbing of points, use of tubes and gloves really about hygiene (is there even compelling evidence for this?) or are they a show for the sake of our medical culture and the appearance of legitimacy?

Were I to move my practice to a jurisdiction where all the above requirements were in place, the powerful clinical effectiveness I have cultivated would be significantly compromised by my need to satisfy regulatory requirements which frankly, seem to serve the appearance of legitimacy more than they do legitimate concerns around risk and safety or for that matter, the practice of Chinese Medicine.

Such concerns are not unique to my situation. Two recent conversations with highly established clinical veterans of our profession has revealed to me distressing signs of bureaucratic over-reach in the frameworks we already have in place. One case involves a Canadian colleague who graduated twenty years ago from one of North America’s oldest and most established acupuncture schools, is fully certified by a globally recognized certification agency, and has 20 years experience running a full time busy clinical practice in the United States. A recent move back to Canada should have been a welcoming experience for her. Instead, she has faced a bureaucratic intransigence in the Canadian Province to which she has chosen to move, with a demand she write the basic entry-level certification exam. Given her training, certification and history, this simply should not be the case and reflects one thing and one thing only – excessive and intransigent bureaucracy. What she is facing has nothing to do with safety or protection. Furthermore, such a level of disrespect to the elders in our profession, the very people who worked so hard decades ago, to establish our legitimacy at the leading edge, is simply unacceptable. The situation we have already created should alarm us all; deeply.

Another case involves a ‘professional elder’ with full training, certification and decades of clinical experience in delivering acupuncture. He has also pursued extensive, comprehensive and high level training and certification in osteopathy. His acupuncture regulatory body has informed him he is not allowed to indicate anywhere on his website or in any of his promotional materials that he is trained in or practices osteopathic therapy. And if he does, he will lose his license to practice acupuncture in his Province of practice. It is not the case that he has a weekend or week course in either acupuncture or osteopathy. By any standard, his training in both acupuncture and osteopathy is comprehensive. What does such restriction have to do with safety or protection? Again, this is simply unacceptable bureaucratic over-reach. To the contrary, such individuals have the tremendous potential to generate insights and therapeutic creativity that leads us all into the future of medicine. The future is demanding of us that we set such people free to do their work, not bury them in suffocating frameworks of pathetic small-mindedness.

These are all early-warning signs that demand our attention. In our profession, more than any other, we should clearly appreciate the degree to which individual health, and its social and cultural context are mutually embedded within one another. We, more than any other health care providers surely must appreciate the importance of not replicating the diseased social and cultural structures within which we currently find ourselves. Bureaucratic over-reach is as much a disease of our times as is diabetes or breast cancer.

As we generate the very infrastructure of our profession, it is most appropriate that we strive to resonate with the philosophical tradition of our medicine. This is well reflected in the archetypal image of bamboo. The characteristics of bamboo convey a uniquely dynamic blend of flexibility and structure. A healthy future requires us to put in place just enough structure to be reliable, dependable and durable, yet also enough flexibility to be adaptable and amenable to growth, emergence and evolution.