美国当代主要针灸流派的诊疗特点及现状的研究
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摘要
中医药学的起源、形成和发展与社会、历史、文化因素紧密相关,是在多元民族及全球文化相互交融的土壤中发展起来的。文化传播与交流是中医药学术体系的形成与发展的催化剂和推进器,而医学流派的形成,百家争鸣,亦促进了中医学的不断完善和发展,充实和丰富了中医学宝库。尽管与欧亚各国相比,针灸传入美国较晚,但美国多元文化的背景孕育了美国针灸流派的多样性,不同流派的学术争鸣不仅对针灸及中医在海外的发展有推动作用,带着移民国家特色的不同流派针灸在本土化进程中所形成的独特诊疗风格也是中医学发展的重要补充。
本研究主要采用文献整理、调查研究的方式,通过分析梳理美国各针灸流派的诊疗特点,调查其存在现状,从社会、历史、文化角度探讨美国各针灸流派形成发展的影响因素,为中医、针灸开拓自身发展、扩大对外交流提供借鉴和启示。
本论文共分为7部分：
第一部分针灸在美国的传入及发展
本部分将针灸在美国的传入与发展历史进程概括为三个阶段：①针灸在美国的早期传入；②纽约时报著名记者詹姆斯·赖斯顿有关针灸的报道掀起的第一次针灸热潮；③美国针灸在立法、保险、教育、科研多系统推进的第二次针灸热潮。40年来,针灸在美国由初始的边缘化、局限化、非正规化逐渐朝着普遍化、合法化、正规化的方向发展,为美国针灸流派的形成奠定了基础。
第二部分美国主要针灸流派的形成及分类
美国多元文化的社会环境孕育了美国针灸流派的多样性。美国针灸多渠道的传入特点是美国针灸流派形成的基础。在给各针灸流派定义的基础上,通过追溯美国各针灸流派的形成、发展源流,特别是传入美国的历程,勾画出美国针灸流派的分布概况。
本文以理论基础的来源为基准,将当代美国针灸分为两大阵营：一类是以阴阳五行等中医基础理论为主导的学派；另一类则是以解剖、生理、病理等西医理论为主导的学派。又根据传入途径及诊疗特点将以中医基础理论为主导的学派分为：①由中国传入的中医针灸流派。以传统中医针灸(Tradit ional Cinese Medicine Acupuncture, TCM针灸)为主体,附派生出的民间家族式针灸----董氏奇穴针灸及谭氏平衡针灸；②由欧洲传入的五行体质针灸流派；③由日本传入的日本针灸流派；④由韩国传入的韩国针灸流派；⑤美国的针灸物理医学。而以西医理论为主导的针灸流派主要为医学针灸,包括扳机点针灸。
第三部分综述有关美国当代主要针灸流派的研究概况
通过主要替代医学搜寻系统EBSCO的Alt Health Watch搜寻1990年至2011年4月有关针灸的全文文献,在搜寻所得的5528篇文献中,有关TcM针灸及医学针灸两大类别的临床疗效及作用机理的研究比重在针灸文献中不容置疑地占有绝对优势。其余各流派经逐一搜寻仅得171篇,再经逐篇手检剔出无关及重复文献,得出除TCM及医学针灸以外的美国其他针灸流派的相关报道及研究共125篇；再经北京中医药大学图书馆检索系统搜寻得到近30年中文文献中涉及有关各国针灸流派的文献有62篇,其中仅4篇涉及美国针灸流派的研究。由此得出有关美国针灸流派的整体研究尚属空白的观点,为进一步研究美国针灸流派提供了依据。
第四部分美国主要针灸流派的诊疗特点
本部分研究以迄今出版的美国各针灸流派的主要参考书及美国各有关院校的教学大纲为依据,从诊法、诊断、治则、治法四方面系统梳理美国各针灸流派的诊疗特点,比较其诊疗特点的共性及个性。探讨美国各针灸流派在本土化进程中为适应环境而出现的的自我整合变化,概括出美国针灸在临床上形神兼顾、以人为本的总体诊疗特点。
具体而言：美国针灸诊疗的主要特点表现为①在诊法上各流派均重视按诊；②在诊断上,流派间各有偏重,以中医理论体系为主导的各针灸流派多重视辨证,其中又以最能体现针灸特点的经络辨证及以经典五运六气理论为指导的体质辨识作为重点；③在治疗·上,大都遵循中医整体观念进行身心并治的全面调理,重视经络治疗；④在针法上,以轻浅刺激为主,常结合多种治疗手段以期达到最佳疗效。
第五部分美国当代主要针灸流派现状的调查研究
本部分的调查包括以下两个部分的内容：
1、美国针灸及东方医学院校课程设置现状的调查
本研究以普查的形式通过电子邮件、电话咨询及查阅各院校教学大纲,调查美国针灸及东方医学院校理事会(CCAOM)属下的54所院校有关针灸流派的课程设置状况,比较各针灸流派在针灸教学中所占的比重,以了解各针灸流派在美国针灸中所处的地位。
调查结果表明：从收到反馈的51所院校有关美国主要针灸流派的课程设置中可以看出,TCM针灸为大多数针灸院校教学中的主体,除个别院校以非TCM针灸为主体教学外,大多数院校将各非TCM针灸流派列为主体教学之外的必修或选修课,加上课外及继续教育课程中有关各针灸流派的讲座,使得美国本土毕业的针灸师具有了兼容多种不同文化背景针灸流派的知识结构。
2、美国主要针灸流派应用现状的调查
本调查以CCAOM属下的54所针灸及东方医学院校校友会及美东,美西主要针灸学会的不同族裔、不同教育背景的针灸师为对象,通过网络调查及书面调查结合的形式,调查美国不同针灸流派诊疗方法的临床应用状况。以了解不同族裔及教育背景对针灸流派选择的倾向性、各针灸流派在针灸临床应用中所占的比重及与常见病的关系。
调查结果表明：调查中共收回来自24所美国针灸院校的校友及3个主要针灸团体会员的297份问卷。结果显示：
①参与此次调查的人员大多(80%以上)为接受过硕士以上专业培训的、富有临床经验的针灸师。尽管他们来自不同的国家和地区,但针灸专业的培训除中国外大多是在美国完成的(76%)。对TCM针灸认知的普及度最高,但其中80%以上的问卷填写者同时亦对美国的其他针灸流派有所了解,其中来自欧洲及美国本土的问卷填写者对美国各针灸流派的了解明显高于来自亚洲的中国及韩国的问卷填写者；
②99%以上的问卷填写者接受过TCM针灸教育外,他们中的半数以上亦接受过五行体质针灸流派及董氏、谭氏针灸的培训,其次为日本针灸、扳机点针灸及韩国针灸；
③临床上大多数人选择多种针灸流派的诊疗方法并用,其中以TCM针灸、董氏、谭氏针灸、扳机点针灸、五行体质针灸及日本针灸最为多见,但TCM针灸常常为首选；
④本研究的临床常见病调查显示,痛症为最常见病症,其次为情志病及妇科病。这与美国针灸市场的常见病分布相符。痛症在美国各针灸流派的临床实践中均占重要地位,其中以扳机点针灸及医学针灸更为显著。而在以五行体制针灸及针灸物理医学为主的针灸诊所中情志病于业务量中所占比重较高；
⑤大部分问卷填写者对进一步学习来自中国的TCM针灸(87%有兴趣)及董氏奇穴,谭氏平衡针灸(91%有兴趣)表示了极大的兴趣。
总之,美国的多元文化孕育了美国针灸流派的多样性,以上两个调查显示美国的针灸自70年代针灸热之后经过40年的发展,已逐渐形成一个适合本国特点的从教学到临床以TCM针灸为主体、兼容不同针灸流派的初级体系
第六部分美国针灸流派形成发展历程对海内外针灸发展的启示
在回顾以上文献研究及调查研究的基础上,总结分析美国本土针灸的特点,从社会、历史、文化等多个角度探讨影响美国针灸流派形成发展的因素。提出东方与西方、古典与现代,躯体与精神的碰撞与结合,形成了美国本土化针灸躯体、精神、心灵并治,以人为本的诊疗特色。其生存发展过程中所得出的经验为海内外针灸的发展提供了借鉴与启示。
第七部分美国针灸流派前景展望
从技术、社会、文化多个层面分析影响美国针灸流派发展的因素。指出对于今后美国针灸的发展来说,①从技术层面,需找寻传统与科学之间的平衡点,摒弃门户之争,才能共同发展；②从社会文化层面,需提高素质、缩短差异,争取权益,才能融入主流社会。
结语
1.根据上述研究内容和结果,可初步得出以下结论：美国的多元文化孕育了美国针灸流派的多样性,经过40年的发展,美国针灸已形成一个从教学到临床适合本国特点的、以TCM针灸为主体,兼容不同针灸流派的初级体系。
2.美国针灸在本土化整合过程中,经过中为西用、古为今用的变通,形成了一套形神兼顾、以人为本的诊疗模式。美国针灸流派形成发展过程中所摸索出的经验和教训,为中医的发展提供了借鉴与启示。
3.由于社会文化的差异,美国针灸在发展过程中还有许多障碍需要克服,只有通过提高素质、争取权益,才能融入主流社会,为中医针灸在海外的发展作贡献
4.本论文的创新点：通过文献整理结合数据调查,首次对美国的针灸流派进行了全面系统的梳理。
(1)首次多层次地按理论来源及传入途径将美国针灸流派进行分类,并对TCM的概念提出广义及狭义之分；
(2)首次系统比较及整理美国针灸流派的诊疗特点,概括出美国针灸形神兼顾、以人为本的诊疗模式；
(3)对美国针灸流派现状的调查补充了迄今类似研究的不足,将美国针灸流派与文化背景挂钩,初次进行了流派与常见病相关性的研究。
Introduction:
The origin, formation and development of Traditional Chinese Medicine(TCM) are closely related to social, historical, and cultural factors. Cultural communication and exchange have been the catalysts for formation and development of the academic system of Traditional Chinese medicine, while the formation of different medical schools and the competition among them have contributed to the continuous improvement and enrichment of TCM. Compared with European and Asian countries, acupuncture entered the United States at the later stage, the multicultural background of the U.S. enhanced the diversity of acupuncture schools, and the academic contention among them promoted the overseas development of acupuncture and traditional Chinese medicine. The resultant unique styles of diagnosis and treatment, derived from the localization of different schools of acupuncture in a nation of immigrants, has significantly complemented the development of traditional Chinese medicine.
This study mainly utilizes review of literary sources along with surveys to analyze the diagnosis and treatment characteristics of acupuncture in the U.S., to investigate the status of U.S. acupuncture, to discuss the factors that have affected the foundation and development of acupuncture schools in the U.S. from social, historical, cultural and other perspectives, and to provide a reference and inspiration to the development of acupuncture at home and abroad.
This thesis will be divided into7main sections:
Part1:The introduction and development of TCM in the U.S
This section is divided into3parts:①acupuncture's early venture into America,②Y Times reporter James Reston's first report on acupuncture, which triggered the first acupuncture wave, and③S legislation, insurance, education, and research, which promoted the second acupuncture wave. In these40years, acupuncture in America has spread from a minor, local role to a more recognized, standard role in society.
Part2:The foundation and classification of acupuncture schools in the U.S
The diverse nature of the U.S. supports a variety of acupuncture styles. Different national viewpoints offer opportunities for the foundation of various acupuncture schools. The origins and names of these schools have been explained, along with the development of each school and its spread into America. The distribution of acupuncture schools in the U.S. is outlined.
This thesis will mainly discuss the theoretical origins in two parts—those based on Chinese medicine theories, like Yin Yang and five elements, and those based on western medicine theories, such as anatomy, physiology and pathology. According to the origins and practice characteristics, the schools based on Chinese medicine theories are further divided into:①Chinese medicine acupuncture (broad sense of TCM) that originated in China and then spread into the US, including TCM acupuncture and family-style acupuncture, such as Tong style acupuncture and Tan style acupuncture.②Five elements constitutional acupuncture which spread from Europe,③Jpanese acupuncture the practice of which originated in Japan,④Korean acupuncture, which originated in Korea, and⑤American acupuncture physical medicine.
The schools which is based on western medicine theory, the focus lies on medical acupuncture and trigger point acupuncture.
Part3:Summary of status of related research on acupuncture schools in the U.S
Through EBSCO and Alt Health Watch, there have been5528acupuncture-related papers published between1990and April2011. Most of these papers consisted of clinical and mechanical research about TCM and medical acupuncture. Only171papers were on other styles of acupuncture,125of which were selected after individual review. Using the Beijing University of Chinese Medicine library's online database,62articles have been found regarding various nations'acupuncture styles,4of which are related to US acupuncture schools. No one has ever done research on the entire system of American acupuncture styles; therefore, this thesis can be used as future reference on this topic.
Part4:Diagnosis and treatment characteristics of acupuncture schools in the U.S
Drawing from main references related to this research, this paper will utilize the diagnosis method, diagnosis, treatment principle, and treatment method to examine the characteristics of diagnosis and treatment of American acupuncture, comparing common traits and individual traits. Changes present in the process of localization and assimilation of American acupuncture will be analyzed. In general, a set of body-, mind-, and spirit-effective and people-oriented treatment modes has been formed with the following characteristics:
1. Diagnosis method focusing on palpation;
2. Diagnosis focusing on pattern diagnosis, especially channel differentiation and constitutional diagnosis;
3. Treatment of the entire body according to Chinese medicine theories, including physical and psychological;
4. Treatment method giving preference to gentle needle techniques;
5. Treatment often combined with a variety of other techniques to achieve the best results.
Part5:Research on the current status of major acupuncture schools in the USA. The research includes two parts:
1. Survey on American acupuncture and oriental medicine curricula.
(1) Research through contacting various colleges through email and telephone combined with curricula review investigates the curricula in the54acupuncture schools of the CCAOM (Council of Colleges of Acupuncture and Oriental Medicine). It compares the priorities of the various acupuncture schools and tries to understand the position of each style of acupuncture in America.
(2) Result:51schools responded. Judging by their curricula, TCM lies as the main subject for most acupuncture schools. Most non-TCM based styles of acupuncture are taught in required and elective courses along with TCM content. In addition to lectures outside of class, requirements to graduate from American acupuncture schools encompass multiple cultural encounters and much knowledge. Therefore, graduates from American acupuncture schools have usually come into contact and gained insight into each style of acupuncture before graduating.
2. Survey on the current status of major acupuncture schools in the USA
(1) Research was conducted through web and paper, and a survey given to the alumni of54acupuncture and Oriental Medicine schools belonging to CCAOM and major acupuncture associations on the East and West Coasts. This paper examines the status of various acupuncture styles in clinical practice, and the relation between the styles, cultural backgrounds and the disease being treated.
(2) Results:297surveys were taken from alumni of24American acupuncture schools and members of3major acupuncture associations.
1) Over80%of the survey participants consisted of those who have achieved masters degree or above. Though these professionals came from different cultural backgrounds,76% were trained and educated in the US. TCM is the most recognized form of acupuncture based on the survey, but over80%of those surveyed had heard of other schools of acupuncture. Subjects from Europe or America had heard of more schools than subjects from Asia, including China and Korea.
2) Over99%of the subjects were educated in TCM. Over half of them were educated in five element constitutional acupuncture, Tong style and Tan style acupuncture, and secondarily in Japanese acupuncture, trigger point acupuncture and Korean acupuncture.
3) Most clinical acupuncturists choose to combine various schools of acupuncture, including TCM, Tong style, Tan style, trigger point, and five element constitutional, and Japanese acupuncture. TCM still remains the most widely used style.
4) Based on the survey, pain is the most frequent patient complaint, followed by emotional illnesses and gynecological diseases. These results reflect the experience of a common acupuncture clinic in the US. Pain occurs as the main complaint in all acupuncture styles, especially in trigger point acupuncture and medical acupuncture. Acupuncturists using five element constitutional acupuncture and acupuncture physical medicine treat emotional illnesses the most.
5) Most subjects expressed interest in TCM acupuncture (87%) and Tong style, Tan style (91%).
The cultural diversity of the United States led to the diversity of American acupuncture schools. After four decades of development, American acupuncture has primarily formed a system that fits the domestic circumstances of the U.S. in terms of teaching and clinical practice, the main body of which is TCM acupuncture, while merging with different schools of acupuncture.
Part6. The inspiration that the development of the American acupuncture schools brings to acupuncture development at home and abroad
Based on the review of the above sources and research, the characteristics of acupuncture in the U.S is summarized and analyzed. The factors that affected the formation and development of the American acupuncture schools is discussed from social, historical, cultural and other perspectives. It is proposed that the collision and combination of East and West, ancient and modern, and body and spirit led to the physical, mental, spiritual, and people-oriented treatment characteristics of the localized American acupuncture. The lessons learned during its survival and development provided a reference and inspiration to the development of acupuncture at home and abroad.
Part7. The outlook of the acupuncture schools in the U.S
The factors that influenced the development of American acupuncture schools are analyzed from technical, social, and cultural perspectives, so as to point out the future development of American acupuncture:①from the technical level, it is necessary to find a balance between tradition and science, and to set aside school disputes, so as to achieve common development, and②from the social and cultural level, it is necessary to improve quality, reduce differences, and fight for rights, in order to integrate acupuncture into mainstream society.
Conclusion:
The following conclusions can be made from the research above:
(1) The cultural diversity of the United States led to the diversity of American acupuncture schools. After four decades of development, American acupuncture has primarily formed a system that fits the domestic circumstances of the U.S. in terms of teaching and clinical practice, the main body of which is TCM acupuncture, while merging with different schools of acupuncture.
(2) During the localization of acupuncture in the U.S, a set of body-,mind-, spirit-effective and people-oriented treatment modes has been formed after various transitions of acupuncture from China to America, from the past to the present.
(3) Due to social and cultural differences, acupuncture in the U.S has many obstacles to overcome in the development process. In order to integrate into mainstream society and to contribute to the development of acupuncture overseas, it is essential to improve the quality of the profession and to fight for more rights through efforts based on specific factors including location, time, people and needs.
本研究主要采用文献整理、调查研究的方式,通过分析梳理美国各针灸流派的诊疗特点,调查其存在现状,从社会、历史、文化角度探讨美国各针灸流派形成发展的影响因素,为中医、针灸开拓自身发展、扩大对外交流提供借鉴和启示。
本论文共分为7部分：
第一部分针灸在美国的传入及发展
本部分将针灸在美国的传入与发展历史进程概括为三个阶段：①针灸在美国的早期传入；②纽约时报著名记者詹姆斯·赖斯顿有关针灸的报道掀起的第一次针灸热潮；③美国针灸在立法、保险、教育、科研多系统推进的第二次针灸热潮。40年来,针灸在美国由初始的边缘化、局限化、非正规化逐渐朝着普遍化、合法化、正规化的方向发展,为美国针灸流派的形成奠定了基础。
第二部分美国主要针灸流派的形成及分类
美国多元文化的社会环境孕育了美国针灸流派的多样性。美国针灸多渠道的传入特点是美国针灸流派形成的基础。在给各针灸流派定义的基础上,通过追溯美国各针灸流派的形成、发展源流,特别是传入美国的历程,勾画出美国针灸流派的分布概况。
本文以理论基础的来源为基准,将当代美国针灸分为两大阵营：一类是以阴阳五行等中医基础理论为主导的学派；另一类则是以解剖、生理、病理等西医理论为主导的学派。又根据传入途径及诊疗特点将以中医基础理论为主导的学派分为：①由中国传入的中医针灸流派。以传统中医针灸(Tradit ional Cinese Medicine Acupuncture, TCM针灸)为主体,附派生出的民间家族式针灸----董氏奇穴针灸及谭氏平衡针灸；②由欧洲传入的五行体质针灸流派；③由日本传入的日本针灸流派；④由韩国传入的韩国针灸流派；⑤美国的针灸物理医学。而以西医理论为主导的针灸流派主要为医学针灸,包括扳机点针灸。
第三部分综述有关美国当代主要针灸流派的研究概况
通过主要替代医学搜寻系统EBSCO的Alt Health Watch搜寻1990年至2011年4月有关针灸的全文文献,在搜寻所得的5528篇文献中,有关TcM针灸及医学针灸两大类别的临床疗效及作用机理的研究比重在针灸文献中不容置疑地占有绝对优势。其余各流派经逐一搜寻仅得171篇,再经逐篇手检剔出无关及重复文献,得出除TCM及医学针灸以外的美国其他针灸流派的相关报道及研究共125篇；再经北京中医药大学图书馆检索系统搜寻得到近30年中文文献中涉及有关各国针灸流派的文献有62篇,其中仅4篇涉及美国针灸流派的研究。由此得出有关美国针灸流派的整体研究尚属空白的观点,为进一步研究美国针灸流派提供了依据。
第四部分美国主要针灸流派的诊疗特点
本部分研究以迄今出版的美国各针灸流派的主要参考书及美国各有关院校的教学大纲为依据,从诊法、诊断、治则、治法四方面系统梳理美国各针灸流派的诊疗特点,比较其诊疗特点的共性及个性。探讨美国各针灸流派在本土化进程中为适应环境而出现的的自我整合变化,概括出美国针灸在临床上形神兼顾、以人为本的总体诊疗特点。
具体而言：美国针灸诊疗的主要特点表现为①在诊法上各流派均重视按诊；②在诊断上,流派间各有偏重,以中医理论体系为主导的各针灸流派多重视辨证,其中又以最能体现针灸特点的经络辨证及以经典五运六气理论为指导的体质辨识作为重点；③在治疗·上,大都遵循中医整体观念进行身心并治的全面调理,重视经络治疗；④在针法上,以轻浅刺激为主,常结合多种治疗手段以期达到最佳疗效。
第五部分美国当代主要针灸流派现状的调查研究
本部分的调查包括以下两个部分的内容：
1、美国针灸及东方医学院校课程设置现状的调查
本研究以普查的形式通过电子邮件、电话咨询及查阅各院校教学大纲,调查美国针灸及东方医学院校理事会(CCAOM)属下的54所院校有关针灸流派的课程设置状况,比较各针灸流派在针灸教学中所占的比重,以了解各针灸流派在美国针灸中所处的地位。
调查结果表明：从收到反馈的51所院校有关美国主要针灸流派的课程设置中可以看出,TCM针灸为大多数针灸院校教学中的主体,除个别院校以非TCM针灸为主体教学外,大多数院校将各非TCM针灸流派列为主体教学之外的必修或选修课,加上课外及继续教育课程中有关各针灸流派的讲座,使得美国本土毕业的针灸师具有了兼容多种不同文化背景针灸流派的知识结构。
2、美国主要针灸流派应用现状的调查
本调查以CCAOM属下的54所针灸及东方医学院校校友会及美东,美西主要针灸学会的不同族裔、不同教育背景的针灸师为对象,通过网络调查及书面调查结合的形式,调查美国不同针灸流派诊疗方法的临床应用状况。以了解不同族裔及教育背景对针灸流派选择的倾向性、各针灸流派在针灸临床应用中所占的比重及与常见病的关系。
调查结果表明：调查中共收回来自24所美国针灸院校的校友及3个主要针灸团体会员的297份问卷。结果显示：
①参与此次调查的人员大多(80%以上)为接受过硕士以上专业培训的、富有临床经验的针灸师。尽管他们来自不同的国家和地区,但针灸专业的培训除中国外大多是在美国完成的(76%)。对TCM针灸认知的普及度最高,但其中80%以上的问卷填写者同时亦对美国的其他针灸流派有所了解,其中来自欧洲及美国本土的问卷填写者对美国各针灸流派的了解明显高于来自亚洲的中国及韩国的问卷填写者；
②99%以上的问卷填写者接受过TCM针灸教育外,他们中的半数以上亦接受过五行体质针灸流派及董氏、谭氏针灸的培训,其次为日本针灸、扳机点针灸及韩国针灸；
③临床上大多数人选择多种针灸流派的诊疗方法并用,其中以TCM针灸、董氏、谭氏针灸、扳机点针灸、五行体质针灸及日本针灸最为多见,但TCM针灸常常为首选；
④本研究的临床常见病调查显示,痛症为最常见病症,其次为情志病及妇科病。这与美国针灸市场的常见病分布相符。痛症在美国各针灸流派的临床实践中均占重要地位,其中以扳机点针灸及医学针灸更为显著。而在以五行体制针灸及针灸物理医学为主的针灸诊所中情志病于业务量中所占比重较高；
⑤大部分问卷填写者对进一步学习来自中国的TCM针灸(87%有兴趣)及董氏奇穴,谭氏平衡针灸(91%有兴趣)表示了极大的兴趣。
总之,美国的多元文化孕育了美国针灸流派的多样性,以上两个调查显示美国的针灸自70年代针灸热之后经过40年的发展,已逐渐形成一个适合本国特点的从教学到临床以TCM针灸为主体、兼容不同针灸流派的初级体系
第六部分美国针灸流派形成发展历程对海内外针灸发展的启示
在回顾以上文献研究及调查研究的基础上,总结分析美国本土针灸的特点,从社会、历史、文化等多个角度探讨影响美国针灸流派形成发展的因素。提出东方与西方、古典与现代,躯体与精神的碰撞与结合,形成了美国本土化针灸躯体、精神、心灵并治,以人为本的诊疗特色。其生存发展过程中所得出的经验为海内外针灸的发展提供了借鉴与启示。
第七部分美国针灸流派前景展望
从技术、社会、文化多个层面分析影响美国针灸流派发展的因素。指出对于今后美国针灸的发展来说,①从技术层面,需找寻传统与科学之间的平衡点,摒弃门户之争,才能共同发展；②从社会文化层面,需提高素质、缩短差异,争取权益,才能融入主流社会。
结语
1.根据上述研究内容和结果,可初步得出以下结论：美国的多元文化孕育了美国针灸流派的多样性,经过40年的发展,美国针灸已形成一个从教学到临床适合本国特点的、以TCM针灸为主体,兼容不同针灸流派的初级体系。
2.美国针灸在本土化整合过程中,经过中为西用、古为今用的变通,形成了一套形神兼顾、以人为本的诊疗模式。美国针灸流派形成发展过程中所摸索出的经验和教训,为中医的发展提供了借鉴与启示。
3.由于社会文化的差异,美国针灸在发展过程中还有许多障碍需要克服,只有通过提高素质、争取权益,才能融入主流社会,为中医针灸在海外的发展作贡献
4.本论文的创新点：通过文献整理结合数据调查,首次对美国的针灸流派进行了全面系统的梳理。
(1)首次多层次地按理论来源及传入途径将美国针灸流派进行分类,并对TCM的概念提出广义及狭义之分；
(2)首次系统比较及整理美国针灸流派的诊疗特点,概括出美国针灸形神兼顾、以人为本的诊疗模式；
(3)对美国针灸流派现状的调查补充了迄今类似研究的不足,将美国针灸流派与文化背景挂钩,初次进行了流派与常见病相关性的研究。
Introduction:
The origin, formation and development of Traditional Chinese Medicine(TCM) are closely related to social, historical, and cultural factors. Cultural communication and exchange have been the catalysts for formation and development of the academic system of Traditional Chinese medicine, while the formation of different medical schools and the competition among them have contributed to the continuous improvement and enrichment of TCM. Compared with European and Asian countries, acupuncture entered the United States at the later stage, the multicultural background of the U.S. enhanced the diversity of acupuncture schools, and the academic contention among them promoted the overseas development of acupuncture and traditional Chinese medicine. The resultant unique styles of diagnosis and treatment, derived from the localization of different schools of acupuncture in a nation of immigrants, has significantly complemented the development of traditional Chinese medicine.
This study mainly utilizes review of literary sources along with surveys to analyze the diagnosis and treatment characteristics of acupuncture in the U.S., to investigate the status of U.S. acupuncture, to discuss the factors that have affected the foundation and development of acupuncture schools in the U.S. from social, historical, cultural and other perspectives, and to provide a reference and inspiration to the development of acupuncture at home and abroad.
This thesis will be divided into7main sections:
Part1:The introduction and development of TCM in the U.S
This section is divided into3parts:①acupuncture's early venture into America,②Y Times reporter James Reston's first report on acupuncture, which triggered the first acupuncture wave, and③S legislation, insurance, education, and research, which promoted the second acupuncture wave. In these40years, acupuncture in America has spread from a minor, local role to a more recognized, standard role in society.
Part2:The foundation and classification of acupuncture schools in the U.S
The diverse nature of the U.S. supports a variety of acupuncture styles. Different national viewpoints offer opportunities for the foundation of various acupuncture schools. The origins and names of these schools have been explained, along with the development of each school and its spread into America. The distribution of acupuncture schools in the U.S. is outlined.
This thesis will mainly discuss the theoretical origins in two parts—those based on Chinese medicine theories, like Yin Yang and five elements, and those based on western medicine theories, such as anatomy, physiology and pathology. According to the origins and practice characteristics, the schools based on Chinese medicine theories are further divided into:①Chinese medicine acupuncture (broad sense of TCM) that originated in China and then spread into the US, including TCM acupuncture and family-style acupuncture, such as Tong style acupuncture and Tan style acupuncture.②Five elements constitutional acupuncture which spread from Europe,③Jpanese acupuncture the practice of which originated in Japan,④Korean acupuncture, which originated in Korea, and⑤American acupuncture physical medicine.
The schools which is based on western medicine theory, the focus lies on medical acupuncture and trigger point acupuncture.
Part3:Summary of status of related research on acupuncture schools in the U.S
Through EBSCO and Alt Health Watch, there have been5528acupuncture-related papers published between1990and April2011. Most of these papers consisted of clinical and mechanical research about TCM and medical acupuncture. Only171papers were on other styles of acupuncture,125of which were selected after individual review. Using the Beijing University of Chinese Medicine library's online database,62articles have been found regarding various nations'acupuncture styles,4of which are related to US acupuncture schools. No one has ever done research on the entire system of American acupuncture styles; therefore, this thesis can be used as future reference on this topic.
Part4:Diagnosis and treatment characteristics of acupuncture schools in the U.S
Drawing from main references related to this research, this paper will utilize the diagnosis method, diagnosis, treatment principle, and treatment method to examine the characteristics of diagnosis and treatment of American acupuncture, comparing common traits and individual traits. Changes present in the process of localization and assimilation of American acupuncture will be analyzed. In general, a set of body-, mind-, and spirit-effective and people-oriented treatment modes has been formed with the following characteristics:
1. Diagnosis method focusing on palpation;
2. Diagnosis focusing on pattern diagnosis, especially channel differentiation and constitutional diagnosis;
3. Treatment of the entire body according to Chinese medicine theories, including physical and psychological;
4. Treatment method giving preference to gentle needle techniques;
5. Treatment often combined with a variety of other techniques to achieve the best results.
Part5:Research on the current status of major acupuncture schools in the USA. The research includes two parts:
1. Survey on American acupuncture and oriental medicine curricula.
(1) Research through contacting various colleges through email and telephone combined with curricula review investigates the curricula in the54acupuncture schools of the CCAOM (Council of Colleges of Acupuncture and Oriental Medicine). It compares the priorities of the various acupuncture schools and tries to understand the position of each style of acupuncture in America.
(2) Result:51schools responded. Judging by their curricula, TCM lies as the main subject for most acupuncture schools. Most non-TCM based styles of acupuncture are taught in required and elective courses along with TCM content. In addition to lectures outside of class, requirements to graduate from American acupuncture schools encompass multiple cultural encounters and much knowledge. Therefore, graduates from American acupuncture schools have usually come into contact and gained insight into each style of acupuncture before graduating.
2. Survey on the current status of major acupuncture schools in the USA
(1) Research was conducted through web and paper, and a survey given to the alumni of54acupuncture and Oriental Medicine schools belonging to CCAOM and major acupuncture associations on the East and West Coasts. This paper examines the status of various acupuncture styles in clinical practice, and the relation between the styles, cultural backgrounds and the disease being treated.
(2) Results:297surveys were taken from alumni of24American acupuncture schools and members of3major acupuncture associations.
1) Over80%of the survey participants consisted of those who have achieved masters degree or above. Though these professionals came from different cultural backgrounds,76% were trained and educated in the US. TCM is the most recognized form of acupuncture based on the survey, but over80%of those surveyed had heard of other schools of acupuncture. Subjects from Europe or America had heard of more schools than subjects from Asia, including China and Korea.
2) Over99%of the subjects were educated in TCM. Over half of them were educated in five element constitutional acupuncture, Tong style and Tan style acupuncture, and secondarily in Japanese acupuncture, trigger point acupuncture and Korean acupuncture.
3) Most clinical acupuncturists choose to combine various schools of acupuncture, including TCM, Tong style, Tan style, trigger point, and five element constitutional, and Japanese acupuncture. TCM still remains the most widely used style.
4) Based on the survey, pain is the most frequent patient complaint, followed by emotional illnesses and gynecological diseases. These results reflect the experience of a common acupuncture clinic in the US. Pain occurs as the main complaint in all acupuncture styles, especially in trigger point acupuncture and medical acupuncture. Acupuncturists using five element constitutional acupuncture and acupuncture physical medicine treat emotional illnesses the most.
5) Most subjects expressed interest in TCM acupuncture (87%) and Tong style, Tan style (91%).
The cultural diversity of the United States led to the diversity of American acupuncture schools. After four decades of development, American acupuncture has primarily formed a system that fits the domestic circumstances of the U.S. in terms of teaching and clinical practice, the main body of which is TCM acupuncture, while merging with different schools of acupuncture.
Part6. The inspiration that the development of the American acupuncture schools brings to acupuncture development at home and abroad
Based on the review of the above sources and research, the characteristics of acupuncture in the U.S is summarized and analyzed. The factors that affected the formation and development of the American acupuncture schools is discussed from social, historical, cultural and other perspectives. It is proposed that the collision and combination of East and West, ancient and modern, and body and spirit led to the physical, mental, spiritual, and people-oriented treatment characteristics of the localized American acupuncture. The lessons learned during its survival and development provided a reference and inspiration to the development of acupuncture at home and abroad.
Part7. The outlook of the acupuncture schools in the U.S
The factors that influenced the development of American acupuncture schools are analyzed from technical, social, and cultural perspectives, so as to point out the future development of American acupuncture:①from the technical level, it is necessary to find a balance between tradition and science, and to set aside school disputes, so as to achieve common development, and②from the social and cultural level, it is necessary to improve quality, reduce differences, and fight for rights, in order to integrate acupuncture into mainstream society.
Conclusion:
The following conclusions can be made from the research above:
(1) The cultural diversity of the United States led to the diversity of American acupuncture schools. After four decades of development, American acupuncture has primarily formed a system that fits the domestic circumstances of the U.S. in terms of teaching and clinical practice, the main body of which is TCM acupuncture, while merging with different schools of acupuncture.
(2) During the localization of acupuncture in the U.S, a set of body-,mind-, spirit-effective and people-oriented treatment modes has been formed after various transitions of acupuncture from China to America, from the past to the present.
(3) Due to social and cultural differences, acupuncture in the U.S has many obstacles to overcome in the development process. In order to integrate into mainstream society and to contribute to the development of acupuncture overseas, it is essential to improve the quality of the profession and to fight for more rights through efforts based on specific factors including location, time, people and needs.
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