Historical Legacy of Traditional Chinese Medicine Education in Canada: The Case of Henry C. Lu : Chinese Medicine and Culture

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Special Section in Memory of Henry C. Lu

Historical Legacy of Traditional Chinese Medicine Education in Canada: The Case of Henry C. Lu

Yang, Li-Wen1,✉; Wang, Li-Li1; Jia, Rong-Man2

Author Information
doi: 10.1097/MC9.0000000000000021
  • Open

Abstract

1 Dr. Henry C. Lu’s profile

Dr. Henry C. Lu of Vancouver, British Columbia, Canada, who passed away on January 18, 2022, was hailed as a scholar, educator, and writer of traditional Chinese medicine (TCM hereafter). He devoted most of his lifetime to the practice and dissemination of TCM through books, translations, and college teaching.

Born on September 3, 1936 and raised in Taiwan, China, Dr. Lu finished his undergraduate studies in Taipei before attending the University of Hawaii of the United States, where he received his master’s degree. He earned his PhD in pedagogy from the University of Alberta, Edmonton, Canada. After that, he taught at the University of Alberta and University of Calgary between 1968 and 1971.1

Dr. Lu encountered TCM during his trip back to Taipei after his graduation. He had chronic constipation and constant nasal discharge since high school. He turned to Western medicine for help but in vain. It was not until someone suggested that he should see a Chinese herbalist that he sought help from TCM. After 1-month-long TCM treatment, he became energetic. This experience sparked his interest in TCM, and he started to practice TCM in 1972. In that year, James Reston, a member of the US President Nixon’s delegation to China, suffered from acute appendicitis and had to undergo appendectomy in Beijing. He was relieved of his post-surgery abdominal distension and discomfort by the Chinese TCM doctors with acupuncture and moxibustion. After that, TCM started to become noticeable in the United States.

In 1986, Dr. Lu founded the Chinese College of Acupuncture and Herbology in Vancouver and Victoria, British Columbia, Canada. The college gained widespread prominence during its three-decade-long operation. It was donated to the Buddhist Compassion Relief Tzu Chi Foundation Canada, or Tzu Chi Canada, an international charity organization dedicated to charity, medicine, education, culture, international relief, and environmental care. In September 2018, the College officially changed its name to Tzu Chi International College of Traditional Chinese Medicine (TCICTCM). As the founding president of Traditional Chinese Medicine Association of British Columbia (TCMABC), Dr. Lu was most notable for his contributing role in making the British Columbia government legalize TCM and acupuncture as recognized healthcare profession.

Dr. Lu has written and translated extensively on TCM classics. He published over 100 books which are widely used in TCM education, TCM clinical practice and Mandarin Chinese learning . He is best known for his English translation of Huangdi Neijing (《黄帝内经》 The Yellow Emperor’s Inner Classic) and Nan Jing (《难经》The Classic of Difficult Issues). The translations and his numerous other books are recommended by examination committees of acupuncture in many parts of the world.

2 Dr. Lu’s contribution to TCM education in Canada

Through four decades of TCM practice, Dr. Lu believed that, “if TCM and acupuncture are to take root in the Western world, it is not enough that they have been practiced: their wisdom must also be spread to North America by means of education.”2 His education background and working experience qualified him to write books on TCM in English. These books contributed to the widespread promotion of TCM recognition in the West.

2.1 Productive publications

With a view that TCM could be spread through books and documentaries, Dr. Lu embarked on his publication journey. He translated TCM classics introducing TCM philosophy and recording practice of TCM and acupuncture. Dr. Lu wrote and translated over 100 books of different TCM specialties from 1973 to 2018. His books were mostly published by the Academy of Oriental Heritage, Pelanduk Publications, Kodansha Amer Inc, Sterling Publishing Company Inc, Black Dog & Leventhal, Basic Health Publications Inc, International College of Traditional Chinese Medicine of Vancouver and Create Space Independent Publishing Platform. He made extraordinary efforts to design TCM textbooks and reference books for TCM certification examinations for his college. He also wrote books on language learning to help both domestic and international students to better understand the knowledge of TCM.

2.1.1. TCM translation

Dr. Lu gained attention among the translation research scholars in the mainland China due to his translation of Huangdi Neijing and Nan Jing. His first publication made his way to the readers in 1978. In 2004, he took a step further by re-translating these classics into an 800-page text in a more comprehensive way, incorporating various research findings, annotations, and commentaries made by excellent physicians and scholars.1 Parts of TCM classics translated by Dr. Lu are listed in Table S1.

2.1.2. TCM textbooks and reference books for examination

While teaching TCM courses, Dr. Lu emphasized the importance of textbooks for the students in his college. He believed that textbooks are the primary sources of information for students who are committed to become TCM practitioners. Students cannot learn the subject matter without textbooks and thus they need to select a textbook that caters to their needs. A textbook is therefore a theoretical work sufficiently detailed and necessarily complicated to provide an adequate amount of knowledge to the readers.3 To ensure high-quality TCM education, Dr. Lu started to compile a series of textbooks from 1973 to 2017 for students registering in his college. He took the trouble to write an English book, the Study Guide for Traditional Chinese Medicine and Acupuncture Students, for students preparing to become a practitioner of TCM or acupuncture.

With the legislation of recognizing acupuncture and TCM as healthcare professions in provinces in Canada, the authorities launched a system of occupational competency examination on TCM, requiring qualified doctors to pass the examination before registering in the respective College of provinces (in Canadian English, “college” means not only an educational institutions, but also a regulatory body). Books for the examination should be significantly practical and useful for students to pass the exam. In this regard, Dr. Lu compiled A Question Bank of Acupuncture, which included over 3,000 test questions, Simulated 3,200 Licensing Examination Questions with Answers in Acupuncture, and A Comprehensive Review of Chinese Herbal Therapy for Licensing Examinations, which is a profoundly comprehensive question bank on the Chinese herbal therapy. Designed for the qualification examination, these books also provide introduction to many innovative ideas and comprehensive review to help the students embark on a smooth professional journey through the entire program. A total of 13 textbooks and books are designed for the examination (Table S2).

2.1.3. Language learning books

During his TCM practice, Dr. Lu found that there were more non-Mandarin-speaking patients seeking help from TCM treatment. His success in TCM education also attracted more English-speaking Canadian students to enter his college, in addition to the Mandarin-speaking Chinese Canadians. Backed up by his education background in pedagogy, he published a number of books on language learning (Table S3), both in English for students of the Chinese immigrants and in Chinese Mandarin for the western learners. His language books in English cover English grammar and many other subjects, which become a guide to Chinese learners who wish to learn English as a second language. His language books in Chinese cover Mandarin pronunciation, speaking, reading, and Chinese characters to help non-Chinese-speaking students learning Chinese. With good mastery of language, people who speak Chinese can better express the ideas of TCM in English and people who speak English can better understand TCM knowledge, and even read the original TCM classics in Chinese.

2.1.4. TCM practice

Dr. Lu was also a licensed TCM practitioner. Dr. Lu was once interviewed on the topic of TCM, including its role in today’s health care and his ideas on how TCM and Western medicine can work together.4 With the increasing prevalence of TCM among Canadians, he realized that it became more important for medical students, physicians, and other health care professionals to be better informed on TCM to effectively interview patients, assess potential drugs, interact with patients during the treatment, and provide evidence-based recommendations.5 With rich experience in his TCM clinical practice, Dr. Lu explained TCM in traditional way and modern scientific approaches. He published many TCM practice-related works (Table S4), including fundamental introductions to TCM philosophies, diagnosis, acupuncture, herbology, Chinese medicine formulas, clinical case report, and food therapy. These wide varieties of English books serve as a bridge for western students to learn both original and advanced TCM in their own languages.

2.2 Establishment of International College of Traditional Chinese Medicine

During his course of practice, Dr. Lu mooted the concept to launch a TCM college to provide training programs in a bid to promote TCM on a wider scale. In 1986, he founded the Chinese College of Acupuncture and Herbology in Vancouver and Victoria, British Columbia. The college was renamed as the International College of Traditional Chinese Medicine in 1988 (Fig. 1).6 One year later, the college established its first proper campus at the East Hastings Street in Vancouver’s Chinatown. It then moved to 1847 West Broadway in 1991. To operate efficiently, the Vancouver campus was separated in 1995 and began independently operating under the name of International College of Traditional Chinese Medicine of Vancouver. The college moved to 201-1508 West Broadway 3 years later. The college opened a new site in 2015 on 200-1215 West Broadway for the purpose of teaching and administration.

F1
Figure 1:
Celebration of faculty members of International College of Traditional Chinese Medicine6

Since 2011, Dr. Lu had expressed his will to donate the college to the Buddhist Compassion Relief Tzu Chi Foundation Canada, or Tzu Chi Canada for better management and development. The foundation is an international charity organization dedicated for charity, medicine, education, culture, international relief, and environmental care. It has donated funds to the college since 1992 and Dr. Lu and his wife were its members. On December 31, 2015, at the age of nearly 80, Dr. Lu officially donated the college. On May 5, 2016, Dr. Lu personally handed over the tablet symbolizing the International College of Traditional Chinese Medicine of Vancouver to the foundation on a celebration ceremony. The college officially changed its name to TCICTCM in September 2018, but its website retained the former name until the end of 2018 (Fig. 2).6

F2
Figure 2:
Change of the college name in the official website6

During three decades of managing the college, Dr. Lu took the lead in formulating its own series of textbooks and developing accredited curriculum to guarantee the quality of TCM education. Since 1986, the college has trained a vast number of Canadian students as well as international students from over 30 countries and regions, thus making the college as one of the biggest TCM colleges with the longest history in Canada. In 2016, the college had over 40 faculties and about 140 students, of which 90% was local and 10% was international students. Dr. Lu made unremitting efforts to promote the popularization of TCM in the West. The college now provides diploma programs, exceeding minimum requirements of British Columbia. The college also offers certificate program for students who wish to acquire skills and get into the healthcare profession within a relatively short period of time. The credits earned in the Tui Na certificate program can be transferred to the diploma programs if a student continues his study. The certificate program, therefore, has served as a stepping-stone for many students aiming at the college’s diploma programs. The TCICTCM’s courses are listed in Table S5.7

3 TCM education in Canada

Dr. Lu has been involved in the legislation for TCM in British Columbia.4 As the founding president of TCMABC, Dr. Lu and his fellow TCM practitioners succeeded in lobbying the British Columbia government to recognize and legalize TCM and acupuncture as a healthcare profession.

Dr. Lu’s entire lifetime is, in part, a reflection of the history of TCM education in Canada. His dedication and contribution, as well as the continuous efforts and involvement of his students, have shaped the current TCM education system in Canada.

3.1 Legislation of TCM in Canada

Canada is a multicultural country with many ethnics and immigrants from all over the world. The history of TCM started with the significant immigration of Chinese workers during the gold rush and the development of the Canadian Pacific Railway in the 1880s.8 During the initial period, TCM was only available within the Chinese community, but later became more popular with Canadians. Since acupuncture was legislated in Quebec, Canada in 1973,9 four other provinces have subsequently legislated TCM as a recognized health profession. The provinces which legalized TCM are Alberta in 1988,10 British Columbia in 2000,11 Ontario in 2006,12 and Newfoundland and Labrador in 2012.13 Colleges of TCM in the five provinces are, namely, Ordre des Acupuncteurs du Québec, College of Traditional Chinese Medicine Practitioners +Acupuncturists of British Columbia (CTCMA), The College of Acupuncturists of Alberta, College of Traditional Chinese Medicine Practitioners and Acupuncturists of Ontario, and The College of Traditional Chinese Medicine Practitioners and Acupuncturists of Newfoundland and Labrador. These colleges regulate TCM practices in their province, that is, codes of ethics and professional practice standards have been formulated by each provincial college.

3.2 Development procedures of TCM education

The Canadian College Acupuncture and Oriental Medicine was founded in 1985. It was the first college legally registered for TCM education in British Columbia, Canada.14 Unfortunately, this college was closed in 2011,15 leaving behind a few numbers of other colleges or schools offering clinical training for TCM and acupuncture through personal mentoring. Personal mentoring was a common TCM phenomenon until the early 1990s evident by the opening of a branch TCM clinic by the offspring of early Chinese immigrants who engaged in TCM practice. From the mid-1990s, with a rapid increase in the number of TCM acupuncture and moxibustion schools, Canada witnessed the establishment of about 50 TCM and acupuncture colleges.15

At the beginning of the 21st century, the Canadian governments issued the Private Career Colleges Act 2005 to supervise the TCM and acupuncture practice. This has resulted in the declining number of TCM colleges.

As TCM became legalized in Canada, the educational system on TCM or acupuncture went under provincial regulation as mentioned above. The five provincial regulatory bodies, who govern individuals who practice TCM or acupuncture and regulate the use of titles, have formed a national organization named the Canadian Alliance of Regulatory Bodies of Traditional Chinese Medicine Practitioners and Acupuncturists (CARB-TCMPA).

CARB-TCMPA is responsible for administering the Pan-Canadian Entry-level Examinations in TCM and Acupuncture (the “Pan-Canadian Examinations”) to assess whether an examinee acquires occupational competencies of entry-level TCM profession. Successful completion of the Pan-Canadian Examinations is one of the requirements imposed by provincial regulators for registering as a TCM practitioner, acupuncturist, or TCM herbalist.16 The Pan-Canadian Examinations offer examinations in English. In Quebec and Ontario, the examinee can also choose French on request. In British Columbia, the examinations are also offered simplified Chinese and traditional Chinese in addition to English.

Meanwhile, the Federation of Colleges of Traditional Chinese Medicine of Canada is founded in 2008. It is instituted with eight TCM colleges as the national voice of TCM education across Canada. The aim of the federation is to promote professionalism, standardization, and high-quality education of TCM and acupuncture.17 The federation issued National Standard for The Training Acupuncturists, TCM Practitioners, and Doctors of TCM,18 to strive for quality improvement in education, research, and service through the full participation of its member colleges and their collaboration.

TCM education in Canada has become legalized since the implementation of the above regulations and acts, with a collaboration supervision and guidance from governments of different provinces and TCM associations.

3.3 Present status of TCM and acupuncture education in Canada

Colleges, schools, institutes, or academies of TCM and acupuncture in Canada are mainly privately funded with varying scales depending on the campus site, legislation, density of population, fund, faculty, and acceptance of TCM by the locals. The bigger ones often possess 100 to 150 students; the mid-sized ones tend to have 50 to 80 students, while the smaller ones admit about 20 to 40 students.15

Diploma programs are offered for acupuncturists, TCM practitioners, TCM herbalists, and Doctors of TCM (Dr. TCM) and certificate programs are also available in Canada. No college provides degree education in TCM independently, but a few colleges would offer training programs for doctorate degree by cooperating with TCM universities in China. The certificated TCM doctors shall have a continuing competency program (CCP) to achieve high practice standards. They should ensure that they are in compliant with the CCP requirements and keep a record of their activities over the year for annual reports.

Due to provincial regulation on TCM or acupuncture, TCM education varies in the five provinces where TCM or acupuncture are legalized. Take British Columbia, where Henry Lu worked and lived for the most part of his life, as an example, acupuncture has been a legitimate health profession in British Columbia since 1996, and a TCM practitioner has been a legitimate health profession since 2000. According to statistics from 2021 to 2022 Annual Report,19 there are a total of 2,373 renewed registrations at the start of the 2021–2022 Registration Year in British Columbia. Among them, 1,417 practicing registrants obtained education in British Columbia. Education and examination committee in CTCMA is responsible for determining eligibility of examinations and reviewing education programs for compliance with entry-to-practice standards. From 2016, schools offering TCM and acupuncture education programs in British Columbia are evaluated by the Education Program Review developed by CTCMA with the minimum requirements for each program (Table S6).20 The review will be performed based on the program length, program structure, learning outcomes, and student clinical practice. Schools whose programs meet the requirements and their recognized education/training programs are listed in CTCMA Bylaws (effective August 20, 2020) (Table 1).20

Table 1 - Recognized TCM and acupuncture education/training programs21
1. PCU College of Holistic Medicine
220-5021 Kingsway
Burnaby, BC
 • Registered Acupuncturist
 • Registered Traditional Chinese Medicine Herbalist
 • Registered Traditional Chinese Medicine Practitioner
 • Doctor of Traditional Chinese Medicine
2. Tzu Chi International College of Traditional Chinese Medicine
#200-1215 West Broadway
Vancouver, BC
 • Registered Acupuncturist
 • Registered Traditional Chinese Medicine Herbalist
 • Registered Traditional Chinese Medicine Practitioner
 • Doctor of Traditional Chinese Medicine
3. Vancouver Beijing College of Chinese Medicine
3135-8888 Odlin Crescent
Richmond, BC
 • Registered Acupuncturist
 • Registered Traditional Chinese Medicine Herbalist
 • Registered Traditional Chinese Medicine Practitioner
 • Doctor of Traditional Chinese Medicine
4. Pacific Rim College
229-560 Johnson Street
Victoria, BC
 • Registered Acupuncturist
 • Registered Traditional Chinese Medicine Herbalist
 • Registered Traditional Chinese Medicine Practitioner
 • Doctor of Traditional Chinese Medicine
5. Kootenay Columbia College of Integrative Health Sciences
Suite 2-560 Baker Street
Nelson, BC
 • Registered Acupuncturist
 • Registered Traditional Chinese Medicine Herbalist
 • Registered Traditional Chinese Medicine Practitioner
 • Doctor of Traditional Chinese Medicine
6. Oshio College of Acupuncture and Herbology
100-3491 Saanich Road
Victoria, BC
 • Registered Acupuncturist
 • Registered Traditional Chinese Medicine Herbalist
 • Registered Traditional Chinese Medicine Practitioner
 • Doctor of Traditional Chinese Medicine
7. Central College
200-60 8th Street
New Westminster, BC
 • Registered Acupuncturist
 • Registered Traditional Chinese Medicine Herbalist
 • Registered Traditional Chinese Medicine Practitioner
8. Kwantlen Polytechnic University
8771 Lansdowne Road
Richmond, BC
 • Registered Acupuncturist
TCM: traditional Chinese medicine.

Currently, Pan-Canadian standards for education programs are under development, and corresponding accreditation with these standards is planned to evaluate and guarantee the quality and safety of TCM and acupuncture education. The standards represent the general requirement for competency-based learning outcomes. The accreditation standards are divided into nine sections, including leadership, program operations, students service and support, human resources, curriculum, clinics and laboratories, student assessment, and program evaluation.21 These rigorous standards and comprehensive accreditation process will ensure that a TCM or acupuncture program that can offer a professional curriculum to students in Canada is available from the provincial colleges under the supportive environment.

3.4 Challenges in TCM education in Canada

TCM is still regarded as a form of traditional medicine rather than a branch of the mainstream medicine in Canada. With a limited number of patients seeking TCM and acupuncture treatment, the clinics of each college are the venues where all the TCM trainees go for internship. This has caused overcrowding in the clinics. The clinics are also less ideal for clinical training due to narrow case range.

Overseas TCM education is of crucial importance for the international recognition of TCM’s role in safeguarding human health. However, the absence of unified policies for TCM education in Canada has obliged each province to devise its own regulations and rules. Moreover, most colleges cannot offer degree programs. They are allowed to provide no more than a diploma certifying the successful completion of a course. Thus, the quality of TCM education varies from college to college and from province to province, depending on factors such as the number and the quality of teachers, quality of internship, and quality of textbooks. These factors are not considered in the registration requirement for the practice of TCM and acupuncture. Although these factors are now considered in the accreditation standards of education program, there is still a long way before the accreditation is implemented. For now, the standards only focus on the quality of education programs without considering how to regulate TCM institutions.

In addition, internationally trained practitioners are accepted for registering as a certified TCM practitioner in Canada. This has caused growing popularity for more Canadians to complete their studies or training at TCM universities in mainland China or China’s Taiwan province. These factors have complicated the prospects of developing localized TCM education in Canada.

4 Suggestions for overseas TCM education

4.1 Devising international standards in TCM education

Standards are the basis of excellence. Independent third-party accreditation, an assessment to determine on what extent a program meets the recognized standards, is the implementation of the standards. Dr. Lu became aware of the significance of standards. Thus, he compiled textbooks and developed curriculum for his college at an incredibly early age. Additionally, Canada’s experience on setting accreditation standards for TCM education programs is a good example for other countries to learn from.

Canada is taking the lead in the global TCM education by drafting standards for TCM education. It is now more imperative for other countries to co-develop a series of international standards evaluating the quality of TCM education and the safety of TCM internship. It is a task to promote TCM education around the globe. International standards are the lingua franca for the international community to carry out exchanges and cooperations on issues concerning the application and promotion of TCM. The influence of TCM worldwide will be strengthened by a joint work through formulating international TCM standards on practitioners, education programs, and schools to improving the quality of TCM education.

In view of the varying cultures, laws, regulations, and habits of people, education standards shall be established to set the minimum requirements of an educational program so as to ensure that the knowledge and skills of TCM are properly passed down to the next generations. Standards on institutions, teaching plans, textbooks, internship process, and basic requirements of clinics shall be formulated to support an all-round development of overseas TCM education. The World Federation of Chinese Medicine Society has issued SCM 3-2009 World Standard of Chinese Medicine Undergraduate (Pre-CMD) Education and SCM 15-2015 The International Catalogue of Chinese Medicine discipline, to regulate the development of overseas TCM education. Proper international accreditation in the TCM education shall be explored to make these standards materialized. In addition, it is a matter of concern to fully accept advice and suggestions from overseas TCM educational institutions and regularly revise the documents to timely update and perfect the standards so that the TCM international development is sustainable.

4.2 Promoting international exchanges and communications in TCM education

The current international development of TCM is facing a critical period of strategic challenges, in particular the restrictions in international travel caused by the COVID-19 pandemic. However, through innovative approaches, the World Health Organization, the United Nations Educational, Scientific and Cultural Organization, and other international organizations can play a role in promoting communications and cooperation among international organizations to help TCM make greater contributions to global health. Meanwhile, full cooperation is to be given to the international non-government organizations which provide TCM consulting services to assist local governments in public health and other social work.

Additionally, it is of great pertinence to strengthen collaborations between TCM universities and institutions in China, and renowned universities and institutions in other parts of the world on short-term training, clinical internship, academic education, vocational education, and continuing education.

4.3 Cultivating international inter-disciplinary talents

Dr. Lu is an example illustrating a talented TCM practitioner who made brilliant influence on TCM education globally. His case demonstrated that promoting the internationalization, inheritance and innovation of TCM in other countries worldwide depends highly on talents who has good mastery of TCM philosophy and expertise, proficient practice, and good communication skills in multiple languages. China should also strengthen the construction of multi-level teams of multi-disciplinary TCM talents and develop a systematic planning on cultivating TCM talents. This will help ensure that TCM philosophy, TCM academic expertise and practical experience are passed down from famous and renowned TCM experts to younger generations.

5 Conclusion

TCM embodies profound philosophy and wisdom of Chinese people, and it plays a fundamental role in the protection of human health through thousands of years of development. By reviewing Dr. Henry C. Lu’s life-long contribution to the international recognition of TCM and acupuncture, the authors believe that it is advisable for China to devise a national plan to promote overseas TCM education by setting up institutions and academies responsible for the practice of TCM all over the world for safeguarding human health. With the growing popularity of TCM in many countries, it is also important to follow the success stories of the early generations of overseas Chinese TCM practitioners who made a living by opening TCM clinics, with Dr. Henry C. Lu being a typical example. By contributing due importance to the prevention, control and treatment of the COVID-19 pandemic around the world, TCM is expected to further play a more prominent role in public health, with more and more countries recognizing and legalizing the status of TCM practice and acupuncture in the future.

Funding

None.

Ethical approval

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author contributions

Li-Wen Yang undertook the tasks of conceptualization, methodology, resource collection, investigation, writing and revision. Rong-Man Jia undertook the tasks of resource collection and revision. Li-Li Wang undertook the tasks of resource collection and supervision.

Conflicts of interest

The authors declare no financial or other conflicts of interest.

Supplementary information

Supplementary data to this article can be found online at: https://links.lww.com/CMC/XXXX.

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Keywords:

Canada; Henry C. Lu; Traditional Chinese medicine; TCM classics; TCM education

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