Chinese Medicine in the United States: Historical Development and Growth

Abstract

Chinese medicine is growing rapidly in the United States both as a field of research and in the daily treatment of illnesses. The popularity of Chinese medicine, particularly acupuncture, as a healing mechanism demonstrates American people’s positive experience with Chinese medicine and their embracing it as an alternative to the mainstream Western biomedicine. Chinese medicine is an important part of the Alternative and Complementary Medicine or Integrated Medicine in the United States health system. It is increasingly used and covered by health insurance. Although Chinese medicine has been in the United States since colonial times, it was discriminated against by local authorities. However, things began to change in the 1970s when individual states gradually passed laws to legalize the practice of acupuncture as a healing mechanism. American public interest in Chinese medicine, particularly acupuncture, was aroused by the media’s report of the “magic” power of acupuncture during President Nixon’s visit to China. Non-Asians studied acupuncture in the following decades, which contributed to the establishment of acupuncture as a profession in the American health system. The history of Chinese medicine in the United States illustrates that Chinese and Asian immigrants promoted Chinese medicine in the communities, while Chinese American medical scientists who were trained in biomedicine played an important role in shaping the biomedical method of acupuncture research. This article investigates the changes of Chinese medicine in the United States, with a focus on acupuncture. Situating the discussion in a larger context of social and cultural changes, this study examines the contributions of Chinese immigrants and the popularity of acupuncture in the United States. It analyzes the development of acupuncture practice and research, the professional training in Chinese medicine, and American people’s interest in using Chinese medicine as a reliable healing mechanism to many health problems, including chronic pain, cancer, and drug addictions.

1 Introduction

Chinese medicine is a dynamic field in the United States, particularly the use of acupuncture and herbal medicine. The latest publications of research show that the United States had 37,886 actively licensed acupuncturists as of January 1, 2018.¹ That was an increase of 257% from 1998. For every 100,000 Americans there are 12 licensed acupuncturists. Herbal medicine, which American laws define as a dietary supplement, is also very popular with American consumers.

Chinese medicine is taught at accredited institutions that have been called Acupuncture and Oriental Medicine (AOM) or Acupuncture and Eastern Medicine colleges and schools. The Accreditation Commission for Acupuncture and Herbal Medicine decided in 2022 to remove the term “oriental” as part of accreditation standard requirements.² They are now being changed to Acupuncture and Herbal Medicine colleges and schools. The term “oriental” has historical implications of Western imperialism in reference to China and Asia, which is not suitable for the promotion of cultural appreciation of different societies. In 2018, the United States had about 60 accredited AOM schools and colleges and more than 100 different AOM programs. The latest data from the Accreditation Commission for Acupuncture and Herbal Medicine indicate that the United States has 52 schools of Acupuncture and Herbal Medicine in 2022. They include Masters and doctoral degree programs on acupuncture or such degrees in acupuncture with Chinese herbal medicine specialization. The majority of those accredited acupuncture and herbal medicine schools are located on the east and west coast. Half of the schools are located in the three states of California, Florida, and New York.¹ The profession of acupuncture is growing steadily, as acupuncture has become a popular treatment of many ailments for Americans. Almost every state in the United States has established laws to regulate acupuncture practice.

Chinese medicine has a long history in the United States. Chinese immigrants spread and sustained Chinese medicine in Chinese American communities. Acupuncture gained the attention of the American public during President Nixon’s visit to China in 1972. When Henry Kissinger led an advance team to China in 1971 to prepare for Nixion’s visit, a large group of news media journalists came to report and re-introduce China to the American people. In the media group was James Reston, Vice President and a columnist of The New York Times. Reston suffered an acute attack of appendicitis one week after his arrival in China. He was hospitalized at Beijing Union Medical College Hospital (Beijing Anti-Imperialist Hospital at the time), where Chinese doctors removed his appendix in an emergency procedure. Chinese doctors treated his postsurgical pain with acupuncture. After he recovered, Reston wrote about his experience with Chinese medicine and acupuncture treatment in Beijing and published his report in the New York Times.³ In his article, Reston praised China’s medical achievement in combining “the very old and the very new” of Chinese medicine and Western biomedicine, and Chinese doctors’ dedication to improving the healthcare and quality of life for the people.

Reston’s report on acupuncture created a great sensation in America and caused lots of curiosity about acupuncture and Chinese medicine. Reston helped open the doors to the exploration of Chinese medicine by non-Asian Americans.⁴ After President Nixon’s visit to China, his personal physician, Tkach, commented that acupuncture was superior to the anesthetics used in American hospitals. Tkach was a Major General of the US Air Force. He published an article in the July 1972 issue of Readers Digest, with the title “I watched acupuncture work.”⁵ His article and comments further stimulated American interest in Chinese acupuncture. The United States witnessed a craze for acupuncture and everything about China after Nixon’s visit, as the two countries resumed friendly relations following a quarter of a century’s isolation in the Cold War.

American society underwent significant social and cultural changes after World War II. The changing social landscape provided a larger context for the understanding of Chinese medicine in American society. First, increasing numbers of Chinese and Asian immigrants came to the United States due to new immigration and refugee laws. Many of them were highly educated professionals who contributed to the American brain gain after the war. Second, the change of Asian component of the American population, especially the increase of Chinese and Asians who had knowledge of Chinese medicine from East and Southeast Asia, led to a broader spread of Chinese medicine in America’s Asian communities. The diverse Asian communities interacted with the increasing interest of the American public in acupuncture and contributed to making Chinese medicine an important part of the Alternative and Complementary Medicine in the Western medicine dominated America.

Chinese medicine is sometimes called traditional Chinese medicine (TCM). This article uses the term Chinese medicine throughout the discussion. The study traces the history of Chinese medicine in the United States, with Chinese immigrants promoting and sustaining its development and growth. It discusses the growth of acupuncture as a field of study and a profession in the context of social and cultural changes that shaped the increased interest of American people in Chinese medicine since the 1970s. Although Chinese medicine is considered an “alternative” medical knowledge and practice to the mainstream Western biomedicine, it is increasingly used and integrated into the daily treatment of many ailments. It is now embraced by non-Asian Americans as an effective healing mechanism.

2 Historical background and immigrants’ contributions

American ginseng and Chinese tea and herbs were traded for medicinal use between the two countries since the colonial time of America. After Chinese acupuncture was introduced to Europe during the 16th to 18th centuries, it has been studied and practiced by European and American doctors since. They used acupuncture to treat arthritis, paralysis and spinal injuries on the battlefields.⁶ In the 19th century America, William Osler (1849–1919), who was regarded as the “father of modern medicine,” studied and used acupuncture in his own medical practice and wrote about acupuncture.^7,8 Osler made the statement in his classical medical textbook, The Principles and Practices of Medicine (1892), that lumbar acupuncture was the most efficient treatment for acute pain.⁹

Chinese immigrants brought the knowledge and practice of Chinese medicine to the United States in the 19th century when tens of thousands immigrated to the United States. They first Chinese immigrants came during the gold rush and then as free labor for American industrialization after the US government signed the Burlingame-Seward Treaty to recruit Chinese workers for the building of American transcontinental railroads.¹⁰ Those immigrants carried Chinese medical books with them and learned all the healing knowledge and practice while living in America. Their practice of Chinese medicine covered a wide range of services, including diagnosis by pulsing, prescription of herbal medicine for ailments, setting broken bones, delivering babies, and providing abortions. Despite the discrimination in the United States, Chinese doctors and herbalists practiced Chinese medicine in their own communities, with the majority concentrated in California and states on the west coast. They offered treatment for both Chinese and non-Chinese patients, with natural and herbal medicine. They explained health and illness with the yin-yang and wu-xing doctrine of Chinese medical knowledge. As these concepts were novel to conventional Western medicine, Chinese medicine was attacked by the American medical profession as quackery. No license was allowed for the practice of Chinese medicine and local authorities arrested and persecuted Chinese doctors for practicing Chinese medicine without a license.¹¹

Chinese medicine was able to continue and survive the attacks because Chinese Americans relied on it for their health in Chinatowns. Chinese doctors promoted and advertised Chinese medicine as natural medicine for natural healing in contrast to the mainstream biomedicine. In addition to Chinese patients, non-Chinese Americans also sought the treatment of Chinese medicine because they believed in natural healing and found Chinese medicine effective and affordable in comparison to Western biomedicine. Chinese doctors were usually community leaders and merchants. They served as bankers, shopkeepers, postmaster, translators, labor brokers and contractors, and legal consultants and defenders. When natural healing and homeopathy enjoyed a revival in the United States in the late 19th and early 20th centuries, Chinese medicine had a period of popularity among Americans as natural medicine. Chinese Americans, who were discriminated against and isolated in Chinatowns, could deal with all kinds of ailments, thanks to the availability of Chinese medicine. Other Americans and immigrants used Chinese herbal medicine for natural healing because they did not trust biomedicine. The demands by Chinese and non-Chinese patients helped the continuation of Chinese medicine in the United States. However, Chinese medicine declined in the 1930s–1960s.¹¹

The change of American immigration laws during and after World War II significantly impacted the lives of Chinese and Asians in the United States. In 1943 when China was an important ally in World War II, Congress repealed the 1882 Chinese Exclusion Act and made Chinese eligible for American citizenship. In 1952 when the United States was deeply involved in the Korean War, Congress passed the McCarran–Walter Act which made all Asians eligible for American citizenship. Although the law was a calculated political ploy to improve relations with Asian nations and to boost American democratic credentials during the Cold War, the McCarran–Walter Act was a turning point for Asians to become citizens in America. When students were allowed to stay and become American citizens, their talent and educational credentials meant a vital brain gain for the United States. The highly educated professionals of Chinese and Asian origins subsequently formed a significant part of the middle-class of Asian American population.^12,13 The 1965 immigration law, which Congress passed during the high time of the Civil Rights Movement, further opened up the United States to non-European immigrants. It ended the restrictive national quota system and gave preference to immigration of scientists and educated professionals. The preference for professional immigration significantly increased the brain power of the United States, including many Chinese and Asian professional immigrants.

Interestingly, the post-World War II growth of Chinese population in the United States did not lead to the revival but a further decline of Chinese medicine in American society, according to Tamara Shelton. The reason for this development had much to do with the predominance of the biomedical profession and the extraordinary achievements of biomedical research buttressed by the military-industrial complex of America. Chinese students and U.S.-born Chinese Americans chose to study biomedicine for their professional career in medicine. Hence, the “golden age” of American biomedicine and Chinese youth’s pursuit of career in the medical practice of biomedicine simultaneously led to the decline of “the practice of Chinese medicine and the close of many Chinese herbal companies” in the 1950s to 1960s.¹¹ The large numbers of refugees and immigrants from East and Southeast Asia after the Korean War and the Vietnam War brought significant changes to Asian population in the United States. Those new immigrants brought their traditions with them, including their traditional medicine that was influenced by Chinese medicine. In Asian immigrant communities, various forms of Chinese medicine were practiced and spread into the larger American society.

3 Studies of acupuncture by non-Asians

In the late 1960s, a new movement of counterculture emerged in America from the anti-Vietnam War demonstrations that challenged American authorities in many forms. Many young Americans sought Eastern traditional wisdom in their search for new answers, new approaches and beliefs for world peace in the tumultuous years of war and social upheaval. Medical students began to question the monopoly of biomedicine and sought new venues to seek knowledge and wisdom from the East. Non-Asian graduate students at the University of California Los Angeles founded the Institute for Taoist Studies in 1969. They learned to practice Tai-chi from local Chinese American Tai-chi teachers and took Tai-chi studies very seriously with dedicated daily practice. From Tai-chi, the students started learning Chinese medicine and acupuncture. Ten of them formed the first class to learn acupuncture from a Chinese medicine doctor, Ju Gim Shek, in Los Angeles. They studied acupuncture in the traditional way by studying and staying at their teacher’s studio like apprentices.¹⁴

This group of American students, who were studying Chinese medicine and acupuncture in Los Angeles, found themselves famous when Americans became fascinated with Chinese acupuncture during Nixon’s visit to China. They were “discovered” by local news media and interviewed on television about their studies. Riding on their fame, the students seized the opportunity and formed a National Acupuncture Association.¹⁴ This association was the first professional organization of acupuncture in the United States, even though the practice of acupuncture was still banned by local laws in California. At the time, people who practiced acupuncture faced the danger of being arrested and put in jail. For example, in 1974, Miriam Lee, the “Mother of Acupuncture in California,” was arrested when her success in using acupuncture to treat patients caught the attention of local authorities. She was charged for practicing medicine without a license. When she was put on trial for treating patients with acupuncture without a license, her patients—both Chinese and non-Chinese—came to the courtroom to defend her right to practice and to testify the effectiveness of acupuncture.¹¹

In order to win the legal right to practice acupuncture, the students who formed the National Acupuncture Association, worked with the California legislature to have bills passed for the practice of acupuncture from 1970 to 1975. Ronald Reagan, who was governor of California during this time, vetoed the bills every year. Finally, in 1975, the bill of California legislation was signed into law to allow the practice of acupuncture by non-physician professionals. The students, who lobbied and succeeded in getting the law established for the practice of acupuncture in California, became the first generation of non-Asian acupuncture professionals. They started educational programs of acupuncture at major university campuses across America from 1972 to 1975, after they completed their own training and became teachers of acupuncture. In the 1970s, they conducted acupuncture training across North America from the United States to Canada and Mexico. They set up several licensed colleges of acupuncture studies, including New England School of Acupuncture, California Acupuncture College (one of the branches is Pacific College of Oriental Medicine, now renamed as Pacific College of Health and Science), and Oregon College of AOM, and invited renowned acupuncturists from Hong Kong to teach. Studies at those schools usually lasted for three years before graduation. The students of these schools then became the next generation of American acupuncture professionals who promoted and multiplied the study centers of acupuncture and Chinese medicine across the United States.¹⁴

Some Americans went to study Chinese medicine and acupuncture in Hong Kong and Macau. In 1975, Ted J. Kaptchuk and Dan Bensky completed their training in acupuncture and Chinese medicine in Macau and returned to the United States to promote the study and practice of traditional therapies of Chinese medicine that had been reinvented and developed in China in the 1950s to 1970s. In the 1980s, working with the New England School of Acupuncture, Kaptchuk published his book, The Web That Has No Weaver: Understanding Chinese Medicine, and Bensky with Andrew Gamble and Kaptchuk published their book, Chinese Herbal Medicine: Materia Medica. Those books became essential English-language textbooks of Chinese medicine for American students and practitioners.¹¹

The rise of acupuncture as a field of study and a health profession happened in the larger context of promoting better relations between the United States and China, and the changing perceptions of Chinese medicine in the United States after President Nixon’s visit to China, in addition to the impact made by Chinese and Asian immigrants.

4 Research and professional development: the role of Chinese American medical scientists

Following President Nixon’s footsteps, many groups of Americans went to visit China. They were eager to see what China was like with their own eyes. Delegations of physicians, educators, scientists, businessmen, and other professionals came one after another. Among American delegations of medical scientists and physicians were public health experts, Chinese American doctors, and African American doctors. They witnessed Chinese medical development and the healthcare system with first-hand observations. Many of them wrote about medicine and healthcare in China after they returned to the United States. The renowned American physician and public health advocate, Victor Sidel, first visited China in the autumn of 1971. Impressed with China’s cost-effective achievements in public health, he made several visits to China in the following years and published several books on China’s healthcare.^15–17 Moreover, a delegation of the Black Panther Party came and visited China in 1972, with a few physicians on the delegation. They observed and learned Chinese acupuncture during their visit. Upon returning to the United States, they began to integrate acupuncture in their medical practice. They formed the Black Acupuncture Association, which played an important role in popularizing acupuncture among African Americans.¹⁸

Chinese American doctors who were trained in biomedicine suddenly became a new force to introduce Chinese medicine to the American biomedical professionals when the American public became interested in acupuncture. They updated their knowledge of Chinese medicine with the latest development in China and observed acupuncture anesthesia in Chinese hospitals. Some Chinese American doctors even tried acupuncture anesthesia with success in a few American hospitals that generated more publicity for acupuncture.¹⁹ Chinese American medical scientists translated Chinese medicine and explained it in biomedical terms to their colleagues in acupuncture research. The fact that they were trained in biomedicine but grew up with Chinese medicine gave them a unique advantage of being able to speak the language of biomedicine in the explanation of Chinese medicine and acupuncture. A few names stood out from the generation of Chinese and Chinese American medical doctors who built the bridge of understanding between Western and Chinese medical knowledge systems since the 1970s.

Frederick F. Kao (1919–1992), who studied Western Medicine but grew up with Chinese medicine in China, founded and served as editor of The American Journal of Chinese Medicine in 1973 when he was on the faculty of State University of New York Downstate Medical Center. As an editor of the journal in the following years, Kao shaped the American research of Chinese medicine with biomedical framework in the exploration and explanation of the effectiveness of acupuncture, herbs, and other traditional Chinese medical therapies. The American Journal of Chinese Medicine has published articles and research reports on Chinese medicine that were conducted in clinics and laboratories from all over the world, reaching readers in more than 60 nations. Kao also founded and directed the Institute for Advanced Research in Asian Science and Medicine, which became a collaborative center within the World Health Organization.²⁰

James Y.P. Chen (1914–2012) was a Tianjin native with a medical degree from Beijing Union Medical College^.21 He and Frederick Kao were members of the first delegation of Chinese American physicians to visit China in 1973, where they observed the latest development of acupuncture and Chinese medicine. Chen had been keeping track of acupuncture development and changes in China before his visit.²² He joined the acupuncture research program at the National Institutes of Health in 1972. The National Institutes of Health research program used biomedical models to explain the theory and clinical therapies of Chinese acupuncture. Chen translated traditional formulas and practices of Chinese medicine in the biomedical language that his colleagues and scientists were familiar with.²³ In their different capacities as researcher and journal editor, Chen and Kao became the two prominent Chinese Americans who made significant contributions to the biomedical explanation of acupuncture and Chinese medicine in the United States.

The biomedicalization of “scientific” explanation and clinical tests of acupuncture raise questions as to the methodological appropriateness. Medical historian Vivienne Lo points out the fundamental incompatibility between the randomized controlled trials of Western medicine and Chinese medicine.²⁴ She explains that there are many different forms of therapies and styles of acupuncture in practice, and those variables undermine any trials of acupuncture as a unitary phenomenon. Scholars of Chinese medicine in China continue to explore how ancient Chinese came to understand the invisible or unseen tracks and points. Sensory and physiological experiences within and about the human body during Qigong and Tai-chi exercises may hint at a possible venue from which ancient Chinese medical sages figured out the tracts and points of acupuncture.²⁵ They used the human body as a living lab to understand the unseen mechanism of and within the human body. The inner logic of Chinese acupuncture theories and practices remains to be unlocked for fuller understanding.

Ka-Kit Hui at the University of California Los Angeles is another Chinese American doctor of biomedicine who has made important contributions to the research of Chinese medicine in the United States.²⁶ Hui was studying at the Medical School of UCLA when the publication of James Reston’s report of Chinese acupuncture swept across America. Hui was intrigued by Reston’s report and determined to learn more about acupuncture, as he had known Chinese medicine growing up in Hong Kong. When he was back to Hong Kong during school break in 1973, he took lessons with a master teacher in acupuncture and Chinese medicine. Hui had the ambition to combine scientific biomedicine with Chinese medicine in his work. After he became a professor of medicine at UCLA, Hui gradually integrated Chinese herbal medicine and acupuncture into clinical pharmacology and drug development for the treatment of hypertension and heart failure.¹¹ In 1994, he founded the UCLA Center for East-West Medicine, which is now a major institution that offers clinical care, education, and research in integrating biomedicine with Chinese medicine.²⁶

Research of acupuncture has generated a significant increase of publications in the 20 years from 1995 to 2014 when compared to the publications on biomedicine. According to a study published in 2016, publications on acupuncture had 10.7% annual growth rate while biomedicine had an average of 4.5% annual growth rate.²⁷ Publications on clinical trials of acupuncture surged from 7.4% in 1995 to 20.3% in 2014. The most common focus of acupuncture research was on pain, comprising 37.9% of publications. Other major focuses of acupuncture research include arthritis, neoplasms/cancer, pregnancy or labor, mood disorders, stroke, nausea/vomiting, sleep, and paralysis/palsy. More than 60 countries in the world conducted acupuncture research, with China (47.4%), the United States (17.5%), and the United Kingdom (8.2%) as the top contributors.²⁷ The publications of acupuncture research mostly appear in journals on complementary and alternative medicine and in specialized journals on neuroscience, pain, anesthesia/analgesia, and international medicine, although publications also appear in major medical journals such as New England Medical Journal and Journal of American Medical Association.

Acupuncture has become an important health and healing alternative to mainstream biomedicine, as the daily use of acupuncture to treat diverse ailments is gaining increasing popularity among Americans. For this reason, acupuncture, together with herbal medicine, is called Alternative and Complementary Medicine or Integrative Medicine. With the increasing use of alternative and complementary medicine, American medical colleges have adjusted to public demands by offering studies of integrative medicine, including Chinese acupuncture and herbal medicine. People often use acupuncture and herbal medicine in combination with biomedicine in the daily practice of healing. Many prominent American hospitals, medical centers, research institutes and medical colleges have incorporated acupuncture and Chinese herbal formula into the treatment of chronic pain and in the integrative medical care programs. They include the Mayo Clinic, the Cleveland Clinic, the Massachusetts General Hospital in Boston, Mount Sinai in New York, and University of California San Francisco. As acupuncture gains more popularity among patients and in medical training of doctors, major health insurance companies are expanding their coverage of acupuncture in medical treatments.

In the United States, acupuncture and Chinese herbal medicine are two separate disciplines and professional fields, although they are integrated in China.⁶ This separation was primarily caused by American laws that define acupuncture and herbal medicine as two completely different categories. The regulations, therefore, are different in these two fields. The US government passed the Dietary Supplement Health and Education Act in 1994, which defined Chinese herbal remedies as dietary supplements and therefore exempted from the regulatory examination of the approval process for pharmaceuticals. This law substantially boosted the herbal medicine market, making the United States the biggest non-Asian importer of Chinese herbal medicine. Currently, Chinese herbal medicine is a thriving business in the United States.

5 Information on the use of acupuncture and Chinese herbal medicine

Acupuncture and Chinese herbal medicine have become an important part of Alternative Medicine in the United States. Studies show that acupuncture is a major practice of Complementary and Alternative medical treatment. In 2017 alone, over 14 million Americans used acupuncture, according to a study conducted by the Acupuncture and Massage College in Florida. The majority of those who use acupuncture tend to be people of 45 years and older, and well-educated with college degrees.

There are many sources that offer information on Chinese medicine, including websites of government health institutions, university medical schools, major hospitals, organizations and foundations of Chinese medicine. For example, the National Center for Complementary and Integrative Health under the US Department of Health and Human Services provides comprehensive online information about Chinese medicine (which it defines as TCM), including the definition, effectiveness, and major components of acupuncture, herbal products, and Tai-chi. It also offers information on how and where to find licensed practitioners of Chinese medicine.²⁸ The Mount Sinai Health System, located in New York City, provides detailed information on what Chinese medicine is good for and what patients should expect on their first visit. It explains the theoretical concepts of Chinese medicine in terms of understanding the human body’s internal organs not only as individual structures but also as complex networks and systems. Such understanding of the connected systems and networks of human internal organs is lacking in Western biomedicine.²⁹

6 Conclusion

Chinese medicine has a long history in the United States, but its rapid growth and development began in the 1970s after President Nixon’s visit to China. Friendly relations between the two countries helped create a social and cultural context in which Chinese medicine was studied and appreciated by American people. In addition to the contributions that Chinese and Asian immigrants made to the development of Chinese medicine in the United States, many non-Asian Americans have been trained in acupuncture and Chinese herbal medicine since the 1970s. They helped spread the study of Chinese medicine in different parts of the United States. In the research of acupuncture, Chinese American doctors who were trained in biomedicine have played an important role in framing up the biomedical research approach to acupuncture and herbal medicine. Publications of acupuncture research have increased enormously in recent decades, despite lingering skepticism of acupuncture in the society. The use of Chinese medicine as a healing mechanism is gaining popularity among the American population. Chinese medicine, particularly acupuncture, has proved to be effective in treating many illnesses, especially in dealing with chronic pains and drug addictions that Western biomedicine has few solutions.

Funding

None.

Ethical approval

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

Author contributions

Liping Bu wrote and revised this paper.

Conflicts of interest

The author declares no financial or other conflicts of interest.