Overview of the Development of Chinese Medicine in North America

1 Introduction The world is now in an era of the globalization of traditional Chinese medicine (TCM). A hundred and thirty-three member states responded in the World Health Organization’s (WHO) Global Report on Traditional & Complementary Medicine 2019, which was based on the second WHO global survey in 2012, 113 member states formally acknowledged that their population uses acupuncture and 100 member states acknowledged that they use TCM.1 The data in this report also showed that 30 member states have regulations on acupuncture and 18 member states on TCM. In the category of traditional and complementary medicine, acupuncture is the most common form of practice in the world. In 2022, the International Classification of Diseases 11th Revision (ICD-11) is officially in effect.2–4 Chapter 26, Traditional Medicine, was first forever published in this international standard of diseases classification and the technical terms mostly compiled from TCM which indicated that TCM is now officially entering the world health system. Overseas TCM is rapidly growing in North America. Even though Chinese herbal medicine disseminated into the American continent in the middle of the 19th century,5 its development as a profession did not start until half a century ago. The grass root welcome and acceptance of Chinese medicine has made for successful lobbying efforts towards legislation that allows the legal practice of Chinese medicine, mainly passed acupuncture practice acts in the United States, so acupuncture practice is dominant among the modalities of Chinese medicine. North America has the largest number of Chinese medicine practitioners outside of Chinese mainland, about 38,000 licensed acupuncturists in the United States6 and over 6,000 practitioners of acupuncture and TCM in five provinces that can legally practice in Canada.7,8 Along with the development of the acupuncture and Chinese herbal medicine profession continues to grow, corresponding regulations, education, and insurance accessibility are gradually increasing. Since 2020, acupuncture treatment can be reimbursed for low back pain through Medicare in the United States.9 Acupuncture is well accepted by the population in North America which is far beyond the Chinese community. This special issue of Chinese Medicine and Culture has published eight articles covering different aspects of the developmental status of acupuncture and Chinese herbal medicine in legislation, education, clinical practice, and academia (such as cultural integration study). In this highlight, a brief overview is provided for the main contents of these newly researched outcomes. 2 Summary of Chinese medicine in North America in this special issue Medicine operates within the world views of the culture that it serves, and the widespread Chinese diaspora has carried medical practices with it. The resulting creolization takes shape at the borders of intersecting cultures in a distinct form of integration. Exploring the intersections of the integral relative to the spread of Chinese medicine in the West and North America and practical, cognitive, and theoretical terms is useful for practitioners, academics, and policymakers in the areas of integrative and Chinese medicine. With the adoption of multiculturalism in Canada, our health care system has incorporated TCM and acupuncture into medical services and having these approaches along with Western scientific–based medical practice has improved patient care. Generally, alternative medicines rely on organic and natural products, have holistic practices, and include a different inclusive way of thinking. Other factors such as the rising cost of medical expenses and the high cost of pharmaceutical products and respect for Chinese cultural practices affected the growth of alternative approaches in Canada. The practice of TCM of the Chinese-speaking immigrants residing in BC, Canada, is evident by this qualitative research project. Integrating TCM with medical practices in the West, “cultural capital” could be established through expanding choices for health and disease management if the options for each are available.10 Integrating TCM into Western medical practices could diversify the spectrum of services available for all Canadians. A set of congruent behaviors, attitudes, and policies need to come together in a system, agency, or among professionals and enable them to work effectively in cross-cultural situations.11,12 Both “academic societies” and “professional associations” should be the organizations that serve the best interests of their industry. TCM organizations should actively serve the legislation and promote the development of the Chinese medicine profession, and TCM practitioners should have more dedication to the advancement of their profession. For an example of acupuncture legislation in Virginia, US, dedication and strategy are the important factors leading to success. Through the investigation and analysis of the two typical and most representative Chinese medicine schools in the eastern United States, the current situation of Chinese medicine education in the United States is discussed. Chinese medicine education, especially acupuncture education, in the United States has entered the localization development. It is foreseeable that with the joint efforts of local Chinese medicine practitioners to promote legislation and education standards, the development of Chinese medicine in the United States will have a bright future. Evidence from historical, sociological, ecological, and agronomic factors has accumulated suggesting that an undetermined number of the herbs of the Chinese Materia Medica could be produced in North America. The US growers’ network, over the years, has developed a list of 150 species that are prioritized for production. Priority factors include: availability of reliably identified germplasm, suitability to various ecological niches available on member farms, and the level of interest or demand among the customer base. Priority species can be adapted to the wide range of production systems available on American organic farms. Although Chinese herb growers in the United States are hard-pressed to overcome the obstacles they face, several long-term trends can be identified that could alter the framework of the problem which include continued innovation in agriculture, increasing acceptance and support from the market, disruption of supply lines for imported products whether from scarcity or increased costs. Adding TCM to conventional Western medicine treatments for coronavirus disease 2019 (COVID-19) patients may be promising with respect to improved treatment outcomes. Unfortunately, TCM is not widely used in the American hospital system, if any. Although vaccination in the United States has greatly reduced hospitalizations and deaths from COVID-19, how to manage complications of COVID-19 is still a challenge.13 The effects of what is now formally referred to as long-lasting COVID-19 disease or long COVID is estimated to affect millions of individuals who have previously contracted COVID-19, with symptoms including fatigue, headache, dyspnea, and anosmia.14 If TCM were more integrated into the healthcare system of the United States and demonstrated similar safety and efficacy as the results observed in China, then severe/critical cases and associated mortality hypothesized would be significantly reduced. At the current time, there is only one registered clinical trial of TCM to treat mild to moderate COVID-19 in the United States. The most common treatment principle to treat pain with acupuncture is to activate channels to relieve pain but there is not much attention on treating the patient’s shen. Shen is the governor of life; it controls all physical and mental activities. Pain is a subjective symptom. The disorders of shen, include the disorders of hun (the ethereal soul) and the disorders of po (the corporeal soul), in pain sufferers can negatively affect how they feel or recognize pain, how they respond to pain and how they report their pain level. Guarding shen or treating shen is the key to an effective treatment for chronic pain. A list of points with names related to shen is provided that give clues that they could be beneficial for the treatment of shen. The practitioner should palpate the point to detect and determine the state of shen of that point before needling. It is essential to apply tonification and reduction needling technique to restore the normal state of shen in each and all selected points in a treatment. A clinical case report presented. 3 Future perspective In North America, acupuncture and Chinese herbal medicine is categorized as a part of complementary and integrative medicine, showing its advantages, and confirmed therapeutic effects through accepted and standardized clinical trials. Integrative medicine is a trend of 21st century medicine in North America which has been described as “the full range of physical, psychological, social, preventive, and therapeutic factors known to be effective and necessary for the achievement of optimal health throughout the life span … which could shift the focus of the healthcare system toward efficient, evidence-based practice, prevention, wellness, and patient-centered care, creating a more personalized, predictive, and participatory health care experience.”15 It is foreseeable that Acupuncture and Chinese herbal medicine will play more important roles in integrative medicine, especially in regards to the non-pharmacological pain management initiatives in North America.16,17 The development of TCM in North America, both clinically and academically, will greatly contribute and promote the globalization of TCM. Funding None. Ethical approval This article does not contain any studies with human or animal subjects performed by the author. Author contributions Yemeng Chen wrote and reviewed the article. Conflicts of interest Ye-Meng Chen is an Executive Editors-in-Chief of Chinese Medicine and Culture. The article was subject to the journal's standard procedures, with peer review handle independently of this Executive Editors-in-Chief and their research groups.

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