整脊有方 ──脊骨神經科醫師陳家恩

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2002 / 12月

文‧滕淑芬 圖‧薛繼光


畢業自美國加州洛杉磯脊骨神經醫學院的陳家恩,一九九○年回台灣執業,是國內第一位脊骨神經科醫師,他的病人遍及政商名流,包括了裕隆集團董事長吳舜文、台灣大哥大董事長孫道存等人。

由於脊骨神經科在台灣尚未被官方承認,整脊師也被歸類為另類療法。但陳家恩強調,他不是整脊師,而是脊骨神經科醫師。


胡太太因為幫在病院的媽媽翻身而閃到腰,前一天被兩位親戚扶著來到位於台北市兩條鬧街口的一家脊骨神經保健中心,主治醫師陳家恩詢問她昨天回家有沒有作抱腿運動,強化腰力,再看看X光片,對她解釋,腰椎沒有受傷。陳醫師徒手調整她的腰椎後,胡太太今天已經可以自己走出診所。

中國人俗稱脊椎為「龍骨」,因為它是人體最重要的支撐架構,除了得承受我們的體重與體型外,還連接著重要的神經系統網絡。以往台灣民眾若是腰酸背痛或閃到腰,不是到坊間的整骨所,就是西醫的復健科,現在不少人會去找「脊骨神經科」醫師。

以龍骨為中心

在美國,「整脊」堪稱最接近主流的另類療法,而這個療法所以成形,也是一則傳奇故事。

十九世紀末,一位居住在美國愛荷華州、自學研究磁療的帕爾曼先生,調整一位失聰十七年工人的脊椎,奇蹟式地恢復了他的聽力。這名工人對帕爾曼表示,有一天他蹲下去搬東西,起身後覺得自己的背好像被卡住,就再也聽不見了。帕爾曼檢查後,覺得問題出在他的脊椎偏離正確位置,壓迫到聽覺神經,經他徒手將脊椎調整回原來位置,這位失聰十七年的工人居然又能聽見聲音。

帕爾曼並創造出chiropractic(整脊)這個字,他結合兩個古希臘字,以字根「手」,加上字尾「運用」,意思是利用各種徒手技巧來調整脊椎,以解除疼痛或治病。

幾年後,帕爾曼成立了整脊學校。一九二七年,美國已有三十九州賦予脊骨神經醫師合法的證照,以後增加到五十州。一九七三年,美國聯邦政府保險制度開始給付整脊的醫療費用,但只限於經由X光檢驗出來的下背錯位;一九八○年代中期,美國衛生部曾電話詢問一百四十五位脊骨神經醫師開立醫療費用的依據標準,結果百分之八十四回答,有些下背部錯位無法從X光中看出來。因此也有些報導指出,如果X光看不出脊椎錯位,那麼脊骨神經醫師究竟以何依據來調整脊椎錯位?經過多年遊說與辯論,一九九七年,美國脊骨神經醫師學會說服了美國國會,取消了「X光條款」。

經過一世紀的發展,美國脊骨神經醫師的地位越來越高。一九八○年,美國醫師學會在芝加哥年會上承認脊骨神經科的合法地位,一九九七年世界衛生組織正式通過世界脊骨神經醫學聯盟。目前美國的脊骨神經醫師有六萬多人,已成為僅次於醫生的第二大團體,人數還超過牙醫師、眼科醫師。

時代雜誌一九九一年的報導指出,大約有三十家醫院聘請合法的脊骨神經醫師,有些骨科醫師會將自己的病人轉介給他們。但時代的記者也認為,「脊椎上佈滿了神經,脊骨神經師卻宣稱他們可以經由『調整』脊骨,治療所有疾病。但除了對付下背部疼痛,偶爾可以看到幾起成功病例外,目前無法證明這個方法有效。」

雖然現在美國各大醫院都有脊骨神經醫師,美國保險公司也普遍對整脊給予醫療給付,但不少報導也紛紛提出警告,譬如對整脊療效抱持懷疑態度的「整脊原理」網站即提醒患者,「千萬別被脊骨神經醫師給騙了」。

西醫的「跌打損傷」?

回到台灣,脊骨神經科更是一個相當陌生的科別,有人稱它為西醫的「跌打損傷」科,目前在台灣領有美國該科執照的醫師不超過十五位,陳家恩是第一位自美回國的脊骨神經科醫師。

陳家恩會對脊骨神經感興趣,因為自己就是脊骨神經復健的受惠者。十二歲赴美求學的陳家恩,大學主修生物,一九八二年他在加州高速公路上,迎面和開錯車道的車相撞,整個人當場昏死,他還感覺自己身體浮了起來。

送醫急救後,腦後縫了四十針、右眼縫了十幾針,雙眼失明了兩個星期,紗布拆開後,眼睛只能看到微微的光,半年後,看任何東西都會出現二個影像。由於腦神經受到撞擊,頭痛了一年才穩定,他不得不休學,前幾個月每天都得到醫院報到,幸賴脊骨神經科醫師細心地幫他復健,一年後他的視力才恢復正常。康復之後,陳家恩從加州大學雨彎分校生物系畢業後,再赴洛杉磯脊骨神經醫學院念書,並取得該科醫學博士學位。

陳家恩表示,脊骨神經醫學院的課程相當於台灣的學士後醫學系,前兩年修習基礎醫學課程,如解剖學、生理學、生物化學等,後兩年是臨床醫學課程,如骨科、皮膚科、婦產科、小兒科等。畢業後得通過國家考試、州政府考試,才能執業。

整脊師的難題

一九九○年陳家恩回國,任職於台北宏恩醫院復健科,三年後出來開業,期間他還擔任中華奧運和北京亞運棒球隊的領隊。「因為他們覺得我太好用了,可以當領隊、醫生、翻譯,一人當三個人用,」他笑說。

「現代人很多病因都是因為脊椎神經不正而引起的,如坐骨神經痛、手麻、腳麻等,」他解釋說,頭痛可能有一百種原因造成,但百分之八十的頭痛都是因為頸椎受到壓迫;而相較於開刀,整脊確實是比較溫和的治療手法。

他舉例說,一位病患耳鳴了一個月,吃了一個月的藥,經過他診斷,原來是椎間盤突出壓迫到神經和血管,矯正三次後,就不再耳鳴。執業十多年,回國後治療最困難的病例是一位五十歲的先生,椎間盤突出的狀況嚴重到差一點就會爆裂。六年來每天走路的時間無法超過十分鐘,但經過他一個月的治療、並要求他每天游泳半小時,現在每天走路的時間已經可以延長到一小時。

「台灣太封閉了,」他指出,美國政府多年前已開始對針灸、整脊給予一年最少十二次的醫療給付,台灣仍漠視這個領域的最新發展。對於坊間上千家依循祖傳或是修習短期課程,便打著治療背部酸痛毛病旗號開業做生意的情形,他更是感嘆不已。

倒底脊骨神經科醫師與坊間整骨師在徒手操弄手法上,有何差別?陳家恩強調,「最重要的差別在診斷和治療。」

他表示,雖然西醫復健科的物理治療師,也可以為病患進行頸部的牽引動作,但所有動作必須在醫生指示下進行,尤其禁止作脊椎矯正,因為這不屬於物理治療師的醫療範圍。

「頸椎上有很多神經、血管,沒學過解剖學的整脊師,矯正稍有誤差,神經、血管就會發生卡嚓聲,導致中風,」陳家恩說,整脊的力道若未掌握好,只要第一和第二節頸椎扭斷就會癱瘓或中風。

「台灣社會對脊骨神經完全沒有認識,到處都是整骨師,政府也不重視。」陳家恩回國後,奔走於衛生署、教育部,致力成立台灣脊骨神經研究學會,希望協助有關單位對脊骨神經專業人員的立案、考試認證,和成立脊骨神經醫學院。但被踢皮球了十年,仍不見蹤影。

脊椎保健一半靠自己

背痛已成現代人文明病之一,不少人的困擾都是:背部疼痛該找誰?矯正脊椎對背部疼痛可以恢復到什麼程度?如果真有效果,又該到那裡找可以信賴的脊骨神經醫師?可惜目前這些問題在台灣都還沒有答案。

身為脊骨神經科醫師的陳家恩表示,脊椎復健的第一階段是止痛,再讓痙攣後的肌肉放鬆,最後是訓練、強化肌肉。此外,美國的醫學報告也指出,因為骨骼問題需開刀的病患中,有百分之七十五事實上都不需開刀,可以藉由醫師的協助,加上病人的復健、運動而逐步改善。也就是說,治癒文明病,除了靠醫生,更重要的仍需依賴自身的決心。

p.021

陳家恩是最早自美返國的脊骨神經科醫師, 雖已回國十年,但對台灣民眾來說,脊骨神經科仍是相當陌生的科別。

p.023

肩頸酸痛已成上班族的夢魘之一,現代人坐姿不良、少運動,都會導致頸椎不當受力而產生疼痛現象。

p.025

脊椎俗稱「龍骨」,坊間整骨師素質參差不齊,若專業訓練不足,整骨也可能「整」出更多毛病。

p.026

西醫復健科利用儀器為患者做頸部牽引動作,舒緩疼痛。

相關文章

近期文章

EN

Get Your Back to Where It Once Belonged-- Chiropractor Edward Chen

Teng Sue-feng /photos courtesy of Hsueh Chi-kuang /tr. by Phil Newell

A graduate of Los An-geles College of Chiropractic, Edward Chen returned to Taiwan to go into practice in 1990 as Taiwan's first chiropractor. Today, his patients include many leading figures from the worlds of politics and commerce.

Because chiropractic is not yet officially recognized in Taiwan, chiropractors fall under the category of "alternative medicine," like zhenggushi (sometimes called "bonesetters") practitioners of a traditional form of "bone adjustment" (or "spine adjustment") based on Chinese medical theory. But Edward Chen emphasizes that he is not a zhenggushi but a doctor of chiropractic (DC).


A few days earlier, Mrs. Hu had to be carried by relatives into the Chen Chiropractic Rehabilitation Center, located at the intersection of two of Taipei's busiest streets, after she injured her lower back while helping her hospitalized mother turn over in bed. Edward Chen asks her if yesterday when she went home she did her exercises to strengthen her waist. He again looks over her x-rays, and explains to her that her lumbar vertebrae have not been injured. After manipulation to adjust her lumbar vertebrae, Mrs. Hu can today walk out of the clinic on her own.

Chinese people commonly called the spine the "dragon bone," because it is the most important structural pillar in the human body. Besides bearing our body weight and maintaining our posture, it also connects to the vital nervous system. In the past whenever people in Taiwan suffered hip or back pain, they would either go to an independent zhenggushi or to a Western hospital for rehabilitative medicine. But now more and more people are going to see chiropractors.

Enter the dragon bone

In the US, chiropractic medicine is known as the form of alternative medicine closest to mainstream science. There's quite an interesting story behind the founding of this therapeutic approach.

At the end of the 19th century, there was a Dr. Daniel Palmer, a self-taught practitioner of magnetic therapy, living in the state of Iowa in the US. A janitor in the same block where Palmer had his office had been deaf for 17 years. The doctor asked around and was told, as Palmer later recalled, that the man "was exerting himself in a cramped, stooping position, [when] he felt something give way in his back and immediately became deaf." After examining him, Palmer decided that "there a vertebra racked from its normal position," and "reasoned that if that vertebra was replaced, the man's hearing should be restored. I racked it into position by using the spinous process as a lever and soon the man could hear as before."

Palmer himself came up with the term "chiropractic." It is a combination of two ancient Greek roots, one meaning "hand," and the other meaning "to use." It simply refers to the use of manipulation to adjust the spine to relieve pain or treat illness.

A few years later, Palmer established his own school of chiropractic. By 1927, 39 American states were issuing certificates for chiropractic medicine, and this figure later rose to 50. In 1973, the insurance system of the American federal government began to pay for chiropractic, but limited to cases in which x-rays could show physical evidence of "subluxation" (which is how chiropractors refer to their key concept of spinal misalignment). In the mid-1980s, the US Department of Health and Human Services interviewed 145 chiropractors by phone to get a sense of the basis of their fees. It turned out that 84% responded that in many cases subluxation does not show up on x-rays. Skeptics asked, if x-rays cannot show subluxation, on what basis do chiropractors adjust the supposedly mispositioned spine? Nonetheless, after many years of lobbying and debate, in 1997 the national association of chiropractors convinced Congress to eliminate the x-ray provision.

After a century of development, chiropractors are gaining in status in the US. In 1980, at its annual meeting in Chicago, the American Medical Association recognized the medical value and legal status of chiropractic medicine, and in 1997 the World Health Organization formally recognized the World Federation of Chiropractic. There are currently more than 60,000 chiropractors in the States, making it the second-largest form of medical practice after MDs, ahead of even dentists and ophthalmologists.

But not everyone is so upbeat. A 1991 report on alternative medicine in Time magazine noted that at that time about 30 hospitals employed licensed chiropractors, and even some orthopedic surgeons referred their patients to them. However, the Time reporter warned: "Because almost every nerve in the body runs through the spinal cord, chiropractors maintain that they can treat all manner of ills by 'adjusting' the lower back. However, beyond the lower back there is no proof-aside from reams of anecdotal testimony-that the method works." Websites like Chirobase and consumer groups like the National Association of Chiropractic Medicine actively work to debunk what they see as the exaggerated, "metaphysical," and even fraudulent claims of chiropractic.

Although many hospitals in the US now have chiropractors on staff and American insurance companies now commonly pay for chiropractic treatment, many skeptical medical and media sources warn: "Don't let chiropractors fool you."

Collision course

The specialty of chiropractic is still quite unfamiliar in Taiwan, and some doctors here jokingly compare it to the traditional Chinese specialty of treating bruises incurred in falls. Currently there are less than 15 US-licensed chiropractors in Taiwan, the first of whom to return home as a DC was Edward Chen.

Chen became interested in chiropractic because he himself was a beneficiary. Having gone to the US to go to school at age 12, by 1982 he was studying biology in university when he had a head-on collision on a California highway with a car driving the wrong way. He passed out and nearly died, and he can still remember a feeling of floating above his body.

After being sent for emergency treatment, he had 40 stitches to the back of his head, and more than ten around his right eye. He was blind in both eyes for two weeks, and after the bandages were removed, he could only see a small amount of light. Even after half a year he had double vision whenever he looked at anything. He was plagued by headaches for a year. He had no choice but to leave school, and for the first few months he had to go to the hospital every day. Fortunately, a DC saw him through his rehabilitation, and after a year his vision returned to normal. After regaining his health, Chen transferred to the Los Angeles College of Chiropractic, where he eventually earned a DC.

Edward Chen states that the curriculum at a chiropractic college is quite similar to the post-baccalaureate curriculum in medical departments in Taiwan. In the first two years students study basic medicine, such as anatomy, biology, and biochemistry. In the latter two years they do clinical work in various fields, such as osteopathy, dermatology, obstetrics, and pediatrics. After graduation it is necessary to pass a national and state examination in order to be licensed to practice.

A touchy subject

In 1990 Edward Chen returned to Taiwan and took a position in the department of rehabilitative medicine at Hung En Hospital in Taipei. Three years later he went into private practice. He has also served as a coach to the Chinese Taipei Olympic team and to the baseball team at the Asian games in Beijing. "That was because I could be put to so many different uses, as a coach, doctor, and translator, so they got three employees for the price of one," he laughs.

"Many of the illnesses of modern people are caused by subluxation, such as sciatica, or numbness in the hands or feet," he explains. There are more than 100 causes of headaches, but 80% of headaches, he says, are because the cervical vertebrae come under pressure. Compared to surgery, chiropractic medicine is certainly a more gentle therapeutic approach in treating such problems.

He takes an example of one case he had of a patient with ringing in his ears who took medication for a month to no effect. Chen's diagnosis was that a spinal disc was protruding and pressing down on the blood vessel. After three "adjustment" sessions, the ringing in the ears was gone.

In practice for more than a decade, Chen's most difficult case since coming back to Taiwan was that of a 50-year-old man whose disc was so out of line that it had nearly ruptured. For six years, the man could walk no more than ten minutes a day. But after a month of therapy, in which Chen also required that his patient swim for half an hour daily, currently the man can walk for up to an hour each day.

"Taiwan is too closed," he argues. Two years ago the American government began authorizing up to 12 insurance payments per year for acupuncture and chiropractic, while Taiwan still ignores the latest developments in these fields. However, Chen reserves his greatest sigh of disapproval for the thousands of self-styled zhenggushi who practice forms of bone adjustment based on family traditions or who have taken a brief course and then hang out their shingle as specialists in curing back pain.

So what is the difference between a chiropractor and a zhenggushi? Edward Chen emphasizes that chiropractors can explain your diagnosis to you based on an understanding of anatomy, rather than just going on experience.

Chiropractors are doctors, not just therapists. Chen explains that although physiotherapists in departments of rehabilitative medicine in Western hospitals can also do neck-traction for their patients, all actions must be taken under the direction of a doctor. Chiropractors also can use a variety of techniques. For example, it is particularly forbidden for physiotherapists to do "spinal adjustment."

"There are many nerves and blood vessels around the cervical vertebrae. If zhenggushi who have not studied anatomy make even the slightest error in adjustment, then there can be a cracking sound, affecting the nerves or blood vessel and leading to stroke," says Chen. If the amount of force used in adjustment is not precisely controlled, if even only the first cervical vertebra is broken, than the result will be paralysis or stroke.

"There is no real understanding of chiropractic in Taiwan society. Meanwhile there are zhenggushi everywhere, but the government doesn't take any notice." After returning to Taiwan, Edward Chen went to the Department of Health and Ministry of Education trying to establish a chiropractic association, in hopes of helping the relevant agencies create a legal foundation and examination and licensing system for specialist practitioners and hospitals. But after being kicked around for ten years, there is still not the slightest sign of a result.

Its mostly up to you

As a chiropractor, Edward Chen says that the first stage in treating back pain is to stop th epain, the second it to relax the muscles, and the third is to do exercise to strengthen the muscles.

Back pain is one of the most common "diseases of civilization," and many people wonder whom they should seek out for help when they have this problem. They wonder to what extent "spinal adjustment" can heal their backs. If it is really effective, then where should they go to find it a reliable specialist? Unfortunately there is still no answer to these questions in Taiwan at the present moment in time.

p.021

Edward Chen was the first qualified chiropractor to return to Taiwan from the US. Although he has been practicing in Taiwan for ten years, there is still very little awareness of chiropractic among the Taiwanese public.

p.023

Neck and shoulder pain has become a nightmare for office workers. Poor sitting posture and insufficient exercise may lead to inappropriate stresses on the neck vertebrae, leading to pain.

p.025

The spinal column is popularly known in Chinese as the "dragon bone." The many bone manipulators who offer their services in Taiwan are of very variable levels of skill. With inadequate specialist training, skeletal manipulation can create more problems than it cures.

p.026

A Western-style physiotherapist uses traction apparatus to extend a patient's neck, to relieve pain.

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