Case 1: Mr. Chiang's left shoulder is paralyzed after a road accident. Although the bones have knitted together again after surgery, his muscles have gradually withered and lost strength. So he is visiting a traditional Chinese medicine clinic on Taipei's Chunghsiao East Road, where the doctor, Ma Chih-hsiang, inserts fine needles into Mr. Chiang's acupuncture points and passes an electric current through them to stimulate his muscles. In the next bed is a Mrs. Liu, whose arms are swollen because of diabetes. After six sessions of acupuncture and electrical stimulation, the swelling in her arms-which were as thick as her thighs-has gradually gone down again.

Case 2: Bank worker Mr. Hung was last year diagnosed with liver cancer. His doctor suggested he undergo chemotherapy, but Mr. Hung felt that chemotherapy would not get to the root of the disease, so instead he decided to tackle it by changing his dietary habits. He went to southern Taiwan to find apples that were not treated with pesticides, and went over to a macrobiotic diet to restore his health. A year later when Mr. Hung returned to hospital for another examination, his two-centimeter tumor had disappeared.

At swimming pools and health centers one can see powerful downward-pointing jets of water that are said to help relax neck and shoulder muscles. But to avoid neck injuries, they should be used with caution.

When patients go their own way

The quickening pace of life, environmental degradation, and stress bearing down from all sides impact us physically, emotionally and spiritually. Although people today are living longer, they are inescapably plagued by chronic ailments and stress. The standard procedures of mainstream medicine, such as drugs and surgery, cannot effectively relieve patients of the fear they experience when battling with disease. Faced with these difficulties, more and more people are willing to try alternative treatments, which have become popular worldwide.

In November 1991 the US news magazine Time ran a cover story that examined the phenomenon of patients turning their backs on mainstream Western medicine to seek alternative therapies, including acupuncture, reflexology, hypnosis, Ayurvedic medicine and many more.

An opinion poll commissioned by Time showed that 30% of the US residents surveyed had tried some form of unconventional therapies. The magazine estimated annual national expenditure on alternative medicine at US$27 billion. The growth of alternative medicine reflected "a gnawing dissatisfaction with conventional, or 'allopathic' medicine." For all Western medicine's brilliant achievements, such as vaccines, penicillin and organ transplants, it also had some severe failings, and the one most complained about was the endless waiting for doctors who viewed one as a sore back, an inoperable tumor or a cardiac case, but never as a person.

In view of the rising popularity of alternative medicine, in 1992 the US Congress set up the Office of Alternative Medicine under the National Institutes of Health, and in 1998 the Office was expanded into the National Center for Complementary and Alternative Medicine. The center categorizes over 40 types of treatment as alternative medicine. They range from familiar staples such as acupuncture, moxibustion, Chinese herbal medicine, qigong and shiatsu, to more exotic-sounding varieties such as homeopathy, magnetic healing and energetic medicine. (Homeopathy is a traditional European treatment method in which the practitioner first diagnoses the patient's symptoms, then prescribes tiny doses of drugs that in larger quantities would elicit the same symptoms. The drug's affinity for the disease boosts the body's own defense mechanisms. This is similar to the Chinese principle of "fighting poison with poison.")

Cupping has a similar effect to a hot compress-it can accelerate local blood circulation and promote metabolism.

Mass movement

If the rising popularity of alternative medicine in the US is a reaction against the rapid development of Western scientific culture, in Taiwan it is more a case of people taking a fresh look at some "old stuff" that is deeply rooted in local traditional culture.

Associate Professor Ting Chih-yin of National Taiwan University's school of public health has been researching alternative therapies for many years. She divides them into four major categories, as seen from the user's perspective. The first category comprises those therapies that involve the injection, ingestion or inhalation of substances; these include traditional Chinese medicine (TCM), herbalism, macrobiotic foods, health foods, and aromatherapy. The second comprises physical therapeutic methods applied externally by a practitioner, such as acupuncture, massage, chiropractic, guasha, hydrotherapy, and cupping. The third comprises physical, mental or spiritual exercises to be practiced by users themselves, such as qigong, taijiquan, yoga and meditation. The fourth comprises methods involving the redirection of supernatural forces, such as feng shui and shoujing (a Taiwanese folk ritual to calm a child after a frightening experience).

In order to understand the Taiwanese public's attitudes towards alternative medicine, Ting conducted a questionnaire-based survey in which she asked: "In the past year, have you used any of the following methods to deal with illness?" The 16 choices included Chinese medicine, other herbal medicines, and macrobiotic foods. As many of 75% of those polled had used some form of alternative medicine.

Among those who had used therapies of the first type, involving the intake of substances, the highest proportion had taken Chinese herbal medicines (44%), followed by health foods (24%), macrobiotic foods, other herbal medicines, and aromatherapy. Frequently used physical therapies were tuina massage, guasha, and other types of massage (all over 20%). For supernatural methods, shoujing (10%) and shamanism scored the highest, while only 2.8% of those polled had turned to feng shui or fortune telling.

Ting Chih-yin notes that research in countries such as the UK, the US and Australia shows that demographically speaking, people there who accept alternative medicine tend to be white-collar workers, middle-class, relatively well educated, and with a high degree of self-control, such as cultural and creative workers, environmentalists, and feminists. But in Taiwan, there is almost no differentiation according to level of education-alternative therapies are used by people throughout society. Looking more closely, this is related to the fact that what is referred to as alternative medicine also includes many therapies from traditional Chinese medicine, and these are currently enjoying a market revival.

Reflexology has found a widespread following among the Taiwanese public. In parks large and small one can find foot massage paths surfaced with small round pebbles.

Ancient wisdom

From the point of view of TCM practitioners, some of the alternative treatments currently popular in Taiwan, such as massage, cupping and guasha, are in fact traditional external treatment methods used in TCM, and are not "alternative" treatments at all.

Thousands of years ago, before the advent of the science of anatomy, our ancient Chinese ancestors developed the theory of meridians, based on their experience and understanding of the structure of the human body. According to this theory, running through the body are 12 channels or meridians, along which are distributed various acupoints (acupuncture points) corresponding to various organs. Within these meridians flows the "qi" or vital energy, composed of yin and yang. Qi is regarded as the source of the body's life, and if a meridian is injured, or if the balance of the qi is upset or its flow is obstructed, the function of the corresponding organs will be disturbed and disease will result.

The TCM treatment methods of cupping, guasha, and various types of massage and manipulation such as tuina, are all based on the theory of meridians. In cupping, for example, heat is used to expel the air from small suction cups, so that they attach themselves to the skin. The cups are placed over certain acupoints and over the afflicted part of the body, and the low pressure within them causes the tissues beneath to become engorged with blood. As explained by TCM dictionaries, the mild congestion of blood under the skin allows the qi to flow freely through the meridians, thus invigorating the qi and the blood (in TCM theory, the qi controls the flow of blood). Cupping is said to invigorate blood circulation, promote and normalize the flow of qi, relieve pain, dispel "wind," "cold" and "dampness" (pathogenic factors in TCM) and eliminate toxins. The ailments it is considered appropriate for are colds and flu, chronic rheumatoid arthritis, asthma, lower back pain, and upper back and shoulder pain.

Massage and manipulation techniques such as tuina, meanwhile, attempt to deal with localized injuries and pain. The Qing-dynasty work Yi Zong Jin Jian ("The Golden Mirror of Medicine," published 1749) avers that "by pressing on the meridians to free the flow of stagnant qi, and by rubbing the swollen parts to dispel the swelling, the ailment may be cured."

For the good of his health, an early-rising senior citizen gently swings his arms and legs and adjusts his breathing in time to the instructions on an audio tape.

A renaissance of tradition

The ancient art of TCM and various folk methods of maintaining health have few side effects, and are almost an element of everyday life. For instance, in the cold of autumn and winter, many ordinary people go to herbal apothecaries to buy some dried herbs which they directly infuse or boil into teas, or else add to their food as a tonic. If they put their back out or twist an ankle, they will still go to a dilapidated neighborhood martial arts studio to ask the bonesetter to manipulate the affected part.

We have now arrived in the 21st century and the age of genetic medicine, yet some tried and tested folk remedies with gentle and predictable curative effects have not receded before the advance of science. On the contrary, some traditional treatments that had been abandoned or were rarely used by TCM practitioners have been commercially repackaged and are enjoying a "renaissance" amid the fashion for alternative treatments.

Recently there have been reports of members of the public suffering burns while undergoing "navel therapy" for slimming or to treat ailments. Such accidents have focused renewed attention on this therapy, which combines traditional medicine and modern commercial innovation.

Navel therapy is a form of moxibustion, in which a container holding a burning moxa stick is placed over the patient's navel. It is mentioned as long ago as in the 4th-century TCM classic Zhou Hou Bei Ji Fang. ("Handbook of Prescriptions for Emergencies"). The treatment involves applying medication to the umbilical area (the shenque acupoint) as a paste, patch, ointment, liquid, smoke or steam, to prevent or treat disease. In TCM clinical practice it is traditionally used for acute diarrhea, dysentery, coldness of the limbs, and prostration or exhaustion in chronic disease.

As for the effectiveness of navel therapy for weight loss, Cheng Sui-tsung, president of the Chinese Internal Medicine Society of the ROC and director of Liu Fu Tang TCM clinic, has his reservations.

"If there is no organic problem, a woman with qi deficiency and 'cold' of the uterus can be treated by navel therapy to improve her constitution and improve the flow of qi and blood, allowing her to conceive more easily." Cheng further explains that the danger in navel therapy is that "if you don't control the temperature correctly, or if burning moxa leaves fall onto the skin, or if you use the wrong herbs, the skin around the navel may be burned, stained black or infected."

The Chinese believe that the system of meridians holds the key to health or disease. Acupuncture is one of the treatment methods that reveal the core spirit of traditional Chinese medicine. s

New keep-fit fashions

Apart from the high level of acceptance in Taiwan of rejuvenated versions of native treatment methods, Ting Chih-yin's research also shows that the public here are also very willing to try imported therapies such as aromatherapy and macrobiotic diets, and even entirely new therapies.

For instance, ingenious packaging by beauty centers has transformed "ear candling," which is derived from a native American remedy, into a fashionable "aromatic therapy for cranial purification." An ear candle is a hollow beeswax candle something over ten centimeters long, encased in cotton cloth, with a wick at one end and a small hole at the other through which the smoke can emerge. The candle is placed into the patient's ear and the smoke slowly flows into the ear canal, giving a sensation of heat. Beauty centers claim that ear candling accompanied by a lymph drainage massage using essential oils can relax the nerves and also effectively improve problems such as giddiness, a stuffy nose, ringing in the ears, poor memory, and unstable moods.

The colorful imported bottles of fresh-smelling essential oils of rose and lavender offered for sale at department-store cosmetics counters have reawakened modern people's sense of smell and made them willing to have close encounters with flower fragrances. Essential oils derived from different parts of plants, such as flowers, leaves and seeds, contain many chemical compounds. After the tiny molecules of these compounds enter the body through inhalation, rubbing, massage or fragrant baths, they are said to be transported to the areas of the brain that control moods, where they promote the secretion of serotonin and endorphins. This has the effect of stabilizing moods and relieving stress. In countries such as Germany and France, essential oils are used in medical treatment.

"Wellness centers" tout their ability to stave off aging, and woo customers with scented hot spring baths, quartz sound wave therapy, and whole-body pummeling with contoured mallets. They stress that these therapies can adjust slight lopsidedness or other deformations of the spine caused by modern people's poor posture, thus restoring mental and physical balance.

An old lady holding incense calms the soul of young woman who has suffered a shock. From a modern perspective, shoujing may not be scientific, but it can have a similar effect to psychotherapy.

No elixir of life

In fact, whether the alternative therapies on the market are home-grown or imported, their curative effects are often deliberately hyped up and exaggerated. There have also been many reports of incidents such as people's neck vertebrae being injured by powerful water jets in spas, or patients suffering strokes due to chiropractic procedures.

As for the idea that ear candling can cure ringing in the ears or improve the memory, one ENT specialist points out that the cervical nerves, vagus nerve, glossopharyngeal nerve and facial nerves all pass through the outer ear canal, so it is possible that the smoke and heat of an ear candle may stimulate these nerves to some degree. But it is very doubtful whether this can produce any curative effects. If some people feel more relaxed after ear candling, it may have more to do with the soft lighting and music in the beauty center-in other words, the effect is entirely psychological.

In fact, the terms "alternative medicine" and "folk remedy" do not appear anywhere in the healthcare legislation administered by the Department of Health. There only references to "actions not governed by the healthcare regulatory system," which means that as long as treatments do not involve such things as bonesetting, prescribing medicines to be taken internally, using medical instruments, or other invasive procedures, then they are not subject to regulation. Treatments that fall outside the regulatory net in this way include the external use of herbal preparations, massage techniques such as tuina and shiatsu, guasha, reflexology, shoujing, amulets, incense ash, cupping, qigong and the like.

Lin Yi-hsin, chairman of the DOH's Committee on Chinese Medicine and Pharmacy, states that the reason the DOH does not regulate folk remedies is because-in keeping with the principle that the government should not interfere unnecessarily in citizens' lives-it believes there is nothing wrong with ordinary members of the public practicing therapies such as guasha or tuina in their own homes. But if businesses exaggerate their curative effects, then there is a need for review.

However, in the absence of a regulatory framework, and with very variable levels of skill among persons engaged in alternative medicine businesses, the quality of alternative therapies is a real cause for concern. Even people who are very open to alternative medicine have begun to be less than satisfied with the healthcare environment it offers.

Mr. Lin, a writer who generally speaking is not averse to tuina massage, once went to a TCM traumatology clinic near his home for some skeletal manipulation. The hundred-square-meter clinic was packed full of patients, and in the middle were three reclining chairs attended a young tuina masseur. The masseur worked on Lin's neck and back and rotated his shoulders and arms for 20 minutes. Lin heard the sound of his own joints cracking, and felt that his muscles had relaxed quite a lot. But the next day as soon as he woke up he felt that his neck was even more painful than it had been before his massage session.

Just as we frequently hear reports of medical disputes involving conventional hospitals, there are also many problems associated with alternative medicine. But the degree of acceptance of some alternative treatments among the public means that the regulatory authorities cannot ignore their value.

To cite reflexology as an example, during 20 years of energetic promotion in Taiwan, Swiss priest Father Josef Eugster taught students throughout the island, and thus trained many later practitioners. But these people never had a legal status. In 1991, Father Josef and over ten reflexologists registered with the Ministry of the Interior as the "ROC Foot Reflexology Health Association" (now the Chinese Foot Reflexology Association, CFRA); but the MOI categorized the association as a sports club. After persistent efforts, in 1993 the Department of Health finally deemed the association's activities to be a traditional treatment that is not subject to the healthcare regulatory system, and the practitioners were at last freed from the fear of being prosecuted as "underground doctors."

At present, countries such as the PRC, Japan, South Korea and the US already have compulsory licensing systems for professional medical masseurs. In Taiwan, the CFRA and Father Josef are currently working to define a training, assessment, certification and licensing system for reflexologists.

Lighting a burner spiked with essential oils to fill the room with flower fragrance can be an effective way of relieving stress.

Cross-sectoral dialogue

Apart from uneven levels of quality, the main reason why alternative medicine is not welcomed by the regulatory authorities or mainstream medical practitioners is that it is difficult or impossible to test the effectiveness of alternative treatments by scientific methods.

Dr. Julia Tsuei, an internationally respected gynecologist with a background in Western medicine, is director of the Clinic for East-West Medicine in Taipei. Twenty years ago she began researching TCM and various kinds of alternative medicine. Now aged 76, she says she is devoting her life to finding scientific methods of testing. "TCM simply treats disease by methods that are unfamiliar to Western medicine. An acupuncture needle inserted into the same place can reinforce the qi in one person but reduce it in another. It's very mysterious, but the real issue is, which methods are the most effective? Today, everyone is confounded by the lack of standardized test methods," she laments.

Tsuei explains that the biggest difference between Chinese and Western medicine is their different understanding and explanations of "qi" (energy). When diagnosing and treating imbalances in the body, the great majority of alternative medicine practitioners lay great emphasis on adjusting energy, which TCM practitioners speak of as "nourishing the qi."

Fortunately, in 1975 the German physician Rheinhold Voll invented a method of measuring biological energy. His instrument, called an electro-dermal screening device (EDSD), makes use of the property of the meridian system in guiding the qi, and for the first time converts the qi energy of the meridians into electrical energy that can be measured in order to diagnose disease. Western medicine previously did not acknowledge the existence of channels for "qi" in the human body. But since the development and clinical application of the EDSD, measurements on the surface of the skin can be used to detect the movements and distribution of energy within the body, from which one can deduce whether the structure and function of the various organs within the body are in balance, and also whether the patient is in a harmonious psychological state. These methods are called "bioenergetic medicine" or "information medicine."

The method of treatment currently used at the Clinic for East-West Medicine is to first use the EDSD to discover which bodily system has a problem, and then use pathology tests with reagents to make a detailed diagnosis. For instance, from the pancreatic meridian one can determine whether the levels of urea, insulin, cholesterol and triacylglycerols are too high or too low; while from the liver meridian system one can determine whether the patient has hepatitis or cirrhosis, or has been affected by pesticide pollutants.

Lighting a burner spiked with essential oils to fill the room with flower fragrance can be an effective way of relieving stress.

Body, mind and soul

Proponents say that as well as measuring changes in bodily organs, bioenergetic medicine can also detect moods and psychological problems.

Ten years ago Julia Tsuei began to introduce the Bach flower remedies, which originated in Britain in the early 20th century. Different flower essences are directed toward different moods or psychological states, and at present practitioners use 300 different flower essences to address over 70 moods. Tsuei compares the process of selection to the way an office worker has to spend time in front of her wardrobe every morning choosing what color clothes to wear that day. Many people may pick them according to whim, but when selecting remedies one has to use scientific methods to weigh this "intuition."

Flower remedies are not the same as aromatherapy, which is popular in Taiwan. As with other similar European remedies, the method used is to add a few drops of various flower essences to pure water and sip the mixture from time to time. Electromagnetic fields emitted by these concoctions are said to resonate with the imbalanced portions of the body and mind, to cause electrochemical changes in the brain and glands. This produces a self-healing effect that brings the emotions into balance.

Julia Tsuei believes that flower remedies are simply a way of reacquainting modern people with nature. "The greatest threat to people today, apart from pollution, is all kinds of stress. Physical illness can lead to psychological depression, but on the other hand a deeply depressed mood can also be the cause of disease," says Tsuei. Bioenergetic medicine aims not only to detect imbalances in organs and systems in the body, but also to find the causes of the disease, determine whether the causes of imbalance are physical or psychological, and eliminate toxins from the body. Tsuei says that only if it achieves all these things can it be called a holistic medicine that takes care of body, mind and spirit.

But there are still very few people with a background in mainstream medicine who, like Julia Tsuei, have developed an interest in alternative medicine and gone on to research it.

"I don't believe everything can be verified scientifically, because the concept of yin and yang and the five elements in TCM, and biology in Western medicine, are two completely different theories with a different vocabulary, structure and concepts," says Professor Ting Chih-yin. TCM's and Western medicine's ways of understanding human health are still poles apart, but US research shows that the driving force behind the development of alternative medicine is not a desire for it to "replace" mainstream medicine, but rather for it to play a "complementary" role. The same is true in Taiwan: surveys show that 48% of people seeking alternative therapies have first visited an institution offering Western medical treatment.

In other words, although most patients seek alternative therapies because of the limitations of mainstream medicine, most of them do not regard alternative medicine as the only answer.

In the cold of winter, people in Taiwan have long been in the habit of buying some Chinese herbal ingredients to add to their food, to make dishes that are both nourishing and health-promoting.

Joint guardians of health

It will still take a long time to establish just what specific curative effects alternative therapies have. But since the former Office of Alternative Medicine at the US National Institutes of Health was expanded into a "national center" in 1998, its annual research budget has grown hugely, from US$2 million then to US$150 million today. At present, 76 US medical schools offer courses in alternative medicine. In the international academic community, bioenergetic medicine organizations are holding frequent symposia, to take the first steps toward putting the field on a sound scientific footing. They have also begun active dialogue with practitioners of Chinese and Western medicine. It looks as if the health authorities in Taiwan ought not to completely ignore alternative medicine.

As for patients, whatever kind of therapy they are looking for, surely they also hope that the practitioners can look to their deeper psychological and spiritual needs, for only when body, mind and spirit all receive proper care can one achieve true health.