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.

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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.

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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.

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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.

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