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A BRIEF HISTORY OF ACUPUNCTURE AND EAST ASIAN MEDICINE IN THE UNITED STATES


Part I

Background

Acupuncture and East Asian Herbal Medicine has a varied history in the United States of America. During the first part of the 19th century, herbal medicine dominated. Then the latter half of the 20th century was dominated by acupuncture. For many, Acupuncture is a recent phenomenon in the United States that appeared in the early 1970s in the South Bronx in the form of Ear Acupuncture. In the U.S., the history of East Asian Medicine is of course much older than what has been presented. As its development has taken new forms in the U.S., its legacy and future cannot be denied. In this writing, I make a sincere effort to track the trajectory of acupuncture and herbal medicine from an East Asian medicine inception to this land of America, describing its past, modernity and *future. *Please keep in mind this is a two part series.

Context

The field of East Asian medicine has gained significance in the United States in the last fifty years. Patients in the U.S. have increased visits to practitioners of acupuncture and East Asian medicine for "stress-related syndromes, to enhance the immune system, to reduce insomnia, to improve athletic performance, and to address Alzheimer's disease, as well as for cardiac and post-stroke therapy" (Lu, 2013). This artifact briefly studies East Asian Medicine’s inception in the United States, its obscurity, its cultural repression and its anticipated growth into the future.

Discussion

East Asian Medicine is being defined as a medicine that comes from East Asia. Specifically that which encompasses ethnic groups that are indigenous to East Asia; consisting of China, Hong Kong, Macau, Taiwan, Japan, Mongolia, North Korea, and South Korea.

East Asian Medicine (Acupuncture, Herbal Medicine, with many other insights) is remarkably established in the history of the United States and yet has been discussed with curiosity, inspiration and even contempt. Its ancient origins found their way to America earlier than most know.

Much later, its wholesale rejection was combined with immigrant expulsion kept in American Chinese enclaves. After years of a survivalist dormancy, innovation and resurfacing in the U.S., foundations have been laid to continue its development through professionals, practitioners and schools of higher learning (Lu, 2013).

Reflection

Over the years, I have had many conversations about Chinese and East Asian medicine with colleagues. Conversations on the history of Acupuncture and East Asian herbal medicine traditions were difficult to have with clarity and honesty. While many colleagues could discuss this or that on Chinese theory, many could not give a definitive account of East Asian Medicines origins and development in the United States. This revealed a pressing need to give practitioners and the general public, a central resource. It has also inspired a need to research, interview and find as much living information as possible on this history for future generations of the profession.

Introduction



After careful review and combing through hundreds of articles, discussion boards and book titles, it became very clear that no definitive timeline of Acupuncture & East Asian medicine history in North America exists. That is to say there are works which will detail the past to the modern era of medicine yet none which focus on the chronological and parallel of the modern era. In this work we shall spare no effort to begin this undertaking. And while there are many excellent works on acupuncture and East Asian medicine; its origins and its expansion to Europe via Jesuits and other groups, until very recently has proved very difficult to find one source that followed the development of Acupuncture as we now know it today in the U.S. It is with this inquiry that I have begun an exhaustive effort to connect the proverbial dots of Acupuncture’s history in North America.

As the history and debate of immigration rages on, parallels drawn with the history of East Asian Medicine in the U.S. speaks to the nation’s cultural amnesia of today. We can learn from the past -if we are honest- to vitalize the future of the field. While there may be little debate over where acupuncture, the theory of channels, and East Asian medicine originate, the history of their development belongs to all. Paying homage and respect to the original lineages of the practice could help to better inform its future.


Slavery received, but the prejudice to which it has given birth remains

stationary.”Alexis de Tocqueville, Democracy in America

United States Healthcare, Race, and Medicine in The 1800s


The construction of race in the late 19th century and subsequent centuries dominated the societal landscape of the United States. Some have noticed this construction was more of a caste system, than simply a racial system. This caste system studied from perversions of the story of Noah and his sons, as well as the caste system of India without the underpinnings of spiritual aspects, created an artificial hierarchical prototype enforced by racial skin color constructs.

In the early 19th century, the definition of white was in its early stages. Anglicized groups readily chose White (WASP), while the German, French, Eastern/Western Europe were not quite solidified or welcomed in the United States at this time. (It would not be until late 19th century and early 20th that the Irish would be given such a status.) This system created to maintain societal control for wealth and enforcement, lasted for generations against those who were considered at the lowest rung of it- brown and black people- (Wilkerson, Caste, 2020). In between these artificial precepts relying solely on arbitrary phenomena of skin color, existed every “other” Human. This included the Irish early on, Italians and later the East Asian people. In this landscape, this artificial caste system was in full enforcement in all strata of society, especially in Healthcare for generations to come.

Healthcare in the United States in the early 19th century consisted of mostly indigenous peoples' practice of traditional medicines. From midwifery to herbal medicine, this was the norm in most of the United States. Yet with the advent in the rise of density in cities, the most important part of the changing landscape of Healthcare in this era came by way of learning to improve sanitation so infectious diseases such as cholera, diphtheria and the plague did not erupt.

On January 21st 1801, Philadelphia became the first major city in the U.S. to provide clean drinking water citywide. This was a high improvement of healthcare for the young nation at this time.

Other than alms houses along the East River in New York in 1811, and one of the first psychiatric books published by Benjamin Rush, M.D., entitled Inquiries and Observations on the Diseases of the Mind, American folk medicine was considered normal and self-contained among the growing populous (Rush, 1812).

In 1820, the first compendium of conventional drugs in the U.S. entitled Pharmacopeia was published by eleven physicians in Washington, D.C. While strong concepts of the caste system and race were taking shape, the repair from the Revolutionary War was still fresh in most places. A sharp consensus on national identity, wealth building and labor classes took precedent.

Acupuncture in a New Land, 1826

The introduction of acupuncture in the 19th century to the United States came by way of Europe via Asia, mainly by medical doctors. This generational wave of radical, medical and pseudo-medical innovations included homeopathy, mesmerism, phrenology, hydropathy and more. The burgeoning medical profession at this time was hesitant on the usage of acupuncture because of being "burned" again by previous claims of "medical panaceas" (Lu, 2013, 311).

In the

In 1826, articles reported on the effects of acupuncture, were led by Dr. Franklin Baché (the great-grandson of Benjamin Franklin), a physician, who translated from the French and published in Philadelphia an American edition of Morand's Memoir on Acupuncture (Cassedy, 1974). The English,

Germans and French were introduced to East Asian medicine (Chinese, Japanese and Korean), mainly acupuncture and moxibustion, in the 1500s. All regions had published articles, yet the French developed acupuncture techniques and wrote about it more extensively. Nevertheless, having access to these articles, Bache experimented on State penitentiary prisoners, suffering from muscular rheumatism, chronic pains, neuralgia & ophthalmic concerns with acupuncture in Philadelphia (Bache, 1826).

Acupuncture could have taken root earlier in the United States, yet it did not, for many reasons. A few would be; the limited accepted socially structured thinking at the time. For example the term white was not as yet defined in 1826. Only those old anglicized colonist families were considered heirs to the spoils of the United States. Not even the Irish, Germans and definitely not the Italians were considered white in this era. Asian people were out of sight out of mind. Another were the medical charlatans or commonly referred to as snake oil salesmen. And of course the ever present burgeoning codified dehumanization of enslaved indigenous and black people preoccupied the labor building conditions of the young nation.

For some medical doctors in Philadelphia, proving effectiveness by reproducing a claim made in Europe that acupuncture worked to revive dead kittens, was a goal. When the experiment failed, the claim for acupuncture legitimacy drew skepticism. This was of course an undue expectation, yet one which many in the burgeoning medical field accepted (Cassedy, 1974).

In 1829, a surgical book, Elements of Operative Surgery, contained a three-page section describing acupuncture techniques (Tavernier, 1829). These techniques included when and how to perform acupuncture, including electro-acupuncture, or as it was known then Acupuncturation. Years later- in 1833- editors of the Medical Magazine, reprinted from The Cyclopedia of Medicine an original article by Editor John Elliotson on Acupuncture. In 1836, Dr. William Markley Lee wrote an article in the Southern Medical Journal recommending Acupuncture for pain relief. In the same year, he published in the Boston Medical and Surgical Journal an article entitled “Acupuncture as a Remedy

for Rheumatism” (Waring, 1973).

In 1843, Robley Dunglison and Bache were the most prominent in Philadelphia to employ Acupuncture. Dunglison reported using Acupuncture "to drain off the fluid from the cellular membrane in anasarca"; he suggested employing larger needles for this operation than were ordinarily used in other diseases (Cassedy, 1974). Through his New Remedies compendium (1839 1st ed-1859 7th ed), Dunglison's role in publicizing his method revealed an "eight-page account of acupuncture" (Dunglison, 1839). This was the era of Andrew Jackson’s government expansion to the southern states to enforce the murderous ideals of the recent Caste system.

In Medical Apartheid (Washington, 2006), it shares how the curious and depraved medical experiments most physicians studied to learn the Human anatomy was with the bodies of stolen bodies of enslaved black and brown people. This era of society laid the groundwork for the medical institutions for centuries. It clearly did not give the medical profession a holistic perspective for acupuncture to root in the public consciousness.

In addition, the perception of the needle carried risks of infection. This pre-listerian era coupled with advances in anesthetics and the promise of pain relief in surgery may have also contributed to acupuncture’s obscurity. Detractors in this period included Samuel D. Gross, who said, "Its advantages have been much overrated, and the practice has fallen into disrepute" (Gross, 1859, 575).

According to the Surgeon-General's Library, less than a half of a dozen American publications were compiled on American acupuncture during the years of 1850-1900. Some physicians still employed acupuncture during these years.

Acupuncture did not go quietly into the dark. Benjamin Bache and Robley Dunglison saw themselves becoming the leading proponents of acupuncture in early American history. In a summarized report by Bache of "I7 cases (some cases were not among the prisoners) he noted seven "were completely cured, seven considerably relieved, and in the remaining three cases, the remedy produced no effect." Overall, Bache was clear that acupuncture "offered great promise"

for "removing and mitigating pain." He concluded that it could well be "a proper remedy in almost all diseases, whose prominent symptom is pain" (Bache, 1826, 311-21). Other medical doctors of the era continued to study acupuncture. In 1892, Sir William Osler stated in his classic textbook The Principles and Practices of Medicine that lumbar acupuncture was the most efficient treatment for managing acute pain (Osler, 1892). However, acupuncture remained an in-depth medical and academic curiosity to most.

We can see from the initial influence of Europe on the spread of acupuncture to the United States, there was a flurry of activity in the early 1820s to the latter half of the century. As we shall see, there was another trail that was making its way toward the shores of America. It was part and parcel of acupuncture’s mother culture.

The Taiping Revolution, 1857

By the early 1820s, Philadelphian doctors had contributed to acupuncture research in the incipient medical landscape. Halfway across the world, events were shaping that would influence and quietly support acupuncture’s framework and East Asian medicine in the United States. Consequently, while acupuncture was finding resonance on a small scale in America, in 1822 the Qing Dynasty officials ordered the department of the Imperial Medical College to permanently abolish acupuncture and moxibustion because it was not suitable to be applied to the emperor.



From December 1850 to January 1866, a full-scale civil war began between the Taiping Heavenly Kingdom movement and the Qing Dynasty. It is known as one of the largest and bloodiest civil wars in China, affecting and displacing over 70 million people. This movement affected every province except Gansu. Led by a self-proclaimed brother of Jesus Christ, Hong Xiuquan, a descendant of the Hakka ethnic tribe, the strategy was nationalistic, religious and political. From their base in Nanjing (then Tianjin), the main goal was to overthrow the Manchu-Qing Dynasty and establish the Taiping Heavenly Kingdom, a syncretic Christianity, throughout all of China. This war caused the

migration of millions of Chinese throughout the world. Sensing war was prevalent, this displacement for some began as early as 1848 (Cao, 2001).

During the years of 1565-1815, the Spanish ruled over the Philippines, and many Chinese visited North America as fishermen, sailors, and merchants on Spanish galleons (Manila galleons) that sailed between the Philippines and Mexican ports. The state of California still belonged to Mexico until 1848, and some historians have claimed small numbers of Chinese were settled in the Golden State as early as the 1750s. A fur trader named John Meares sailed British expeditions from Canton to Vancouver Island in 1788 and 1789, with several Chinese sailors and craftsmen contributing to the first European-designed boats launched in British Columbia (Pethick, 1980).

Post-American Revolutionary War, the United States began transpacific maritime trade with the Qing Dynasty. This inevitably brought Chinese into contact with American merchants and sailors in the commercial port of Canton (Guangzhou). Here, the locals were attuned to unique opportunities of gold and enterprise in America. Canton and New England were the main trade routes for these merchants, sailors, seamen and students. This first wave of Chinese to migrate to the United States arrived via Cape Horn. As you may imagine, many wanted to see and acquaint themselves with the strange opportunities of the foreign American land. Many arrived but did not remain as only a few settled permanently at this time (Chugg, 1997).

In addition to trade, China had allowed American missionaries operational grants, allowing for the passage of several Chinese boys to the United States for schooling. From 1818 to 1825, five students stayed at the Foreign Mission School in Cornwall, Connecticut. In 1854, Yung Wing became the first Chinese graduate from an American college, Yale University.

In 1850, the Pacific Mail Steamship Company established a steamship line competing with the U.S. Mail Steamship Company between New York City and Chagres. George Law placed an opposition line of steamers (SS Antelope, SS Columbus, SS Isthmus, SS Republic) in the Pacific, running from Panama to San Francisco. In April 1851, the rivalry was ended when the U.S. Mail

Steamship Company purchased Pacific Mail steamers on the Atlantic side, and George Law sold his new company and its ships to the Pacific Mail. One of the company's steamships, the SS Winfield Scott, acquired when the New York and California Steamship Company went out of business, ran aground on Anacapa Island in 1853. In 1867, the company launched the first regularly scheduled trans-Pacific steamship service with a route between San Francisco, Hong Kong, and Yokohama, and extended service to Shanghai. This route led to an influx of Japanese and Chinese immigrants, bringing new cultural diversity to California (Wikipedia, 2019).

The First Wave of Chinese Immigration to the US

As seen in the early 19th century, maritime trade began the migration of Chinese to America. Mostly merchants, former sailors and students, the first true wave arrived in the United States in 1815. A few immigrants came in the 1820s through the 1840s, a majority being men. In 1834, only one recorded woman, Afong Moy, from Guangzhou province, immigrated to New York City. She was brought and paraded about by Nathaniel and Frederick Carne, as "the Chinese Lady" (Poon, 2014). By 1848, 325 Chinese Americans immigrated to America. Then 323 immigrants came in 18491(Yale Macmillan Center Council of East Asian Studies. (2018)).

450 in 1850 and 20,000 in 1852 (2,000 in 1 day). By the year 1852, from six districts of Canton (Guangdong Province), there were 25,000, and over 300,000 by 1880, totalling a tenth of the Californian population.

In the following discussion on Chinese enclaves, we will work to deduce the practices of the medicine many of the Cantonese utilized. At this time some specific techniques in the use of acupuncture in the enclaves are still unknown. There are legends we are working to substantiate. One irony is that while many Chinese were displaced, Acupuncture and East Asian medicine was being developed extraordinarily so, secretly and out of necessity, in the United States. By virtue of the Caste structure, none of the irregular medical fields would even consider treating an Asian, Black, Irish

indigenous person or Italian. Which invariably helped East Asian Medicine create a future medical field of its own in the United States. In addition, Acupuncture perspectives from the French during this era- now Americanized- took on new life, even if on a small scale, influenced the forthcoming American medical model of physician doctors.



The First Transcontinental Railroad, 1837

In 1832, Dr. Hartwell Carver advocated for building a transcontinental railroad line from Lake Michigan to Oregon that connected the United States coast-to-coast in a published article in the New York Courier & Enquirer. By 1847, seeking congressional charter support for the idea, Dr. Carver submitted to the U.S. Congress the "Proposal for a Charter to Build a Railroad from Lake Michigan to the Pacific Ocean" (Cooper, 2010).

Two key players emerged from this railroad race— first, the Western Pacific Railroad Company that built 132 mi. (212 km.) of track from Oakland/Alameda to Sacramento, California and secondly, the Central Pacific Railroad Company of California (CPRR) that built track from the Promontory Summit to the Ogden, Utah Territory, known as the transcontinental line and popularly known as the Overland Route. This valuable passenger rail service operated over the length of the line until 1962 (Cooper, 2010). The Western Pacific Railroad mostly used former Union and Confederate soldiers to lay track. The Central Pacific exclusively recruited Chinese laborers. A clear disruptive theme presented as the forces of the nation propelled westward. To go west and expand before a foreign power seized the opportunity was a necessary evil to some and a deliberate business opportunity to others. The evil was its decimation of the Plains Indigenous people’s Nations with the wholesale use and exhaustion of Chinese labor.

The Central Pacific Railroad Company was the leading employer of Chinese immigrants fleeing the Taiping Rebellion, mainly from Guangdong province. From the beginning, distrust and oppressive racism contributed to extreme violence and massacres upon the Chinese immigrants.

Because there was a shortage of white American workers willing to lay track, some of the first Chinese immigrants were recruited in 1865 from the silver mines to work as contracted laborers. Charles Crocker- of Central Pacific Railroad- proposed the use of Chinese labor. Contemptuously called "Crocker's pets," they were initially deemed unsuitable for the heavy physical work (Linda Hall Library, 2012).

Hiring the Chinese "as opposed to whites" to do the exhaustive, back-breaking and dangerous labor kept costs down by a third since the company would not pay their board or lodging. Crocker and CPRC set records for laying track, finishing the project seven years ahead of the government's deadline (Linda Hall Library, 2012). Most of the men received between one and three dollars per day, but the workers from China received much less. Eventually, they went on strike and gained small increases in salary (Ong, 1985).

After 1869, the Southern Pacific Railroad and Northwestern Pacific Railroad led the expansion of the railway further into the American West. Consequently, many of the Chinese who had built the transcontinental railroad remained active in building the railways. After several projects were completed, many Chinese workers migrated and searched for employment in farming, manufacturing firms, garment industries, and paper mills. However, widespread anti-Chinese discrimination and violence from whites, including wholesale massacres and murders, drove many into self-employment (Brownstone, 1988).

Go West, Young Man and the California Gold Rush, 1848–1855

In 1848, the Mexican-American war concluded with the Treaty of Guadalupe Hidalgo. It enforced the Mexican transfer of the northern territories of the modern state of California, including Alta California and Santa Fe de Nuevo México, to the United States. As fate would have it, gold was discovered in California. This led to a swell of miners to California from the United States and other regions of the world, including (Guangdong Province) China and Latin America (Mexico, Peru, and

Guatemala). The year 1849 officially marked the inception of the California Gold Rush. The Chinese, who were in America in smaller numbers went to work in the gold-mining towns of California and Oregon, with many more still fleeing the Taiping War. Some disregarded the Gold Rush altogether settling in southern plantations before and after the Civil war, while others established California fisheries and agriculture. Because of the immense pressures of life at this time, combined with hatred, fear of a lack of jobs, and manipulation by the dominant established white caste society, Chinese migrants (mainly to survive), established Chinese enclaves away from mainland China (with settlement help from mainland Chinese fraternal secret societies such as Three Harmonies Society (三 合會, Sanhehui and later The Triads), known as Chinatowns (Brownstone, 1988).

One of the most famous self-employed doctors of Acupuncture and East Asian medicine to gain prominence in this era was from the most emigrated province of China, Guangdong, was Ing "Doc" Hay (1862—1952). His real name was Wu Yunian and he was a Chinese born American herbalist from Taishan, Guangdong province. He followed his father to Warawowa, Washington in 1883, to earn a living as a goldsmith. In the year of 1897, he left his father and went to the John Day gold mine in eastern Oregon to earn a living.

A two-story building used as a trader post, postulated to serve miners and former railroad men on the Canyon Creek in the town of John Day, became known later as an epicenter to the Chinese as Jinhua City. By 1878, the Kam Wah Chung Company (the Golden Flower of Opportunity) had it under lease and purchased it in 1887. A partnership between Ing “Doc” Hay (伍于念) and Lung On (梁光 榮), a general store proprietor and businessman also from Guangdong, formed a 50-year partnership, providing a social, medical and religious center for the Chinese community (Oregon State Parks, 2019).

During the years of the Spanish Flu (1918-1919) in eastern Oregon, the disease killed more than 3,688 people. It is said that Ing “Doc” Wu Yunian Hays had a solid foundation in the Neijing and Compendium of Materia Medica. He gained prestige and more by saving many lives including whites from “septicemia, meningitis, lupus, mumps, stomach diseases and influenza.” The center’s relatively untouched items were left in a time capsule after the passing of Doc Hay. It was restored from 1940 to 1967 into a museum and is open for tourism today (Oregon State Parks, 2019).

Taxes and the Chinese Exclusion Act, 1885

The Gold Rush and building of the transcontinental railroad coincided with the Mexican-American War. Initially, as long as the work was achieved, whites tolerated Chinese immigrants. Laws to restrict movement, such as prohibitions on marrying white European women (one of the caste systems main tenets in the United States- preventing race mixing or miscegenation) were accepted by Chinese men (as well as Blacks, Mexicans, Italians and anyone with dark or colored skin). Keep in mind each of these groups simultaneously fought against massacres and unfair taxation. At this time, the tipping point for many Chinese men in California began when exorbitant individual taxes levied against the immigrants became law via the Foreign Miners' Tax Act of 1850 (Ong, 1985). The law stated that every non-citizen miner of California was to be taxed a monthly fee of $20, or $520 adjusted for inflation in 2019. It was enacted to curtail "competition from foreign miners," due to resentment among the white miners, prompting the governor of California at the time, "to limit foreign competition in mining" (Norton, 2019).

The Chinese Exclusion Act

Between 1848 and 1882, an estimated 300,000 Chinese had arrived in the U.S. On May 6th, 1882, The Chinese Exclusion Act was signed into United States federal law by President Chester A. Arthur. This law specifically prohibited Chinese laborers from immigrating to the US and continued to build upon the 1875 Page Act, a federal law that banned the immigration of all Chinese women to the United States. The Chinese Exclusion Act represented the first time a federal law was enacted to "prevent all members of a specific ethnic or national group from immigrating" to the United States (Wikipedia, 2019).

Chinese Enclaves & Expansion of Chinese Medicine, 1870s -1910s

In the 1870s United States, many Americans lost their jobs due to several economic crises. Anti-Chinese movements, especially in the American West, reached a fervent pitch by local agitators, labor organizations, governors and U.S. presidents. The labor party focused a vicious aim against Chinese immigrant labor and the Central Pacific Railroad. The famous slogan of the party at this time was "The Chinese must go!" The Workingman's party of California led the attacks against the Chinese and found great support among white people in the American West.

Their propaganda branded the Chinese migrants as "perpetual foreigners" whose work caused wage dumping and thereby prevented American men from "gaining work." In the 1893 economic downturn, coupled with the bubonic plague in 1900, measures were adopted in the severe depression that included anti-Chinese riots that eventually spread throughout the West from which came racist violence and the "driving out" massacres. Most of the Chinese farm workers, which by 1890 comprised 75% of all Californian agricultural workers, were expelled. These Chinese communities and their medicines fled northwest and to areas like New York for shelter. This period began Chinatowns in two of the largest cities in the United States at this time: San Francisco and New York. Cities with concentrated Chinese enclaves became Chinatowns. The main cities were San Francisco and New

York; other cities would follow later. Each supported low-end wage laborers, restaurateurs, and laundrymen. Some settled in towns throughout the west to begin serving the community with medicine from the homeland.

Expansion of Chinese Medicine 1871-1910

California saw the first expansion of Chinese medicine through Chinatowns, herbal dispensary shops and treatment clinics. Most were opened in residential and commercial districts, naturally in response to the serious health concerns of the community. The cities of San Francisco and Los Angeles braved health epidemics of smallpox, cholera and the bubonic plague of 1871, 1900 and 1904. The

anti-Chinese sentiment, as we have seen, was rampant. The epidemics did not help their plight. The Chinese were already considered dirty and unhygienic and were seen as responsible for the poor state of their sanitation within the city. (Wikipedia, 2019) “Chinatowns in the United States.”

The average admission rates to public hospitals by Chinese from 1870-1882 in San Francisco was less than 0.1%. As biomedical relief was restricted to the Chinese community, it was only natural to use what was known in East Asian medical cannons (Palma, 2017). In a proportional relationship, against the backdrop of this anti-white violence, the Chinese community, and other nationalities, opened herbal dispensaries and clinics to provide treatments. In 1869, a Presbyterian minister described his experience of the "medical arts" of the Chinese in San Francisco, as "judging from the number of apothecary stores, one would suppose that the Chinese were large consumers of medicines." One could conclude all Chinese herbal dispensaries were bonafide practitioners of Chinese herbal medicine, yet this was not the case. Medical charlatans and snake oil salesmen were rampant everywhere in this era. In the years between the 1880s and early 1900s, the number of trained professional doctors was low, and many of those who practiced medicine were not professionals. Some were just businessmen with shops. The problem of "medical charlatanism" was not limited to western biomedical doctors (Loomis, 1869).

In the late 1890s, one journalist travelled throughout California and recorded the presence of genuine respected Chinese healers using herbal medicines in the community. To compound matters, the turn of the century brought with it innovation, creativity and detritus. A period of economic turmoil, broad-sweeping ideas and epidemics would devastate the Pacific Coast and the Nation, which ill in turn rapidly expand Chinese medicine (Tisdale, 1899).

In 1900, the Californian authorities imposed a quarantine on San Francisco's Chinatown, launching discriminatory health policies including intrusive housing searches, disinfection and mandatory vaccinations. The residents of Chinatown responded by distrusting white doctors and turning to Chinese doctors and their traditional herbal medicines. The distrust of vaccinations helped health authorities align themselves with Chinese doctors, allowing them to vaccinate whomever they wanted, legitimizing their position in the community and getting them to act as cultural brokers (Shah, 2001).

In the late 1800s and early twentieth century, doctors in the U.S. were viewed as well-respected professionals. Patients and the general public agreed this profession to be a precursor to political life and a link to state bureaucracy. In the 1900s, as the Chinese solidified movements into enclaves, Chinese medicine grew outside of its confines. Work generally seen as inferior, such as laundry cleaning, mining, prostitution and railroad work, helped the profession of Chinese doctors and herbalism become more prestigious than other members of the community. This privilege bestowed by the Chinatown’s community on Chinese practitioners of acupuncture and herbalism flew in the face of the anti-Chinese sentiment as an "inferior race" (Shah, 2001). Even during the most racist period under the "Chinese exclusion era" in the U.S. (1882-1943), herbalists were still in demand, even among American European patients. Some were even able to obtain voting rights and permanent residency in the U.S. (Marcus, 2011).

After everything the Chinese community had been through, does it not seem right that the Chinese medicine ethos should rise from the ashes? Some reasons to explain its prestige at this time were issues over ownership. It provided ownership of aspects of life that seemed too elusive. This, coupled with the distrust of the local physicians and doctors in treating certain diseases, made Chinese medicine and Chinatown tolerable for many (Buell, 1998).

Many allopathic patients preferred going to a Chinese doctor for blood and venereal diseases since they had a lot more experience and success than America’s irregular medical doctors, who lacked the training and perspective to treat such ailments. Unsurprisingly, prostitutes were frequent patients turning to "Celestial Hippocrates" to prevent and cure venereal diseases, a deadly situation at this time, which continued until at least 1930, even after the pharmaceutical industry emerged to treat the same illnesses. Another reason why local patients chose Chinese medicine was that allopathic patients considered Chinese medicine less invasive, both in terms of treatment and diagnosis. At the time, the "imperfect science" of European medicine allowed Chinese medicine to bring patients a preferably less pain and agitation of the administration of "compounds" by medical professionals (Leong, 1936, 230).

In California, East Asian medical practitioners, namely Chinese doctors, and herbalists faced prosecution for practicing medicine without a license. For some doctors, patients and authorities came out in defense of their practitioners, especially the important ones. From 1910 onward, Chinese doctors and herbalists suffered persecution from local physicians, and many were taken to court. The case of Dr. Hong Chung, arrested for possession of medicine, or of G.T. Lai, accused of practicing medicine without a license, was a recurring story in the newspapers of various cities in the state of California (San Francisco Call, 1912).

Persecution would intensify after 1925 when a bill prohibiting herbalists was debated in Congress. In contrast, many essential herbalists like Dr. Li Po Tai, one of the richest men in San Francisco, held the support of Senator Leland Stanford (the founder of Stanford University) and Governor Mark Hopkins, both shareholders in the first transcontinental railway. These influential

members of the Republican Party in California protected Po Tai and prevented legal exposure (Liu, 2006).

Some doctors of Chinese medicine were less fortunate. Many were sued for practicing medicine, as the physician profession gained credence and power. Other doctors of Chinese medicine managed to emerge victorious thanks to the support of their patients. One of the best-documented cases is that of Fong Wan, an herbalist based in Oakland, California. In 1929, Wan published the book Herb Lore, one of the complete works on Chinese medicine in America at that time, which explained the uses and preparation of medicinal herbs and also demonstrated the efficacy of his treatments with patient testimonials. Wan writes that in 1915, he was summoned to appear in court on over twenty occasions, all of which he was ruled not guilty. The testimonials of his patients, mostly residents of the city who did not belong to the Chinese community, played a crucial role in his acquittals (Wan, 1929).

At this time of eugenic fervor, medical professionals identified patients consulting Chinese doctors as ignorant. The press and public testimonials that appeared for Chinese doctors and herbalists show that patients came from different social groups. Many of them were well educated and viewed the success of the procedures they had undergone as providing an alternative to allopathic medicine. This support among the public was critical and gave Chinese doctors protection from criticisms by professional physicians (Wan, 1929).

The Commercialization of Chinese Herbal Medicine in the U.S.

The dream of many immigrants was simple, build a house for your family from the mountain of gold in America! Chinese herbal medicine shops developed a significant role in the expansion of Chinese herbal medicine, especially in California. The proverbial gold was immeasurable, because it came from a place beyond systems created to hold them. In California, herbal medicine became a lucrative business. The origin of many Chinese herbal companies began as imports to distribute Chinese herbs throughout California. One enterprise, based in Oakland, was called the Fong Wan Herb Company (Bowen, 2002).

As mentioned earlier, Li “Po” Tai, became one of the richest men in San Francisco by the end of the nineteenth century. He owned one of the largest herbal dispensaries in the city, with an annual income of over $75,000 at the time (near 2 million USD annually in 2019). Doctor Po saw 150-300 patients a day. To give an idea of how essential stores for Chinese medicine and customers outside of the city of Los Angeles were, there was an international directory of twenty-two herbal dispensaries and drugstores of Chinese businesses published in 1933. The substantial income received through customs tariffs in both countries was not to be ignored (Bowen, 2002).

In October of 1875 in San Francisco, J.W. Armes describes the first of Chinatown stores like this; “it contained many herbal dispensaries and tea shops, one of which was run by the great and well-known Dr. Po.” As a doctor of this medicine remarks, many herbalists sought to set up their stores in affluent neighborhoods, outside Chinatown, but only a minority succeeded in doing so (Bowen, 2002).

In regards to English and Spanish speaking customers, a widely-used strategy was to replace the Chinese language with English or Spanish in advertisements. While the herbalists continued to use Chinese to write their prescriptions, many of them began to use the local language in their medical consultations. In 1858, the herbalist Wo Tsun Yuen in Chinatown in San Francisco was the first to post an advertisement in English in his store to attract the recent American European population. Some Chinese herbalists in California attempted to broaden their clientele by using Spanish-speaking translators to attract the Hispanic population (Liu, 2006).

Even among the Chinese doctors who maintained their traditions, many opted for an American marketing style to reach a wider audience (Marcus, 2011, 379). The use of advertisements in newspapers in California has been studied extensively. Many historians have stated the use of advertisements written in English or Spanish to speak to potential patients was explicitly created with a photo of the herbalist(s) in typical Chinese regalia to appear skilled and competent in their respective medical field. These advertisements also established the type of medicinal herbs available and the

types of treatment offered, especially pulse diagnosis and the use of herbs (Bowen, 2006). Often, the advertisements were accompanied by testimonials of successful treatments.

Above all, testimonials by American Europeans who had undergone treatment and were treated by the herbalist were used exclusively. Further, advertisements in the newspapers were a valuable source for finding out who the patients were and what these Chinese doctors were treating. They published their advertisements in the same sections of the paper as their American counterparts, declaring that "diagnosis and examination are free," which rendered them not only competitors but treacherous competitors, in the eyes of the local physicians (Marcus, 2011, 379).

The State of Medicine in 1900s: Eugenics, Flexnor, Welch-Rose & Goldmark Reports In the early 1900’s the caste system was in full effect. At the same time, from 1900 to 1910, the dawn of the medical philosophy of the “well-born” from the Greek eugenes, or eugenics, metastasized the caste system to unfathomable lows. Established by the mendelian geneticist Francis Galton -a fourth removed cousin of Charles Darwin- perpetuated a mathematical assumption that the blending of two parents (ill or healthy), resulted in specific types of carrier offspring. When a child born was affected with any deformity -including later skin color- it is indicated that the parents are carriers of bad genes.

It was proposed by Galton, to use selected desirability eugenics to refine and or regulate social deviation. By the 1930’s, Eugenics had been widely accepted in the United States, abroad- especially in Nazi Germany to populations and individuals (Washington, 191).

While eugenics and the caste system worked in tandem from 1900 to 1930 and well into the late twentieth century, eugenics began to fall out of favor in the early 30s with most of the then scientific community due to its illogical assumptions. However, by this time the damage had been done, the subtle vapor of eugenics would now be infused in all aspects of modern American medicine.

The Flexnor, Welch-Rose & Goldmark Reports

The United States medical education experienced a significant shift in the early twentieth century. Change from the 1900s would be felt in the nation for the next 100 years or more. At the beginning of the 20th century, the fields of medicine and public health had been left behind by scientific advances, with no rigorous standards of education and practice based on modern foundations (Frenk, 2010). Three seminal US reports (Flexner, Welch-Rose, and Goldmark) had powerful effects in professional health education in North America, and arguably by extension around the world. All the reports recommended major instructional reforms to integrate modern medical sciences into the core curriculum, and institutional reforms to link education to research and the basing of professional education in comprehensive universities (Frenk, 2010).

The first phase of 20th-century medical education reforms in North America began with one major report and two subsequent reports. Abraham Flexnor in his Medical Education in the US and Canada (1910) laid the framework for medical education reform. Subsequent reports, the Welch-Rose Report (1915), shared two new competing perspectives on public health education, the Goldmark Report (1923) on university nursing reforms, and the Gies Report (1926) on dental education reform. These reports moved modern health sciences into the classrooms and laboratories in medicine, public health, nursing and dentistry fields. These reforms, first sequenced education in biomedical sciences and next included in recommended training for clinical and public health practice, met similar efforts in other regions. Curricular reform was linked to institutional transformation—university bases, academic hospitals linked to universities, closure of low-quality proprietary schools, and the bringing together of research and education. The goals were to advance scientifically based professionalism with high technical and ethical standards (Frenk, 2010).

Let us look into a summary timeline of these reports.

Flexner Report, 1910

The Flexner Report introduced the modern sciences as foundational for the medical curriculum into two successive phases: two years of basic biomedical sciences, based in universities, followed by two years of clinical training, based in academic medical hospitals and centers. The research was to be viewed not as an end in itself but as a link to improved patient care and clinical training. Flexner also changed the doctor's education from an apprenticeship model to an academic model, and his report created the conditions for the birth of academic medical centers, ushering in a hitherto unknown era of discovery (Flexner, 1910). In 1912, Flexner extended his study of medical education to a group of key European countries. Although the Flexner model of professional education was widely adopted outside the USA and Canada, it has often not been sufficiently adapted to address health in vastly different societal contexts.

Welch-Rose Report, 1915

This report offered two competing visions of public health professional education. Rose's plan was for a national system of public health training with central national schools acting as the focus for a network of state schools, both emphasizing public health practice. By contrast, Welch's plan called for institutes of hygiene, following the German model, with increased emphasis on scientific research and connections to a medical school in comprehensive universities. Welch's plan was financed by the Rockefeller Foundation to create the Johns Hopkins School of Public Health and Hygiene in 1916 and the Harvard School of Public Health in 1922 (Welch, 1915). Most schools of public health in the U.S. followed the Welch model as independent faculties in universities. Outside the U.S. and Canada, both institutional models described by Rose and Welch were implemented and exist to this day.

Goldmark Report, 1923

This report advocated for university-based schools of nursing, citing the inadequacies of existing educational facilities for training skilled nurses. The report put nursing on the same academic trajectory as medicine and public health in the USA, albeit a little later. Although significant health burdens prevailing at the time—such as infant mortality and tuberculosis—had substantially decreased, the importance of an improved trained nursing workforce remained, including high standards of nursing educational attainment (The Committee for the Study of Nursing Education, 1923).

Discussion

In the United States, acupuncture and East Asian herbal medicine are modalities that have been used to treat many disorders for some time. Acupuncture has been utilized in the city of Philadelphia since the early 1800s for muscular rheumatism, chronic pains, neuralgia and ophthalmic concerns (Bache, 1826). During the early and mid-1800s, the Gold Rush and the transcontinental railroad work brought Chinese and East Asian immigrants with a cultural ethos (which included herbal medicine), to create services of necessity that rivalled local doctors. Various laws, massacres and manufactured strife against these immigrants created concentrations of Chinese and East Asians into proverbial Chinatowns. Many patients, including authorities, statesman and governors, were treated by these Chinese doctors and herbalists in cases of epidemics and pain management.

The medical landscape at the time of these doctors of acupuncture, herbalism and East Asian medicine, created an opportunity in the void of the local mistrusted physician. Many examples of Chinese doctors and herbalists paved the way for the profession of Chinese medicine in the USA. From clever advertising to powerful patronage, these doctors created examples and prestige for the beleaguered community that affected many patients far and wide. In the early 20th century, the medical landscape in the United States went through reformation. The main architect of this reform was Abraham Flexnor. This report, funded by the Carnegie Foundation, helped to foster massive

change throughout the nation for medical education reform. Subsequent reports followed in the spirit of reform for medical education in public education, nursing and dentistry. In further development of this work, we will discuss the impact of these reforms among practitioners of Acupuncture and East Asian medicine in the latter half of the 20th century. We will also discuss, due to necessity, the rise in utilization of the acupuncture and East Asian medicine by different ethnic groups in the U.S., the subsequent U.S. medical education origins for acupuncturists and herbalists, professional modernity and the future.

Conclusions

By reviewing the history of acupuncture and East Asian medicine in the United States, we may strengthen the field to study the timeline of discoveries for the benefit of many into the future. It is very true that “acupuncture occupies a unique place in modern medicine” (Lu, 2013, 316). Understanding its timeline in the US, is vital to any and all future practitioners. Medical knowledge has greatly improved in most areas of human existence. By acknowledging the difficult integration period of East Asian medicine into the US to its evolution today, we can create a new foundation through medical education reforms for the benefit of patients.


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