We have seen that different factors interact and shape the plurality found in acupuncture practice. The questionnaire outcomes suggested that the two main factors influencing acupuncture practice were related to the geographical situation and the education background. The age of the physician also played an important role. The years of practice, the type of hospitals and the cities/districts areas distinction were factor that influenced secondarily the practice. Concerning the general use of acupuncture almost all the factors were involved but concerning the diagnosis and treatment of low back pain only the influence of one or two factor were involved. From those analysis we can see how different factors influenced acupuncture practice at different levels.
Appendix: Questionnaire
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Abstract in Chinese
台灣針灸使用現況調查研究
碩士研究生：鐵雲 指導教授： 蘇奕彰 教授 中國醫藥大學 針灸研究所
摘 要
針灸是中醫常用之治療方法之一，不論是醫學歷史學家、醫學人 類學家亦或針灸臨床醫師，均強調了針灸臨床應用上多重的診斷方法 與操作方式。雖有學者在報導台灣中醫現況時提到針灸的治療範圍，
但至今仍缺乏對於台灣針灸使用現況的調查與深入探討。
本研究目的在瞭解台灣針灸使用現況，並進一步探討中醫師的教 育背景、年齡，執業年資與執業環境對其針灸操作方式影響之相關 性。研究採用問卷調查方式，問卷內容包括三大主題：（1）醫師基本 資料（2）針灸使用概況（3）對於「腰痛」的診斷與治療。調查對象 為地區醫院以上中醫科部及中醫醫院之中醫師，共寄出問卷 403 份，
回收有效問卷 177 份（回收率 44％）。
結果顯示與中醫師「針灸治療方法之選擇」及「疾病治療範圍」
相關性較強的因素為中醫師的「執業地區」與「教育背景」；與「年 齡」、「執業年資」與「執業場所」亦有相關性，但強度較弱：（1）
在台灣北部地區，針灸之使用頻繁及範圍較其他地區廣。（2）特考中 醫師使用針灸治療之系統疾病種類較其他教育背景之中醫師多。（3）
年紀較大與執業年資較久之中醫師以針灸治療疾病的種類亦較多樣。
（4）在中醫醫院執業的中醫師使用中醫診斷方法的比率較其他中醫師 高，而且使用針灸治療之系統疾病種類較在西醫醫院中醫科部執業之 中醫師多。
本研究之調查對象侷限於西醫醫院中醫科部與中醫醫院之中醫 師，因此對於中醫診所的針灸使用現況及健保制度在針灸使用上的影 響則還需更進一步地研究與探討。
關鍵字：台灣、針灸、問卷、西醫醫院、中醫醫院
Notes
1 For the transcription of the Chinese names, we used the Taiwanese
transcription for the proper names of the cities, districts and hospitals names in Taiwan. For the others transcription we used the pinyin transcription.
2 Through history we still find some schools of Chinese medicine, the most ancient one identified was established during the Southern and Northern Dynasties in 433. But in general the school of Chinese medicine were intended to form elite physicians whose would be at the service of the emperor and his court. Therefore it does not represent the most usual ways Chinese medicine was transmitted trough generations.
3 Chi C, Lee JL, Lai JS, Chen CY, Chang SK, Chen SC. The practice of Chinese medicine in Taiwan. Soc Sci Med. 1996; 43: 1330. This school was also the first medical school ever established in Taiwan.
4 Chen BC. Traditional Medicine in Taiwan. In: Oriental medicine: an illustrated guide to the Asian arts of healing, Serindia publication, London 1995; pp. 203.
5 陳立德 : 台灣中醫師學歷背景之研究 ，博士論文， 指導教授: 陳榮
洲 、 賴俊雄 、李采娟、中國醫藥學院，中國醫學研究所 1997
6 Chi C, 1996; pp. 1330. One can adds that in Taiwan, the trust of the
population toward a physician do not come principally from his degree, but more from his authority and his reputation. Actually in Taiwan, there are many practitioners of Chinese medicine without a licence that treat a large number of patients and teach students.
7 A long pause was observed between 1955 and 1964. After that the examination take place almost every two years, then from 1977 on, the examinations were held every year. In 1984 and 1986 because of an affaire of irregularity in the examination process, the examination was closed until
1989. Until this time, the examination took place every year. 陳立德, 1997;
pp.11.
8 Chi C, 1996; pp. 1331. 陳立德, 1997; pp. 20. After the constitution of the National Health Insurance (NHI), these factors changed. Actually the difference of the income between Western and Chinese medicine
practitioners are not so obvious even if the social position of the Western medicine physicians still remain significantly higher.
9 Chen BC, 1995; pp. 206.
10 Kleinman A. Patients and healers in the context of culture, an exploration of the borderland between anthropology, medicine and psychiatry.
University of California Press, Berkley 1980.
11 Kleinman A, 1980, pp. 52.
12 Chen FP, Kung YY, Chen TJ, Hwang SJ. Demographics and patterns of acupuncture use in the Chinese population: the Taiwan experience. J Compl Altern Med. 2006; 12: 379-387.
13Chen FP, Chen TJ, Kung YY, Chen YC, Chou LF, Chen FJ, Hwang SJ.
Use frequency of traditional Chinese medicine in Taiwan. BMC Health Services Res. 2007; 7: 26-36.
14Chang LC, Huang N, Chou YJ, Lee CH, Kao FY and Huang YT.
Utilization patterns of Chinese medicine and Western medicine under the National Health Insurance Program in Taiwan, a population-based study from 1997 to 2003. BMC Health Services Res. 2009; 8: 170-179.
15 Unschuld PU. Medicine in China: a history of ideas. University of California Press, California 1985.
16 Kuriyama S. The expressiveness of the body and the divergence of Greek and Chinese medicine. Zone Books, New York 1999.
17 “In this examination of clinical encounter, I will try to show why
flexibility and responsiveness of knowledge constructs are more valued in Chinese Medicine practice than are explanatory ‘rigor ‘of generalized
predictive power.” Farquhar J. Knowing practice: the clinical encounter of Chinese medicine. Westview Press, Boulder 1994; pp. 39.
18 Hsu E. The transmission of Chinese Medicine. Cambridge University Press, Cambridge 1999.
19 “Chinese medical terms seems to have some affinity with words like bobility and baraka which have proven socially eminently functional precisely because they lack a clearly defined referential meaning and their referential meaning changes as the contexts in witch they are uttered changed.” Hsu E, 1999; pp. 232.
20 “(In Western science key concepts) are defined with the aim of being as unambiguous as possible, while in the latter (Chinese Medicine) are often useful for the therapeutic intervention precisely because their vagueness and polysemy.” Hsu E, 1999: pp. 233.
21 Scheid V. Chinese medicine in contemporary China: plurality and synthesis. Duke University Press, Durham 2002.
22 Scheid V, 2002; pp. 59.
23 Scheid V. Shaping Chinese medicine: two case studies from contemporary China. In: Innovation in Chinese medicine, Cambridge University Press, New York 2001.
24 Birch S, Sherman K. Zhong Yi. Acupuncture and low-back pain:
traditional Chinese medical acupuncture differential diagnoses and treatments for chronic lumbar pain. J Alterna Complem Med. 1999; 5(5):
415-425.
25 Sherman KJ, Cherkin DC, Hogeboom C.J. The Diagnosis and treatment of patients with chronic low-back pain by traditional Chinese medical
acupuncturists. J Alterna Complem Med. 2001; 7(6): 641-50.
26 Sherman K, Hogeboom CJ, Cherkin DC. How traditional Chinese medicine acupuncturists would diagnose and treat chronic low back pain:
result of a survey of licensed acupuncturists in Washington State.
Complement Ther Med. 2001; 9: 146-153.
27 Hogeboom CJ, Sherman K, Cherkin DC. Variation in diagnosis and treatment of chronic low back pain by traditional Chinese medicine acupuncturists. Complement Ther Med. 2001; 9: 154-166.
28 MacPherson H, Thorpe L, Thomas K, Campbell M. Acupuncture for low back pain: traditional diagnosis and treatment of 148 patients in a clinical trial. Complement Ther Med. 2004; 12: 38–44.
29 Kalauokalani D, Cherkin DC, Sherman KJ. A comparison of physician and nonphysician acupuncture treatment for chronic low back pain. Clin J Pain. 2005; 21(5): 406-411.
30 Taiwan national health insurance use to distinguish between Taipei area 台北業務組 (that regrouped Taipei city, Taipei county, Keelung city and Ilan district) ; the northern region 北區 (that regrouped Taoyuan district, Hsinchu city, Hsinchu district and Miaoli district) ; the central region 中區 (that regrouped Taichung city, Taichung district, Changhua district and Nantou district) ; the southern region 南區 (that regrouped Chiayi city, Chiayi district, Yunlin district,Tainan city and Tainan district) ; the Kaoping region 高屏區 (that regrouped Kaohsiung city, Kaohsiung district and
Pingtung district) and the eastern region 東區 (that regrouped Taitung district, Hualian district and the Green island and the Orchid island).
31 The acceptable range of alpha is debatable. According to JL Fleiss, an ICC
>= 0.4 to <0.75 represents a fair to good reproducibility. An ICC > 0.75 indicates and excellent reproducibility. Fleiss JL. The design and analysis of clinical experiments. Wiley, New York 1996.
32 We selected Western medicine hospitals that were not smaller than the rural hospital rank.
33 This association brings together Chinese medicine physicians but also Western medicine physicians as well as dentists. Almost half of the members are Western medicine physicians.
34 By manipulations techniques we refer to the techniques of Chinese traumatology including massage or tuina.
35 In Taiwan, massage or tuina are seldom practiced by Chinese medicine physicians. The massage or tuina are more the speciality of another kind of practitioners that practiced in private clinics. These practitioners knowledge is traditionally related to the practice of martial arts. Practitioners developed a specific knowledge of the body as much for acquiring effective attacks than for treating injuries bring about training. Nowadays the private clinics are still called martial arts institute (國術館) even the martial’s arts are not taught anymore. This separation that occurred in Taiwan between the legally recognized Chinese medicine physicians that used mainly Chinese medicinal and acupuncture and in the other side more marginal practitioners that
practice tuina and often also acupuncture (which is traditionally a part of Chinese medicine) is interesting. But because we decided to focus only on the legally recognized practitioners, we will no discuss this issue.
36 “欲以微真針通其經脈調其血氣” 內徑。九針十二原第一.
37 This was also the conclusion draw by FP Chen “Muskuloskeletal and neurologic disorders and injuries are the diseases categories commonly treated by acupuncture” Chen FP, Kung YY, Chen TJ, Hwang SJ, 2006;
pp.385. In this article, the authors chose to use the ICD9 classification of diseases. In this classification, injuries are separated from the diseases of the musculoskeletal system. Therefore in their table of major disease categories for acupuncture visits (table 5, p.382) the second major category of disease treated by acupuncture is “Injury and poisoning”. Apart the categories of musculoskeletal and neurologic diseases, their results differed quite a lot of our results.
38 We referred to the table of the 新編彩圖針灸學 for the WHO
recommendation on acupuncture use. This version is from 1996 and contain 64 diseases classed in three categories. A new version exist since 2003 in the site of the WHO on the internet, it contain 107 diseases classified in four categories. The latest version was to detailed and less convenient to use in the questionnaire. Therfore we chose the 1996 version.
林昭庚 : 新編彩圖針灸學 (A new illustrated book of Acupuncture and Moxibustion). 知音 出版社, 台北 2009; pp. 728-730.
39 This observation was also present in the article written by American physicians in their comparison between diagnosis done by different Chinese medicine physicians “despite agreement at the broadest level, acupuncturist generally differed in the specific diagnoses and treatments they
recommended for the same patient.” Hogeboom CJ, Sherman K, Cherkin DC, 2001; pp. 164.
40 We chose to present only the acupuncture points that were used by at least
40 We chose to present only the acupuncture points that were used by at least