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The experience attending “Chinese
orthopedics Spine advanced course”
参加“中国整脊学高级研修班”体会
Jason Chen
D.C.（陈信孝 博士·美国）
（5423 PAL
MAL AVE TEMPLE CITY CA91780 USA）
【按语】陈信孝博士是在美国出生的美籍华人，Chiropractic博士，于2004年5月，参加第六期中国整脊学高级研修班学习，在学习班中和同学交流中国整脊和美国整脊的特色，后将学习心得发表于《世界中医骨科杂志》，参加第四届世界中医骨科学术交流大会（德国·美茵茨
2004.7）大会交流。
陈博士的文章是英文的，为方便国内读者阅读，在后附上汉译。
I graduated from Cleveland Chiropractic
College Los Angeles in 2003, and South
Baylo University Los Angeles Campus, a
Chinese Medicine School, in 2003.In
2004, I received my license as a
Chiropractor. After graduation, I felt I
need to learn more Chinese Medicine than
what schools teach me, so I had made two
trips back to Taiwan to learn herbal
medicine and acupuncture. During my
second visit to Taiwan, my teacher had
recommended me to go to China Academy of
Traditional Chinese Medicine, one of the
primer acupuncture school in China. I
applied for the school, and was enrolled
in the short-term classes offered by the
institute. I made couple of friends in
the class, and one of the classmates
happened to know I am a Chiropractor. He
told me he is a spinal manipulation
therapist, and he is really interested
in finding out what I know about the
"western-style" spinal manipulation or
Chiropractic adjustment.
I know there are many spinal
manipulation therapists in Taiwan and in
China. My understanding at the time was
there were no such profession as spinal
manipulation before, but it was just
part of the way to treat patients in the
Traditional Chinese Traumatology and
Orthopedics. I also knew there were
couple of Chiropractors that graduated
from U.S., Canada, and Australia that
were both practicing and teaching in
Taiwan. So my perception of spinal
manipulation therapist in Taiwan and
China was they just integrated many
styles of spinal manipulation both from
the East and the West, and had only
little understanding of the anatomy,
biomechanics, and physiology of the
spine.
My friend and I had long talks about how
to treat the spine, and he suggested
that he is going to take me to a place
where he learned his technique. Because
of my perception regarding spinal
manipulation here, it didn't excite me
too much. However, I thought since I am
here in China to learn, I might as well
go with him to see what kind of
techniques my friend learned.
We got to Beijing Guangming Hospital of
Orthopedics, and I met Dr. Yi-Zong Wei.
We immediately got into the discussion
about the spine. Dr. Wei showed me some
of the cases that he had treated, and I
became very interested. There was one
lady that Dr. Wei treated that has canal
steno sis. Canal steno sis is only
treatable with surgical intervention, as
I was taught in school. I remembered
when I was an intern in the Chinese
Medicine School; there is a patient of
another intern that had the same
problem. After the patient found out I
also attended Chiropractic school, he
became excited, and was hoping I could
tell him there is another alternative to
having surgery. I told him surgery is
the only way to relieve him of his
symptoms. I can still remember the
sadness in his eyes when I said that to
him.
Dr. Wei also gave me a brief talk
regarding his theory of the biomechanics
of the spine, and he showed me two books
that he wrote. I flipped a few pages,
and from the book I learned he is also a
surgeon, and he has really in depth
knowledge of modern medicine. I
immediately bought the books. Dr. Wei
then told me that there was a class
coming up in May regarding Chinese
Spinal Manipulation theory and
technique, and told me it would benefit
me if I could attend. Since I also have
class in China Academy of Traditional
Chinese of Medicine, I told him I would
try to see if I could attend. After our
meeting, I spent a lot of times reading
the books Dr. Wei wrote in my spare
time.
Personally, I think these books are one
the best books pertaining to the spine
that I have read. Because of Dr. Wei's
background as a Orthopedic surgeon and
Chinese Medicine Doctor, he understand
and explain the working of the spine and
its affiliated disorders better than any
books written by a Chiropractor that I
have read. I became to have a different
perception regarding Chinese spinal
manipulation, and I decided to take the
class to learn more from Dr. Wei.
Beginning of the class Dr. Wei first
told us the fundamental difference
between Traditional Chinese Orthopedic
and Chiropractic. Traditional Chinese
Orthopedic targets spinal disorders, and
Chiropractors treats spinal-related
disorders. He also told us the
importance of learning the history of
Traditional Chinese Orthopedics. He
showed us many references on treating
the spines from many ancient treatises
such as "Yellow Emperor Internal
Classic". He showed us a picture drawn
in Song Dynasty depicting a
"bell-doctor", old term for spinal
manipulation therapist, performing
spinal manipulation. He told us how he
used this picture to help an
Acupuncturist in Texas won a court case
filed by a Chiropractor who claimed
spinal manipulation could only be
performed by Chiropractors only, and
Chinese Medicine Doctor do not posses
enough knowledge regarding the spine.
Dr. Wei also showed us pictures
depicting ways to treat spinal
fractures. I then realized the education
back in Chiropractic College is biased.
All I have learned is the history
development of spinal manipulation from
Hippocrates to D.D. Palmer, and B.J.
Palmer. I didn't know Chinese medical
doctors long before D.D. Palmer's time
had being using manipulation techniques
to treat spinal and spinal related
disorders.
Later on in the class, Dr. Wei
introduced the theory of motion pivot,
cylindrical pivot motion theory, and the
theory on parallelogram equilibrium of
spinal contour stress. These three
theories were developed by Dr. Wei, and
is the cornerstone of the contemporary
Chinese Orthopedics. Through these three
theories, the purpose and mechanism of
both classical spinal manipulation
techniques and Dr. Wei's "Yi-Zong
eighteen methods" can be understood.
These three theories are all based on
the biomechanics of the spine during
weight-beating function during motion.
What strikes me the most was the theory
on parallelogram equilibrium of spinal
contour stress. The theory shows how the
line of gravity have an impact on the
cervical, lumbar lordosis, and thoracic,
sacrum kyphosis during active and
stationary phase. The mid-point of
kyposis and lordosis is the point of
highest spinal contour stress. For
further detailed explanation on this
theory, please refer to World Journal of
Traditional Chinese Orthopedics Vol.5
№l
Jun. 2003. What impressed me about this
theory is that it explained the
phenomenon of upper-cross and
lower-cross syndrome. Chiropractors
realized the existence of these two
syndromes, and these two symptoms were
explained by the nature of the
antagonistic muscles (phasic and
non-phasic). The line of vectors drawn
in the parallelogram equilibrium theory
can explain biomecanically why some
muscles are always phasic, and the some
are non-phasic.
I remembered while I was in school, in
palpation class my instructor had once
told us that if we really know how to
adjust the C1, C7, T12, and L5 well, we
would be able to treat a lot of
patients. At the time, I thought he was
referring to these vertebrates because
they are atypical vertebrates, and they
are harder to adjust. His clinical
experience correlates with Dr. Wei's
Motion Pivot Theory, which focuses on
these four vertebrates as well. The
difference is that Dr. Wei's theory
points out these four vertebrates act as
the center, or pivot during motion and
movement. B.J. Palmer's hit theory,
Gonstead's emphasis on L5, Sacrum
Occipital Technique's emphasis on sacrum
and the occipital can be explained by
the Cylindrical Motion Pivot Theory.
Dr.Wei's theory not only explained the
importance of C1,and L5, but the theory
also pointed out the importance of C7
and T12, which we don't see in the
present Chiropractic literature.
Dr. Wei also emphasized the importance
of adjusting spinal curvatures. He
believed any abnormal deviation to the
spinal curvatures is the cause to many
symptoms. Adjusting curves has been a
very controversial issue in
Chiropractic. Techniques such as
Chiropractic Biophysics, and Gonstead
are a few proponents to adjusting
curves. However, many of my instructors
in school gave me other opinions. Some
said we as Chiropractors could only stop
the progression of curves, and some even
questioned the reason why curves needed
to be corrected. My clinical instructor,
who is the second generation
Chiropractor, told me the same argument.
He himself showed me his cervical x-ray
which showed decreased cervical
lordosis. The only thing he do for
himself was performing rehabilitation
exercises to strengthen the deep neck
flexors to stabilize the neck, and
receiving regular cervical adjustments.
It really saddens me as a Chiropractic
student at that time to learn my
profession could only offer limited help
to the patients. By understanding the
motion pivot theory, and through
understanding the biomechanics of the
spine, I learned spinal curves could be
corrected. Dr.Wei's three theories,
Without question, it's no doubt that the
three theories from Prof.Wei fill up the
research blankness for the spinal
biomechanics at present.
Dr. Wei throughout the course told us
the importance of giving safe treatment
method. He listed series of malpractice
cases due to improper manipulation
techniques. Dr. Wei's techniques are
very gentle, safe, and yet effective.
Some of his treatment protocols were
derived from classical Chinese medical
texts. There are some other treatment
methods that were developed by Dr. Wei
that were inspired by classical
treatises. For example, Dr. Wei's
"Gu-kong" Acupuncture Needling Technique
was his explanation of "Yellow Emperor's
Internal Classic: Gu-Kong Treatise".
This technique also utilized the TCM
theory of "needling bone to treat Bone
Bi". Besides Acupuncture, Dr. Wei also
utilized moxibustion, Tui-Na (Chinese
therapeutic massage), atopic herbal
treatment, herbal decoction, and
rehabilitation exercises as part of his
treatment protocols. Dr. Wei believed
one must use the appropriate treatment
method for each specific symptoms, and
there is no one cure-all technique for
all the disorders.
Towards the end of the course, Dr. Wei
lectured on series of spinal
pathologies. For every pathology, Dr.
Wei explained about the etiology,
pathogenesis, and treatment protocol.
Dr. Wei also has his unique perspective
on the etiology for diseases. These
perspectives all came from his and other
researcher's clinical findings. For
example, most of the treatment methods
for adhesive causalities, or "frozen
shoulder" all focused on either the
bicepital tendon, or the rotator cuff
muscles (S.I.T.S. muscles). Dr. Wei
however pointed out the problem had to
do with the scapula. To increase the
shoulder range of motion, one must treat
the scapula first. This treatment method
makes perfect sense, however, most of
the treatment methods often overlook
this fact. Prior to taking this course,
the treatment protocol I learned both in
Chiropractic school and Acupuncture
school was the following: giving
patients rehabilitation exercises to
increase shoulder range of motion,
prescribing ultrasound to bread the
adhesion around the shoulder and scapula
region, performing Chiropractic
adjustment around the cervical and upper
thoracic region, performing acupuncture,
cupping, and scraping method. All these
method are effective to certain extent,
however, these methods do not resolve
the adhesion underneath that scapula.
Scapula can't regain most of its range
of motion unless the adhesion between
the scapula and the ribs are resolved.
Even ultrasound can't penetrate the
scapula. Ultrasound can only break the
adhesions around the rotator cuff
muscles. Not be able to break this
adhesion area, in my opinion, is the
reason why some of the treatment method
failed to help patients restore full
shoulder range of motion.
For me, it is an invaluable experience
taking this course. Not only have I
gained so much knowledge about vertebral
disorders, treatment methods, but it is
also an honor to learn under Dr. Wei,
who is renowned in China as one of the
best Chinese Orthopedic and Trauma
Doctor. I, being a Chinese American,
after taking this course carry a sense
of pride to know that the knowledge I
learned were passed down from my Chinese
ancestors. Also, 1 carry the sense of
duty to utilize the knowledge and skills
I learned here in China to be put in
practice in the States so my patients
and the health community can appreciate
Traditional Chinese Medicine.
我于2003年毕业于洛杉矶克利夫兰市脊椎治疗大学，同时还毕业于洛杉矶大学的一个中医学校南Baylor大学。2004年我考取了按脊师执照。毕业之后，我感觉到我需要学习更多的中医技能，因此我两次来到台湾学习中草药和针灸。我第二次在台湾学习期间，我的老师推荐我到中国中医研究院来学习，这是中国最好的针灸学校。于是我向这个学院提出申请，并进入了学院的一个短期学习班。在这个学习班上，我交了许多朋友，有一位同班同学偶然知道我是一名按脊师。他告诉我他是一名脊椎整复治疗师，而且他非常想了解“西医”的脊椎整复治疗手法。
我知道中国台湾和中国大陆有很多脊椎整复治疗师，以前我并不知道有脊椎整复这个专业，认为这只是用于治疗中医骨伤科病人的一种方法手段而已。我也知道有许多毕业于美国，加拿大和澳大利亚的按脊师在台湾行医或教学，所以我认为台湾和中国的脊椎整复治疗师只是综合了东西方脊椎整复手法而已，他们对于脊椎的解剖，生物力学和生理学并不了解。
我的朋友和我针对如何治疗脊椎疾病进行了长时间的交谈，他建议说要带我去他学习脊椎整复手法的地方看看。由于我对这里的脊椎整复手法的一些看法，他所说的并没让我有多兴奋。然而，既然我来中国是为了学习，所以我想我不妨跟他去了解一下他所学的技术手法。
我们来到北京光明骨伤医院并且认识了韦以宗教授。我们随即对脊椎疾病进行了一番探讨。韦教授给我看了他所治疗过的病例，我马上就来了兴趣。韦教授治疗的病例中，有一位女士，她得的是椎管狭窄。对于椎管狭窄，我在学校所学到的都是必须通过手术治疗。我记得我在美国的中医学校当实习医师时，另一位实习医生的病人就存在椎管狭窄。病人知道我也读过美国的按脊学校，他就变得非常高兴，希望我能告诉他可以有另一种治疗方法来替代手术治疗。我告诉他手术治疗是唯一可以缓解症状的治疗手段。而且我还记得当我告诉他时他眼睛里所流露出来的悲伤。
韦教授简单告诉我一些他的有关脊椎生物力学的理论，还给我看了两本他的著作。我翻了几页，从他的著作里我知道他也是个外科医师，而且他对于现代医学了解得非常透彻。我当即买了他的《现代中医骨科学》。韦教授告诉我五月份有一个学习班，讲述中医整脊理论和操作技术，而且告诉我如果我能参加，将会让我受益匪浅。由于我在中国中医研究院还有课程，我告诉他我会尽量参加。此次会面之后，我花了大量的业余时间拜读《现代中医骨科学》。我个人认为，这是我所读过的有关脊椎方面的书籍中最好的著作。因为韦教授的背景是骨科外科医师和中医师，比起我所读过的一些由按脊师所写的书来，韦教授更能清楚地解释脊椎的运动方式和与其相关的机能紊乱。对于中医整脊疗法我有了不同的认知，我决定参加韦教授的课程，跟随他学习更多的技能。
课程一开始，韦教授就告诉我们传统的中国整脊疗法和美国按脊疗法的基本差别。传统的中国整脊疗法着重于脊椎的紊乱，而按脊疗法治疗的是与脊椎相关的紊乱。他还告诉我们学习传统中医整脊疗法历史的重要性。他给我们看了很多有关治疗脊椎的古代论述参考资料，如“黄帝内经”，他还给我们看了一幅宋朝的画像，里面画的是一位“铃医”，这是古代对整脊治疗师的称呼。他告诉我们他如何利用这幅画帮助得克萨斯州的针灸医师赢了一场诉讼，这场诉讼是一位按脊师声称整脊治疗只能由按脊师进行，中医师对于脊椎没有足够的了解，不应该进行整脊治疗。韦教授给我们看的这幅图画描述的就是如何治疗脊椎骨折。那时我意识到了脊椎指压大学教育中存在的偏见。我所学的是从希波克拉底到公元前和公元后的整脊发展史，我不知道在公元前中医大夫就已经开始通过整脊技术治疗脊椎疾病和与脊椎相关的疾病。
那次课之后，韦教授给我介绍了他自己发展的三个理论：板块移动椎曲论，圆筒枢纽学说和脊椎轮廓压力平行四边形平衡理论，这是当代中医整脊技术的基础。通过这三个理论，经典的整脊技术和韦教授的“以宗十八法”的目的和机理就可以明白了，这三个理论完全以脊椎在承重功能和运动中的生物力学为基础。最让我震惊的是脊椎轮廓应力平行四边形平衡理论，这个理论体现的是：在活动或静止期间，重力线对颈椎，腰椎的脊柱前弯，以及胸椎和骶骨驼背所产生的影响作用。驼背和脊柱前弯的中点是脊椎轮廓压力最高处的点。对于这一理论更详细的解释，请参考世界中医骨伤科杂志2003年6月第五卷第一期。这个理论让我印象深刻的是它解释了上对角线和下对角线综合症的现象。按脊师了解到这两个综合症的存在，并且这两个症状可以通过拮抗肌肉来解释(相对性和非相对性)。这个甲行四边形平衡理论中所画的向量线可以从生物力学的角度解释为什么有些肌肉总是相对性的，而有些肌肉是非相对性的。
我记得在学校触诊课上，我的老师曾经告诉我如果我们知道如何调整好C1，C7，T12，和L5，那我们就能治疗很多病人。那个时候，我认为他指的是由于这些椎体不典型，所以很难调整。他的临床经验与韦教授的运动枢纽理论有一定关联，都是着重在这四个椎体。区别在于韦教授指出了这四个椎体在运动中作为中心，或者作为枢纽。B．J．Palmer的HIO理论，Gonstead的重点在L5，骶一枕技术的重点可以通过圆筒枢纽学说来解释。韦教授的理论不仅解释了C1和L5的重要性，而且还指出C7和T12的重要性，这一点是目前脊椎指压治疗文献中没有的。
韦教授也强调调整脊椎生理曲度的重要性。他相信脊椎生理曲度的任何异常偏歪是引发许多症状的原因。在脊椎指压治疗中，调整曲度是一个非常有争议性的问题。脊椎指压生物物理技术和Gonstead支持调整椎曲。然而，我学校的老师却有其他的看法。有的说作为按脊师，我们可以抑制椎曲的进展，有的甚至置疑椎曲为什么需要矫正。我的临床老师是第二代按脊师，他也告诉我相同的争议观点。他自己给我看他的颈椎x光片，颈椎前弯减少了。他自己唯一可以做的就是做一些复原锻炼以加强颈部深屈肌来平衡颈部，也要进行常规的颈部调整。在那个时候，作为一名按脊师，我确实很难过，我的职业也只能给病人提供很有限的帮助。通过了解运动枢纽理论和脊椎生物力学，我知道椎曲能够矫正过来。韦教授的三个理论，毫无疑问是填补了目前脊柱生物力学研究的空白。
在整个学习过程中，韦教授告诉我们安全疗法的重要性。他列举了一系列由于不恰当的手法所造成的治疗失误的病例。韦教授的手法非常柔和，但却非常有效。他的一些治疗方案都取自于经典的中医著作。有一些其他的治疗方法是韦教授受古文著作的启发自我创造的。比如：韦教授的“骨空”针技术来源于《黄帝内经》的“骨空论”。这项技术也利用了中医理论“针骨以治骨痹”。除了针刺之外，在他的治疗方案中，韦教授还利用艾灸，推拿，祖传中药熏蒸，内服中草药以及康复锻炼。韦教授相信每一个特殊的症状都必须用合适的治疗手段，没有全能的治疗技术去医治所有的疾病。
在课程快结束的时候，韦教授讲了很多系列的脊椎病理，对于每一个病理，韦教授都要讲解其病因，发病机理和治疗方案。对于疾病的病因，韦教授也有独特的观点。这些观点都来自于他和其他研究者的临床总结。比如：肩周炎，或称“肩关节冻结症”，其大多数的治疗方法都是集中在肱二头肌腱，或是肩袖肌肉(S.I.T.S.肌肉)。然而，韦教授却指出问题于肩胛骨有关。为了增加肩关节的运动范围，就必须先要治疗肩胛骨。这个治疗方法非常有效，可大部分的治疗手段经常忽略了这个事实。参加这个课程之前，我在脊椎指压学校和针灸学校所学到的治疗方案都是如下列所说：让病人进行康复锻炼以增加肩胛骨的活动范围，利用超声波来松解肩关节和肩胛骨的粘连，在颈椎和胸椎的上段进行指压调整，再配合针刺，拔罐和刮痧。从某种程度来讲，所有这些方法都是有效的，然而，这些方法并不能解决肩胛骨下方的粘连。除非肩胛骨和肋骨之间的粘连松解，否则肩胛骨无法恢复其活动范围。即使是超声波也不能渗透到肩胛骨下。超声波也只能松解肩袖肌肉周围的粘连。在我看来，不能松解粘连区域是一些治疗方法无法帮助病人完全恢复肩关节运动范围的原因。
对我来说，参加这次课程受益匪浅。不仅加深了我对脊椎疾病和其治疗方法的了解，还很荣幸能跟随中国最负盛名的中医整脊医师一一韦教授学习。我，作为一名美籍华人，参加完这次课程后，非常自豪地领会到我所学的知识是中医先祖们传授下来的。同时，我也感觉到身上担负着一种责任，要利用我在中国学到的知识和技能在美国好好行医，我的父母和健康社区都会感激中医技术。
左起第一位为陈博士
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